Effects of Supervised Exercise on the Development of Hypertensive Disorders of Pregnancy: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Material and Methods
2.1. Search Strategy and Selection Criteria
2.2. Data Analysis
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Rana, S.; Lemoine, E.; Granger, J.P.; Karumanchi, S.A. Preeclampsia: Pathophysiology, challenges, and perspectives. Circ. Res. 2019, 124, 1094–1112. [Google Scholar] [CrossRef] [PubMed]
- Braunthal, S.; Brateanu, A. Hypertension in pregnancy: Pathophysiology and treatment. SAGE Open Med. 2019, 7, 2050312119843700. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Wang, W.; Xie, X.; Yuan, T.; Wang, Y.; Zhao, F.; Zhou, Z.; Zhang, H. Epidemiological trends of maternal hypertensive disorders of pregnancy at the global, regional, and national levels: A population-based study. BMC Pregnancy Childbirth 2021, 21, 364. [Google Scholar] [CrossRef] [PubMed]
- James, J.L.; Whitley, G.S.; Cartwright, J.E. Pre-eclampsia: Fitting together the placental, immune and cardiovascular pieces. J. Pathol. 2010, 221, 363–378. [Google Scholar] [CrossRef] [PubMed]
- Vata, P.K.; Chauhan, N.M.; Nallathambi, A.; Hussein, F. Assessment of prevalence of preeclampsia from dilla region of ethiopia. BMC Res. Notes 2015, 8, 816. [Google Scholar] [CrossRef] [Green Version]
- (NICE) National Institute for Health and Care Excellence. Hypertension in Pregnancy: Diagnosis and Management [Nice Guidelines n. 133]. 2019. Available online: https://www.nice.org.uk/guidance/ng133 (accessed on 15 December 2021).
- Romero-Arauz, J.F.; Ortiz-Díaz, C.B.; Leaños-Miranda, A.; Martínez-Rodríguez, O.A. Progression of gestational hypertension to preeclampsia. Ginecol. Obs. Mex 2014, 82, 229–235. [Google Scholar]
- Poon, L.C.; Shennan, A.; Hyett, J.A.; Kapur, A.; Hadar, E.; Divakar, H.; McAuliffe, F.; da Silva Costa, F.; von Dadelszen, P.; McIntyre, H.D.; et al. The international federation of gynecology and obstetrics (figo) initiative on pre-eclampsia: A pragmatic guide for first-trimester screening and prevention. Int. J. Gynaecol. Obstet. Off. Organ Int. Fed. Gynaecol. Obstet. 2019, 145 (Suppl. 1), 1–33. [Google Scholar] [CrossRef] [Green Version]
- Brown, M.; Best, K.; Pearce, M.; Waugh, J.; Robson, S.; Bell, R. Cardiovascular disease risk in women with pre-eclampsia: Systematic review and meta-analysis. Eur. J. Epidemiol. 2013, 28, 1–19. [Google Scholar] [CrossRef]
- Hollegaard, B.; Lykke, J.A.; Boomsma, J.J. Time from pre-eclampsia diagnosis to delivery affects future health prospects of children. Evol. Med. Public Health 2017, 2017, 53–66. [Google Scholar] [CrossRef] [Green Version]
- Guidance from the Department of Health of the Physical Activity and Pregnancy Infographic. 2019. Available online: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/829894/5-physical-activity-for-pregnant-women.pdf (accessed on 15 December 2021).
- Sharma, V.K.; Subramanian, S.K.; Radhakrishnan, K.; Rajendran, R.; Ravindran, B.S.; Arunachalam, V. Comparison of structured and unstructured physical activity training on predicted vo2max and heart rate variability in adolescents—A randomized control trial. J. Basic Clin. Physiol. Pharmacol. 2017, 28, 225–238. [Google Scholar] [CrossRef]
- Fennell, C.; Peroutky, K.; Glickman, E.L. Effects of supervised training compared to unsupervised training on physical activity, muscular endurance, and cardiovascular parameters. MOJ Orthop. Rheumatol. 2016, 5, 187. [Google Scholar] [CrossRef] [Green Version]
- O’Connor, P.J.; Poudevigne, M.S.; Cress, M.E.; Motl, R.W.; Clapp, J.F., 3rd. Safety and efficacy of supervised strength training adopted in pregnancy. J. Phys. Act. Health 2011, 8, 309–320. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Ong, M.J.; Guelfi, K.J.; Hunter, T.; Wallman, K.E.; Fournier, P.A.; Newnham, J.P. Supervised home-based exercise may attenuate the decline of glucose tolerance in obese pregnant women. Diabetes Metab. 2009, 35, 418–421. [Google Scholar] [CrossRef] [PubMed]
- Halse, R.E.; Wallman, K.E.; Dimmock, J.A.; Newnham, J.P.; Guelfi, K.J. Home-based exercise improves fitness and exercise attitude and intention in women with gdm. Med. Sci. Sports Exerc. 2015, 47, 1698–1704. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Kokic, I.S.; Ivanisevic, M.; Biolo, G.; Simunic, B.; Kokic, T.; Pisot, R. Combination of a structured aerobic and resistance exercise improves glycaemic control in pregnant women diagnosed with gestational diabetes mellitus. A randomised controlled trial. Women Birth 2018, 31, e232–e238. [Google Scholar] [CrossRef]
- Muhammad, H.F.L.; Pramono, A.; Rahman, M.N. The safety and efficacy of supervised exercise on pregnant women with overweight/obesity: A systematic review and meta-analysis of randomized controlled trials. Clin. Obes. 2021, 11, e12428. [Google Scholar] [CrossRef]
- Liberati, A.; Altman, D.G.; Tetzlaff, J.; Mulrow, C.; Gøtzsche, P.C.; Ioannidis, J.P.A.; Clarke, M.; Devereaux, P.J.; Kleijnen, J.; Moher, D. The prisma statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. PLoS Med. 2009, 6, e1000100. [Google Scholar] [CrossRef]
- Higgins, J.; Thomas, J.; Chandler, J.; Cumpston, M.; Li, T.; Page, M.; Welch, V. (Eds.) Cochrane Handbook for Systematic Reviews of Interventions. Version 6.2; Updated February 2021; Cochrane Training. 2021. Available online: https://training.cochrane.org/handbook (accessed on 15 December 2021).
- Higgins, J.P.; Thompson, S.G. Quantifying heterogeneity in a meta-analysis. Stat. Med. 2002, 21, 1539–1558. [Google Scholar] [CrossRef]
- Sterne, J.A.C.; Savović, J.; Page, M.J.; Elbers, R.G.; Blencowe, N.S.; Boutron, I.; Cates, C.J.; Cheng, H.Y.; Corbett, M.S.; Eldridge, S.M.; et al. Rob 2: A revised tool for assessing risk of bias in randomised trials. BMJ 2019, 366, l4898. [Google Scholar] [CrossRef] [Green Version]
- Higgins, J.P.T.; Altman, D.G.; Gøtzsche, P.C.; Jüni, P.; Moher, D.; Oxman, A.D.; Savović, J.; Schulz, K.F.; Weeks, L.; Sterne, J.A.C.; et al. The cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011, 343, d5928. [Google Scholar] [CrossRef] [Green Version]
- Linhares, G.M.; Machado, A.V.; Malachias, M.V.B. Hydrotherapy reduces arterial stiffness in pregnant women with chronic hypertension. Arq. Bras. Cardiol. 2020, 114, 647–654. [Google Scholar] [PubMed]
- Yeo, S.; Davidge, S.; Ronis, D.L.; Antonakos, C.L.; Hayashi, R.; O’Leary, S. A comparison of walking versus stretching exercises to reduce the incidence of preeclampsia: A randomized clinical trial. Hypertens Pregnancy 2008, 27, 113–130. [Google Scholar] [CrossRef] [PubMed]
- Awad, M.A.; Hasanin, M.E.; Taha, M.M.; Gabr, A.A. Effect of stretching exercises versus autogenic training on preeclampsia. J. Exerc. Rehabil. 2019, 15, 109–113. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Bhartia, N.; Jain, S.; Shankar, N.; Rajaram, S.; Gupta, M. Effects of antenatal yoga on maternal stress and clinical outcomes in north indian women: A randomised controlled trial. J. Indian Acad. Clin. Med. (JIACM) 2019, 20, 10–14. [Google Scholar]
- Barakat, R.; Pelaez, M.; Cordero, Y.; Perales, M.; Lopez, C.; Coteron, J.; Mottola, M.F. Exercise during pregnancy protects against hypertension and macrosomia: Randomized clinical trial. Am. J. Obs. Gynecol. 2016, 214, 649.e1-8. [Google Scholar] [CrossRef] [PubMed]
- de Oliveria Melo, A.S.; Silva, J.L.; Tavares, J.S.; Barros, V.O.; Leite, D.F.; Amorim, M.M. Effect of a physical exercise program during pregnancy on uteroplacental and fetal blood flow and fetal growth: A randomized controlled trial. Obs. Gynecol 2012, 120, 302–310. [Google Scholar] [CrossRef] [Green Version]
- da Silva, S.G.; Hallal, P.C.; Domingues, M.R.; Bertoldi, A.D.; Da Silveira, M.F.; Bassani, D.; Da Silva, I.C.M.; Da Silva, B.G.C.; de Vargas Nunes Coll, C.; Evenson, K. A randomized controlled trial of exercise during pregnancy on maternal and neonatal outcomes: Results from the pamela study. Int. J. Behav. Nutr. Phys. Act. 2017, 14, 175. [Google Scholar] [CrossRef] [Green Version]
- Haakstad, L.A.; Edvardsen, E.; Bø, K. Effect of regular exercise on blood pressure in normotensive pregnant women. A randomized controlled trial. Hypertens Pregnancy 2016, 35, 170–180. [Google Scholar] [CrossRef] [Green Version]
- Maharana, S.; Nagarathna, R.; Padmalatha, V.; Nagendra, H.R.; Hankey, A. The effect of integrated yoga on labor outcome: A randomized controlled study. Int. J. Childbirth 2013, 3, 165–177. [Google Scholar] [CrossRef]
- Price, B.B.; Amini, S.B.; Kappeler, K. Exercise in pregnancy: Effect on fitness and obstetric outcomes-a randomized trial. Med. Sci. Sports. Exerc. 2012, 44, 2263–2269. [Google Scholar] [CrossRef] [Green Version]
- Perales, M.; Valenzuela, P.L.; Barakat, R.; Cordero, Y.; Peláez, M.; López, C.; Ruilope, L.M.; Santos-Lozano, A.; Lucia, A. Gestational exercise and maternal and child health: Effects until delivery and at post-natal follow-up. J. Clin. Med. 2020, 9, 379. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Rakhshani, A.; Nagarathna, R.; Mhaskar, R.; Mhaskar, A.; Thomas, A.; Gunasheela, S. The effects of yoga in prevention of pregnancy complications in high-risk pregnancies: A randomized controlled trial. Prev. Med. 2012, 55, 333–340. [Google Scholar] [CrossRef] [PubMed]
- Jayashree, R.; Malini, A.; Rakhshani, A.; Nagendra, H.; Gunasheela, S.; Nagarathna, R. Effect of the integrated approach of yoga therapy on platelet count and uric acid in pregnancy: A multicenter stratified randomized single-blind study. Int. J. Yoga 2013, 6, 39–46. [Google Scholar] [PubMed]
- Tomić, V.; Sporiš, G.; Tomić, J.; Milanović, Z.; Zigmundovac-Klaić, D.; Pantelić, S. The effect of maternal exercise during pregnancy on abnormal fetal growth. Croat Med. J. 2013, 54, 362–368. [Google Scholar] [CrossRef] [Green Version]
- Yeo, S.; Steele, N.M.; Chang, M.C.; Leclaire, S.M.; Ronis, D.L.; Hayashi, R. Effect of exercise on blood pressure in pregnant women with a high risk of gestational hypertensive disorders. J. Reprod. Med. 2000, 45, 293–298. [Google Scholar]
- Ruiz, J.R.; Perales, M.; Pelaez, M.; Lopez, C.; Lucia, A.; Barakat, R. Supervised exercise-based intervention to prevent excessive gestational weight gain: A randomized controlled trial. Mayo Clin. Proc. 2013, 88, 1388–1397. [Google Scholar] [CrossRef]
- Stafne, S.N.; Salvesen, K.; Romundstad, P.R.; Eggebø, T.M.; Carlsen, S.M.; Mørkved, S. Regular exercise during pregnancy to prevent gestational diabetes: A randomized controlled trial. Obstet. Gynecol. 2012, 119, 29–36. [Google Scholar] [CrossRef]
- Wang, C.; Wei, Y.; Zhang, X.; Zhang, Y.; Xu, Q.; Sun, Y.; Su, S.; Zhang, L.; Liu, C.; Feng, Y.; et al. A randomized clinical trial of exercise during pregnancy to prevent gestational diabetes mellitus and improve pregnancy outcome in overweight and obese pregnant women. Am. J. Obstet. Gynecol. 2017, 216, 340–351. [Google Scholar] [CrossRef]
- Kasawara, K.T.; Burgos, C.S.G.; do Nascimento, S.L.; Ferreira, N.O.; Surita, F.G.; Pinto e Silva, J.L. Maternal and perinatal outcomes of exercise in pregnant women with chronic hypertension and/or previous preeclampsia: A randomized controlled trial. ISRN Obstet. Gynecol. 2013, 2013, 857047. [Google Scholar] [CrossRef] [Green Version]
- Evenson, K.R.; Barakat, R.; Brown, W.J.; Dargent-Molina, P.; Haruna, M.; Mikkelsen, E.M.; Mottola, M.F.; Owe, K.M.; Rousham, E.K.; Yeo, S. Guidelines for physical activity during pregnancy: Comparisons from around the world. Am. J. Lifestyle Med. 2014, 8, 102–121. [Google Scholar] [CrossRef] [Green Version]
- National Institute of Health and Care Excellence. Antenatal Care. Clinical Guideline [NG201]. Published Date: 19 August 2021. Available online: https://www.nice.org.uk/guidance/ng201 (accessed on 27 January 2022).
- Arena, B.M.N. Exercise in pregnancy: How safe is it? Sports Med. Arthrosc. Rev. 2002, 10, 15–22. [Google Scholar] [CrossRef]
- Rodríguez-Blanque, R.; Sánchez-García, J.C.; Sánchez-López, A.M.; Aguilar-Cordero, M.J. Physical activity during pregnancy and its influence on delivery time: A randomized clinical trial. PeerJ 2019, 7, e6370. [Google Scholar] [CrossRef] [PubMed]
- Chiavaroli, V.; Hopkins, S.A.; Derraik, J.G.B.; Biggs, J.B.; Rodrigues, R.O.; Brennan, C.H.; Seneviratne, S.N.; Higgins, C.; Baldi, J.C.; McCowan, L.M.E.; et al. Exercise in pregnancy: 1-year and 7-year follow-ups of mothers and offspring after a randomized controlled trial. Sci. Rep. 2018, 8, 12915. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Weissgerber, T.L.; Wolfe, L.A.; Davies, G.A. The role of regular physical activity in preeclampsia prevention. Med. Sci. Sports Exerc. 2004, 36, 2024–2031. [Google Scholar] [CrossRef] [Green Version]
- Genest, D.S.; Falcao, S.; Gutkowska, J.; Lavoie, J.L. Impact of exercise training on preeclampsia: Potential preventive mechanisms. Hypertension 2012, 60, 1104–1109. [Google Scholar] [CrossRef] [Green Version]
- Martin, C.L.; Huber, L.R.B. Physical activity and hypertensive complications during pregnancy: Findings from 2004 to 2006 north carolina pregnancy risk assessment monitoring system. Birth 2010, 37, 202–210. [Google Scholar] [CrossRef]
- Magnus, P.; Trogstad, L.; Owe, K.M.; Olsen, S.F.; Nystad, W. Recreational physical activity and the risk of preeclampsia: A prospective cohort of norwegian women. Am. J. Epidemiol. 2008, 168, 952–957. [Google Scholar] [CrossRef]
- Rakhshani, A.; Nagarathna, R.; Mhaskar, R.; Mhaskar, A.; Thomas, A.; Gunasheela, S. Effects of yoga on utero-fetal-placental circulation in high-risk pregnancy: A randomized controlled trial. Adv. Prev. Med. 2015, 2015, 373041. [Google Scholar] [CrossRef] [Green Version]
- Rudra, C.B.; Sorensen, T.K.; Luthy, D.A.; Williams, M.A. A prospective analysis of recreational physical activity and preeclampsia risk. Med. Sci. Sports Exerc. 2008, 40, 1581–1588. [Google Scholar] [CrossRef]
- Dipietro, L.; Evenson, K.; Bloodgood, B.; Sprow, K.; Troiano, R.; Piercy, K.L.; Vaux-Bjerke, A.; Powell, K.E. Benefits of physical activity during pregnancy and postpartum: An umbrella review. Med. Sci. Sports Exerc. 2019, 51, 1292–1302. [Google Scholar] [CrossRef]
- Aune, D.; Saugstad, O.D.; Henriksen, T.; Tonstad, S. Physical activity and the risk of preeclampsia: A systematic review and meta-analysis. Epidemiology 2014, 25, 331–343. [Google Scholar] [CrossRef]
- Davenport, M.H.; Ruchat, S.M.; Poitras, V.J.; Garcia, A.J.; Gray, C.E.; Barrowman, N.; Skow, R.J.; Meah, V.L.; Riske, L.; Sobierajski, F.; et al. Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: A systematic review and meta-analysis. Br. J. Sports Med. 2018, 52, 1367–1375. [Google Scholar] [CrossRef] [PubMed]
- Syngelaki, A.; Sequeira Campos, M.; Roberge, S.; Andrade, W.; Nicolaides, K.H. Diet and exercise for preeclampsia prevention in overweight and obese pregnant women: Systematic review and meta-analysis. J. Matern. Fetal. Neonatal. Med. 2019, 32, 3495–3501. [Google Scholar] [CrossRef] [PubMed]
- Wolf, H.; Owe, K.; Juhl, M.; Hegaard, H. Leisure time physical activity and the risk of pre-eclampsia: A systematic review. Matern. Child Health J. 2013, 18, 899–910. [Google Scholar] [CrossRef] [PubMed]
- Butcher, J.T.; Mintz, J.D.; Larion, S.; Qiu, S.; Ruan, L.; Fulton, D.J.; Stepp, D.W. Increased muscle mass protects against hypertension and renal injury in obesity. J. Am. Heart Assoc. 2018, 7, e009358. [Google Scholar] [CrossRef] [PubMed]
- Elliott, W.J.; Izzo, J.L., Jr. Device-guided breathing to lower blood pressure: Case report and clinical overview. MedGenMed 2006, 8, 23. [Google Scholar]
- al’Absi, M.; Arnett, D.K. Adrenocortical responses to psychological stress and risk for hypertension. Biomed Pharm. 2000, 54, 234–244. [Google Scholar] [CrossRef]
- Sieverdes, J.C.; Mueller, M.; Gregoski, M.J.; Brunner-Jackson, B.; McQuade, L.; Matthews, C.; Treiber, F.A. Effects of hatha yoga on blood pressure, salivary α-amylase, and cortisol function among normotensive and prehypertensive youth. J. Altern. Complement. Med. 2014, 20, 241–250. [Google Scholar] [CrossRef] [Green Version]
Categories | Subgroups | Studies (n) | OR (95% CI), p-Value | I2 | Comparison between Sub-Groups (p-Value) |
---|---|---|---|---|---|
All | 16 | 0.54 (0.40, 0.72), p < 0.001 | 23.1% | ||
Type of exercise | Yoga | 4 | 0.28 (0.13, 0.58) p = 0.001 | 0.0% | Reference |
Aerobic | 5 | 0.87 (0.55, 1.37) p = 0·539 | 23.1% | 0.031 | |
Mixed | 7 | 0.50 (0.33, 0.75) p = 0.001 | 37.5% | 0.203 | |
Type of HDP | PE only | 3 | 0.98 (0.58, 1.65), p = 0.928 | 0.0% | Reference |
PE & GH | 5 | 0.40 (0.21, 0.78), p = 0.007 | 51.4% | 0.053 | |
GH only | 8 | 0.48 (0.35, 0.67), p < 0.001 | 0.0% | 0·083 | |
Region | America | 5 | 0.93 (0.56, 1.54), p = 0.770 | 0.0% | Reference |
Europe | 6 | 0.45 (0.32, 0.62) p < 0.001 | 4.9% | 0.885 | |
Asia | 5 | 0.42 (0.20, 0.87), p = 0.020 | 42.7% | 0.065 | |
Setting | Hospital | 11 | 0.47 (0.33, 0.66), p < 0.001 | 29.0% | Reference |
University | 4 | 0.91 (0.51, 1.64), p = 0.761 | 0.0% | 0.124 | |
Multiple settings | 1 | 0.71 (0.22, 2.30) p = 0.572 | 0.546 |
Study Level Variable | Coefficient (95% CI) | p-Value |
---|---|---|
Mean age | 0.98 (0.84, 1.14) | 0.745 |
Mean BMI | 1.04 (0.91, 1.19) | 0.495 |
Publication year | 0.98 (0.88, 1.09) | 0.695 |
Percentage nulliparous | 0.99 (0.96, 1.02) | 0.634 |
Recommended minutes of exercise | 0.99 (0.99, 1.00) | 0.473 |
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Danielli, M.; Gillies, C.; Thomas, R.C.; Melford, S.E.; Baker, P.N.; Yates, T.; Khunti, K.; Tan, B.K. Effects of Supervised Exercise on the Development of Hypertensive Disorders of Pregnancy: A Systematic Review and Meta-Analysis. J. Clin. Med. 2022, 11, 793. https://doi.org/10.3390/jcm11030793
Danielli M, Gillies C, Thomas RC, Melford SE, Baker PN, Yates T, Khunti K, Tan BK. Effects of Supervised Exercise on the Development of Hypertensive Disorders of Pregnancy: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine. 2022; 11(3):793. https://doi.org/10.3390/jcm11030793
Chicago/Turabian StyleDanielli, Marianna, Clare Gillies, Roisin Clare Thomas, Sarah Emily Melford, Philip Newton Baker, Thomas Yates, Kamlesh Khunti, and Bee Kang Tan. 2022. "Effects of Supervised Exercise on the Development of Hypertensive Disorders of Pregnancy: A Systematic Review and Meta-Analysis" Journal of Clinical Medicine 11, no. 3: 793. https://doi.org/10.3390/jcm11030793