Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160-3° piso, CEP: 96020-220, Bairro Centro, Pelotas, Rio Grande do Sul, Brazil.
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA.
Int J Behav Nutr Phys Act. 2017 Dec 22;14(1):175. doi: 10.1186/s12966-017-0632-6.
Women are encouraged to be physically active during pregnancy. Despite available evidence supporting antenatal physical activity to bring health benefits for both the mother and child, the most effective way to prevent some maternal and fetal outcomes is still unclear. The purpose of this study was to evaluate the efficacy of an exercise intervention to prevent negative maternal and newborn health outcomes.
A randomized controlled trial (RCT) nested into the 2015 Pelotas (Brazil) Birth Cohort Study was carried-out with 639 healthy pregnant women, 213 in the intervention group (IG) and 426 in the control (CG) group. An exercise-based intervention was conducted three times/week for 16 weeks from 16-20 to 32-36 weeks' gestation. The main outcomes were preterm birth and pre-eclampsia. Gestational age was calculated based on several parameters, including routine ultrassounds and/or last menstrual period and categorized as < 37 weeks and ≥ 37 weeks for evaluation of preterm birth. Pre-eclampsia was self-reported. Secondary outcomes were gestational weight gain, gestational diabetes, birth weight, infant length, and head circumference. Analyses were performed by intention-to-treat (ITT) and per protocol (70% of the 48 planned exercise sessions). Odds ratio were derived using unconditional logistic regression.
The IG and CG did not differ at baseline regarding their mean age (27.2 years ± 5.3 vs. 27.1 years ± 5.7) and mean pre-pregnancy body mass index (25.1 ± 3.9 vs. 25.2 ± 4.1 kg/m). The mean adherence to the exercise intervention was 27 ± 17.2 sessions (out of a potential 48) with 40.4% attending > = 70% of the recommended exercise sessions. A total of 594 participants (IG:198; CG: 396) were included in the ITT and 479 (IG: 83; CG: 396) were included in the per protocol analyses. There were no significant differences in the incidence of preterm birth and pre-eclampsia between groups in the ITT and per protocol analysis. There were also no differences between the two groups in mean gestational weight gain, gestational diabetes, birth weight, infant length, and head circumference.
While the RCT did not support the benefits of exercise performed during pregnancy on preeclampsia and preterm birth, the exercise program also did not present adverse impacts on newborn health. Our findings may contribute to promote intervention strategies that motivate health providers to encourage pregnant women to be more physically active.
Clinicaltrials.gov identifier: NCT02148965 , registered on 22 May 2014.
鼓励女性在怀孕期间进行身体活动。尽管有证据表明产前身体活动有益于母亲和儿童的健康，但预防某些母婴结局的最有效方法仍不清楚。本研究的目的是评估运动干预预防母婴不良健康结局的效果。
这是一项嵌套在 2015 年巴西佩洛塔斯出生队列研究中的随机对照试验（RCT），共纳入 639 名健康孕妇，213 名干预组（IG）和 426 名对照组（CG）。从 16-20 周到 32-36 周妊娠期间，每周进行三次基于运动的干预，共 16 周。主要结局是早产和子痫前期。妊娠年龄根据多个参数计算，包括常规超声检查和/或末次月经，并分为<37 周和≥37 周以评估早产。子痫前期由自我报告。次要结局包括妊娠体重增加、妊娠期糖尿病、出生体重、婴儿身长和头围。采用意向治疗（ITT）和方案（计划的 48 次运动课程中的 70%）进行分析。使用无条件逻辑回归得出比值比。
IG 和 CG 在平均年龄（27.2 岁±5.3 岁与 27.1 岁±5.7 岁）和平均孕前体重指数（25.1±3.9 千克/平方米与 25.2±4.1 千克/平方米）方面无差异。运动干预的平均依从性为 27±17.2 次（潜在 48 次中的 40.4%），40.4%的人参加了>70%的推荐运动课程。共有 594 名参与者（IG：198；CG：396）纳入 ITT 分析，479 名（IG：83；CG：396）纳入方案分析。在 ITT 和方案分析中，两组早产和子痫前期的发生率无显著差异。两组在妊娠体重增加、妊娠期糖尿病、出生体重、婴儿身长和头围方面也无差异。
尽管 RCT 并未支持妊娠期间运动对子痫前期和早产的益处，但该运动方案也未对新生儿健康产生不良影响。我们的研究结果可能有助于促进干预策略，促使医疗保健提供者鼓励孕妇更积极地进行身体活动。
Clinicaltrials.gov 标识符：NCT02148965，于 2014 年 5 月 22 日注册。
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