Guillemette Laetitia, Hay Jacqueline L, Kehler D Scott, Hamm Naomi C, Oldfield Christopher, McGavock Jonathan M, Duhamel Todd A
Children's Hospital Research Institute of Manitoba, John Buhler Research Center, University of Manitoba, 511-715 McDermot Avenue, Winnipeg, MB, R3E 3P4, Canada.
Health, Leisure & Human Performance Research Institute, Faculty of Kinesiology & Recreation Management, University of Manitoba, Winnipeg, MB, Canada.
Sports Med Open. 2018 Aug 2;4(1):35. doi: 10.1186/s40798-018-0148-x.
Maternal metabolic health during the prenatal period is an established determinant of cardiometabolic disease risk. Many studies have focused on poor offspring outcomes after exposure to poor maternal health, while few have systematically appraised the evidence surrounding the role of maternal exercise in decreasing this risk. The aim of this study is to characterize and quantify the specific impact of prenatal exercise on children's cardiometabolic health markers, at birth and in childhood.
A systematic review of Scopus, MEDLINE, EMBASE, CENTRAL, CINAHL, and SPORTDiscus up to December 2017 was conducted. Randomized controlled trials (RCTs) and prospective cohort studies of prenatal aerobic exercise and/or resistance training reporting eligible offspring outcomes were included. Four reviewers independently identified eligible citations and extracted study-level data. The primary outcome was birth weight; secondary outcomes, specified a priori, included large-for-gestational age status, fat and lean mass, dyslipidemia, dysglycemia, and blood pressure. We included 73 of the 9804 citations initially identified. Data from RCTs was pooled using random effects models. Statistical heterogeneity was quantified using the I test. Analyses were done between June and December 2017 and the search was updated in December 2017.
Fifteen observational studies (n = 290,951 children) and 39 RCTs (n = 6875 children) were included. Observational studies were highly heterogeneous and had discrepant conclusions, but globally showed no clinically relevant effect of exercise on offspring outcomes. Meta-analyzed RCTs indicated that prenatal exercise did not significantly impact birth weight (mean difference [MD] - 22.1 g, 95% confidence interval [CI] - 51.5 to 7.3 g, n = 6766) or large-for-gestational age status (risk ratio 0.85, 95% CI 0.51 to 1.44, n = 937) compared to no exercise. Sub-group analyses showed that prenatal exercise reduced birth weight according to timing (starting after 20 weeks of gestation, MD - 84.3 g, 95% CI - 142.2, - 26.4 g, n = 1124), type of exercise (aerobic only, MD - 58.7 g, 95% CI - 109.7, - 7.8 g; n = 2058), pre-pregnancy activity status (previously inactive, MD - 34.8 g, 95% CI - 69.0, - 0.5 g; n = 2829), and exercise intensity (light to moderate intensity only, MD - 45.5 g, 95% CI - 82.4, - 8.6 g; n = 2651). Fat mass percentage at birth was not altered by prenatal exercise (0.19%, 95% CI - 0.27, 0.65%; n = 130); however, only two studies reported this outcome. Other outcomes were too scarcely reported to be meta-analyzed.
Prenatal exercise does not causally impact birth weight, fat mass, or large-for-gestational-age status in a clinically relevant way. Longer follow up of offspring exposed to prenatal exercise is needed along with measures of relevant metabolic variables (e.g., fat and lean mass).
Protocol registration number: CRD42015029163 .
孕期母亲的代谢健康是已确定的心脏代谢疾病风险的决定因素。许多研究关注母亲健康状况不佳对后代不良结局的影响，而很少有研究系统评估母亲运动在降低这种风险中所起作用的相关证据。本研究的目的是描述和量化产前运动对儿童出生时及儿童期心脏代谢健康指标的具体影响。
对截至2017年12月的Scopus、MEDLINE、EMBASE、CENTRAL、CINAHL和SPORTDiscus进行系统综述。纳入报告了符合条件的后代结局的产前有氧运动和/或抗阻训练的随机对照试验（RCT）和前瞻性队列研究。四名评审员独立识别符合条件的文献并提取研究水平的数据。主要结局是出生体重；预先设定的次要结局包括大于胎龄儿状态、脂肪和瘦体重、血脂异常、血糖异常和血压。我们从最初识别的9804篇文献中纳入了73篇。使用随机效应模型汇总RCT的数据。使用I²检验量化统计异质性。分析于2017年6月至12月进行，并于2017年12月更新了检索。
纳入了15项观察性研究（n = 290,951名儿童）和39项RCT（n = 6875名儿童）。观察性研究高度异质性且结论不一致，但总体上显示运动对后代结局无临床相关影响。荟萃分析的RCT表明，与不运动相比，产前运动对出生体重（平均差[MD] -22.1 g，95%置信区间[CI] -51.5至7.3 g，n = 6766）或大于胎龄儿状态（风险比0.85，95% CI 0.51至1.44，n = 937）无显著影响。亚组分析表明，产前运动根据运动时间（妊娠20周后开始，MD -84.3 g，95% CI -142.2，-26.4 g，n = 1124）、运动类型（仅有氧运动，MD -58.7 g，95% CI -109.7，-7.8 g；n = 2058）、孕前活动状态（以前不活动，MD -34.8 g，95% CI -69.0，-0.5 g；n = 2829）和运动强度（仅轻度至中度强度，MD -45.5 g，95% CI -82.4，-8.6 g；n = 2651）降低了出生体重。产前运动未改变出生时的脂肪质量百分比（0.19%，95% CI -0.27，0.65%；n = 130）；然而，只有两项研究报告了这一结局。其他结局报告太少，无法进行荟萃分析。
产前运动不会以临床相关方式对出生体重、脂肪质量或大于胎龄儿状态产生因果影响。需要对暴露于产前运动的后代进行更长时间的随访，并测量相关代谢变量（如脂肪和瘦体重）。
方案注册号：CRD42015029163 。
