Pregnancy Health: Exercise Programs to Prevent Gestational Hypertension

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Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) recommends exercise programs for pregnant women to reduce the development of gestational hypertension.

The full CPSTF Finding and Rationale Statement and supporting documents for Healthy Pregnancy: Exercise Programs to Prevent Gestational Hypertension are available in The Community Guide Collection on CDC Stacks.

Intervention

Programs engage women in regular exercise from before their 16th week of pregnancy through birth.

Exercise programs must include one or both of the following:

  • Supervised exercise classes that meet at least three times each week and include 30-60 minutes of moderate-intensity aerobic exercise
  • Regular moderate-intensity walking sessions during which women (alone or in a group) walk 90-150 minutes per week or 11,000 steps per day, as monitored by a pedometer

Interventions may also include:

  • Supervised resistance training
  • Additional education or encouragement on physical activity, nutrition, and weight management

Interventions may be delivered in health system facilities, or in community-based or home settings.

About The Systematic Review

The CPSTF uses recently published systematic reviews to conduct accelerated assessments. The following published review was selected and evaluated by a team of specialists:

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.

Study Characteristics

  • Studies were conducted in Spain (8 studies), the United States (2 studies), Norway (2 studies), Denmark (2 studies), Italy (1 study), 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 lasted 30-60 minutes (14 studies)

Summary of Results

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:

  • Cesarean delivery rate for program participants was 16% lower than the rate for comparison groups (14 studies)
  • 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

  • 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?

Implementation Considerations and Resources

The CPSTF recommends similar interventions to reduce the risk of developing gestational diabetes, another common complication of pregnancy with similar risk factors (e.g., pre-pregnancy overweight or obese status, excessive weight gain during pregnancy).

The overall ratio of benefits to costs is likely to increase as more evidence shows interventions targeting pregnant women improve related outcomes (e.g., cesarean delivery). This will make programs more attractive to health systems and communities and also increase patient and provider demand for interventions.

The CPSTF identified four important considerations for real-world implementation of exercise programs:

  • Interventions will likely depend on health plans or health systems to fund or provide facilities and supervision for exercise programs. Walking programs in community settings may reduce cost barriers for both health systems and women.
  • Health system referral and enrollment systems will be required to ensure pregnant women can access exercise programs early in their pregnancies.
  • Program retention may be increased if programs address barriers to participation, such as childcare.
  • Preventive benefits are likely to be greater when women join programs early in their pregnancies. It will be challenging, yet important, to expand the goals of early pre-natal visits to include an assessment for moderate-intensity aerobic exercise, an exercise prescription with motivational counseling (ACOG 2017), and enrollment or referral to available programs.

Crosswalks

Healthy People 2030 icon Healthy People 2030 includes the following objectives related to this CPSTF recommendation.