Regular Exercise to Prevent the Recurrence of Gestational Diabetes Mellitus: A Randomized Controlled Trial Water aerobics II: maternal body composition and perinatal outcomes after a program for low risk pregnant women A pilot walking program promotes moderate-intensity physical activity during pregnancy. Impact of a walking intervention during pregnancy on post-partum weight retention and infant anthropometric outcomes. Exercise during pregnancy enhances cerebral maturation in the newborn: A randomized controlled trial Antepartum, Intrapartum, and Neonatal Significance of Exercise on Healthy Low‐Risk Pregnant Working Women The impact of exercise during pregnancy on neonatal outcomes: a randomized controlled trial. Physical and psychological changes with vigorous exercise in sedentary primigravidae. Effects of a Partially Home‐Based Exercise Program for Women With Gestational Diabetes The Effect of Vigorous Exercise During Pregnancy on Birth‐Weight Effects of aerobic exercise training on maternal and neonatal outcome: a randomized controlled trial on pregnant women in Iran. Supervised home-based exercise may attenuate the decline of glucose tolerance in obese pregnant women. Water aerobics in pregnancy: cardiovascular response, labor and neonatal outcomes Antenatal exercise and birthweight Does regular exercise during pregnancy influence lumbopelvic pain? A randomized controlled trial Exercise during pregnancy improves maternal glucose screen at 24–28 weeks: a randomised controlled trial A randomized clinical trial of exercise during pregnancy to prevent gestational diabetes mellitus and improve pregnancy outcome in overweight and obese pregnant women Maternal exercise during pregnancy, physical fitness, and fetal growth. Water‐gymnastics reduced the intensity of back/low back pain in pregnant women Resistance exercise training during pregnancy and newborn's birth size: a randomised controlled trial Exercise in pregnant women and birth weight: a randomized controlled trial ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions Physical activity for smoking cessation in pregnancy: randomised controlled trial Effect of supervised exercise training during pregnancy on neonatal and maternal outcomes among overweight and obese women. 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Type of delivery and gestational age is not affected by pregnant Latin-American women engaging in vigorous exercise: a secondary analysis of data from a controlled randomized trial. Comprehensive maternal characteristics associated with birth weight: Bayesian modeling in a prospective cohort study from Iran Prevention of Gestational Diabetes Heart volume and physical fitness of parturients. A randomized controlled trial on the effects of antenatal exercise on birth weight and neonatal body composition Exercise Is Associated with a Reduction in Gestational Diabetes Mellitus. A Program of Exercise Throughout Pregnancy. Is it Safe to Mother and Newborn? No effect of the FitFor2 exercise programme on blood glucose, insulin sensitivity, and birthweight in pregnant women who were overweight and at risk for gestational diabetes: results of a randomised controlled trial Long-term effects of the intrauterine environment. The Northwestern University Diabetes in Pregnancy Center. Efficacy of yoga in pregnant women with abnormal Doppler study of umbilical and uterine arteries. Exercise in pregnancy: effect on fitness and obstetric outcomes-a randomized trial. Exercise training in pregnancy reduces offspring size without changes in maternal insulin sensitivity. Exercise throughout pregnancy does not cause preterm delivery: a randomized, controlled trial. PP046. Adherence to exercise with bicycle during pregnancy in women with risk of preeclampsia. Is Swimming During Pregnancy a Safe Exercise? Regular Exercise Throughout Pregnancy is Associated with a Shorter First Stage of Labor
OBJECTIVE : To investigate the effect of a supervised home-based exercise program on the recurrence and severity of gestational diabetes mellitus ( GDM )  together with other aspects of maternal health and obstetric and neonatal outcomes . METHODS : This r and omized controlled trial allocated women with a history of GDM to an  exercise intervention ( 14-week supervised home-based stationary cycling program ) or to a control group ( st and ard care ) at 13±1 weeks of gestation . The primary outcome was a diagnosis of GDM . Secondary outcomes included maternal fitness , psychological well-being , and obstetric and neonatal outcomes . A sample size of 180 ( 90 in each group ) was required to attain 80 % power to detect a 40 % reduction in the incidence of GDM . RESULTS : Between June 2011 and July 2014 , 205 women provided written consent and completed baseline assessment s. Of these , 33 ( 16 % ) were subsequently excluded as a result of an elevated baseline oral glucose tolerance test ( OGTT ) , leaving 172 r and omized to exercise ( n=85 ) or control ( n=87 ) . Three women miscarried before the assessment of outcome measures ( control=2 ; exercise=1 ) . All remaining women completed the postintervention OGTT . The recurrence rate of GDM was similar between groups ( control 40 % [ n=34 ] ; exercise 40.5 % [ n=34 ] ; P=.95 ) and the severity of GDM at diagnosis was unaffected by the exercise program with similar glucose and insulin responses to the OGTT ( glucose 2 hours post-OGTT 7.7±1.5 compared with 7.6±1.6 mmol/L ; P>.05 ) . Maternal fitness was improved by the exercise program ( P<.01 ) and psychological distress was reduced ( P=.02 ) . There were no differences in obstetric and neonatal outcomes between groups ( P>.05 ) . CONCLUSION : Supervised home-based exercise started at 14 weeks of gestation did not prevent the recurrence of GDM ; however , it was associated with important benefits for maternal fitness and psychological well-being . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , https:// clinical trials.gov , NCT01283854 Background To evaluate the effectiveness and safety of water aerobics during pregnancy . Methods A r and omized controlled trial carried out in 71 low-risk sedentary pregnant women , r and omly allocated to water aerobics or no physical exercise .  Maternal body composition and perinatal outcomes were evaluated . For statistical analysis Chi-square , Fisher 's or Student 's t-tests were applied . Risk ratios and their 95 % CI were estimated for main outcomes . Body composition was evaluated across time using MANOVA or Friedman multiple analysis . Results There were no significant differences between the groups regarding maternal weight gain , BMI or percentage of body fat during pregnancy . Incidence of preterm births ( RR = 0.84 ; 95%CI:0.28–2.53 ) , vaginal births ( RR = 1.24 ; 95%CI:0.73–2.09 ) , low birthweight ( RR = 1.30 ; 95%CI:0.61–2.79 ) and adequate weight for gestational age ( RR = 1.50 ; 95%CI:0.65–3.48 ) were also not significantly different between groups . There were no significant differences in systolic and diastolic blood pressure and heart rate between before and immediately after the water aerobics session . Conclusion Water aerobics for sedentary pregnant women proved to be safe and was not associated with any alteration in maternal body composition , type of delivery , preterm birth rate , neonatal well-being or weight INTRODUCTION Walking may be a strategy for increasing moderate-intensity physical activity ( MPA )  during pregnancy . PURPOSE This study aim ed to promote MPA among overweight and obese pregnant women , via walking , and to evaluate the effect of the intervention on maternal and birth outcomes . METHODS Thirty-seven overweight or obese pregnant women were r and omly assigned to a walking intervention or control group . Anthropometric and objective PA ( StepWatch ™ Activity Monitor ) data were collected for four 1-wk periods : weeks 10 - 14 ( V1 ) , weeks 17 - 19 ( V2 ) , weeks 27 - 29 ( V3 ) , and weeks 34 - 36 ( V4 ) of gestation . Participants provided information about maternal and birth outcomes . A cadence of ≥ 80 steps per minute was defined as MPA , and " meaningful walking " was defined as moderate walking in ≥ 8-min bouts . ANOVA was used to determine the differences in walking amount and meaningful walks , the Kolmogorov-Smirnov test was used for walking intensity distribution analysis , and Fisher 's exact test was used for maternal and infant outcomes analyses . Pearson correlation was used to examine the association between prepregnancy body mass index and gestational weight gain ( GWG ) . RESULTS There was significantly more MPA among women in the intervention group compared with those in the control group at V2 ( overweight , P < 0.0001 ; obese , P < 0.025 ) , V3 ( overweight , P < 0.0001 ) , and V4 ( overweight , P < 0.0001 ; obese , P < 0.025 ) . Women in the intervention group significantly increased their meaningful walks at V2 ( P = 0.054 ) , V3 ( P = 0.01 ) , and V4 ( P = 0.014 ) . There were trends for intervention group women to have more favorable maternal and birth outcomes compared with the control group . Rates of GWG at measurement points during pregnancy were significantly associated with preceding rates of GWG . CONCLUSION The pilot , unsupervised walking intervention increased the MPA of overweight and obese women during pregnancy Few studies have investigated the impact of lifestyle interventions during pregnancy on post-partum weight retention and infant growth .  Thirty seven previously non-exercising , overweight or obese pregnant women were r and omly assigned to a walking intervention or non-intervention control . For the follow-up study , weight of the mother and weight , length and body composition of the infant were collected at 1 month post-partum ( n=37 ) and 6 months post-partum ( n=33 ) . Analysis of variance and linear regression were conducted to determine the differences and association in maternal post-partum weight retention and child outcomes . At 6 months post-partum , weight retention of obese women in the intervention group ( Int-OB ) was -0.10±8.11 kg ; while , obese women in the control group ( Con-OB ) was 6.35±7.47 kg . A significantly higher percentage of Con-OB women retained more than 5 kg at 6 months post-partum ( P=0.046 ) . Even though statistically non-significant between the groups , the growth trend observed among offspring of obese women in the control group was consistently higher than the offspring of obese women in the intervention group from birth to 6-months . Third trimester gestational weight gain rate significantly predicted 6-m weight-for-length z-score after controlling for birth weight , treatment group and pre-pregnancy body mass index ( r 2=0.31 , β=1.75 , P=0.03 ) . The reduced post-partum weight retention observed among the obese women in the intervention group may be explained in part by the lifestyle modification during pregnancy ABSTRACT Accumulating research indicates that the regular practice of physical exercise is beneficial to the human brain . From the improvement of academic achievement in children to the prevention of Alzheimer ’s disease in the elderly , exercise appears beneficial across the developmental spectrum . Recent work from animal studies also indicates that a pregnant mother can transfer the benefits of exercise during gestation to her offspring ’s brain . Exercising pregnant rats give birth to pups that have better memory and spatial learning as well as increased synaptic density . To investigate whether this transfer from the pregnant mother to her child also occurs in humans , we conducted a r and omized controlled trial ( n = 18 ) and measured the impact of exercise during pregnancy on the neuroelectric response of the neonatal brain with electroencephalography ( EEG ) . Here we show that , compared to the newborns of mothers who were inactive during their pregnancy , the children of exercising pregnant women are born with more mature brains . This was measured with the infant slow positive mismatch response ( SPMMR ) , an electroencephalographic potential known to decrease in amplitude with age . The SPMMR reflects processes associated with brain maturation via its response to sound discrimination and auditory memory . In this study , the children of the mothers who exercised throughout their pregnancy  have a smaller SPMMR than the children of mothers who remained sedentary ( p = .019 ) . Our results demonstrate the impact regular exercise during pregnancy can have on the development of the human fetal brain OBJECTIVE To evaluate the influence of exercise on maternal and perinatal outcome in a low‐risk healthy obstetric population . METHODS We conducted a prospect i ve observational study of low‐risk healthy women exercising during their pregnancy . An extensive question naire collected antepartum , intrapartum , and postpartum patient information on 750 women . The women were divided into four groups based on exercise level during pregnancy . RESULTS There were no differences among groups for maternal demographic characteristics , antenatal illnesses , stress , social support , or smoking . Heavily exercising women were older ( P = .042 ) , had higher incomes ( P = .001 ) , and were exercising more at conception ( P = .001 ) . Women who did more exercise were more likely to need an induction of labor ( P = .033 , relative risk 1.84 , 95 % confidence interval 1.05 , 3.20 ) , induction or augmentation with oxytocin ( P = .015 , relative risk 1.53 , 95 % confidence interval 1.19 , 1.97 ) , and had longer first‐stage labors ( P = .032 ) result ing in longer total labors ( P = .011 ) . The difference in the length of first‐stage labor was even greater if the no‐exercise group was compared with the strongly exercising group ( P = .009 , relative risk 1.38 , 95 % confidence interval 0.16 , 2.60 ) . Fewer umbilical cord abnormalities ( P = .034 ) were observed with exercise , but exercising women had more colds and flu ( P = .008 ) . Heavily exercising women had smaller infants ( mean difference 86.5 g ) compared with sedentary women . CONCLUSION Exercise  in working women is associated with smaller babies , increased number of inductions and augmentations of labor , and longer labors . Colds and flu are more frequent in exercising women AIM The effect of exercise training during the course of pregnancy on the newborn 's birth weight is unclear . This study examines the effect of aerobic and strength conditioning exercise performed during the second and the third trimester of pregnancy in nulliparous , previously inactive women on the newborn 's outcome . METHODS Sixty-three nulliparous , previously sedentary , were r and omly assigned to either an exercise ( N.=30 ) or a control ( N.=33 ) group . The subjects participated in the exercise group ( EG ) focused on aerobic and strength-conditioning exercise in three sessions for about 20 weeks . We registered the birth weight , birth length , gestational age at time of delivery , Apgar score and head circumference of the newborn . RESULTS There were no statistically significant differences between the two groups in mean birth weight , length , head circumference , and length of gestation . There was a significant difference between two groups in Apgar scores at 1 min ( P=0.036 ) and 5 min ( P=0.015 ) with newborns of the EG scoring higher than the CG . CONCLUSION Supervised , aerobic and strength conditioning exercise performed over the second and third trimester of pregnancy does not have a negative impact on the newborn 's body size and health PURPOSE The present study examined the effects of exercise on physical and psychological variables in sedentary primigravidae ( PRA ) . METHODS A total of nine women r and omly assigned to an exercise ( E ) ( mean age = 31.3 + /- 3.1 yr ) and six subjects r and omly assigned to a control ( C ) group ( mean age = 27.8 + /- 3.1 yr ) fulfilled all requirements for the study . Exercise included a variety of exercise activities performed to a target heart rate of 150 - 156 beats x min(-1 ) , three times per week for 15 wk . RESULTS Results showed no significant differences between E and C groups in physical characteristics initially . A repeated measures ANOVA showed a significant group effect ( P < 0.05 ) and a significant group by time interaction ( P = 0.001 ) with the E group showing a significantly longer amount of time on the PWC150 test than the C group . There was no significant group , time , or group by time interaction for lactate accumulation . This occurred , despite the fact that the E group spent 56 % longer on the PWC150 test and the C group spent 30 % less time on the same test at the conclusion of the study . Finally , the E group in comparison to the C group showed more favorable improvements in several items related to health and well-being on the Body Cathexis Scale . There were no significant differences between E and C groups in any pregnancy outcome measures . All babies were delivered healthy  at term . CONCLUSIONS These data suggest that a vigorous exercise program can lead to significant improvements in aerobic fitness at similar lactate concentrations compared to a control group and can be well tolerated by low risk sedentary PRA without any deleterious effects occurring to herself or unborn child Objective To examine the effectiveness of a partially homebased , moderate-intensity aerobic exercise program for women with gestational diabetes . Methods This was a r and omized experimental design . Thirty-three women with gestational diabetes were r and omly assigned to the exercise or the no-exercise group . Subjects underwent hemoglobin A1C assay and submaximal cycle ergometer fitness tests at baseline and at study conclusion . Subjects kept diaries of home fasting and 2-hour postpr and ial blood glucose determinations . Exercise subjects were asked to exercise for 30 minutes three to four times weekly at 70 % of estimated maximal heart rate for the weeks of study participation . Two exercise sessions weekly were supervised by the investigator , and two were unsupervised at home .  Control-group  subjects were asked to maintain their current activity level . Results Daily fasting and postpr and ial blood glucose levels , hemoglobin A1C , incidence of exogenous insulin therapy , and incidence of newborn hypoglycemia were not different between the groups . There was a training effect in the exercise group ( P = .005 ) but not in the control group ( P = .25 ) . A significant decline in daily grams of carbohydrate consumed was observed in the control group ( P = .03 ) , but not in the exercise group ( P = .97 ) . No complications were found in the subjects who exercised . Conclusions A partially home-based exercise program did not reduce blood glucose levels , but did result in a modest increase in cardiorespiratory fitness . The intervention appeared safe EDITORIAL COMMENT : When this paper was review ed the question was raised that the period of gestation is an obvious factor which can determine birth‐weight and the authors were asked how this may have affected their results The authors response was as follows OBJECTIVE To assess the effect of aerobic exercise training on maternal and neonatal outcome METHODS The case-control study was conducted between January and July , 2011 . It was approved by the Research Ethics Committee of Toyserkan Azad University , and data was collected at prenatal clinics and delivery centres located in Hamedan , Iran . It comprised 80 pregnant women between 20 - 26 weeks of gestation r and omly assigned to two equal and matching groups of cases and controls . The intervention group did exercise continuously on a bicycle ergometre for 15 minutes , three times a week ; the intensity being 50 - 60 % of maximal heart rate . The control group did not do any exercise training . All information was obtained from the clinics , delivery centres , and from the reports of delivery room midwives . RESULTS No statistically significant difference was found between the two groups in gestational weight gain , pregnancy length , mode of delivery , first and second stage of labour , perineal tear , and 1st and 5th min Apgar score . Mean neonatal weight was significantly less in the intervention group than the control group ( p < 0.001 ) . CONCLUSION Exercising on a bicycle ergometer during pregnancy seems to be safe for the mother and the neonate AIM The significant deterioration of insulin sensitivity and glucose tolerance during pregnancy can have serious health implication s for both the pregnant woman and her baby . Although it is well established that regular exercise benefits insulin sensitivity in the nonpregnant population , the effect on glucose tolerance in obese pregnant women is not known . The purpose of this study was to investigate the effect of a supervised 10-week , home-based , exercise programme , beginning at week 18 of gestation , on glucose tolerance and aerobic fitness in previously sedentary obese women . METHODS Twelve sedentary obese women were r and omized into an exercise ( EX ; n=6 ) or control ( CON ; n=6 ) group at 18 weeks of gestation . Those r and omized to EX engaged in 10 weeks of supervised home-based exercise ( three sessions a week of stationary cycling ) , while those in the CON group maintained their usual daily activity . Their glucose and insulin responses to an oral glucose tolerance test ( OGTT ) , as well as their aerobic fitness , were assessed both pre- and postintervention . RESULTS Reduced glucose tolerance in the CON , but not EX , group was indicated by a tendency postintervention towards higher blood glucose levels at 1h of the OGTT ( P=0.072 ) . Furthermore , at 2h of the postintervention OGTT , blood glucose tended to remain elevated from baseline in the CON ( P=0.077 ) . There was also a trend towards increased fitness in the EX ( P=0.064 ) , but not the CON group . CONCLUSION Regular aerobic exercise begun during pregnancy may have favourable effects on glucose tolerance and fitness in obese women , and warrants further investigation in a larger sample population Background To evaluate the association between water aerobics , maternal cardiovascular capacity during pregnancy , labor and neonatal outcomes . Methods A r and omized , controlled clinical trial was carried out in which 34 pregnant women were allocated to a water aerobics group and 37 to a control group .  All women were su bmi tted to submaximal ergometric tests on a treadmill at 19 , 25 and 35 weeks of pregnancy and were followed up until delivery . Oxygen consumption ( VO2 max ) , cardiac output ( CO ) , physical fitness , skin temperature , data on labor and delivery , and neonate outcomes were evaluated . Frequency distributions of the baseline variables of both groups were initially performed and then analysis of the outcomes was carried out . Categorical data were compared using the chi-square test , and numerical using Student 's t or Mann-Whitney tests . Wilk 's Lambda or Friedman 's analysis of repeat measurements were applied for comparison of physical capacity , cardiovascular outcomes and maternal temperature . Results VO2 max and physical fitness were higher in both groups in the second trimester , returning to basal levels in the third trimester . In both groups , CO increased as pregnancy progressed and peak exercise temperature was higher than resting temperature , increasing further after five minutes of recovery and remaining at this level until 15 minutes after exercise completion . There was no difference between the two groups regarding duration ( 457.9 ± SD 249.6 vs 428.9 ± SD 203.2 minutes ) or type of delivery . Labor analgesia was requested by significantly fewer women in the water aerobics group ( 27 % vs 65 % ; RR = 0.42 95%CI 0.23–0.77 ) . Neonatal results were similar in both groups . Conclusion The regular practice of moderate water aerobics by sedentary and low risk pregnant women was not detrimental to the health of the mother or the child . There was no influence on maternal cardiovascular capacity , duration of labor or type of delivery ; however , there were fewer requests for analgesia during labor in the water aerobics group Does strenuous antenatal exercise reduce birth‐weight ? Does reducing maternal exercise increase birthweight ? What to advise about exercise during pregnancy Objective . To study lumbopelvic pain in women r and omized to a regular exercise program during pregnancy in comparison to women receiving st and ard antenatal care . Design . A two‐armed , two‐center , r and omized controlled trial . Setting . St Olavs Hospital , Trondheim University Hospital and Stavanger University Hospital . Population . A total of 855 pregnant women were r and omized to intervention or control groups . Methods . The intervention was a 12 week exercise program , including aerobic and strengthening exercises , conducted between 20 and 36 weeks of pregnancy . One weekly group session was led by physiotherapists , and home exercises were encouraged twice a week . The control group received st and ard antenatal care . Main outcome measures . Self‐reports of lumbopelvic pain and sick leave due to lumbopelvic pain . The data were analysed according to the “ intention‐to‐treat ” principle . Results . There were no significant differences between groups of women reporting lumbopelvic pain at 36 weeks ( 74 vs. 75 % , p=0.76 ) . The proportion of women on sick leave due to lumbopelvic pain was lower in the intervention group ( 22 % vs 31 % , p=0.01 ) . Conclusions . Exercise during pregnancy does not influence the prevalence of lumbopelvic pain , but women offered a regular exercise course seem to h and le the disorder better Objective The influence of an exercise programme performed by healthy pregnant women on maternal glucose tolerance was studied . Study design A physical activity ( PA , l and /aquatic activities ) programme during the entire pregnancy ( three sessions per week ) was conducted by a qualified instructor . 83 healthy pregnant women were r and omly assigned to either an exercise group ( EG , n=40 ) or a control ( CG , n=43 ) group . 50 g maternal glucose screen ( MGS ) , maternal weight gain and several pregnancy outcomes were recorded . Results Significant differences were found between study groups on the 50 g MGS . Values corresponding to the EG ( 103.8±20.4 mg/dl ) were better than those of the CG ( 126.9±29.5 mg/dl ) , p=0.000 . In addition , no differences in maternal weight gain and no cases of gestational diabetes in EG versus 3 in CG ( 7 % ) ( p>0.05 ) were found . Conclusion A moderate PA programme performed during pregnancy improves levels of maternal glucose tolerance BACKGROUND : Obesity and being overweight are becoming epidemic , and indeed , the proportion of such women of reproductive age has increased in recent times . Being overweight or obese prior to pregnancy is a risk factor for gestational diabetes mellitus , and increases the risk of adverse pregnancy outcome for both mothers and their offspring . Furthermore , the combination of gestational diabetes mellitus with obesity/overweight status may increase the risk of adverse pregnancy outcome attributable to either factor alone . Regular exercise has the potential to reduce the risk of developing gestational diabetes mellitus and can be used during pregnancy ; however , its efficacy remain controversial . At present , most exercise training interventions are implemented on Caucasian women and in the second trimester , and there is a paucity of studies focusing on overweight/obese pregnant women . OBJECTIVE : We sought to test the efficacy of regular exercise in early pregnancy to prevent gestational diabetes mellitus in Chinese overweight/obese pregnant women . STUDY DESIGN : This was a prospect i ve r and omized clinical trial in which nonsmoking women age > 18 years with a singleton pregnancy who met the criteria for overweight/obese status ( body mass index 24≤28 kg/m2 ) and had an uncomplicated pregnancy at < 12 + 6 weeks of gestation were r and omly allocated to either exercise or a control group . Patients did not have contraindications to physical activity . Patients allocated to the exercise group were assigned to exercise 3 times per week ( at least 30 min/session with a rating of perceived exertion between 12‐14 ) via a cycling program begun within 3 days of r and omization until 37 weeks of gestation . Those in the control group continued their usual daily activities . Both groups received st and ard prenatal care , albeit without special dietary recommendations . The primary outcome was incidence of gestational diabetes mellitus . RESULTS : From December 2014 through July 2016 , 300 singleton women at 10 weeks ’ gestational age and with a mean prepregnancy body mass index of 26.78 ± 2.75 kg/m2 were recruited . They were r and omized into an exercise group ( n = 150 ) or a control group ( n = 150 ) . In all , 39 ( 26.0 % ) and 38 ( 25.3 % ) participants were obese in each group , respectively . Women r and omized to the exercise group had a significantly lower incidence of gestational diabetes mellitus ( 22.0 % vs 40.6 % ; P < .001 ) . These women also had significantly less gestational weight gain by 25 gestational weeks ( 4.08 ± 3.02 vs 5.92 ± 2.58 kg ; P < .001 ) and at the end of pregnancy ( 8.38 ± 3.65 vs 10.47 ± 3.33 kg ; P < .001 ) , and reduced insulin resistance levels ( 2.92 ± 1.27 vs 3.38 ± 2.00 ; P = .033 ) at 25 gestational weeks . Other secondary outcomes , including gestational weight gain between 25‐36 gestational weeks ( 4.55 ± 2.06 vs 4.59 ± 2.31 kg ; P = .9 ) , insulin resistance levels at 36 gestational weeks ( 3.56 ± 1.89 vs 4.07 ± 2.33 ; P = .1 ) , hypertensive disorders of pregnancy ( 17.0 % vs 19.3 % ; odds ratio , 0.854 ; 95 % confidence interval , 0.434–2.683 ; P = .6 ) , cesarean delivery ( except for scar uterus ) ( 29.5 % vs 32.5 % ; odds ratio , 0.869 ; 95 % confidence interval , 0.494–1.529 ; P = .6 ) , mean gestational age at birth ( 39.02 ± 1.29 vs 38.89 ± 1.37 weeks ’ gestation ; P = .5 ) ; preterm birth ( 2.7 % vs 4.4 % , odds ratio , 0.600 ; 95 % confidence interval , 0.140–2.573 ; P = .5 ) , macrosomia ( defined as birthweight > 4000 g ) ( 6.3 % vs 9.6 % ; odds ratio , 0.624 ; 95 % confidence interval , 0.233–1.673 ; P = .3 ) , and large‐for‐gestational‐age infants ( 14.3 % vs 22.8 % ; odds ratio , 0.564 ; 95 % confidence interval , 0.284–1.121 ; P = .1 ) were also lower in the exercise group compared to the control group , but without significant difference . However , infants born to women following the exercise intervention had a significantly lower birthweight compared with those born to women allocated to the control group ( 3345.27 ± 397.07 vs 3457.46 ± 446.00 g ; P = .049 ) . CONCLUSION : Cycling exercise initiated early in pregnancy and performed at least 30 minutes , 3 times per week , is associated with a significant reduction in the frequency of gestational diabetes mellitus in overweight/obese pregnant women . And this effect is very relevant to that exercise at the beginning of pregnancy decreases the gestational weight gain before the mid‐second trimester . Furthermore , there was no evidence that the exercise prescribed in this study increased the risk of preterm birth or reduced the mean gestational age at birth The value of exercise during pregnancy is controversial ; both benefits and risks have been hypothesized . As empiric evidence is scant , the issue was investigated in a prospect i ve study that assessed the impact on fetal growth of maternal exercise in each trimester of pregnancy . A cohort of over 800 prenatal patients was recruited from obstetric practice s in Pennsylvania and New York between January 1987 and June 1989 . Subjects were interviewed at entry into care and recontacted at 28 and 36 weeks of gestation . In women with prior adverse outcomes or a lack of conditioning , the associations between maternal exercise and fetal growth were equivocal . In fit , low-risk , prenatal patients , exercise was positively associated with fetal growth . With low-moderate exercise levels , the adjusted mean birth weights were about 100 g higher than in nonexercisers ( 117 g ; 95 % confidence interval 17 to 217 g ) . With heavier exercise , larger birth weight increments were seen , close to 300 g in those who exercised throughout pregnancy at levels of about 2,000 kcal/week in energy expenditure ( 276 g ; 95 % confidence interval 54 to 497 g ) . These results suggest that the guidelines issued by the American College of Obstetricians and Gynecologists may be too stringent for well-conditioned , low-risk , prenatal patients . Additional research to define safe limits more precisely seems warranted OBJECTIVE To investigate if water-gymnastics during pregnancy may reduce the intensity of back/low back pain and the number of days on sick-leave . METHODS A prospect i ve , r and omized study . One hundred and twenty-nine women were r and omized to participate in water-gymnastics once a week during the second half of pregnancy and 129 were r and omized to a control group . The women in both groups filled in question naires in gestational weeks 18 , 34 and within the first postpartum week . Every day from week 18 to labor they assessed the intensity of back/low back pain . RESULTS Back pain intensity increased during pregnancy . No excess risk for the pregnancy associated with water-gymnastics was observed . The women participating in water-gymnastics recorded a lower intensity of back/low back pain . The total number of days on sick-leave because of back/low back pain was 982 in the water-gymnastics group ( 124 women ) compared with 1484 in the control group ( 120 women ) . After weeks 32 33 , seven women in the water-gymnastics group compared with 17 in the control group were on sickleave because of back/ low back pain ( p=0.031 ) . CONCLUSIONS Intensity of back/low back pain increased with advancing pregnancy . There was no excess risk for urinary or vaginal infections associated with water-gymnastics . Water-gymnastics during the second half of pregnancy significantly reduced the intensity of back/ low back pain .  Water-gymnastics decreased the number of women on sick-leave because of back/low back pain .  Water-gymnastics during pregnancy can be recommended as a method to relieve back pain and may reduce the need for sick-leave Objective : We examined the effect of light intensity resistance exercise training performed during the second and third trimester of pregnancy on the  newborn 's birth size . We also studied the association between  maternal body weight prior to pregnancy and newborn 's birth size .  Design : R and omised controlled trial . Subjects : We r and omly assigned 160 sedentary gravidae to either a training ( n=80 ) or a control ( n=80 ) group . The training programme focused on light resistance and toning exercises ( three times per week , 35–40 min per session ) . We recorded the Apgar score , birth weight , birth length , and head circumference of the newborn , as well as gestational age at time of delivery from hospital perinatal records . We also measured maternal weight and height before parity and gestational weight gain . Results : Maternal characteristics neither differed between groups ( all P>0.1 ) nor newborn characteristics ( all P>0.1 ) . Maternal body weight was positively and significantly associated with newborn 's birth weight and length only in the control group ( β=19.20 and 0.065 , respectively , P<0.01 ) . Conclusion : Light intensity resistance training performed over the second and third trimester of pregnancy does not have a negative impact on the newborn 's body size or overall health . Exercise interventions might attenuate the adverse consequences of maternal body weight before pregnancy on the newborn 's birth size Background Birth weight plays an important role in infant mortality and morbidity , childhood development , and adult health . To date there are contradictory results regarding the role of physical activity on birth weight . In addition , it is question ed whether exercise during second and third trimesters of pregnancy might affect gestational age and increase the risk of preterm delivery . Hence , the purpose of this study was to examine the effect of a supervised exercise-program on birth weight , gestational age at delivery and Apgar-score . Methods Sedentary , nulliparous pregnant women ( N = 105 ) , mean age 30.7 ± 4.0 years , pre-pregnancy BMI 23.8 ± 4.3 were r and omized to either an exercise group ( EG , n = 52 ) or a control group ( CG , n = 53 ) . The exercise program consisted of supervised aerobic dance and strength training for 60 minutes , twice per week for a minimum of 12 weeks , with an additional 30 minutes of self-imposed physical activity on the non-supervised week-days . Results There was no statistically significant difference between groups in mean birth weight , low birth weight ( < 2500 g ) or macrosomia ( ≥ 4000 g ) . Per protocol analyses showed higher Apgar score ( 1 min ) in the EG compared with the CG ( p = 0.02 ) . No difference was seen in length of gestation  . Conclusion Aerobic-dance exercise was not associated with reduction in birth weight , preterm birth rate or neonatal well-being . Trial Registration Clinical Trials.gov : Non-r and omised studies of the effects of interventions are critical to many areas of healthcare evaluation , but their results may be biased . It is therefore important to underst and and appraise their strengths and weaknesses . We developed ROBINS-I ( “ Risk Of Bias In Non-r and omised Studies - of Interventions ” ) , a new tool for evaluating risk of bias in estimates of the comparative effectiveness ( harm or benefit ) of interventions from studies that did not use r and omisation  to allocate units ( individuals or clusters of individuals ) to comparison groups . The tool will be particularly useful to those undertaking systematic review s that include non-r and omised studies Objective To determine the effectiveness of a physical activity intervention for smoking cessation during pregnancy . Design Parallel group , r and omised controlled , multicentre trial . Setting 13 hospitals in Engl and , April 2009 to January 2014 . Participants 789 pregnant smokers , aged 16 - 50 years and at 10 - 24 weeks ’ gestation , who smoked at least one cigarette daily and were prepared to quit smoking one week after enrollment were r and omised ( 1:1 ) ; 785 were included in the intention to treat analyses , with 392 assigned to the physical activity group . Interventions Interventions began one week before a target quit date . Participants were r and omised to six weekly sessions of behavioural support for smoking cessation ( control ) or to this support plus 14 sessions combining supervised treadmill exercise and physical activity consultations . Main outcome measures The primary outcome was continuous smoking abstinence from the target quit date until end of pregnancy , vali date d by exhaled carbon monoxide or salivary cotinine levels . To assess adherence , levels of moderate-vigorous intensity physical activity were self reported and in a 11.5 % ( n=90 ) r and om sub sample of participants , physical activity was objective ly measured by an accelerometer . Results No significant difference was found in rates of smoking abstinence at end of pregnancy between the physical activity and control groups ( 8 % v 6 % ; odds ratio 1.21 , 95 % confidence interval 0.70 to 2.10 ) . For the physical activity group compared with the control group , there was a 40 % ( 95 % confidence interval 13 % to 73 % ) , 34 % ( 6 % to 69 % ) , and 46 % ( 12 % to 91 % ) greater increase in self reported minutes carrying out physical activity per week from baseline to one week , four weeks , and six weeks post-quit day , respectively . According to the accelerometer data there was no significant difference in physical activity levels between the groups . Participants attended a median of four treatment sessions in the intervention group and three in the  control group . Adverse events and birth outcomes were similar between the two groups , except for significantly more caesarean births in the control group than in the physical activity group ( 29 % v 21 % , P=0.023 ) . Conclusion Adding a physical activity intervention to behavioural smoking cessation support for pregnant women did not increase cessation rates at end of pregnancy . During pregnancy , physical activity is not recommended for smoking cessation but remains indicated for general health benefits . Trial registration Current Controlled Trials IS RCT N48600346 Background Maternal obesity associates with complications during pregnancy and childbirth . Our aim was to investigate if exercise during pregnancy in overweight/obese women could influence birth weight or other neonatal and maternal outcomes at delivery . Material and methods This is a secondary analysis of a r and omised controlled trial of exercise training in pregnancy for women with body mass index ( BMI ) ≥ 28 kg/m2 . Ninety-one women ( 31.3 ± 4.3 years , BMI 34.5 ± 4.2 kg/m2 ) were allocated 1:1 to supervised exercise during pregnancy or to st and ard care . The exercise group was offered three weekly training sessions consisting of 35 minutes of moderate intensity walking/running followed by 25 minutes of strength training . Data from 74 women  ( exercise 38 , control 36 ) were analysed at delivery . Results Birth weight was 3719 ± 695 g in the exercise group and 3912 ± 413 g in the control group ( CI -460.96 , 74.89 , p = 0.16 ) . Birth weight > 4000 g was 35 % in the exercise group and 52 % in the control group ( p = 0.16 ) . Mean gestational age at delivery was 39.1 weeks in the exercise group and 39.5 weeks in the control group ( CI -1.33 , 0.43 , p = 0.31 ) . No significant between-group differences were found in neonatal body size , skinfold thickness , placental weight ratio , or Apgar score . The prevalence of caesarean section was 24 % in the exercise group and 17 % in the control group ( CI 0.20 , 2.05 , p = 0.57 ) . Mean length of hospital stay was 4.8 days in the exercise group and 4.5 days in the control group ( CI -0.45 , 1.00 , p = 0.45 ) . Conclusions Offering supervised exercise during pregnancy for overweight and obese women did not influence birth weight or other neonatal and maternal outcomes at delivery . However our trial was limited by low sample size and poor adherence to the exercise protocol , and further research is needed . Trial registration Clinical Trials.gov Objectives . To evaluate the association between physical exercise supervised in pregnant women with chronic hypertension and /or previous preeclampsia and maternal and neonatal outcomes . Method . R and omized controlled trial , which included 116 pregnant women with chronic hypertension and /or previous preeclampsia , considered risk of preeclampsia development . They were divided into two groups : study group that performed physical exercise with a stationary bicycle once a week , for 30 minutes ; the intensity was controlled ( heart rate 20 % above resting values ) , under professional supervision and a control group that was not engaged in any physical exercise . The data was retrieved from medical charts . Significance level assumed was 5 % . Results . Women from study group performed 9.24 ± 7.03 of physical exercise sessions . There were no differences between groups comparing type of delivery and maternal outcomes , including maternal morbidity and hospitalization in intensive unit care , and neonatal outcomes , including birth weight , adequacy of weight to gestational age , prematurity , Apgar scale at first and fifth minutes , hospitalization in intensive unit care , and neonatal morbidity . Conclusions . Physical exercise using a stationary bicycle in pregnant women with chronic hypertension and /or previous preeclampsia , once a week , under professional supervision , did not interfere in the delivery method and did not produce maternal and neonatal risks of the occurrence of morbidity . This trial is registered with Clinical Trials.gov NCT01395342 Objectives The long-term consequences of  maternal physical activity during pregnancy for  offspring cardiovascular health are unknown . We examined the association of  maternal self-reported physical activity in pregnancy ( 18 weeks gestation ) with offspring cardiovascular risk factors at age 15 . Design Prospect i ve cohort study . Setting The Avon Longitudinal Study of Parents and Children ( ALSPAC ) . Participants 4665 maternal-offspring pairs ( based on a sample with multiple imputation to deal with missing data ) from the ALSPAC , a prospect i ve cohort based in the South West of Engl and with mothers recruited in pregnancy in 1991–1992 . Primary and secondary outcome measures Offspring cardiovascular risk factors at age 15 ; body mass index ( BMI ) , waist circumference , systolic blood pressure , diastolic blood pressure , glucose , insulin , low-density lipoprotein cholesterol , high-density lipoprotein cholesterol and triglycerides . Results Greater maternal physical activity  was associated with lower BMI , waist circumference , glucose and insulin in unadjusted analyses . The magnitude of associations was generally small with wide CIs , and most associations attenuated towards the null after adjusting for confounders . The strongest evidence of association after adjustment for confounders was for glucose , although the 95 % CI for this association includes the null ; a one SD greater physical activity during pregnancy was associated with a −0.013 mmol/L difference in offspring glucose levels ( equivalent to approximately one-third of a SD ; 95 % CI −0.027 to 0.001 mmol/L ) . Conclusions Our results suggest that maternal physical activity in pregnancy , measured at 18 weeks gestation , is unlikely to be an important determinant of later offspring cardiovascular health . There was some suggestion of association with offspring glucose , but given that all other associations ( including insulin ) were null after adjustment for confounders , this result should be interpreted with caution OBJECTIVE We examined the effect of light-intensity resistance exercise training that is performed during the second and third trimester of pregnancy by previously sedentary and healthy women on the type of delivery and on the dilation , expulsion , and childbirth time . STUDY DESIGN We r and omly assigned 160 sedentary women to either a training ( n=80 ) or a control ( n=80 ) group . We recorded several maternal and newborn characteristics , the type of delivery ( normal , instrumental , or cesarean ) , and dilation , expulsion , and childbirth time . RESULTS The percentage of women who had normal , instrumental , or cesarean delivery was similar in the training ( 70.8 % , 13.9 % , and 15.3 % , respectively ) and control ( 71.4 % , 12.9 % , and 15.7 % , respectively ) groups . The mean dilation , expulsion , and childbirth time did not differ between groups . CONCLUSION Light-intensity resistance training that is performed over the second and third trimester of pregnancy does not affect the type of delivery Objective : To evaluate the effects of aerobic training on submaximal cardiorespiratory capacity in overweight pregnant women . Methods : We conducted a r and omized clinical trial in a referral center prenatal clinic during the period 2000–2002 . Of 132 overweight ( body mass index 26–31 kg/m2 ) but otherwise healthy volunteers , at 20 years of age or older , with gestational age of 20 weeks or less , and without diabetes or hypertension , 92 consented to participate and were r and omized . Intervention consisted of 3 one-hour aerobic exercise sessions per week ; the control group received weekly relaxation and focus group discussion s. The main outcome measure was submaximal exercise capacity evaluated by oxygen uptake at the anaerobic ( first ventilatory ) threshold during cardiopulmonary treadmill testing 12 weeks after r and omization . Results : Oxygen uptake at the anaerobic threshold increased 18 % ( 15.9 ± 2.6 to 18.1 ± 3.1 mL · min−1 · kg−1 ) in the exercise group but decreased 16 % ( 16.9 ± 3.0 to 15.8 ± 2.6 mL · min−1 · kg−1 ) among the control group . Oxygen consumption at the anaerobic threshold , adjusted through analysis of covariance for baseline oxygen uptake , was 2.68 ( 95 % confidence interval 1.23 to 4.12 ) mL · min−1 · kg−1 greater in the exercise group . Women in the exercise group were approximately 5 times more likely than those in the control group to have regular or good cardiorespiratory capacity ( 12/38 versus 2/38 ; relative risk 5.2 , 95 % confidence interval 1.2 to 22.0 , number needed to treat 5 ) . Conclusion : Aerobic training in overweight pregnant women  substantially increases submaximal exercise capacity , overcoming the otherwise negative effects of pregnancy in this regard . Additional studies are required to evaluate its effect on major clinical outcomes . LEVEL OF EVIDENCE : Aim To evaluate the association between  maternal physical activity and  infant ’s birth weight or risk of inappropriate weight for gestational age ( GA )  , and whether this association differs by infant ’s sex , maternal body mass index ( BMI ) or pregnancy complications in a prospect i ve cohort study . Methods 1913 pregnant women from the 3D Birth Cohort ( Québec , Canada ) completed the  Pregnancy Physical Activity Question naire at each trimester . Energy expenditure ( metabolic equivalent of task (MET)*hours/week ) for total activity , sports and exercise and vigorous intensity activities was calculated . The associations with birth weight and risk of inappropriate weight for GA were evaluated by regression modelling . Interactions were tested with infant ’s sex , maternal prepregnancy BMI , gestational diabetes , hypertensive disorders and prematurity . Results Each 1 MET/hours/week increase in sports and exercise in the first trimester was associated with a 2.5 g reduction in infant ’s birth weight ( 95 % CI −4.8 to −0.3 ) but was not associated with the risk of small weight for GA . In contrast , although not significant , a 17 % reduction in the risk of large weight for GA was observed with increasing sports and exercise . Furthermore , in women with subsequent pre-eclampsia ( but not normotensive or hypertensive women ) , each 1 MET/hours/week increment spent in any vigorous exercise in the first trimester reduced the infant ’s birth weight by 19.8 g ( 95 % CI −35.2 to −4.3 ) . Conclusions Pregnant women with higher sports and exercise levels in the first trimester delivered infants with a lower birth weight . The risk of reducing infant ’s birth weight with vigorous exercise in women who develop pre-eclampsia later in pregnancy requires evaluation OBJECTIVE To study the effect on  maternal weight gain of a supervised light- to moderate-intensity exercise-based intervention performed from the ninth week of pregnancy . PARTICIPANTS AND METHODS A total of 962 healthy pregnant women were r and omly assigned to a st and ard care or exercise intervention group conducted between September 1 , 2007 , and January 31 , 2011 . The intervention included light- to moderate-intensity aerobic and resistance exercises performed 3 days a week ( 50 - 55 minutes per session ) . Excessive gestational weight gain was calculated on the basis of the 2009 Institute of Medicine ( IOM ) recommendations . Gestational body weight gain was calculated on the basis of the weight measured at the first prenatal visit ( fifth to sixth weeks of gestation ) and weight measured at the last visit to the clinic before delivery . Women were categorized into normal weight or overweight or obese . RESULTS Women in the intervention group gained less weight ( adjusted mean difference , 1.039 kg ; 95 % CI , 0.534 - 1.545 kg ; P<.001 ) and were less likely to gain weight above the IOM recommendations ( odds ratio , 0.625 ; 95 % CI , 0.461 - 0.847 ) compared with those in the st and ard care group . The main treatment effects according to body mass index category were that normal weight women in the intervention group gained less weight ( adjusted mean difference , 1.393 kg ; 95 % CI , 0.813 - 1.972 kg ; P<.001 ) and were less likely to gain weight above the IOM recommendations ( odds ratio , 0.508 ; 95 % CI , 0.334 - 0.774 ) than normal weight women who received st and ard care . No significant treatment effect was observed in overweight or obese women . CONCLUSION Supervised exercise of light to moderate intensity can be used to prevent excessive gestational weight gain , especially in normal weight women . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01790347 Background : Both large and small birth sizes are associated with an increased risk of developing cardiovascular and metabolic problems later in life . We studied whether such associations can be observed at prepubertal age . Methods : A cohort of 49 large ( LGA ) , 56 appropriate ( AGA ) , and 23 small for gestational age (SGA)-born children ( age range 5 - 8 years ) were studied . Being born SGA , AGA , or LGA was the exposure , and being overweight at prepubertal age was the main outcome . Blood pressure measurements , laboratory parameters , and whole-body dual-energy X-ray absorptiometry were secondary outcomes . Results : The LGA-born children were significantly taller than the AGA controls ( p = 0.03 ) , and the SGA children were lighter and shorter compared to the AGA ( p = 0.002 and 0.001 ) and LGA children ( p < 0.001 ) . The mean plasma glucose was higher in the LGA than in the SGA group ( p = 0.006 ) . Being born LGA ( OR 3.82 ) and the ponderal index Z-score at birth ( OR 4.24 ) were strong predictors for being overweight or obese in childhood . Conclusion : The children born LGA remained taller and heavier than those born AGA or SGA in mid-childhood , and they had a higher body mass index and body fat percentage than the SGA-born children . The differences in other cardiometabolic risk factors were minimal between the birth size groups BACKGROUND Several recent " developmental origins " studies have reported increased long-term risks of adiposity , especially truncal adiposity , among children born small for gestational age ( SGA ) . OBJECTIVE We assessed the effects of SGA birth and weight gain in early infancy on adiposity at age 11.5 y. DESIGN From a cluster-r and omized breastfeeding promotion trial in 17,046 Belarusian children , we measured height , weight , waist and hip circumferences , triceps and subscapular skinfold thicknesses , and bioimpedance measures of percentage body fat at age 11.5 y. Children born SGA ( birth weight < 10th percentile ) and those born large for gestational age ( LGA ; > 90th percentile for gestational age ) were compared with those born appropriate for gestational age ( AGA ) . Weight gain from birth to 6 mo was categorized as high ( > 0.67-SD increase in weight-for-age ) , low ( > 0.67-SD decrease in weight-for-age ) , or normal . Multilevel statistical models accounted for clustered measurement and controlled for maternal and paternal height and body mass index ( BMI ) , maternal education , geographic region , urban compared with rural residence , and the child 's exact age at follow-up . RESULTS Children born SGA had a significantly lower BMI , percentage body fat , and fat mass index than did those born AGA , with a dose-response effect across 2 subcategories of SGA ( P < 0.001 for all comparisons ) . No difference was observed in waist-to-hip ratio , although the subscapular-to-triceps skinfold ratio was slightly but significantly ( P < 0.001 ) higher in children born SGA . Differences among the study groups continued to increase since the previous follow-up at 6.5 y. SGA infants with catch-up growth in the first 3 - 6 mo had growth and adiposity measures intermediate between those born SGA without catch-up and those born AGA . Opposite effects of similar magnitude were observed in children born LGA . CONCLUSION The 11.5-y-old Belarusian children born SGA were shorter , were thinner , and had less body fat than their non-SGA peers , irrespective of postnatal weight gain . The Promotion of Breastfeeding Intervention Trial was registered at www.is rct n.org as IS RCT N-37687716 OBJECTIVE Our purpose was to test the null hypothesis that beginning regular , moderate-intensity exercise in early pregnancy has no effect on fetoplacental growth . STUDY DESIGN Forty-six women who did not exercise regularly were r and omly assigned at 8 weeks either to no exercise ( n = 24 ) or to weight-bearing exercise ( n = 22 ) 3 to 5 times a week for the remainder of pregnancy . Outcome variables included antenatal placental growth rate and neonatal and placental morphometric measurements . RESULTS The offspring of the exercising women were significantly heavier ( corrected birth weight : 3.75 + /- 0.08 kg vs 3.49 + /- 0.07 kg ) and longer ( 51.8 + /- 0.3 cm vs 50.6 + /- 0.3 cm ) than those born to control women . The difference in birth weight was the result of an increase in both lean body mass and fat mass . In addition , midtrimester placental growth rate was faster ( 26 + /- 2 cm(3)/wk vs 21 + /- 1 cm(3)/wk ) and morphometric indexes of placental function were greater in the exercise group . There were no significant differences in neonatal percentage body fat , head circumference , ponderal index , or maternal weight gain . CONCLUSIONS These data indicate that beginning a moderate regimen of weight-bearing exercise in early pregnancy enhances fetoplacental growth OBJECTIVE : To estimate the effect of supervised physical exercise on maternal physical fitness , fetoplacental blood flow , and fetal growth . METHODS : This was a r and omized controlled trial comparing three groups of pregnant women . Groups were as follows : exercise initiated at 13 weeks ( group A ) ; exercise initiated at 20 weeks ( group B ) ; and a control group ( no supervised exercise ; group C ) . The women in groups A and B walked at moderate intensity three times weekly . Physical fitness level was evaluated at weeks 13 , 20 , and 28 . Fetal growth and uteroplacental blood flow were evaluated monthly . Birth weight was registered . Analysis of variance for repeat measures was used for outcomes evaluated throughout pregnancy . Risk ratio was used as a measure of the relative risk of preeclampsia , fetal growth restriction , macrosomia , small-for-gestational-age newborns , and large-for-gestational-age newborns . RESULTS : All the women analyzed completed more than 85 % of the program . According to the evaluation conducted at week 28 , physical fitness improved , with mean maximal oxygen consumptions ( VO2max ) of 27.3±4.3 ( group A ) , 28±3.3 ( group B ) , and 25.5±3.8 ( group C ; P=.03 ) . Mean birth weights were 3,279±453 g ( group A ) , 3,285±477 g ( group B ) , and 3,378±593 g ( group C ; P=.53 ) , with no difference in the frequency of large for gestational age or small for gestational age . No association was found between the practice of physical activity and the variables investigated ( preeclampsia , fetal weight , blood pressure , and pulsatility index of the uterine , umbilical , and middle cerebral arteries ) . CONCLUSION : Moderate-intensity walking improved the physical fitness level of healthy , pregnant , previously sedentary women without affecting fetoplacental blood flow or fetal growth . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00641550 . LEVEL OF EVIDENCE : OBJECTIVE The objective of the study was to evaluate the effect of a resistance exercise program with an elastic b and on insulin requirement and glycemic control in patients with gestational diabetes mellitus ( GDM ) . STUDY DESIGN Sixty-four patients with gestational diabetes mellitus were r and omly assigned into 2 groups : an exercise group ( EG ; n = 32 ) and a control group not su bmi tted to the exercise program ( CG ; n = 32 ) . RESULTS A significant reduction in the number of patients who required insulin was observed in the EG ( 7/32 ) compared with the CG group ( 18/32 ) ( P = .005 ) . The percentage of time spent within the proposed target glucose range ( of at least 80 % of weekly measurements below the limits preestablished for the disease ) was significantly higher in EG compared with the CG group ( EG = 0.63 ± 0.30 ; CG = 0.41 ± 0.31 ; P = .006 ) . CONCLUSION The resistance exercise program was effective in reducing the number of patients with GDM who required insulin and in improving capillary glycemic control in this population OBJECTIVE To investigate the effect of exercise during pregnancy on the intensity of  low back pain  and kinematics of spine . METHOD A prospect i ve r and omized study was design ed . 107 women participated in an exercise program three times a week during second half of pregnancy for 12 weeks and 105 as control group . All filled a question naire between 17 - 22 weeks of gestation and 12 weeks later for assessment of their back pain intensity . Lordosis and flexibility of spine were measured by Flexible ruler and Side bending test , respectively , at the same times . Weight gain during pregnancy , Pregnancy length and neonatal weight were recorded . RESULT Low back pain intensity was increased in the control group . The exercise group showed significant reduction in the intensity of low back pain after exercise ( p<0.0001 ) . Flexibility of spine decreased more in the exercise group ( p<0.0001 ) . Weight gain during pregnancy , pregnancy length and neonatal weight were not different between the two groups . CONCLUSION Exercise during second half of the pregnancy significantly reduced the intensity of low back pain , had no detectable effect on lordosis and had significant effect on flexibility of spine Objective : In this study , the authors assessed the effects of a structured , moderate-intensity exercise program during the entire length of pregnancy on a woman ’s method of delivery . Methods : A r and omized controlled trial was conducted with 290 healthy pregnant Caucasian ( Spanish ) women with a singleton gestation who were r and omly assigned to either an exercise ( n = 138 ) or a control  ( n = 152 ) group . Pregnancy outcomes , including the type of delivery , were measured at the end of the pregnancy . Results : The percentage of cesarean and instrumental deliveries in the exercise group were lower than in the control group ( 15.9 % , n = 22 ; 11.6 % , n = 16 vs. 23 % , n = 35 ; 19.1 % , n = 29 , respectively ; p = 0.03 ) . The overall health status of the newborn as well as other pregnancy outcomes was unaffected . Conclusions : Based on these results , a supervised program of moderate-intensity exercise performed throughout pregnancy was associated with a reduction in the rate of cesarean , instrumental deliveries and can be recommended for healthy women in pregnancy PROBLEM Gestational diabetes mellitus , defined as any carbohydrate intolerance first diagnosed during pregnancy , is associated with a variety of adverse outcomes , both for the mother and her child . AIM To investigate the impact of a structured exercise programme which consisted of aerobic and resistance exercises on the parameters of glycaemic control and other health-related outcomes in pregnant women diagnosed with gestational diabetes mellitus . METHODS Thirty-eight pregnant women diagnosed with gestational diabetes mellitus were r and omised to two groups . Experimental group was treated with st and ard antenatal care for gestational diabetes mellitus , and regular supervised exercise programme plus daily brisk walks of at least 30min . Control group received only st and ard antenatal care for gestational diabetes mellitus . The exercise programme was started from the time of diagnosis of diabetes until birth . It was performed two times per week and sessions lasted 50 - 55min . FINDINGS The experimental group had lower postpr and ial glucose levels at the end of pregnancy ( P<0.001 ) . There was no significant difference between groups in the level of fasting glucose at the end of pregnancy . Also , there were no significant differences in the rate of complications during pregnancy and birth , need for pharmacological therapy , maternal body mass and body fat percentage gains during pregnancy , and neonatal Apgar scores , body mass and ponderal index . Neonatal body mass index was higher in the experimental group ( P=0.035 ) . CONCLUSION The structured exercise programme had a beneficial effect on postpr and ial glucose levels at the end of pregnancy Please cite this paper as : Nascimento S , Surita F , Parpinelli M , Siani S , Pinto e Silva J. The effect of an antenatal physical exercise programme on maternal/perinatal outcomes and quality of life in overweight and obese pregnant women : a r and omised clinical trial . BJOG 2011;118:1455–1463 To investigate the effects of participation in aerobic exercise on pregnancy outcome , 388 women ( mean age = 31.7 , range = 18 - 42 ) were followed from a mean 16.5-wk gestation through delivery . Frequency , duration , and mode of aerobic exercise prior to conception and during the first trimester were determined by in-person interviews . Activity patterns during the second and third trimesters were assessed by telephone interviews . For each time period , women were categorized into one of the following exercise groups : Level I = aerobic exercise , excluding vigorous walking , at least three times a week for at least 20 min a time ; Level II = aerobic exercise at least three times a week and 20 min at a time , if and only if vigorous walking is included ; Level III = aerobic exercise less than three times a week , 20 min a time ; and Level IV = aerobic exercise less than once a week .  Mean birthweight was statistically unrelated to level of exercise preconceptionally or in any trimester . Gestational age , weight gain , and other pregnancy outcomes were also unassociated with exercise level . However , pregnancy symptoms were inversely associated with level of exercise ; women who exercised more earlier in pregnancy reported fewer discomforts later in pregnancy ( P = 0.01 ) . These data suggest that participation in aerobic exercise during pregnancy at a level great enough to produce or maintain a training effect does not adversely affect birthweight or other maternal and infant outcomes but may be associated temporally with fewer perceived pregnancy-associated discomforts OBJECTIVE There is controversy concerning whether exercise during pregnancy may increase preterm delivery risk and type of delivery . The effect of pregnant Latin-American women engaging in  vigorous exercise during the second and third trimester was examined regarding type of delivery and gestational age . MATERIAL S AND METHODS This was a secondary analysis of data from a controlled r and omized trial for determining the influence of physical exercise on pregnant women 's endothelial function . The study included 35 nulliparous women , gestational week 16 - 20 attending prenatal care at three tertiary hospitals in Colombia , who were r and omly assigned to one of two groups . The experimental group engaged in aerobic exercise involving 55 % - 75 % maximum heart rate for 60 min , three times a week for 12 weeks . The control group engaged in their usual physical activity .  Maternal weight , height , weight gain , blood pressure and type of delivery were recorded ; gender , abdominal and head circumference ( cm ) , weight ( g ) , height ( cm ) , vitality ( Apgar score at 1 and 5 min ) and gestational age at the time of delivery ( in weeks , days ) were recorded for the newborn . RESULTS There was no difference in type of delivery by the end of the 12-week program ( p > 0.05 ) , nor regarding newborn anthropometric variables , Apgar score , or maternal variables concerning weight , height , relative weight gain , blood pressure or weeks of gestation ( p>0.05 ) . CONCLUSION The potential public health benefits of vigorous exercise were enormous . This study supported existing guidelines indicating that Latin-American women may begin or maintain an on-going exercise program during pregnancy . TRIAL REGISTRATION NCT00741312 Background : In this study , we aim ed to determine comprehensive maternal characteristics associated with birth weight using Bayesian modeling . Material s and Methods : A total of 526 participants were included in this prospect i ve study . Nutritional status , supplement consumption during the pregnancy , demographic and socioeconomic characteristics , anthropometric measures , physical activity , and pregnancy outcomes were considered as effective variables on the birth weight .  Bayesian approach of complex statistical models using Markov chain Monte Carlo approach was used for modeling the data considering the real distribution of the response variable . Results : There was strong positive correlation between infant birth weight and the maternal intake of Vitamin C , folic acid , Vitamin B3 , Vitamin A , selenium , calcium , iron , phosphorus , potassium , magnesium as micronutrients , and fiber and protein as macronutrients based on the 95 % high posterior density regions for parameters in the Bayesian model . None of the maternal characteristics had statistical association with birth weight . Conclusion : Higher maternal macro- and micro-nutrient intake during pregnancy was associated with a lower risk of delivering low birth weight infants . These findings support recommendations to exp and intake of nutrients during pregnancy to high level OBJECTIVE To examine the feasibility of an individualized exercise program to prevent  gestational diabetes mellitus ( GDM ) in obese pregnant women . RESEARCH DESIGN AND METHODS The study was a pilot r and omized controlled trial with obese pregnant women ( intervention group , individualized exercise program [ n = 25 ] ; control group , usual care [ n = 25 ] ) . Average weekly energy expenditure ( MET hours per week and kilocalories per week ) of exercise-specific activity was assessed during pregnancy using the Pregnancy Physical Activity Question naire . Fasting glucose and insulin and homeostasis model assessment of insulin resistance ( HOMA-IR ) were assessed at baseline and 20 , 28 , and 36 weeks ' gestation . RESULTS Of the women in the intervention group , 16 of 22 ( 73 % ) achieved more than 900 kcal/week of exercise-based activity  at 28 weeks compared with 8 of 19 women in the control group ( 42 % ) , P = 0.047 . However , insulin resistance ( HOMA-IR ) did not differ between the groups . CONCLUSION This intervention was feasible and prompted a modest increase in physical activity . However , we are not confident that this intervention would be sufficient to prevent GDM One hundred and three primigravidae were studied to establish the correlation between physical fitness and heart volume .  Twenty-three of the mothers were allocated at r and om to the exercise group and 21 to control group 1 , between the 10th and 14th weeks of pregnancy . In addition , 59 mothers were allocated to control group 2 , which was formed two weeks before term . The exercise group underwent a rather strenuous training programme during pregnancy . Physical fitness was measured by work tests on a bicycle ergometer two weeks before term . The heart volume was determined radiologically on the 6th day post partum . There was a positive correlation between physical fitness and the relative heart volume , which was greatest when physical fitness was measured by a method which takes the level of training into consideration . The relative heart volume of the exercise group was almost significantly greater than that of control group 1 . The physical performance of the exercise group was very significantly greater than in the control groups . There was no significant correlation between either physical fitness or relative heart volume and the duration of pregnancy or the weight of newborn Methods We are conducting a parallel arm r and omized controlled clinical trial in Auckl and , New Zeal and ( NZ ) . Eligible participants were enrolled to the study from March 2013 to April 2014 . The intervention group participated in a 16-week home-based moderate-intensity exercise programme utilising stationary cycles and heart rate monitors . Maternal measures including weight , aerobic fitness , physical activity and diet were assessed at baseline and end of intervention . Neonatal and maternal body composition were assessed 14 days after delivery PURPOSE The objective of this study is to assess the effectiveness of a maternal exercise program ( l and /aquatic activities , both aerobic and muscular conditioning ) in preventing gestational diabetes mellitus ( GDM ) . METHODS Three hundred and forty-two pregnant women from Spain ( age , 33.24 ± 4.3 yr ) without obstetric contraindications were recruited for a clinical r and omized controlled trial . The intervention group ( IG , n = 101 ) exercised for 60 and 50 min on l and and in water , respectively , three times per week . The control group ( n = 156 ) received usual st and ard care .  RESULTS The prevalence of GDM was reduced in the IG group ( IG , 1 % , n = 1 , vs control group , 8.8 % , n = 13 ( χ1 = 6.84 , P = 0.009 ) ) with a significant risk estimate ( odds ratio = 0.103 ; 95 % confidence interval , 0.013 - 0.803 ) . CONCLUSION The exercise program performed during pregnancy reduced the prevalence of GDM by preserving glucose tolerance Purpose . The aim of the present study was to examine the influence of a program of moderate physical exercise throughout pregnancy on maternal and fetal parameters . Design . The study design was a r and omized controlled trial . Setting . The study took place at the Hospital of Fuenlabrada in Madrid , Spain . Sample . Analyzed were 200 pregnant women ( 31.54 ± 3.86 years ) , all of whom had uncomplicated and singleton gestation . Of these subjects , 107 were allocated to the  exercise group  ( EG ) and 93 to the  control group ( CG ) . Intervention . Women from EG participated in a physical conditioning program throughout pregnancy , which included a total of 55- to 60-minute weekly sessions , 3 days per week . Measures . Pregnancy outcomes . Maternal : gestational age , weight gain , type of delivery , blood pressure during pregnancy , gestational diabetes ( n/% ) . Fetal : birth weight , birth size , head circumference , Apgar score , pH of umbilical cord . Analysis . Student 's unpaired t-test and χ2 test were used ; p values of ≤ .05 indicated statistical significance . Cohen 's d was used to determine the effect size . Results . There were significantly more pregnant women in the CG who gained excessive weight during their pregnancies than in the EG group ( CG : N = 31 , 35.6 % versus N = 22 , 21.2 % ; χ2 = 4.95 ; p = .02 ) . The effect size was small ( Phi value = .16 ) . Other pregnancy outcome showed no differences between groups . Conclusion . A regular and moderate physical exercise program throughout pregnancy is not a risk to maternal and fetal well-being , and it helps to control excessive weight gain Please cite this paper as : Oostdam N , van Poppel M , Wouters M , Eekhoff E , Bekedam D , Kuchenbecker W , Quartero H , Heres M , van Mechelen W. No effect of the FitFor2 exercise programme on blood glucose , insulin sensitivity , and birthweight in pregnant women who were overweight and at risk for gestational diabetes : results of a r and omised controlled trial . BJOG 2012;119:1098–1107 We sought to test the hypothesis that long-term postnatal development may be modified by metabolic experiences in utero . We enrolled offspring of women with pregestational diabetes ( this included type 1 and type 2 diabetes ) and gestational diabetes in a prospect i ve study from 1977 to 1983 . Fetal beta-cell function was assessed by measurement of amniotic fluid insulin ( AFI ) concentration at 32 - 38 weeks ' gestation . Postnatally , offspring were seen yearly for neuropsychological testing , measurement of anthropometrics , and modified glucose tolerance testing . Neuropsychological control subjects were followed longitudinally . Additional control subjects had anthropometrics  measured once , and a r and om subset of these had a single oral glucose challenge at 10 - 16 years . The rates of major neuropsychological disturbances in our cohort did not differ significantly from national estimates . However , aberrant maternal metabolism was associated with poorer intellectual performance and psychomotor development . The macrosomia observed at birth in offspring of diabetic mothers ( ODM ) resolves by 1 year of age . Obesity recurs in childhood ; and by 14 - 17 years , the mean BMI is 24.6 + /- 5.8 kg/m2 in ODM versus 20.9 + /- 3.4 kg/m2 in control subjects . Obesity in adolescence is associated with sex , mother 's weight , and AFI concentration . Impaired glucose tolerance ( IGT ) is found in 36 % of ODM and is also associated with elevated amniotic fluid insulin in utero . In confirmation of our original hypothesis , aberrant maternal metabolism is associated with poorer intellectual and psychomotor development , obesity , and IGT in offspring . Excessive insulin secretion in utero , as assessed by AFI concentration , is a predictor of both obesity and IGT in adolescence . This study is a long-term prospect i ve evaluation of the effects of maternal diabetes on pregnant women and their offspring . In this article , we report the results of the correlations between indexes of maternal and fetal metabolism during pregnancy and the offspring 's subsequent physical , metabolic , and psychological development from birth through adolescence To study the efficacy of yoga on the outcome of complicated pregnancy , 121 women attending antenatal clinic at Gunasheela Surgical and Maternity Hospital ( GSMH ) in Bangalore , India , were enrolled between 18 - 20 weeks of pregnancy in a prospect i ve , matched , observational study . Sixty-eight women were in the yoga group and 53 women in the control group . Women were matched for age , gravida and Doppler velocimetry scores of umbilical and uterine arteries .  Yoga practice s including physical postures , breathing and meditation were practised by the yoga group , one hour daily , from the date of entry into the study until delivery . The control group walked half an hour twice a day during the study period . Compliance in both the groups was ensured . In babies the birth-weight is significantly higher ( P < 0.018 ) in the Yoga group ( 2.78 + /- 0.52 kg ) , compared to the control group ( 2.55 + /- 0.52 kg ) . Occurrence of complications of pregnancy ( pregnancy-induced hypertension , intrauterine growth retardation , pre-term delivery ) shows lower trends in yoga group OBJECTIVE A prospect i ve r and omized controlled trial was design ed to assess the benefits and possible risks of aerobic exercise during pregnancy , using a fitness regimen based on the 2002 American College of Obstetricians and Gynecologists guidelines for exercise during pregnancy . METHODS Inactive women were r and omized at 12 - 14 wk gestation to a group that remained sedentary or to a group that performed moderate aerobic exercise 45 - 60 min , 4 d·wk , through 36 wk gestation . Thirty-one subjects in each group completed the study . RESULTS Compared with women who remained sedentary , active women improved aerobic fitness ( P < 0.05 ) and muscular strength ( P < 0.01 ) , delivered comparable size infants with significantly fewer cesarean deliveries ( P < 0.01 ) , and recovered faster postpartum ( P < 0.05 ) , at least related to the lower incidence of cesarean section . Active women developed no gestational hypertension ( P = 0.16 compared with controls ) and reported no injuries related to the exercise regimen . In the active group , there was one premature birth at 33 wk by a woman with a history of premature delivery of twins at 34 wk . There were no differences between groups in the incidence of gestational diabetes , musculoskeletal pains during pregnancy , flexibility on sit- and -reach test , mean length of pregnancy , neonatal Apgar scores , placenta weights , overall length of labor , weight gain during pregnancy , or weight retention postpartum . CONCLUSION Previously sedentary women who began exercising at 12 - 14 wk improved fitness and delivery outcomes CONTEXT Epidemiological studies have identified the importance of the in utero environment in providing a healthy start to life . Previous studies have suggested that the maternal environment , in particular a reduction in maternal insulin sensitivity , contributes significantly to fetal growth . Regular aerobic exercise , through an effect on maternal insulin sensitivity , may influence offspring size by regulating nutrient supply to the fetus . OBJECTIVE The aim of the study was to determine the effects of aerobic exercise training in the second half of pregnancy on maternal insulin sensitivity and neonatal outcomes . DESIGN AND SETTING We conducted a community-based , r and omized , controlled trial of exercise in pregnancy . PARTICIPANTS Eighty-four healthy nulliparous women ( mean + /- sd , age , 30 + /- 4 yr ; body mass index , 25.5 + /- 4 kg/m(2 ) ) participated in the study . INTERVENTION Subjects participated in a home-based stationary cycling program from 20 wk gestation to delivery . MAIN OUTCOME MEASURES Maternal insulin sensitivity , neonatal auxology , body composition , and growth-related peptides in cord blood were measured . RESULTS Offspring of  exercisers  had lower birth weight ( sd score , control , 0.23 + /- 0.8 ; exercise , -0.19 + /- 0.9 ; P = 0.03 ) and body mass index at birth ( sd score , control , 0.40 + /- 0.9 ; exercise , -0.01 + /- 0.09 ; P = 0.04 ) . The reduction in maternal insulin sensitivity in late gestation was not affected by exercise ( P = 0.45 ) and was unrelated to offspring size . Exercise offspring had lower cord serum IGF-I ( P = 0.03 ) and IGF-II ( P = 0.04 ) . CONCLUSIONS Regular exercise was associated with lower birth weights and reduced cord concentrations of growth-related peptides , suggesting an influence of exercise on endocrine regulation of fetal growth . These effects on offspring growth were not associated with an exercise training effect on maternal insulin sensitivity BACKGROUND In spite of an extensive knowledge of the physiologic features of exercise during pregnancy , we still lack a comprehensive underst and ing of the effects of different types , intensities and duration of exercise throughout pregnancy on maternal and fetal well being . The aim of the current study was to examine the influence of an aerobic exercise program throughout pregnancy on gestational age at the moment of delivery . METHODS This study was a r and omized controlled trial . Three hundred and twenty Caucasian ( Spanish ) healthy pregnant women with singleton gestation were r and omly assigned to either an exercise ( n = 160 ) or a control ( n = 160 ) group . Gestational age ( weeks ) and other outcomes were measured . The exercise program included 85 sessions ( general fitness class , 3 times/week , 55 - 60 min/session from weeks 8 - 10 to weeks 38 - 39 of pregnancy ) . RESULTS Two hundred and ninety women were analyzed ( exercise group EG , n = 138 , control group CG , n = 152 ) . The mean gestational age did not differ between groups ( EG= 39.7 ± 1.3 vs CG= 39.6 ± 1.1 weeks , P = .81 ) . Relative to preterm deliveries in EG we found 6 ( 4.3 % ) and 11 ( 7.2 % ) in CG , ( P = .73 ) . CONCLUSIONS A supervised program of moderate exercise performed throughout pregnancy is not a risk of preterm delivery for healthy pregnant women INTRODUCTION Physical activity ( PA ) has been proposed as an important part of hypertension 's treatment and has been studied as a possibility for the prevention of preeclampsia ( PE ) and its complications .  PA is recommended during pregnancy because it may be beneficial to maternal health . However , some studies relate the difficulty in adherence to exercise during pregnancy . OBJECTIVES The objective of this study was to evaluate the adherence to exercise with bicycle in pregnant women with risk of preeclampsia development and characterize these pregnants . METHODS This is a secondary analysis of a r and omized clinical trial at the Women 's Hospital Dr. José Aristodemo Pinotti - CAISM/Unicamp , Brazil . We enrolled 116 pregnant women presenting with chronic hypertension ( CH ) , previous PE or both factors associated ( risk of PE development ) . Women from 12 to 20 gestational weeks were selected from the prenatal outpatient clinic and r and omly allocated to the study ( SG ) or non-interventional group ( NIG ) . Women at the SG performed exercise using stationary bicycle ( horizontal bench model ) during 30min , once a week , under a physical therapist supervision . The HR was maintained at 20 % above resting heart rate and up to 140 beats per minute , and the BP was evaluated before and after exercise . The NIG followed regular prenatal routine with weekly returns for HR and BP measurements . We analyzed the adherence of the SG to exercise with bicycle and their sociodemographic and clinical characteristics . RESULTS We invited 152 pregnants to participate and 33 ( 21.7 % ) refused . 116 pregnants were r and omized and 58 were allocated to the SG . The mean age was 31.7±6.2 and mean of Body Mass Index ( BMI ) was 34.9±7.9kg/m(2 ) . Previous PE were prevalent in 16 ( 27.6 % ) pregnant , CH in 51 ( 87.9 % ) pregnant and 9 ( 15.5(10.5 % ) pregnants relate to exercise before pregnancy . The average sessions performed by the SG using stationary bicycle were 9.24±7.03 . That those who realized less than the mean session of the SG 14 had discontinued , 3 changed the prenatal city , 4 had TPP , 3 had difficulty in controlling blood pressure , 1 had autoimmune hepatitis diagnosis and 1 had fetal malformation . Considering the sociodemographic and clinical characteristics of these 27 the majority were obese and had had CH , they were not used to practice any type of exercise before pregnancy . Most of them were not primiparous , also had more children at home and found difficul to find time for exercise . The majority did not live next to our center . CONCLUSION The majority of our population were obese , sedentary before pregnancy and with CH . In this study exercise , performed once a week , using stationary bicycle in pregnant women of high risk PE , seems to be difficult Background : Exercise in pregnancy is recommended in many countries , and swimming is considered by many to be an ideal activity for pregnant women . Disinfection by-products in swimming pool water may , however , be associated with adverse effects on various reproductive outcomes . We examined the association between swimming in pregnancy and preterm and postterm birth , fetal growth measures , small-for-gestational-age , and congenital malformations . Methods : We used self-reported exercise data ( swimming , bicycling , or no exercise ) that were prospect ively collected twice during pregnancy for 74,486 singleton pregnancies . Recruitment to The Danish National Birth Cohort took place 1996–2002 . Using Cox , linear and logistic regression analyses , depending on the outcome , we compared swimmers with physically inactive pregnant women ; to separate a possible swimming effect from an effect of exercise , bicyclists were included as an additional comparison group . Results : Risk estimates were similar for swimmers and bicyclists , including those who swam throughout pregnancy and those who swam more than 1.5 hours per week . Compared with nonexercisers , women who swam in early/mid-pregnancy had a slightly reduced risk of giving birth preterm ( hazard ratio = 0.80 [ 95 % confidence interval = 0.72–0.88 ] ) or giving birth to a child with congenital malformations ( odds ratio = 0.89 [ 0.80–0.98 ] ) . Conclusions : These data do not indicate that swimming in pool water is associated with adverse reproductive outcomes Purpose . The aim of the present study was to examine the influence of moderate physical exercise throughout pregnancy on the duration of labor stages . Design . Study was a r and omized controlled trial . Setting . The study took place at Hospital Puerta de Hierro and Hospital Severo Ochoa in Madrid , Spain . Subjects . We examined 166 pregnant women ( 31.6 ± 3.8 years ) , and all had uncomplicated and singleton gestation . Of these 83 were allocated to the exercise group ( EG ) and 83 to the control group ( CG ) . Intervention . Women from the EG participated in a physical conditioning program throughout pregnancy , which included 55- to 60-minute sessions , 3 days per week . Measures . Pregnancy outcomes were measured : duration of labor stages , gestational age , weight gain , type of delivery , birth weight , birth size , head circumference , Apgar score , pH of umbilical cord . Analysis . Student 's unpaired t-tests and χ2 tests were used ; p values of < .05 indicated statistical significance . Cohen 's d was used to determine the effect size . Results . Significant differences were found in the duration of the first stage of labor ( EG = 389.6 ± 347.64 minutes vs. CG = 515.72 ± 353.36 minutes ; p = .02 , effect size Cohen 's d = .36 ) . The second and third stages did not differ between the study groups . Conclusion . A physical exercise program during pregnancy is associated with a shorter first stage of labor . These results may have important relevance to public health
Background Maternal metabolic health during the prenatal period is an established determinant of cardiometabolic disease risk .
Many studies have focused on poor offspring outcomes after exposure to poor maternal health , while few have systematic ally appraised the evidence surrounding the role of maternal exercise in decreasing this risk .
The aim of this study is to characterize and quantify the specific impact of prenatal exercise on children ’s cardiometabolic health  markers , at birth and in childhood .