Andargie Betelhem Abebe, Legas Abdrehman, W/Sellassie Abebe, Abuhay Habtamu, Angaw Dessie Abebaw
Department of Epidemiology and biostatistics, Institute of public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
PLoS One. 2025 Jul 23;20(7):e0326868. doi: 10.1371/journal.pone.0326868. eCollection 2025.
Pregnant women should engage in a range of physical activities as it is not only safe but also has many maternal benefits. This systematic review and Meta -analysis aimed to assess the pooled effect of physical exercise during pregnancy on delivery outcomes.
We conducted a systematic literature search on PubMed, Cochrane Library, Science Direct, Embase, Scopus, HINARI, PsycINFO, Google Scholar, and backward and forward citations for studies published since 2010. Only randomized controlled trials (RCTs) published in English, assessing the effect of exercise on the mode of delivery as a primary or secondary outcome, were included. Quality assessment was performed using Cochrane guidelines, and the certainty of evidence was evaluated using the GRADE approach. A random-effects model was used for meta-analysis, and results were reported as risk ratio (RR) and weighted mean difference (WMD) with 95% confidence intervals (CIs). Heterogeneity was assessed using I² statistics, and potential publication bias was examined. The primary outcome was the mode of delivery, while secondary outcomes included duration of labor, Apgar score, and birth weight.
A total of 16 RCTs involving 3,387 women (1,704 exercise and 1,683 control)were included. Compared to the control group, pregnant women with exercise interventions had a higher rate of normal vaginal delivery (RR = 1.14, 95% CI: 1.08-1.21, I² = 25.6%, moderate certainty of evidence) and a significantly lower rate of cesarean delivery (RR = 0.66, 95% CI: 0.55-0.80, I² = 22.47%, high certainty of evidence). However, no statistically significant association was found between exercise and instrumental delivery (RR = 0.84, 95% CI: 0.70-1.02, moderate certainty of evidence). The mean duration of the first stage of labor was significantly shorter in the exercise group (WMD = -61.30 minutes, 95% CI: -80.63 to -41.97, moderate certainty of evidence). However, no significant differences were observed for second stage of labor birth weight, Apgar scores at one and five minutes (moderate certainty of evidence).
This systematic review and meta-analysis consolidate existing evidence, demonstrating that physical exercise is associated with an increased likelihood of normal vaginal delivery, a reduced rate of cesarean delivery, and a shorter first stage of labor. These findings reinforce the importance of encouraging pregnant women without contraindications to engage in appropriate physical activity during pregnancy, contributing to informing clinical practice.
This study was registered on PROSPERO number CRD42022361132.
孕妇应进行一系列体育活动，因为这不仅安全，而且对母亲有诸多益处。本系统评价和Meta分析旨在评估孕期体育锻炼对分娩结局的综合影响。
我们在PubMed、Cochrane图书馆、Science Direct、Embase、Scopus、HINARI、PsycINFO、谷歌学术以及2010年以来发表研究的前后向引文进行了系统的文献检索。仅纳入以英文发表的随机对照试验（RCT），这些试验将运动对分娩方式的影响作为主要或次要结局进行评估。使用Cochrane指南进行质量评估，并采用GRADE方法评估证据的确定性。采用随机效应模型进行Meta分析，结果以风险比（RR）和加权平均差（WMD）及95%置信区间（CI）报告。使用I²统计量评估异质性，并检查潜在的发表偏倚。主要结局是分娩方式，次要结局包括产程、阿氏评分和出生体重。
共纳入16项RCT，涉及3387名女性（1704名运动组和1683名对照组）。与对照组相比，接受运动干预的孕妇正常阴道分娩率更高（RR = 1.14，95%CI：1.08 - 1.21，I² = 25.6%，中等证据确定性），剖宫产率显著更低（RR = 0.66，95%CI：0.55 - 0.80，I² = 22.47%，高证据确定性）。然而，运动与器械助产之间未发现统计学上的显著关联（RR = 0.84，95%CI：0.70 - 1.02，中等证据确定性）。运动组第一产程的平均时长显著更短（WMD = -61.30分钟，95%CI：-80.63至-41.97，中等证据确定性）。然而，第二产程、出生体重、1分钟和5分钟时的阿氏评分未观察到显著差异（中等证据确定性）。
本系统评价和Meta分析整合了现有证据，表明体育锻炼与正常阴道分娩可能性增加、剖宫产率降低以及第一产程缩短相关。这些发现强化了鼓励无禁忌证的孕妇在孕期进行适当体育活动的重要性，有助于为临床实践提供参考。
本研究在PROSPERO注册，注册号为CRD42022361132。
