School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, 3630 prom. Sir-William-Osler, Montreal, Quebec H3G 1Y5, Canada.
Department of Physical Therapy, Faculty of Allied Health Sciences, Thasmmasat University, Khlong Nueng, Khlong Luang District, Pathum Thani 12120, Thailand.
Eur J Prev Cardiol. 2024 Sep 20;31(13):1606-1620. doi: 10.1093/eurjpc/zwae165.
This systematic review aimed to assess the effects of exercise training during pregnancy and the postpartum period on maternal vascular health and blood pressure (BP).
The outcome of interest was pulse wave velocity (PWV), flow-mediated dilation (FMD), and BP from pregnancy to 1-year postpartum. Five databases, including Ovid MEDLINE, EMBASE, CINAHL, Web of Science, and Cochrane Library, were systematically searched from inception to August 2023. Studies of randomized controlled trials (RCTs) comparing the effects of prenatal or postpartum exercise to a non-exercise control group were included. The risk of bias and the certainty of evidence were assessed. Random-effects meta-analyses and sensitivity analyses were conducted. In total, 20 RCTs involving 1221 women were included. Exercise training, initiated from Week 8 during gestation or between 6 and 14 weeks after delivery, with the programme lasting for a minimum of 4 weeks up to 6 months, showed no significant impact on PWV and FMD. However, it resulted in a significant reduction in systolic BP (SBP) [mean difference (MD): -4.37 mmHg; 95% confidence interval (CI): -7.48 to -1.26; P = 0.006] and diastolic BP (DBP) (MD: -2.94 mmHg; 95% CI: -5.17 to -0.71; P = 0.01) with very low certainty. Subgroup analyses revealed consistent trends across different gestational stages, types of exercise, weekly exercise times, and training periods.
Exercise training during pregnancy and the postpartum period demonstrates a favourable effect on reducing maternal BP. However, further investigations with rigorous methodologies and larger sample sizes are needed to strengthen these conclusions.
本系统评价旨在评估妊娠和产后期间的运动训练对产妇血管健康和血压（BP）的影响。
本研究的主要结局指标是脉搏波速度（PWV）、血流介导的扩张（FMD）和从妊娠到产后 1 年的 BP。从建库至 2023 年 8 月，我们系统性地检索了 5 个数据库，包括 Ovid MEDLINE、EMBASE、CINAHL、Web of Science 和 Cochrane Library。纳入了比较产前或产后运动与非运动对照组效果的随机对照试验（RCT）。评估了偏倚风险和证据质量。进行了随机效应荟萃分析和敏感性分析。共纳入了 20 项 RCT，涉及 1221 名女性。运动训练从妊娠第 8 周开始或产后 6 至 14 周开始，方案持续至少 4 周至 6 个月，结果显示对 PWV 和 FMD 没有显著影响。然而，它显著降低了收缩压（SBP）[平均差值（MD）：-4.37mmHg；95%置信区间（CI）：-7.48 至-1.26；P=0.006]和舒张压（DBP）（MD：-2.94mmHg；95% CI：-5.17 至-0.71；P=0.01），但证据质量为极低。亚组分析显示，不同妊娠阶段、运动类型、每周运动次数和训练期都有一致的趋势。
妊娠和产后期间的运动训练对降低产妇 BP 有有益影响。然而，需要更多具有严格方法学和更大样本量的研究来加强这些结论。
