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Pregnancy Health: Exercise Programs to Prevent Gestational Hypertension

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What the CPSTF Found

About The Systematic Review

The CPSTF uses recently published systematic reviews to conduct accelerated assessments of interventions that could provide program planners and decision makers with additional, effective options. The following published review was selected and evaluated by a team of specialists in systematic review methods, and in research, practice, and policy related to pregnancy health:

Magro-Malosso E, Saccone G, Di Tommaso M, Roman A, Berghella V. Exercise during pregnancy and risk of gestational hypertension disorders: a systematic review and meta-analysis. Acta Obstetrica et Gynecologica Scandinavica 2017;96:921-31.

The published review included 17 studies (search period through February 2017). The CPSTF finding is based on results from the published review, additional analyses of data from included studies, and expert input from team members and the CPSTF.

Context

Regular physical activity is recommended for women before, during, and after pregnancy (DHHS 2018). Physical activity during pregnancy has minimal risks and has been shown to benefit most women (ACOG 2017).

Participation in structured exercise programs can help women, especially those who are not otherwise active, obtain regular physical activity throughout pregnancy. Exercise initiated early in pregnancy can help reduce excessive weight gain and prevent gestational diabetes (CPSTF 2017).

This systematic review assessed the effectiveness of exercise programs in preventing gestational hypertensive disorders, defined as new onset high blood pressure during pregnancy. There are four different types of gestational hypertensive disorders: chronic hypertension, gestational hypertension, preeclampsia, and preeclampsia superimposed on chronic hypertension (Vest et al., 2014). This CPSTF finding is specific to one type—gestational hypertension without the development of preeclampsia-eclampsia.

Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The systematic review and meta-analysis included 17 randomized controlled trials.

  • Compared to interventions without an exercise program or to usual care, exercise programs reduced the development of high blood pressure during pregnancy by 46% (17 studies)

Additional analyses of a subset of 16 studies showed the following:

  • The cesarean delivery rate for program participants was 16% lower than the rate for comparison groups (14 studies).
  • The rate of preeclampsia was 21% lower among program participants when compared with control groups, though the difference was not statistically significant (7 studies).

Summary of Economic Evidence

A systematic review of economic evidence has not been conducted.

Applicability

Based on results from the review, findings should be applicable to healthy women with uncomplicated pregnancies in the United States. The CPSTF expressed concern, however, about the need for further evaluation in specific U.S. settings and populations.

Evidence Gaps

Additional research and evaluation are needed to answer the following questions and fill existing gaps in the evidence.

  • What are the pathways between exercise and preeclampsia?
  • How does program effectiveness vary by population and setting (e.g., participant income, education, race/ethnicity; rural or urban setting)?
  • How effective are community-based interventions when women are referred from their first pre-natal visit?
  • What are the best ways to efficiently assess pregnant women for exercise program eligibility and refer them to clinic- or community-based programs?
  • What is the dose-response relationship between supervised group-format exercise and effectiveness? What are the minimum requirements for program effectiveness?

Study Characteristics

  • Included studies were conducted in Spain (8 studies), the United States (2 studies), Norway (2 studies), Denmark (2 study), Italy (1 studies), and Brazil (1 study).
  • Exercise programs included supervised aerobic exercise classes (8 studies), a mix of supervised and unsupervised exercise (4 studies), or monitored walking sessions (4 studies).
  • Exercise sessions were typically 3 times per week (11 studies), and they lasted 30-60 minutes (14 studies).