Bibliografia sobre gravidez

Does exercise training during pregnancy affect gestational age? A randomised, controlled trial.

Barakat R, Stirling JR, Lucia A.

Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica, Madrid, Spain.

BACKGROUND: Some controversy exists on the possibility that exercise during pregnancy might increase the risk of preterm delivery. OBJECTIVE: We aimed to determine the possible cause-effect relationship between regular exercise performed during the 2nd and 3rd trimester of pregnancy by previously sedentary, healthy gravida and gestational age at the moment of delivery. METHODS: Caucasian (Spanish) women with singleton gestation were assigned to either a training (N=72) or control (N=70) group. The supervised training program focused mainly on light resistance and toning exercises and included ~ 80 sessions (3 times/week, 35 min/session from weeks 12-13 to 38-39 of pregnancy) RESULTS: We found no significant differences (P>0.05) between both groups in those maternal characteristics (age, smoking habits, number of hours standing or prior parity history) that could potentially influence gestational age. The mean gestational age did not differ (P=0.745) between the training (39wk,3d(1d)) and the control group (39wk,4d(1d)). CONCLUSIONS: Previously sedentary, healthy gravida with singleton gestation can safely engage in moderate, supervised exercise programs until the end of gestation as this would not affect gestational age.

PMID: 18552370 [PubMed - as supplied by publisher]

Erratum in:

• J Reprod Med 2000 Jul;45(7):607.

Effect of exercise on blood pressure in pregnant women with a high risk of gestational hypertensive disorders.

Yeo S, Steele NM, Chang MC, Leclaire SM, Ronis DL, Hayashi R.

Nursing School, University of Michigan School of Medicine, Ann Arbor 48109-0482, USA.

OBJECTIVE: To prospectively determine whether moderate exercise during pregnancy lowers blood pressure. STUDY DESIGN: A randomized, controlled trial with one test group and one control group. All subjects have a history of mild hypertension, gestational hypertensive disorders or a family history of hypertensive disorders. Subjects were recruited before 14 weeks' gestation. After four weeks of observation, the subjects were randomly assigned to either the exercise or control group. The exercise group visited the laboratory three times a week for 10 weeks (18-28 gestation weeks) to perform 30 minutes of exercise at Rating of Perceived Exertion level 13. RESULTS: A total of 16 pregnant women (mean age, 30 years) participated. The mean metabolic equivalent during exercise sessions was 4.7 (SD = 0.8). Blood pressure measurements were compared before and after the 10-week exercise period in the two groups. Systolic blood pressures did not change significantly, but diastolic blood pressure (DBP) in the exercise group decreased by 3.5 mm Hg, while that in the control group increased by 1.1 mm Hg. Thus, the pre-post change in DBP differed by 4.6 mm Hg between groups. Exercise treatment reduced the diastolic blood pressure to a near-significant level in the exercise group (t = 2.34, df = 7, P = .052). Percent body fat did not differ between the exercise and control groups either before or after exercise treatment. ANOVA revealed that pregnancy had a significant effect (F(1, 14) = 5.7, P = .03) on increasing the percentage of fat, but exercise treatment did not (F(1, 14) = .18, P = .68). Estimated energy expenditure in overall daily physical activities during the intervention did not differ between the two groups despite the inclusion of exercise. CONCLUSION: This study detected a strong trend that 10 weeks of moderate exercise lowered the diastolic blood pressure among pregnant women at risk of hypertensive disorders. The reductions were probably due to the effect of exercise itself, not to weight or overall daily physical activity levels.

Publication Types:

• Clinical Trial
• Controlled Clinical Trial
• Randomized Controlled Trial
• Research Support, Non-U.S. Gov't

PMID: 10804484 [PubMed - indexed for MEDLINE]

 

2: Cochrane Database Syst Rev. 2006 Jul 19;3:CD000180.

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Update of:

• Cochrane Database Syst Rev. 2002;(2):CD000180.

Aerobic exercise for women during pregnancy.

Kramer MS, McDonald SW.

Faculty of Medicine, 1020 Pine Avenue West, Montreal, Quebec, Canada H3A 1A2. michael.kramer@mcgill.ca

BACKGROUND: Physiological responses of the fetus (especially increase in heart rate) to single, brief bouts of maternal exercise have been documented frequently. Many pregnant women wish to engage in aerobic exercise during pregnancy but are concerned about possible adverse effects on the outcome of pregnancy. OBJECTIVES: The objective of this review was to assess the effects of advising healthy pregnant women to engage in regular aerobic exercise (at least two to three times per week), or to increase or reduce the intensity, duration, or frequency of such exercise, on physical fitness, the course of labour and delivery, and the outcome of pregnancy. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (June 2005), MEDLINE (1966 to 2005 January Week 1), EMBASE (1980 to 2005 January Week 1), Conference Papers Index (earliest to 2005 January Week 1), contacted researchers in the field and searched reference lists of retrieved articles. SELECTION CRITERIA: Acceptably controlled trials of prescribed exercise programs in healthy pregnant women. DATA COLLECTION AND ANALYSIS: Both review authors independently assessed trial quality and extracted data. Study authors were contacted for additional information. MAIN RESULTS: Eleven trials involving 472 women were included. The trials were small and not of high methodologic quality. Five trials reported significant improvement in physical fitness in the exercise group, although inconsistencies in summary statistics and measures used to assess fitness prevented quantitative pooling of results. Seven trials reported on pregnancy outcomes. A pooled increased risk of preterm birth (relative risk 1.82, 95% confidence interval (CI) 0.35 to 9.57) with exercise, albeit statistically nonsignificant, does not cohere with the absence of effect on mean gestational age (weighted mean difference +0.3, 95% CI -0.2 to +0.9 weeks), while the results bearing on growth of the fetus are inconsistent. One small trial reported that physically fit women who increased the duration of exercise bouts in early pregnancy and then reduced that duration in later pregnancy gave birth to larger infants with larger placentas. AUTHORS' CONCLUSIONS: Regular aerobic exercise during pregnancy appears to improve (or maintain) physical fitness. Available data are insufficient to infer important risks or benefits for the mother or infant. Larger and better trials are needed before confident recommendations can be made about the benefits and risk of aerobic exercise in pregnancy.

Publication Types:

• Meta-Analysis
• Review

PMID: 16855953 [PubMed - indexed for MEDLINE]

 

3: Obstet Gynecol. 2005 Dec;106(6):1279-88.

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Comment in:

• Evid Based Med. 2006 Oct;11(5):156.
• Evid Based Nurs. 2006 Oct;9(4):121.

Physical exertion at work and the risk of preterm delivery and small-for-gestational-age birth.

Pompeii LA, Savitz DA, Evenson KR, Rogers B, McMahon M.

Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, USA. lisa.pompeii@uth.tmc.edu

OBJECTIVE: To assess whether exposure to standing, lifting, night work, or long work hours during 3 periods of pregnancy are associated with an increased risk of preterm or small-for-gestational-age birth. METHODS: The Pregnancy, Infection and Nutrition study is a prospective cohort with a nested case-control component that was conducted through clinic and hospital settings in Central North Carolina. A total of 1,908 women pregnant with a singleton gestation were recruited during prenatal visits from January 1995 through April 2000 and provided information during telephone and face-to-face interviews about physical exertion for the 2 longest-held jobs during pregnancy. RESULTS: No significant elevations in preterm delivery were observed among women who lifted repeatedly or stood at least 30 hours per week, with no changes in risk estimates over the course of pregnancy. A 50% elevation in the risk of preterm delivery (relative risk 1.5, 95% confidence interval 1.0-2.0; first trimester) was observed among women who reported working at night (10:00 PM to 7:00 AM), whereas a 40% reduction in risk was observed among women working at least 46 hours per week (relative risk 0.6, 95% confidence interval 0.4-0.9; first trimester), regardless of period of exposure. No elevations in small-for-gestational-age birth were observed among women exposed to any of the 4 types of occupational exertion. CONCLUSION: Physically demanding work does not seem to be associated with adverse pregnancy outcomes, whereas working at night during pregnancy may increase the risk of preterm delivery. Studies to examine the effect of shift work on uterine activity would help to clarify the possibility of a causal effect on preterm birth.

Publication Types:

• Research Support, N.I.H., Extramural
• Research Support, Non-U.S. Gov't
• Research Support, U.S. Gov't, P.H.S.

PMID: 16319253 [PubMed - indexed for MEDLINE]

 

4: Med Sci Sports Exerc. 1999 Jun;31(6):792-9.

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Physical conditioning effects on fetal heart rate responses to graded maternal exercise.

Brenner IK, Wolfe LA, Monga M, McGrath MJ.

School of Physical and Health Education, Department of Physiology, Queen's University, Kingston, Ontario, Canada.

PURPOSE: This study examined the effects of advancing gestational age and maternal aerobic conditioning (stationary cycling) on fetal heart rate (FHR) responses to strenuous non-steady-state maternal exercise. METHODS: Subjects chose to participate in either an exercise group (EG) or control group (CG). Fourteen healthy, previously sedentary pregnant women participated in the exercise group, and six pregnant controls remained sedentary. Stationary cycling (heart rate target: 145 beats x min(-1)) was performed 3 d x wk(-1) by the exercised group. Exercise duration was increased from 14 to 25 min x session(-1) during the second trimester and was maintained at 25 min x session(-1) throughout the third trimester. FHR was monitored before, during, and after a progressive submaximal cycle ergometer test (peak heart rate = 170 beats x min(-1)) performed at approximately 27 and 37 wk gestation. RESULTS: Mean FHR increased significantly (P < 0.05) during exercise, followed by a modest suppression and then a delayed rise during the recovery period at both observation times. Fetal bradycardia was not observed in any of the exercise tests. Effects of advancing gestational age included a lower FHR baseline both at rest and in response to maternal exercise and a lower incidence of exercise-induced tachycardia. Maternal physical conditioning did not significantly alter FHR response to maternal exercise. CONCLUSION: Our results support the hypothesis that FHR responses to strenuous exercise are altered by advancing gestational age and a brief progressive exercise test terminated at a maternal heart rate of 170 beats x min(-1) does not induce fetal distress during a healthy pregnancy.

Publication Types:

• Research Support, Non-U.S. Gov't

PMID: 10378905 [PubMed - indexed for MEDLINE]

 

5: Med Sci Sports Exerc. 1998 Jan;30(1):17-27.

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Physical conditioning attenuates respiratory responses to steady-state exercise in late gestation.

Ohtake PJ, Wolfe LA.

School of Physical and Health Education and Department of Physiology, Queen's University, Kingston, Ontario, Canada.

PURPOSE: To study the ventilatory effects of closely monitored cycle ergometer conditioning (HR target, 145-150 beats x min(-1); 25 min/session; three sessions per week) during the second and third pregnancy trimesters (TMs) in healthy human pregnancy. METHODS: Subjects were 27 previously sedentary pregnant women (exercised group, EG). A sedentary control group (CG, N = 20) was also studied. Subjects were tested at rest and during upright cycle ergometry at three steady-state power outputs (approximately 20, 45, and 65 W) at the start of the second TM (ENTRY), at the end of the second and third TMs (post-training), and 3 months postpartum (PP, nonpregnant control). RESULTS: Significant reductions in exercise HR were observed in the EG at each exercise level, confirming achievement of an aerobic conditioning effect. In both groups the ventilatory equivalent for oxygen (VE/O2) was significantly higher at all work rates during pregnancy compared with that during PP. This effect was caused by significantly higher exercise tidal volumes (VT) at each work rate in both groups during pregnancy versus PP. Respiratory sensitivity as reflected by the ventilatory equivalent for carbon dioxide (E/VECO2) and calculated arterial carbon dioxide tension (PaCO2) was significantly increased at all three work rates in late gestation versus PP and increased slightly with advancing gestational age in both groups. The main effects of physical conditioning were attenuation of increases in VE/VO2 observed at all exercise levels between the end of TM2 and TM3 and reductions in respiratory perception of effort (RPEr) between ENTRY and the end of TM3. Attenuation of increases in VE/VO2 during TM3 in the EG was attributed to the combined effects of enhanced fat versus carbohydrate utilization (resulting in reduced CO2 output and drive to ventilate) and attenuation of pregnancy-induced increases in dead space ventilation in late gestation. CONCLUSION: The study results support the hypothesis that physical conditioning reduces both ventilatory demand and respiratory perception of effort in late gestation.

Publication Types:

• Research Support, Non-U.S. Gov't

PMID: 9475640 [PubMed - indexed for MEDLINE]

 

6: Cochrane Database Syst Rev. 2000;(2):CD000180.

Related Articles, Links

Update in:

• Cochrane Database Syst Rev. 2002;(2):CD000180.

Regular aerobic exercise during pregnancy.

Kramer MS.

Faculty of Medicine, McGill University, 1020 Pine Avenue West, Montreal, Quebec, Canada, H3A 1A2. mikek@epid.lan.mcgill.ca

BACKGROUND: Physiological responses of the fetus (especially increase in heart rate) to single, brief bouts of maternal exercise have been documented frequently. OBJECTIVES: The objective of this review was to assess the effects of advising healthy pregnant women to engage in regular (at least two to three times per week) aerobic exercise on physical fitness, labour and delivery, and the outcome of pregnancy. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register was searched. SELECTION CRITERIA: Acceptably controlled comparisons of prescribed aerobic exercise programmes. DATA COLLECTION AND ANALYSIS: One reviewer assessed trial quality and extracted data. Study authors were contacted for additional information. MAIN RESULTS: Five trials involving 142 women were included. The trials were not of high methodologic quality. Three trials reported significant improvement in physical fitness in the exercise group, although differences in measures used to assess fetuses prevent a quantitative pooling of results. Two small trials reported nonsignificant results on pregnancy outcomes, but apart from a reassurring absence of effect on mean gestational age [+0.3 (-0.2 to +0.9) weeks], these results allow exclusion of only extremely large effects. REVIEWER'S CONCLUSIONS: Regular aerobic exercise during pregnancy appears to improve (or maintain) physical fitness. Available data are insufficient to exclude important risks or benefits for the mother or infant.

Publication Types:

• Review

PMID: 10796173 [PubMed - indexed for MEDLINE]

Physical Activity and Gestational Diabetes Mellitus among Hispanic Women.

Chasan-Taber L, Schmidt MD, Pekow P, Sternfeld B, Manson JE, Solomon CG, Braun B, Markenson G.

Division of Biostatistics & Epidemiology, School of Public Health & Health Sciences, University of Massachusetts, Amherst, Massachusetts.

ABSTRACT Objective: Studies in predominantly non-Hispanic white populations have suggested that physical activity during pregnancy is associated with a reduced risk of gestational diabetes mellitus (GDM). There are few such studies in Hispanic women, a group at increased risk for GDM. Methods: We conducted a prospective cohort study of household/caregiving, occupational, sports/exercise, and active living habits and the risk of GDM among 1006 Hispanic (predominantly Puerto Rican) prenatal care patients in western Massachusetts from 2000 to 2004. Prepregnancy, early pregnancy, and midpregnancy physical activity was assessed using the Kaiser Physical Activity Survey. Results: A total of 33 women (3.3%) were diagnosed with GDM, and 119 women (11.8%) were diagnosed with abnormal glucose tolerance. There were no significant associations between GDM risk and occupational and active living activities in prepregnancy, early pregnancy, and midpregnancy or with a change in levels of household/caregiving, occupational, and active living activities from prepregnancy to during pregnancy. However, after controlling for age and prepregnancy body mass index (BMI), women in the highest quartile of prepregnancy (OR = 0.2, 95% CI 0.1-0.8, p(trend) = 0.03) and midpregnancy (OR = 0.2, 95% CI 0.1-0.8, p(trend) = 0.004) household/caregiving activities as well as midpregnancy sports/exercise (0.1, 95% CI 0.0-0.7, p(trend) = 0.12) had a reduced risk of GDM compared with women in the lowest quartile. Conclusions: Findings in this Hispanic population, although based on small numbers of cases, are consistent with prior research among predominantly non-Hispanic white populations.

PMID: 18582171 [PubMed - as supplied by publisher]

 

2: Pract Midwife. 2008 Jun;11(6):43-6, 48-9, 51.

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Diabetes in pregnancy--dietary management.

Serci I.

Robert Gordon University, Aberdeen.

The provision of adequate energy and nutrients in the woman with DM is essential for normal fetal growth. However, dietary modifications including exercise are essential to normalise blood glycaemic levels and prevent adverse pregnancy outcomes. However, the evidence surrounding the nutritional management in GDM has been controversial. Dornhorst and Frost (2002) state that not only are there conflicting guidelines on nutritional management but disagreement as to the effectiveness of this on pregnancy outcomes. NICE (2008) has issued guidelines on the management of DM before, during and after pregnancy. Dietary prescriptions should include personal preference, body weight and type and level of exercise, blood glucose levels, ketone levels and any medications taken for the DM. Midwives must empower women to manage their condition through making appropriate and acceptable choices for their health and that of their baby.

PMID: 18564524 [PubMed - in process]

 

3: Br J Sports Med. 2008 Jun 14. [Epub ahead of print]

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Does exercise training during pregnancy affect gestational age? A randomised, controlled trial.

Barakat R, Stirling JR, Lucia A.

Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica, Madrid, Spain.

BACKGROUND: Some controversy exists on the possibility that exercise during pregnancy might increase the risk of preterm delivery. OBJECTIVE: We aimed to determine the possible cause-effect relationship between regular exercise performed during the 2nd and 3rd trimester of pregnancy by previously sedentary, healthy gravida and gestational age at the moment of delivery. METHODS: Caucasian (Spanish) women with singleton gestation were assigned to either a training (N=72) or control (N=70) group. The supervised training program focused mainly on light resistance and toning exercises and included ~ 80 sessions (3 times/week, 35 min/session from weeks 12-13 to 38-39 of pregnancy) RESULTS: We found no significant differences (P>0.05) between both groups in those maternal characteristics (age, smoking habits, number of hours standing or prior parity history) that could potentially influence gestational age. The mean gestational age did not differ (P=0.745) between the training (39wk,3d(1d)) and the control group (39wk,4d(1d)). CONCLUSIONS: Previously sedentary, healthy gravida with singleton gestation can safely engage in moderate, supervised exercise programs until the end of gestation as this would not affect gestational age.

PMID: 18552370 [PubMed - as supplied by publisher]

 

4: Hypertens Pregnancy. 2008;27(2):113-30.

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A comparison of walking versus stretching exercises to reduce the incidence of preeclampsia: a randomized clinical trial.

Yeo S, Davidge S, Ronis DL, Antonakos CL, Hayashi R, O'Leary S.

School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7460, USA. syeo@email.unc.edu

OBJECTIVES: To compare a walking exercise to a stretching exercise during pregnancy in high-risk women who were sedentary and had previously experienced preeclampsia. METHODS: A randomized clinical trial of the effects of the two types of physical exercises was conducted between November 2001 and July 2006 in Washtenaw County, Michigan. Both groups engaged in the assigned exercise five times a week until the end of pregnancy. RESULTS: Women were randomized to either the walking group (n = 41) or the stretching group (n = 38). The walkers exercised an average of 36 (SD, 6) minutes at 18 weeks gestation, 34 (SD, 7) minutes at 28 weeks gestation, and 31 (SD, 12) minutes at the last week of the intervention. On average, they exercised within target heart rate ranges 35% (SD, 32%) at 18 weeks gestation, 22% (SD, 25%) at 28 weeks gestation, and 17% (SD, 25%) at the last week of the intervention. The stretching group engaged in stretching exercises following a 40-minutes videotape. On average, the walking group exercised 4 (SD, 1) times a week at 18 weeks gestation, 4 (SD, 1) time a week at 28 weeks gestation, and 3 (SD, 1) times a week at the last week of the intervention. Equally on average, the stretching group exercised 4 (SD, 2) times a week at 18 weeks gestation, 5 (SD, 1) times a week at 28 weeks gestation, and 3 (SD, 1) times a week at the last week of the intervention. No difference between groups was observed, but both exercised significantly less frequently over the time (p 0.0001). Together, participants reported average 7,040 (SD, 2,612) steps at the beginning and 5,711 (SD, 2,739) steps at the end of the study. The walkers tracked an average 8,501 (SE, 778) steps a day at 20 weeks gestation and 7,418 (SE, 788) steps at 34 weeks gestation (n.s.). The stretchers tracked an average 6,189 (SE, 704) steps at 20 weeks gestation and 4,848 (SE, 452) steps at 34 weeks gestation (p 0.05). The incidence of preeclampsia was 14.6% (95% CI, 5.6 to 29.2) among the walkers and 2.6% (95% CI; 0.07 to 13.8) among the stretchers. The incidence of gestational hypertension was 22 % (95% C.I., 8.7 to 35.2) for the walkers and 40% (95% CI, 23.2 to 55.8) for the stretchers. The mean transferrin level, an antioxidant marker, was significantly higher in the stretching group mean (412 mg/dL, 95%CI, 389 to 435) than the walkers at the time of labor (mean = 368 mg/dL, 95%CI, 346 to 391) (p 0.05). No significant group differences were observed in birth outcomes. CONCLUSION: Regular stretching exercises may promote endogenous antioxidants among women at risk for preeclampsia.

Publication Types:

• Comparative Study
• Randomized Controlled Trial
• Research Support, N.I.H., Extramural

PMID: 18504873 [PubMed - indexed for MEDLINE]

 

5: Clin Obstet Gynecol. 2008 Jun;51(2):467-80.

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Effect of exercise on pregnancy outcome.

Gavard JA, Artal R.

Department of Obstetrics, Gynecology, and Women's Health, St Louis University School of Medicine, St Louis, Missouri, USA.

The purpose of this review was to critically evaluate the scientific literature for the effects of exercise on pregnancy outcome. Evidenced-based studies were reviewed. Maternal outcomes analyzed in this review were gestational diabetes mellitus, preeclampsia, and weight gain, fetal outcomes evaluated were birth weight, time of delivery, and mode of delivery. Despite methodological pitfalls in the studies published, the evidence suggests a benefit of exercise in pregnancy. Exercise in pregnancy could prevent and limit adverse maternal and fetal morbidities and provide a long-term benefit through reduction of maternal weight gain during pregnancy, and improvement in cardiovascular fitness. Pregnancy emerges as a unique time for behavior modification.

Publication Types:

• Review

PMID: 18463475 [PubMed - indexed for MEDLINE]

 

6: Appl Physiol Nutr Metab. 2008 Jun;33(3):511-7.

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A walking intervention improves capillary glucose control in women with gestational diabetes mellitus: a pilot study.

Davenport MH, Mottola MF, McManus R, Gratton R.

Exercise prescriptions that can be translated into clinical recommendations are clearly needed for women with gestational diabetes mellitus (GDM). A pilot project was developed to document the effectiveness of a structured low-intensity walking protocol on capillary glucose control in GDM women. Ten GDM women followed conventional management of diet and insulin therapy, plus a low-intensity walking program (W) from diagnosis to delivery. Capillary glucose concentrations, insulin requirements, and pregnancy outcomes were compared with a matched cohort by body mass index (BMI), age, and insulin usage (20 GDM women who followed conventional management alone (C)). Baseline capillary glucose concentrations were not significantly different between the W and C groups. The W group had an average acute drop in capillary glucose concentration from pre- to post-exercise of 2.0 mmol.L-1. In addition, the W group had significantly lower mean glucose concentrations in the fasted state and 1 h after meals than the C group in the week prior to delivery. These lower glucose concentrations were achieved while requiring fewer units of insulin per day (C, 0.50 +/- 0.37 U.kg-1; W, 0.16 +/- 0.13 U.kg-1; p < 0.05), injected less frequently. These results suggest an effective role in glucose regulation for this structured walking program.

PMID: 18461104 [PubMed - in process]

 

7: Metab Syndr Relat Disord. 2006 Summer;4(2):84-90.

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Effects of Diet and Exercise on Insulin Resistance during Pregnancy.

Clapp JF.

Departments of Reproductive Biology and Obstetrics and Gynecology and Schwartz Center for Metabolism and Nutrition, MetroHealth Medical Campus of Case Western Reserve University, Cleveland, Ohio; and Department of Obstetrics and Gynecology, University of Vermont College of Medicine, Burlington, Vermont.

Current evidence suggests that both diet and exercise can alter the usual increase in insulin resistance seen in Western societies during mid and late pregnancy. A low-glycemic diet combined with a low-volume exercise regimen during pregnancy decreases the glucose and insulin response to both mixed caloric intake and exercise, and probably lowers both 24-h blood glucose concentrations and the maternal substrate utilization ratio of carbohydrate/fat. The end result is a marked decrease in both maternal weight gain and size at birth. Regular weight-bearing exercise alone lowers markers of insulin resistance and lowers blood glucose concentration during and immediately after exercise during pregnancy. Changes in diet and/or physical activity appear to prevent the onset of gestational diabetes mellitus in at-risk women and may be of value in the treatment of those who develop gestational diabetes.

PMID: 18370754 [PubMed - as supplied by publisher]

 

8: J Midwifery Womens Health. 2008 Mar-Apr;53(2):155-9.

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The effect of vigorous exercise during pregnancy.

Penney DS.

debra.penney@nurs.utah.edu

Pregnant women without medical or obstetric problems should be encouraged to exercise. The paucity of experimental data on exercise in pregnancy forces recommendations to be drawn from a synthesis of available information. Vigorous exercise during pregnancy seems to pose no adverse maternal or neonatal outcomes. Nonetheless, the safety of vigorous exercise necessitates surveillance of fetal growth, the woman's weight, nutritional intake, and exercise duration and intensity.

Publication Types:

• Case Reports
• Clinical Conference

PMID: 18308267 [PubMed - indexed for MEDLINE]

 

9: Am J Epidemiol. 2008 Apr 1;167(7):859-66. Epub 2008 Feb 25.

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Physical exercise during pregnancy and the risk of preterm birth: a study within the Danish National Birth Cohort.

Juhl M, Andersen PK, Olsen J, Madsen M, Jørgensen T, Nøhr EA, Andersen AM.

National Institute of Public Health, Copenhagen, Denmark. mju@niph.dk

According to many national recommendations, women should be physically active during pregnancy, but empirical evidence to support this recommendation is sparse. The authors' aim in this study was to examine the relation between physical exercise during pregnancy and the risk of preterm birth. Self-reported data on physical exercise during pregnancy were collected prospectively for 87,232 singleton pregnancies included in the Danish National Birth Cohort between 1996 and 2002. Hazard ratios for preterm birth according to hours of exercise per week, type of exercise, and metabolic equivalent-hours per week, respectively, were calculated using Cox regression analysis. Results showed a reduced risk of preterm birth among the almost 40% of women who engaged in some kind of exercise during pregnancy in comparison with nonexercisers (hazard ratio = 0.82, 95% confidence interval: 0.76, 0.88), but no dose-response relation was seen. The association was not affected by the type of exercise, and the results were not altered when the degree of preterm birth was taken into account. These findings do not indicate any adverse effects of exercise on the risk of preterm birth and therefore do not contradict current recommendations.

Publication Types:

• Research Support, Non-U.S. Gov't

PMID: 18303008 [PubMed - indexed for MEDLINE]

Exercise during the childbearing year.

Hammer RL, Perkins J, Parr R.

R oger H ammer is a professor of exercise science at Central Michigan University in Mt. Pleasant, Michigan. His research interest is in fitness and body composition changes in special populations.

Many women wish to continue to pursue an active lifestyle during pregnancy, while the pregnancy itself may provide the motivation for other more sedentary women to begin an exercise program for the sake of improved health/fitness. Also, female competitive athletes, upon becoming pregnant, may wish to continue sports performance and require careful monitoring to assure maternal-fetal safety. This review is designed to assist the perinatal educator who is in the position to advise the pregnant patient on the risks and benefits of physical activity during the childbearing year and provide suggestions for developing individualized exercise programs.

PMID: 17273187 [PubMed - in process]

PMCID: PMC1595006

 

2: Curr Sports Med Rep. 2003 Dec;2(6):325-30.

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Exercise during pregnancy: a practical approach.

Paisley TS, Joy EA, Price RJ Jr.

Department of Family and Preventive Medicine, University of Utah, Madsen Family Health Clinic, 555 Foothill Drive, Suite 301, Salt Lake City, UT 84112, USA. tsp@alum.dartmouth.org

Attitudes toward exercise during pregnancy have changed dramatically over the past 20 years. Recent studies show that, in most cases, exercise is safe for both the mother and fetus during pregnancy, and support the recommendation to initiate or continue exercise in most pregnancies. This report discusses the rationale behind the changes, and offers educational tools that may be employed to initiate behavioral change. We also propose exercise prescriptions for pregnant women who are sedentary, physically active, and competitive athletes. Armed with this information, the practitioner will be better equipped to counsel patients and incorporate a discussion on physical activity into prenatal visits.

Publication Types:

• Review

PMID: 14583162 [PubMed - indexed for MEDLINE]

 

3: J Sci Med Sport. 2002 Mar;5(1):55-7.

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Pregnant athletes: a summary review of the legal issues.

Villa D, O'Reilly T.

Barrister (Sydney Bar), NSW, Australia.

This summary review is not, and should not be relied upon as, legal advice. It has been prepared at the request of the Journal of Science and Medicine in Sport as a discussion paper for the purposes of providing a background in the legal issues arising from the participation of pregnant women in sport. The discussion is necessarily pitched at a very general level, and without any specific circumstances in mind. Readers with particular concerns, or with specific issues to be addressed, should seek independent legal advice.

PMID: 12054387 [PubMed - indexed for MEDLINE]

 

4: J Sci Med Sport. 2002 Mar;5(1):46-54.

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Comment in:

• J Sci Med Sport. 2002 Sep;5(3):274.

The risk of abdominal injury to women during sport.

Finch CF.

Victorian State Trauma Outcomes Registry and Monitoring, Department of Epidemiology and Preventive Medicine, Monash University, Australia.

Although trauma to pregnant women is a potential risk during sport, as there is no published information about the magnitude of this risk, it is presumed to be low. Whilst there is an emerging literature about the risk of adverse outcomes following severe and catastrophic trauma to pregnant women, this literature almost exclusively focuses on road trauma victims or the result of assault. This paper describes the risk of abdominal injuries to women participants across a range of sports in Australia. An extensive search of the available literature could not identify any studies that had discussed this issue specifically in pregnant women. Studies, which have reported injuries in athletes, have generally found abdominal/chest injuries to account for fewer than 2% of all injuries, even in contact sports. Most of these published studies do not differentiate between the chest and abdomen and provide no specfic details on the exact nature or mechanisms of the injuries. Given the limitations of the published studies, an examination of data from two Australian general injury databases (one describing hospital admissions, the other hospital emergency department presentations), three Australian sports-injury treatment databases (sports medicine clinic attendances and medical coverage services) and one cohort study was undertaken to describe sports-related abdominal injuries. These analyses confirm that the risk of abdominal injury during sport is very low. In conclusion, currently there is not an adequate evidence-base for quantifying the risk of abdominal injuries during sport in women, let alone pregnant women or for justifying a ban of sport on this basis. Recommendations for future epidemiological sports injury studies and the potential for linkages with perinatal morbidity and mortality databases are given.

PMID: 12054386 [PubMed - indexed for MEDLINE]

 

5: J Sci Med Sport. 2002 Mar;5(1):11-9.

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SMA statement the benefits and risks of exercise during pregnancy. Sport Medicine Australia.

[No authors listed]

There are numerous benefits to pregnant women of remaining active during pregnancy. These include improved weight control and maintenance of fitness. There may also be benefits in terms of reduced risk of development of gestational diabetes meilitus and improved psychological functioning. Moderate intensity aerobic exercise has been shown to be safe in pregnancy, with a number of studies now indicating that for trained athletes it may be possible to exercise at a higher level than is currently recommended by the American College of Obstetricians and Gynecologists. Studies of resistance training, incorporating moderate weights and avoiding maximal isometnc contractions, have shown no adverse outcomes. There may be benefits of increased strength and flexibility. The risk of neural tube defects due to exercise-induced hyperthermia that is suggested by animal studies is less likely in women, because of more effective mechanisms of heat dissipation in humans. There is accumulating evidence to suggest that participation in moderate intensity exercise throughout pregnancy may enhance birth weight, while more severe or frequent exercise, maintained for longer into the pregnancy: may result in lighter babies. There have been no reports of foetal injury or death in relation to trauma or contact during sporting activities. Despite this, a risk of severe blunt trauma is present in some sporting situations as pregnancy progresses. Exercise and lactation are compatible in the post-partum period, providing adequate calories are consumed. Considerations of pelvic floor function and type of delivery are relevant in planning a return to certain types of exercise at this time.

Publication Types:

• Review

PMID: 12054382 [PubMed - indexed for MEDLINE]

 

6: Baillieres Best Pract Res Clin Endocrinol Metab. 2000 Mar;14(1):37-53.

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The female athlete.

Warren MP, Shantha S.

Department of Obstetrics and Gynecology, Columbia Presbyterian Hospital, Columbia University, New York, NY 10032, USA.

Over the past 30 years, the number of women participating in organized sports has grown dramatically. Several forms of menstrual irregularities have been described in the female athlete: primary and secondary amenorrhoea, oligomenorrhoea, short luteal phases and anovulation. The incidence of menstrual irregularities is much higher in activities where a thin body is required for better performance. The hormonal pattern seen in these athletes is a hypothalamic amenorrhoea profile. There appears to be a decrease in gonadotrophin-releasing hormone (GnRH) pulses from the hypothalamus, which in turn decreases the pulsatile secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) and shuts down stimulation of ovary. Recently, another type of amenorrhoea has been described in swimmers which is characterized by mild hyperandrogenism. Athletes with low weight are at risk of developing the female athletic triad, which includes amenorrhoea, osteoporosis and disordered eating. Athletes with this triad are susceptible to stress fractures. Other issues include the pregnant athlete. Intensive exercise during pregnancy can cause bradycardia. Safe limits of aerobic exercise in pregnancy depend on previous exercise habits. Infertility, which may develop with exercise, is probably reversible with reduction of exercise or weight gain. High impact sports activities may produce urinary incontinence. Oestrogen replacement therapy is often prescribed in amenorrhoeic athletes, but bone loss may not be completely reversible.

Publication Types:

• Review

PMID: 10932809 [PubMed - indexed for MEDLINE]

 

7: Am J Obstet Gynecol. 1998 Feb;178(2):280-6.

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Training in pregnant women: effects on fetal development and birth.

Kardel KR, Kase T.

Department of Biology, University of Oslo, Norway.

OBJECTIVE: The effects of high- and medium-intensity exercise on the fetus and on the onset and length of labor, birth weight, and Apgar score were studied in healthy athletes who performed a high level of exercise before conception. STUDY DESIGN: Forty-two women were recruited to the study by newspaper ads and through acquaintances. They elected to follow either a high- or a medium-intensity exercise program throughout pregnancy until 6 weeks after delivery. Documentation of their intensity of activity before conception (retrospectively), during pregnancy, and after delivery was obtained. RESULTS: There were no differences between the high- and medium-intensity exercise group in duration of labor, birth weight, or 1- and 5-minute Apgar scores. The higher level of exercise correlated with a significantly greater maternal weight gain during pregnancy and significantly earlier onset of labor for those women who gave birth to girls but not for those who gave birth to boys. CONCLUSION: Our results indicate that healthy and well-conditioned women may take part in exercise during pregnancy without compromising fetal growth and development as judged by birth weight or complicating the course of pregnancy or labor.

Publication Types:

• Research Support, Non-U.S. Gov't

PMID: 9500487 [PubMed - indexed for MEDLINE]

 

8: J Am Acad Orthop Surg. 1997 Mar;5(2):87-96.

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The Female Athlete: Evaluation and Treatment of Sports-Related Problems.

Teitz CC, Hu SS, Arendt EA.

Department of Orthopaedic Surgery, University of Washington, Seattle.

Although many of the problems faced by the female athlete affect the male athlete as well, some occur exclusively or more commonly in women. These include spondylolisthesis, stress fractures in the pelvis and hip, and pelvic floor dysfunction. Female athletes are also more likely to have patellofemoral problems, noncontact anterior cruciate ligament tears, and bunions. For many of these conditions, the relative influences of osseous anatomy, ligamentous laxity, and the effect of sex hormones have not yet been established. There are also problems related specifically to the menstrual cycle and pregnancy. Amenorrhea is present in up to 20% of vigorously exercising women. The term "female athlete triad" has been coined to describe the complex interplay of menstrual irregularity, disordered eating, and premature osteoporosis seen in the female athlete. Many of the concerns related to exercise during pregnancy focus on the safety of the fetus rather than the athlete herself. Musculoskeletal problems in the physically active pregnant woman are related to weight gain, ligamentous relaxation, lordosis, and change in the center of gravity.

PMID: 10797211 [PubMed - as supplied by publisher]