A Pregnancy and Postpartum Lifestyle Intervention in Women With Gestational Diabetes Mellitus Reduces Diabetes Risk Factors Regular Exercise to Prevent the Recurrence of Gestational Diabetes Mellitus: A Randomized Controlled Trial Measuring Adherence to a Nutrition and Exercise Lifestyle Intervention: Is Program Adherence Related to Excessive Gestational Weight Gain? Water aerobics II: maternal body composition and perinatal outcomes after a program for low risk pregnant women Home-Based Exercise Improves Fitness and Exercise Attitude and Intention in Women with GDM. A pilot walking program promotes moderate-intensity physical activity during pregnancy. Treatments of pelvic girdle pain in pregnant women: adverse effects of standard treatment, acupuncture and stabilising exercises on the pregnancy, mother, delivery and the fetus/neonate Effect of Physical Activity and/or Healthy Eating on GDM Risk: The DALI Lifestyle Study. Exercise during pregnancy enhances cerebral maturation in the newborn: A randomized controlled trial Yoga during pregnancy: effects on maternal comfort, labor pain and birth outcomes. Safety and efficacy of a lifestyle intervention for pregnant women to prevent excessive maternal weight gain: a cluster-randomized controlled trial Effect of exercise intensity and duration on capillary glucose responses in pregnant women at low and high risk for gestational diabetes. The impact of exercise during pregnancy on neonatal outcomes: a randomized controlled trial. Improving diet and exercise in pregnancy with Video Doctor counseling: a randomized trial. Effect of a behavioural intervention in obese pregnant women (the UPBEAT study): a multicentre, randomised 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. Lifestyle intervention on diet and exercise reduced excessive gestational weight gain in pregnant women under a randomised controlled trial GRADE guidelines: 4. Rating the quality of evidence--study limitations (risk of bias). 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Preventing Urinary Incontinence With Supervised Prenatal Pelvic Floor Exercises: A Randomized Controlled Trial Water‐gymnastics reduced the intensity of back/low back pain in pregnant women Pelvic Floor Muscle Training During Pregnancy to Prevent Urinary Incontinence: A Single‐Blind Randomized Controlled Trial A 12-Week Exercise Program for Pregnant Women with Obesity to Improve Physical Activity Levels: An Open Randomised Preliminary Study How does a lifestyle intervention during pregnancy influence perceived barriers to leisure-time physical activity? The Norwegian fit for delivery study, a randomized controlled trial Effects of lifestyle intervention on dietary intake, physical activity level, and gestational weight gain in pregnant women with different pre-pregnancy Body Mass Index in a randomized control trial Physical activity for smoking cessation in pregnancy: randomised controlled trial Maternal and Perinatal Outcomes of Exercise in Pregnant Women with Chronic Hypertension and/or Previous Preeclampsia: A Randomized Controlled Trial Effect of lifestyle intervention on dietary habits, physical activity, and gestational weight gain in obese pregnant women: a randomized controlled trial. A pregnancy lifestyle intervention to prevent gestational diabetes risk factors in overweight Hispanic women: a feasibility randomized controlled trial. Aerobic Exercise and Submaximal Functional Capacity in Overweight Pregnant Women: A Randomized Trial Effect of the "sitting pelvic tilt exercise" during the third trimester in primigravidas on back pain. Supervised exercise-based intervention to prevent excessive gestational weight gain: a randomized controlled trial. Effect of pelvic floor muscle training on labour and newborn outcomes: a randomized controlled trial. A randomized controlled trial of antenatal pelvic floor exercises to prevent and treat urinary incontinence Randomized controlled trial to prevent excessive weight gain in pregnant women Home-based walking during pregnancy affects mood and birth outcomes among sedentary women: A randomized controlled trial. Exercise during pregnancy and gestational diabetes-related adverse effects: a randomised controlled trial Beginning regular exercise in early pregnancy: effect on fetoplacental growth. Effect of a Physical Exercise Program During Pregnancy on Uteroplacental and Fetal Blood Flow and Fetal Growth: A Randomized Controlled Trial Resistance exercise and glycemic control in women with gestational diabetes mellitus. GRADE guidelines: 3. Rating the quality of evidence. Effect of dietary carbohydrate on the glucose and insulin response to mixed caloric intake and exercise in both nonpregnant and pregnant women. The effect of an antenatal physical exercise programme on maternal/perinatal outcomes and quality of life in overweight and obese pregnant women: a randomised clinical trial Assessment of foetal wellbeing in pregnant women subjected to pelvic floor muscle training: a controlled randomised study Effect of pelvic floor muscle training (PFMT) during pregnancy on bladder neck descend and delivery. Exercise during pregnancy and pregnancy outcome. Regular Exercise During Pregnancy to Prevent Gestational Diabetes: A Randomized Controlled Trial Gestational Diabetes Mellitus Can Be Prevented by Lifestyle Intervention: The Finnish Gestational Diabetes Prevention Study (RADIEL) 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. Prevention of Gestational Diabetes Effect of regular exercise on prevention of excessive weight gain in pregnancy: A randomised controlled trial Therapeutic exercise for insulin-requiring gestational diabetics: effects on the fetus — results of a randomized prospective longitudinal study Exercise Is Associated with a Reduction in Gestational Diabetes Mellitus. [Effect of pelvic floor exercise during pregnancy and puerperium on prevention of urinary stress incontinence]. 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 Yoga and massage therapy reduce prenatal depression and prematurity. Longitudinal changes in insulin release and insulin resistance in nonobese pregnant women. The London Exercise And Pregnant smokers (LEAP) trial: a randomised controlled trial of physical activity for smoking cessation in pregnancy with an economic evaluation. Exercise in pregnancy: effect on fitness and obstetric outcomes-a randomized trial. Endurance exercise and pregnancy outcome. Is supine exercise associated with adverse maternal and fetal outcomes? A systematic review Preterm Heart in Adult Life: Cardiovascular Magnetic Resonance Reveals Distinct Differences in Left Ventricular Mass, Geometry, and Function Simple lifestyle recommendations and the outcomes of gestational diabetes. A 2×2 factorial randomized trial The Treatment of Obese Pregnant Women (TOP) study: a randomized controlled trial of the effect of physical activity intervention assessed by pedometer with or without dietary intervention in obese pregnant women. Effect of intensive counselling on physical activity in pregnant women at high risk for gestational diabetes mellitus. A clinical study in primary care. Primary Prevention of Gestational Diabetes Mellitus and Large-for-Gestational-Age Newborns by Lifestyle Counseling: A Cluster-Randomized Controlled Trial Gestational weight gain in overweight and obese women enrolled in a healthy lifestyle and eating habits program Randomized trial of a behavioral intervention to prevent excessive gestational weight gain: the Fit for Delivery Study.
OBJECTIVE To pilot , among women with gestational diabetes mellitus ( GDM ) , the feasibility of a prenatal/postpartum intervention to modify diet and physical activity similar to the Diabetes Prevention Program . The intervention was delivered by telephone , and support for breastfeeding was addressed . RESEARCH DESIGN AND METHODS The goal was to help women return to their prepregnancy weight , if it was normal , or achieve a 5 % reduction from prepregnancy weight if overweight . Eligible participants were identified shortly after a GDM diagnosis ; 83.8 % consented to be r and omly assigned to intervention or usual medical care ( 96 and 101 women , respectively ) . The retention was 85.2 % at 12 months postpartum . RESULTS The proportion of women who reached the postpartum weight goal was higher , although not statistically significant , in the intervention condition than among usual care ( 37.5 vs. 21.4 % , absolute difference 16.1 % , P = 0.07 ) . The intervention was more effective among women who did not exceed the recommended gestational weight gain ( difference in the proportion of women meeting the weight goals : 22.5 % , P = 0.04 ) . The intervention condition decreased dietary fat intake more than the usual care ( condition difference in the mean change in percent of calories from fat : −3.6 % , P = 0.002 ) and increased breastfeeding , although not significantly ( condition difference in proportion : 15.0 % , P = 0.09 ) . No differences in postpartum physical activity were observed between conditions . CONCLUSIONS This study suggests that a lifestyle intervention that starts during pregnancy and continues postpartum is feasible and may prevent pregnancy weight retention and help overweight women lose weight . Strategies to help postpartum women overcome barriers to increasing physical activity are needed 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 To identify adherence required to achieve target health outcome ( s ) in nutrition and /or exercise interventions , a measurement tool that tracks objective and self-reported measures of adherence is necessary . The purpose of this study was to design an adherence measurement tool and test it retrospectively on the  Nutrition and Exercise Lifestyle Intervention Program  ( NELIP ; Ruchat et al. , Medicine and Science in Sports and Exercise , 44(8 ) , 1419–1426 , 2012 ; Mottola et al. , Medicine and Science in Sports and Exercise , 42(2 ) , 265–272 , 2010 ) , design ed to prevent excessive gestational weight gain ( EGWG ) . The tool was based on the goals of the NELIP and included a grading system for each behavior ( exercise and nutrition ) . It was used to determine whether adherence scores could differentiate excessive versus acceptable weight gain during pregnancy across pre-pregnancy body mass index ( BMI ) categories . Results showed irrespective of pre-pregnancy BMI , women with acceptable weight gain had significantly higher adherence ( p < 0.05 ) than women with excessive weight gain . It is recommended that this adherence tool be included in future prospect i ve lifestyle intervention studies 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 PURPOSE The purpose of the study was to determine the effect of a home-based cycling program for women with a recent diagnosis of gestational diabetes mellitus ( GDM ) on aerobic fitness , weight gain , self-reported mobility , attitude , and intentions toward maternal exercise , and obstetric and neonatal outcomes . METHODS Forty women ( mean ± SD , 28.8 ± 0.9-wk gestation ) were r and omized to either a supervised , home-based exercise program , combining continuous steady-state and interval cycling at various intensities , in combination with unsupervised moderate intensity aerobic activity and conventional diabetic management ( EX ; n = 20 ) or to conventional management alone ( CON ; n = 20 ) . The program began following diagnosis until week 34 of pregnancy ( mean ± SD duration of training , 6 ± 1 wk ) . RESULTS Mean compliance to the training program was 96 % . Maternal aerobic fitness , and attitude and intentions toward exercise were improved in response to the home-based exercise intervention compared with CON ( P < 0.05 ) . No differences were observed between the groups with respect to maternal weight gain or obstetric and neonatal outcomes ( P > 0.05 ) . CONCLUSION A home-based exercise program of 6 ± 1 wk in duration commenced after diagnosis of GDM can improve aerobic fitness and attitude and intentions toward exercise , with no adverse effect on maternal and neonatal pregnancy outcomes 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 Background Previous publications indicate that acupuncture is efficient for the treatment of pelvic girdle pain , PGP , in pregnant women . However , the use of acupuncture for PGP is rare due to insufficient documentation of adverse effects of this treatment in this specific condition . The aim of the present work was to assess adverse effects of acupuncture on the pregnancy , mother , delivery and the fetus/neonate in comparison with women that received stabilising exercises as adjunct to st and ard treatment or st and ard treatment alone . Methods In all , 386 women with PGP entered this controlled , single-blind trial . They were r and omly assigned to st and ard treatment plus acupuncture ( n = 125 ) , st and ard treatment plus specific stabilising exercises ( n = 131 ) or to st and ard treatment alone ( n = 130 ) for 6 weeks . Acupuncture that may be considered strong was used and treatment was started as early as in the second trimester of pregnancy . Adverse effects were recorded during treatment and throughout the pregnancy . Influence on the fetus was measured with cardiotocography ( CTG ) before-during and after 43 acupuncture sessions in 43 women . A st and ardised computerized method to analyze the CTG reading numerically ( Oxford 8000 , Oxford , Engl and ) was used . After treatment , the women rated their overall experience of the treatment and listed adverse events if any in a question naire . Data of  analgesia and oxytocin augmentation during labour , duration of labour , frequency of preterm birth , operative delivery , Apgar score , cord-blood gas/acid base balance and birth weight were also recorded . Results There were no serious adverse events after any of the treatments . Minor adverse events were common in the acupuncture group but women rated acupuncture favourably even despite this . The computerized or visually assessed CTG analyses of antenatal recordings in connection with acupuncture were all normal . Conclusion This study shows that acupuncture administered with a stimulation that may be considered strong led to minor adverse complaints from the mothers but had no observable severe adverse influences on the pregnancy , mother , delivery or the fetus/neonate Context Lifestyle approaches for preventing gestational diabetes mellitus ( GDM ) have produced mixed results . Objective The aim of the present study was to compare the effectiveness of 3 lifestyle interventions [ healthy eating ( HE ) , physical activity ( PA ) , and both HE and PA ( HE+PA ) ] with usual care ( UC ) in reducing GDM risk . Design The present study was a multicenter r and omized controlled trial conducted from 2012 to 2014 [ the DALI ( vitamin D and lifestyle intervention for GDM prevention ) lifestyle study ] . Setting The study occurred at antenatal clinics across 11 centers in 9 European countries . Patients Consecutive pregnant women at < 20 weeks of gestation with a body mass index ( BMI ) of ≥29 kg/m2 and without GDM using the International Association of Diabetes and Pregnancy Study Group criteria ( n = 436 ) . For the intervention , women were r and omized , stratified by site , to UC , HE , PA , or HE+PA . The women received 5 face-to-face and ≤4 telephone coaching sessions using the principles of motivational interviewing . A gestational weight gain ( GWG ) < 5 kg was targeted . The coaches received st and ardized training and an intervention toolkit tailored to their culture and language . Main Outcome Measures The endpoints were the GWG at 35 to 37 weeks and the fasting glucose and insulin sensitivity [ homeostasis model assessment insulin resistance ( HOMA-IR ) ] at 24 to 28 weeks . Results We r and omized 108 women to HE+PA , 113 to HE , 110 to PA , and 105 to UC . In the HE+PA group , but not HE or PA alone , women achieved substantially less GWG than did the controls ( UC ) by 35 to 37 weeks ( -2.02 ; 95 % confidence interval , -3.58 to -0.46 kg ) . Despite this reduction , no improvements were seen in fasting or postload glucose levels , insulin concentrations , or HOMA-IR . The birthweights and large and small for gestational age rates were similar . Conclusions The combined HE+PA intervention was able to limit GWG but did not reduce fasting glycemia . Thus , lifestyle changes alone are unlikely to prevent GDM among women with a BMI of ≥29 kg/m2 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 This study examined the effects of a yoga program during pregnancy , on  maternal comfort , labor pain , and birth outcomes .  A r and omized trial was conducted using 74-primigravid Thai women who were equally divided into two groups ( experimental and control ) . The yoga program involved six , 1-h sessions at prescribed weeks of gestation . A variety of instruments were used to assess maternal comfort , labor pain and birth outcomes . The experimental group was found to have higher levels of maternal comfort during labor and 2h post-labor , and experienced less subject evaluated labor pain than the control group . In each group , pain increased and maternal comfort decreased as labor progressed . No differences were found , between the groups , regarding pethidine usage , labor augmentation or newborn Apgar scores at 1 and 5 min . The experimental group was found to have a shorter duration of the first stage of labor , as well as the total time of labor Background Excessive gestational weight gain ( GWG ) is associated with short- and long-term health problems among mothers and their offspring . There is a strong need for effective intervention strategies targeting excessive GWG to prevent adverse outcomes . Methods We performed a cluster-r and omized controlled intervention trial in eight gynecological practice s evaluating the feasibility and effectiveness of a lifestyle intervention presented to all pregnant women ; 250 healthy , pregnant women were recruited for the study . The intervention program consisted of two individually delivered counseling sessions focusing on diet , physical activity , and weight monitoring . The primary outcome was the proportion of pregnant women exceeding weight gain recommendations of the Institute of Medicine ( IOM ) . Secondary outcome variables were maternal weight retention and short-term obstetric and neonatal outcomes . Results The intervention result ed in a lower proportion of women exceeding IOM guidelines among women in the intervention group ( 38 % ) compared with the control group ( 60 % ) ( odds ratio ( OR ) : 0.5 ; 95 % confidence interval ( CI ) : 0.3 to 0.9 ) without prompting an increase in the proportion of pregnancies with suboptimal weight gain ( 19 % vs. 21 % ) . Participants in the intervention group gained significantly less weight than those in the control group . Only 17 % of the women in the intervention group showed substantial weight retention of more than 5 kg compared with 31 % of those in the control group at month four postpartum ( pp ) ( OR : 0.5 ; 95 % CI : 0.2 to 0.9 ) . There were no significant differences in obstetric and neonatal outcomes . Conclusions Lifestyle counseling given to pregnant women reduced the proportion of pregnancies with excessive GWG without increasing suboptimal weight gain , and may exert favorable effects on pp weight retention . Trial registration German Clinical Trials Register DRKS00003801 BACKGROUND Exercise may influence glucose metabolism during pregnancy . We examined the effect of exercise intensity and duration on capillary glucose responses in pregnant women at low and high risk for gestational diabetes mellitus ( GDM ) who followed a modified GDM meal plan . METHODS R and omization occurred at study entry ( 16 - 20 weeks ' gestation ) into a low-intensity [ 30 % heart rate reserve , low risk-30%I , n = 12 ; high risk-30%I , n = 11 ] or vigorous-intensity ( 70 % heart rate reserve , low risk-70%I , n = 12 ; R-70%I , n = 11 ) exercise program with similar nutritional control . Exercise consisted of walking three to four times a week , gradually increasing time from 25 to 40 min/session . Free-living capillary glucose concentrations were measured once a week pre-exercise and post-exercise . RESULTS Capillary glucose responses to exercise were strongly influenced by an interaction between GDM risk , exercise duration and exercise intensity ( p = 0.006 ) . Decreases in glucose concentrations were observed after 25 ( 4 ± 13 % ) , 35 ( 21 ± 12 % ) and 40 min ( 15 ± 18 % ) of walking in high risk-30%I women , with the most noticeable decline after 35 and 40 min . In the high risk-70%I , glucose concentrations decreased significantly only after 25 ( 22 ± 14 % ) and 35 min ( 7 ± 23 % ) and increasing the exercise time attenuated glucose concentrations decline . In low risk women , regardless of exercise intensity and duration , decreases in glucose concentrations were significant and similar . CONCLUSION To achieve the best decline in glucose concentrations , pregnant women who follow a modified GDM meal plan should walk for 25 min/session at vigorous intensity or for 35 - 40 min/session at low intensity if they are at risk for GDM and for at least 25 min at either low or vigorous intensity if they are at low risk for GDM 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 OBJECTIVE To determine if an interactive , computerized Video Doctor counseling tool improves self-reported diet and exercise in pregnant women . METHODS A r and omized trial comparing a Video Doctor intervention to usual care in ethnically diverse , low-income , English-speaking pregnant women was conducted . Brief messages about diet , exercise , and weight gain were delivered by an actor-portrayed Video Doctor twice during pregnancy . RESULTS In the  Video Doctor group ( n=158 ) , there were statistically significant increases from baseline in exercise ( + 28 min ) , intake of fruits and vegetables , whole grains , fish , avocado and nuts , and significant decreases in intake of sugary foods , refined grains , high fat meats , fried foods , solid fats , and fast food . In contrast , there were no changes from baseline for any of these outcomes in the usual care group ( n=163 ) . Nutrition knowledge improved significantly over time in both groups but more so in the Video Doctor group . Clinician-patient discussion s about these topics occurred significantly more frequently in the Video Doctor group . There was no difference in weight gain between groups . CONCLUSION A brief Video Doctor intervention can improve exercise and dietary behaviors in pregnant women . PRACTICE IMPLICATION S The Video Doctor can be integrated into prenatal care to assist clinicians with effective diet and exercise counseling BACKGROUND Behavioural interventions might improve clinical outcomes in pregnant women who are obese . We aim ed to investigate whether a complex intervention addressing diet and physical activity could reduce the incidence of gestational diabetes and large-for-gestational-age infants . METHODS The UK Pregnancies Better Eating and Activity Trial ( UPBEAT ) is a r and omised controlled trial done at antenatal clinics in eight hospitals in multi-ethnic , inner-city locations in the UK . We recruited pregnant women ( 15 - 18 weeks plus 6 days of gestation ) older than 16 years who were obese ( BMI ≥30 kg/m(2 ) ) . We r and omly assigned participants to either a behavioural intervention or st and ard antenatal care with an internet-based , computer-generated , r and omisation procedure , minimising by age , ethnic origin , centre , BMI , and parity . The intervention was delivered once a week through eight health trainer-led sessions . Primary outcomes were gestational diabetes ( diagnosed with an oral glucose tolerance test and by criteria from the International Association of Diabetes in Pregnancy Study Groups ) and large-for-gestational-age infants ( ≥90th customised birthweight centile ) . Analysis was by intention to treat . This trial is registered with Current Controlled Trials , ISCRTN89971375 . Recruitment and pregnancy outcomes are complete but childhood follow-up is ongoing . FINDINGS Between March 31 , 2009 , and June 2 , 2014 , we assessed 8820 women for eligibility and recruited 1555 , with a mean BMI of 36·3 kg/m(2 ) ( SD 4·8 ) . 772 were r and omly assigned to st and ard antenatal care and 783 were allocated the behavioural intervention , of which 651 and 629 women , respectively , completed an oral glucose tolerance test . Gestational diabetes was reported in 172 ( 26 % ) women in the st and ard care group compared with 160 ( 25 % ) in the intervention group ( risk ratio 0·96 , 95 % CI 0·79 - 1·16 ; p=0·68 ) . 61 ( 8 % ) of 751 babies in the st and ard care group were large for gestational age compared with 71 ( 9 % ) of 761 in the intervention group ( 1·15 , 0·83 - 1·59 ; p=0·40 ) . Thus , the primary outcomes did not differ between groups , despite improvements in some maternal secondary outcomes in the intervention group , including reduced dietary glycaemic load , gestational weight gain , and maternal sum-of-skinfold thicknesses , and increased physical activity . Adverse events included neonatal death ( two in the st and ard care group and three in the intervention group ) and fetal death in utero ( ten in the st and ard care group and six in the intervention group ) . No maternal deaths were reported . Incidence of miscarriage ( 2 % in the st and ard care group vs 2 % in the intervention group ) , major obstetric haemorrhage ( 1 % vs 3 % ) , and small-for-gestational-age infants ( ≤5th customised birthweight centile ; 6 % vs 5 % ) did not differ between groups . INTERPRETATION A behavioural intervention addressing diet and physical activity in women with obesity during pregnancy is not adequate to prevent gestational diabetes , or to reduce the incidence of large-for-gestational-age infants . FUNDING National Institute for Health Research , Guys and St Thomas ' Charity , Chief Scientist Office Scotl and , Tommy 's Charity 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 Please cite this paper as : Hui A , Back L , Ludwig S , Gardiner P , Sevenhuysen G , Dean H , Sellers E , McGavock J , Morris M , Bruce S , Murray R , Shen G. Lifestyle intervention on diet and exercise reduced excessive gestational weight gain in pregnant women under a r and omised controlled trial . BJOG 2012;119:70–77 In the GRADE approach , r and omized trials start as high- quality evidence and observational studies as low- quality evidence , but both can be rated down if most of the relevant evidence comes from studies that suffer from a high risk of bias . Well-established limitations of r and omized trials include failure to conceal allocation , failure to blind , loss to follow-up , and failure to appropriately consider the intention-to-treat principle . More recently recognized limitations include stopping early for apparent benefit and selective reporting of outcomes according to the results . Key limitations of observational studies include use of inappropriate controls and failure to adequately adjust for prognostic imbalance . Risk of bias may vary across outcomes ( e.g. , loss to follow-up may be far less for all-cause mortality than for quality of life ) , a consideration that many systematic review s ignore . In deciding whether to rate down for risk of bias -- whether for r and omized trials or observational studies -- authors should not take an approach that averages across studies . Rather , for any individual outcome , when there are some studies with a high risk , and some with a low risk of bias , they should consider including only the studies with a lower risk of bias Intrauterine Growth Retardation ( IUGR ) is defined as a rate of growth of a fetus that is less than normal for the growth potential of the fetus ( for that particular gestational age ) . Small for Gestational Age ( SGA ) is defined infant born following IUGR , with a weight at birth below the 10th percentile . Suboptimal fetal growth occurring in IUGR fetuses is an important cause of perinatal mortality and morbidity . The acute neonatal consequences of IUGR include metabolic and hematological disturbances , and disrupted thermoregulation ; in addition , respiratory distress ( RDS ) , necrotizing enterocolitis ( NEC ) , and retinopathy of prematurity ( ROP ) may contribute to perinatal morbidity . Metabolic disturbances are related to glucose and fatty acid metabolism . It is well-known that individuals who display poor growth in utero are at significantly increased risk for type 2 diabetes mellitus ( T2DM ) , obesity , hypertension , dyslipidemia , and insulin resistance ( the so-called metabolic syndrome , MS ) . MS ultimately leads to the premature development of cardiovascular diseases . In addition , short stature in children and adults , premature adrenarche , and the polycystic ovarian syndrome ( PCOS ) are endocrinological sequelae of IUGR . ( 8) Early onset growth delay and prematurity significantly increase the risk for neurological sequelae and motor and cognitive delay . Future prospect i ve studies need to investigate risk factors for infants who are SGA . If reliable prediction can be achieved , there is potential to reduce future perinatal morbidity and mortality , and long term consequences among SGA babies 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 examine the effect of an individually tailored , motivationally matched prenatal exercise intervention on gestational diabetes mellitus ( GDM ) and other measures of glucose intolerance among ethnically diverse prenatal care patients at increased risk for GDM . METHODS : The Behaviors Affecting Baby and You study r and omized eligible women at a mean ( st and ard deviation ) of 18.2 ( 4.1 ) weeks of gestation to a 12-week individually tailored , motivationally matched exercise intervention or a comparison health and wellness intervention . The goal of the exercise intervention was to achieve the American College of Obstetricians and Gynecologists ' guidelines for physical activity during pregnancy . Diagnosis of GDM , impaired glucose tolerance , abnormal glucose screen , and screening glucose values ( mg/dL ) were abstract ed from medical records . A sample size of 352 women ( 176 per group ) was planned to have 80 % power to detect reductions in risk of 35 % or larger . RESULTS : From July 2007 to December 2012 , a total of 251 ( 86.5 % ) women completed the intervention ; n=124 and 127 in the exercise and comparison interventions , respectively . Based on an intention-to-treat analysis , no statistically significant differences between the intervention groups were observed ; the relative odds of GDM in the exercise group was 0.61 ( 95 % confidence interval [ CI ] 0.28–1.32 ) as compared with the health and wellness comparison group . Odds ratios for impaired glucose tolerance and abnormal glucose screen were 0.68 ( 95 % CI 0.35–1.34 ) and 0.86 ( 95 % CI 0.51–1.47 ) , respectively . The intervention had no effect on birth outcomes . CONCLUSION : In this r and omized trial among ethnically diverse pregnant women at increased risk for GDM , we found that a prenatal exercise intervention implemented in the second trimester did not result in a statistically significant reduction in relative odds for GDM , impaired glucose tolerance , or abnormal glucose screen . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00728377 . LEVEL OF EVIDENCE : Background Pregnancy is a recognised high risk period for excessive weight gain , contributing to postpartum weight retention and obesity development long-term . We aim ed to reduce postpartum weight retention following a low-intensity , self-management intervention integrated with routine antenatal care during pregnancy . Methods 228 women at increased risk of gestational diabetes , < 15 weeks gestation were r and omised to intervention ( 4 self-management sessions ) or control ( generic health information ) . Outcomes , collected at baseline and 6 weeks postpartum , included anthropometrics ( weight and height ) , physical activity ( pedometer ) and question naires ( health behaviours ) . Results Mean age ( 32.3 ± 4.7 and 31.7 ± 4.4 years ) and body mass index ( 30.4 ± 5.6 and 30.3 ± 5.9 kg/m2 ) were similar between intervention and control groups , respectively at baseline . By 6 weeks postpartum , weight change in the control group was significantly higher than the intervention group with a between group difference of 1.45 ± 5.1 kg ( 95 % CI : -2.86,-0.02 ; p < h0.05 ) overall , with a greater difference in weight found in overweight , but not obese women . Intervention group allocation , higher baseline BMI , GDM diagnosis , country of birth and higher age were all independent predictors of lower weight retention at 6 weeks postpartum on multivariable linear regression . Other factors related to weight including physical activity , did not differ between groups . Conclusions A low intensity intervention , integrated with st and ard antenatal care is effective in limiting postpartum weight retention . Implementation research is now required for scale-up to optimise antenatal health care . Trial registration Australian New Zeal and Clinical Trial Registry Number : ACTRN12608000233325 . Registered 7/5/2008 Background The effectiveness of exercise training for preventing excessive gestational weight gain ( GWG ) and gestational diabetes mellitus ( GDM ) is still uncertain . As maternal obesity is associated with both GWG and GDM , there is a special need to assess whether prenatal exercise training programs provided to obese women reduce the risk of adverse pregnancy outcomes . Our primary aim was to assess whether regular supervised exercise training in pregnancy could reduce GWG in women with prepregnancy overweight/obesity . Secondary aims were to examine the effects of exercise in pregnancy on 30 outcomes including GDM incidence , blood pressure , blood measurements , skinfold thickness , and body composition . Methods and Findings This was a single-center study where we r and omized ( 1:1 ) 91 pregnant women with a prepregnancy body mass index ( BMI ) ≥ 28 kg/m2 to exercise training ( n = 46 ) or control ( st and ard maternity care ) ( n = 45 ) . Assessment s were done at baseline ( pregnancy week 12–18 ) and in late pregnancy ( week 34–37 ) , as well as at delivery . The exercise group was offered thrice weekly supervised sessions of 35 min of moderate intensity endurance exercise and 25 min of strength training . Seventeen women were lost to follow-up ( eight in the exercise group and nine in the control group ) . Our primary endpoint was GWG from baseline testing to delivery . The principal analyses were done as intention-to-treat analyses , with supplementary per protocol analyses where we assessed outcomes in the women who adhered to the exercise program ( n = 19 ) compared to the control group . Mean GWG from baseline to delivery was 10.5 kg in the exercise group and 9.2 kg in the control group , with a mean difference of 0.92 kg ( 95 % CI −1.35 , 3.18 ; p = 0.43 ) . Among the 30 secondary outcomes in late pregnancy , an apparent reduction was recorded in the incidence of GDM ( 2009 WHO definition ) in the exercise group ( 2 cases ; 6.1 % ) compared to the control group ( 9 cases ; 27.3 % ) , with an odds ratio of 0.1 ( 95 % CI 0.02 , 0.95 ; p = 0.04 ) . Systolic blood pressure was significantly lower in the exercise group ( mean 120.4 mm Hg ) compared to the control group ( mean 128.1 mm Hg ) , with a mean difference of −7.73 mm Hg ( 95 % CI −13.23 , −2.22 ; p = 0.006 ) . No significant between-group differences were seen in diastolic blood pressure , blood measurements , skinfold thickness , or body composition in late pregnancy . In per protocol analyses , late pregnancy systolic blood pressure was 115.7 ( 95 % CI 110.0 , 121.5 ) mm Hg in the exercise group ( significant between-group difference , p = 0.001 ) , and diastolic blood pressure was 75.1 ( 95 % CI 71.6 , 78.7 ) mm Hg ( significant between-group difference , p = 0.02 ) . We had planned to recruit 150 women into the trial ; hence , under-recruitment represents a major limitation of our results . Another limitation to our study was the low adherence to the exercise program , with only 50 % of the women included in the intention-to-treat analysis adhering as described in the study protocol . Conclusions In this trial we did not observe a reduction in GWG among overweight/obese women who received a supervised exercise training program during their pregnancy . The incidence of GDM in late pregnancy seemed to be lower in the women r and omized to exercise training than in the women receiving st and ard maternity care only .  Systolic blood pressure in late pregnancy was also apparently lower in the exercise group than in the control group . These results indicate that supervised exercise training might be beneficial as a part of st and ard pregnancy care for overweight/obese women . Trial Registration Clinical Trials.gov 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 Antenatal preparation programmes are recommended worldwide to promote a healthy pregnancy and greater autonomy during labor and delivery , prevent physical discomfort and high levels of anxiety . The objective of this study was to evaluate effectiveness and safety of a birth preparation programme to minimize lumbopelvic pain , urinary incontinence , anxiety , and increase physical activity during pregnancy as well as to compare its effects on perinatal outcomes comparing two groups of nulliparous women . Methods A r and omized controlled trial was conducted with 197 low risk nulliparous women aged 16 to 40 years , with gestational age ≥ 18 weeks . Participants were r and omly allocated to participate in a birth preparation programme ( BPP ; n=97 ) or a control group ( CG ; n=100 ) . The intervention was performed on the days of prenatal visits , and consisted of physical exercises , educational activities and instructions on exercises to be performed at home . The control group followed a routine of prenatal care . Primary outcomes were urinary incontinence , lumbopelvic pain , physical activity , and anxiety . Secondary outcomes were perinatal variables . Results The risk of urinary incontinence in BPP participants was significantly lower at 30 weeks of pregnancy ( BPP 42.7 % , CG 62.2 % ; relative risk [ RR ] 0.69 ; 95 % confidence interval [ CI ] 0.51 - 0.93 ) and at 36 weeks of pregnancy ( BPP 41.2 % , CG 68.4 % ; RR 0.60 ; 95%CI 0.45 - 0.81 ) . Participation in the BPP encouraged women to exercise during pregnancy ( p=0.009 ) . No difference was found between the groups regarding to anxiety level , lumbopelvic pain , type or duration of delivery and weight or vitality of the newborn infant . Conclusions The BPP was effective in controlling urinary incontinence and to encourage the women to exercise during pregnancy with no adverse effects to pregnant women or the fetuses . Trial registration Clinical trials.gov , ( NCT01155804 OBJECTIVE We have studied the effect of moderate physical activity that is performed by healthy women during their entire pregnancy on their perception of health status . STUDY DESIGN Eighty sedentary women were assigned r and omly to either an exercise group ( n = 40 ) or a control group ( n = 40 ) . Maternal perception of health status and several pregnancy outcomes were recorded . RESULTS Significant differences ( P = .03 ) were found between study groups in the percentage of women who perceived their health status as " very good " ; the values that corresponded to the exercise group ( n = 18 ; 54.5 % ) were better than those of the control group ( n = 9 ; 27.3 % ) . In addition , the women of the exercise group gained less weight ( 11,885 ± 3146 g ) than those of the control group ( 13,903 ± 2113 ; P = .03 ) . CONCLUSION A moderate physical activity program that is performed over the first , second , and third trimester of pregnancy improves the maternal perception of health status OBJECTIVE : To compare , in an unselected population of nulliparous pregnant women , the postnatal effect of prenatal supervised pelvic floor muscle training with written instructions on postpartum urinary incontinence ( UI ) . METHODS : In a r and omized controlled trial in two parallel groups , 282 women were recruited from five university teaching hospitals in France and r and omized during the second trimester of pregnancy . The physiotherapy group received prenatal individually supervised exercises . Both groups received written instructions about how to perform exercises at home . Women were blindly assessed at baseline , end of pregnancy , and 2 and 12 months postpartum . The primary outcome measured was UI severity , assessed with an International Consultation on Incontinence Question naire-Urinary Incontinence Short Form score ( range 0–21 ; 1–5 is slight UI ) at 12 months postpartum ; other outcomes were UI prevalence and pelvic floor troubles assessed using self-administered question naires . To give a 1-point difference in UI severity score , we needed 91 women in each group ( st and ard deviation 2.4 , & agr;=0.05 , & bgr;=0.20 , and bilateral analysis ) . RESULTS : Between February 2008 and June 2010 , 140 women were r and omized in the physiotherapy group and 142 in the control group . No difference was observed between the two groups in UI severity , prevalence , or pelvic floor troubles at baseline , end of pregnancy , and at 2 and 12 months postpartum . At 12 months postpartum , the primary outcome was available for 190 women ( 67.4 % ) ; mean UI severity was 1.9 in the physiotherapy group compared with 2.1 in the control group ( P=.38 ) . CONCLUSION : Prenatal supervised pelvic floor training was not superior to written instructions in reducing postnatal UI . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov ; www . clinical trials.gov , NCT00551551 . LEVEL OF EVIDENCE : 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 Urinary incontinence is a chronic health complaint that severely reduces quality of life . Pregnancy and vaginal delivery are main risk factors in the development of urinary incontinence . The aim of this study was to assess whether intensive pelvic floor muscle training during pregnancy could prevent urinary incontinence . METHODS We conducted a single-blind r and omized controlled trial at Trondheim University Hospital and three outpatient physiotherapy clinics in a primary care setting . Three hundred one healthy nulliparous women were r and omly allocated to a training ( n = 148 ) or a control group ( n = 153 ) . The training group attended a 12-week intensive pelvic floor muscle training program during pregnancy , supervised by physiotherapists . The control group received the customary information . The primary outcome measure was self-reported symptoms of urinary incontinence . The secondary outcome measure was pelvic floor muscle strength . RESULTS At follow-up , significantly fewer women in the training group reported urinary incontinence : 48 of 148 ( 32 % ) versus 74 of 153 ( 48 % ) at 36 weeks ' pregnancy ( P = .007 ) and 29 of 148 ( 20 % ) versus 49 of 153 ( 32 % ) 3 months after delivery ( P = .018 ) . According to numbers needed to treat , intensive pelvic floor muscle training during pregnancy prevented urinary incontinence in about one in six women during pregnancy and one in eight women after delivery . Pelvic floor muscle strength was significantly higher in the training group at 36 weeks ' pregnancy ( P = .008 ) and 3 months after delivery ( P = .048 ) . CONCLUSION Intensive pelvic floor muscle training during pregnancy prevents urinary incontinence during pregnancy and after delivery . Pelvic floor muscle strength improved significantly after intensive pelvic floor muscle training Objective To evaluate whether a 12-week supervised exercise program promotes an active lifestyle throughout pregnancy in pregnant women with obesity . Methods In this preliminary r and omised trial , pregnant women ( body mass index ≥ 30 kg/m2 ) were allocated to either  st and ard care or supervised training , from 15 to 27 weeks of gestation . Physical activity was measured by accelerometry at 14 , 28 and 36 weeks , while fitness ( oxygen consumption ( VO2 ) at the anaerobic threshold ) , nutrition ( caloric intake and macronutrients percentage ) and anthropometry were assessed at 14 and 28 weeks of gestation . Analyses were performed using repeated measures ANOVA . Results A total of fifty ( 50 ) women were r and omised , 25 in each group . There was no time-group interaction for time spent at moderate and vigorous activity ( pinteraction = 0.064 ) , but the exercise group ’s levels were higher than controls ’ at all times ( pgroup effect = 0.014 ) . A significant time-group interaction was found for daily physical activity ( p = 0.023 ) ; similar at baseline ( ( 22.0 ± 6.7 vs 21.8 ± 7.3 ) x 104 counts/day ) the exercise group had higher levels than the control group following the intervention ( ( 22.8 ± 8.3 vs 19.2 ± 4.5 ) x 104 counts/day , p = 0.020 ) and at 36 weeks of gestation ( ( 19.2 ± 1.5 vs 14.9 ± 1.5 ) x 104 counts/day , p = 0.034 ) . Exercisers also gained less weight than controls during the intervention period despite similar nutritional intakes ( difference in weight change = -0.1 kg/week , 95 % CI -0.2 ; -0.02 , p = 0.016 ) and improved cardiorespiratory fitness ( difference in fitness change = 8.1 % , 95 % CI 0.7 ; 9.5 , p = 0.041 ) . Conclusions Compared with st and ard care , a supervised exercise program allows pregnant women with obesity to maintain fitness , limit weight gain and attenuate the decrease in physical activity levels observed in late pregnancy . Trial Registration Clinical Trials.gov Background To develop effective health promotional and preventive prenatal programs , it is important to underst and perceived barriers to leisure-time physical activity during pregnancy , including exercise and sport participation . The aims of the present study was 1 ) to assess the effect of prenatal lifestyle intervention on the perceived barrier to leisure-time physical activity during pregnancy and the first year after delivery and 2 ) identify the most important perceived barriers to leisure-time physical activity at multiple time points during and after pregnancy . Methods This secondary analysis was part of the Norwegian Fit for Delivery study , a combined lifestyle intervention evaluated in a blinded , r and omized controlled trial . Healthy , nulliparous women with singleton pregnancy of ≤20 gestational weeks , age ≥ 18 years and body mass index ≥19 kg/m2 were recruited via healthcare clinics in southern Norway , including urban and rural setting s. Participants were r and omized to either twice-weekly supervised exercise sessions and nutritional counselling ( n = 303 ) or st and ard prenatal care ( n = 303 ) . The principal analysis was based on the participants who completed the st and ardized question naire assessing their perceived barriers to leisure-time physical activity at inclusion ( gestational week 16 , n = 589 ) and following intervention ( gestational week 36 , n = 509 ) , as well as six months ( n = 470 ) and 12 months ( n = 424 ) postpartum . Results Following intervention ( gestation week 35.4 ± 1.0 ) , a significant between-group difference in perceived barriers to leisure-time physical activity was found with respect to time constraints : “ ... I do not have the time ” ( intervention : 22 vs. control : 38 , p = 0.030 ) , mother-child safety concerns : “ ... afraid to harm the baby ” ( intervention : 8 vs. control : 25 , p = 0.002 ) and self-efficacy : “ ... I do not believe/think that I can do it ” ( intervention : 3 vs. control : 10 , p = 0.050 ) . No positive effect was seen at postpartum follow-up . Intrapersonal factors ( lack of time , energy and interest ) were the most frequently perceived barriers , and consistent over time among all participants . Conclusion The intervention had effect on intrapersonal perceived barriers in pregnancy , but not in the postpartum period . Perceived barriers to leisure-time physical activity were similar from early pregnancy to 12 months postpartum . Trial registration Clinical Trials.gov : NCT01001689 , registered July 2 , 2009 Background The objectives of this study were to assess the efficacy of lifestyle intervention on gestational weight gain in pregnant women with normal and above normal body mass index ( BMI ) in a r and omized controlled trial . Methods A total of 116 pregnant women ( < 20 weeks of pregnancy ) without diabetes were enrolled and 113 pregnant women completed the program . Participants were r and omized into intervention and control groups . Women in the intervention group received weekly trainer-led group exercise sessions , instructed home exercise for 3 - 5-times/week during 20 - 36 weeks of gestation , and dietary counseling twice during pregnancy . Participants in the control group did not receive the intervention . All participants completed a physical activity question naire and a 3-day food record at enrolment and 2 months after enrolment . Results The participants in the intervention group with normal pre-pregnancy BMI ( ≤24.9 kg/M2 , n = 30 ) had lower gestational weight gain ( GWG ) , offspring birth weight and excessive gestational weight gain ( EGWG ) on pregnancy weight gain compared to the control group ( n = 27 , p < 0.05 ) . Those weight related-changes were not detected between the intervention ( n = 27 ) and control group ( n = 29 ) in the above normal pre-pregnancy BMI participants . Intervention reduced total calorie , total fat , saturated fat and cholesterol intake were detected in women with normal or above normal pre-pregnancy BMI compared to the control group ( p < 0.05 or 0.01 ) . Increased physical activity and reduced carbohydrate intake were detected in women with normal ( p < 0.05 ) , but not above normal , pre-pregnancy BMI at 2 months after the onset of the intervention compared to the control group . Conclusion The results of the present study demonstrated that the lifestyle intervention program decreased EGWG , GWG , offspring birth weight in pregnant women with normal , but not above normal , pre-pregnancy BMI , which was associated with increased physical activity and decreased carbohydrate intake . Trial registration 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 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 BACKGROUND Maternal obesity and excessive gestational weight gain ( GWG ) are major short- and long-term risk factors for maternal and fetal complications . OBJECTIVE The objective was to study whether a lifestyle intervention based on a brochure or on active education can improve dietary habits , increase physical activity ( PA ) , and reduce GWG in obese pregnant women . DESIGN In this r and omized controlled trial , 195 white , obese pregnant women [ age : 29 + or - 4 y ; body mass index ( in kg/m(2 ) ) ; 33.6 + or - 4.2 ] were r and omly assigned into 3 groups : a group that received nutritional advice from a brochure , a group that received the brochure and lifestyle education by a nutritionist , and a control group . Nutritional habits  were evaluated every trimester through 7-d food records . PA was evaluated with the Baecke question naire . RESULTS Energy intake did not change during pregnancy and was comparable in all groups . Fat intake , specifically saturated fat intake , decreased and protein intake increased from the first to the third trimester in the passive and active groups compared with an opposite change in the control group . Calcium intake and vegetable consumption increased during pregnancy in all groups . PA decreased in all groups , especially in the third trimester . No significant differences in GWG and obstetrical or neonatal outcome could be observed between the groups . CONCLUSIONS Both lifestyle interventions improved the nutritional habits of obese women during pregnancy . Neither PA nor GWG was affected AIMS To pilot the feasibility of a prenatal lifestyle intervention to modify physical activity and diet among pregnant overweight and obese Hispanic women , with the aim of reducing risk factors for gestational diabetes mellitus . METHODS Women were r and omized either to a  lifestyle intervention ( n = 33 , 48.5 % ) , consisting of a culturally and linguistically modified , motivationally targeted , individually tailored 6-month prenatal programme , or to st and ard care  ( n = 35 , 51.5 % ) . Bilingual and bicultural health educators encouraged women to achieve guidelines for physical activity , decrease saturated fat and increase dietary fibre . Outcomes included gestational weight gain , infant birth weight and biomarkers associated with insulin resistance . RESULTS Patient retention up to delivery was 97 % in both study groups . The lifestyle intervention attenuated the pregnancy-associated decline in moderate-intensity physical activity , but differences between groups were not significant ( mean ± se -23.4 ± 16.6 vs -27.0 ± 16.2 metabolic equivalent of task h/week ; P = 0.88 ) . Vigorous-intensity activity increased during the course of pregnancy in the lifestyle intervention group ( mean ± se 1.6 ± 0.8 metabolic equivalent of task h/week ) and declined in the st and ard care group ( -0.8 ± 0.8 metabolic equivalent of task h/week ; P = 0.04 ) . The lifestyle intervention group also had slightly lower gestational weight gain and infant birth weights compared with the st and ard care group ; however , these differences were not statistically significant . There were no statistically significant differences in biomarkers of insulin resistance between groups . CONCLUSIONS Findings suggest that a motivationally matched lifestyle intervention is feasible and may help attenuate pregnancy-related decreases in vigorous physical activity in a population of overweight and obese Hispanic women . The intervention protocol can readily be translated into clinical practice in underserved and minority population 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 : A single center , prospect i ve , r and omized , single blinded , controlled study comparing the effects and safety of " sitting pelvic tilt exercise " in relieving back  pain during the third trimester in primigravida was carried out . The sample s were composed of 67 primigravidas who attended the prenatal clinic at King Chulalongkorn Memorial Hospital . All subjects were selected by the r and om sampling technique and allocated into two groups for the experimental group and the control group ; for 32 and 35 pregnants , respectively . The experimental group received the pelvic tilt exercise program for 8 weeks during the third trimester . Pain intensity was measured by visual analogue scale ( VAS ) at day 0 and day 56 in both groups . The result of the study revealed 1 ) The mean VAS of back pain in the experimental group was significantly lower at day 56 than at day 0 and lower than the control group at day 56 ( p < 0.05 ) by unpaired t-test 2 ) There was no incidence of preterm labor , low birth weight or neonatal complication in the experimental group . In conclusion , the " sitting pelvic tilt exercise " during the third trimester in primigravidas could decrease back pain intensity without incidence of preterm labor , low birth weight or neonatal complication 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 The use of the pelvic floor muscle training for urinary incontinence treatment is well established but little is known about its effects in labor and newborn outcomes . OBJECTIVES To evaluate the effects of antenatal pelvic floor muscle training and strength in labor and newborn outcomes in low-income pregnant women . METHODS This is a r and omized controlled trial that recruited forty-two nulliparous healthy pregnant women aged between 18 - 36 years old and able to contract the pelvic floor muscles . The participants were included in the study with 20 weeks of gestational age and had their pelvic floor muscles measured by vaginal squeeze pressure . They were r and omly allocated into two groups : training group and a non-intervention control group . Then , all participants had their labor and newborn outcomes evaluated through consultation of medical records by a blinded research er . RESULTS There were no statistically significant differences between the groups regarding gestational age at birth , type of labor , duration of the second stage of labor , total time of labor , prevalence of laceration , weight and size of the baby , and Apgar score . No correlation was observed between pelvic floor muscle strength and the second stage or the total length of labor . CONCLUSIONS This r and omized controlled trial did not find any effect of pelvic floor muscle training or pelvic floor muscle strength on labor and newborn outcomes Introduction and hypothesisThe aim of the study was to evaluate the effect of antenatal pelvic floor muscle exercise ( PFME ) in the prevention and treatment of  urinary incontinence during pregnancy and postpartum period . Methods Three hundred women were r and omly assigned to the PFME group and control group . Urinary symptoms were measured by Urogenital Distress Inventory-6 ( UDI-6 ) , Incontinence Impact Question naire-7 ( IIQ-7 ) , and question of self-reported urinary incontinence . Question naire scores of the PFME and the control groups were compared and analyzed . Results During late pregnancy and the postpartum period , the PFME group had significantly lower total UDI-6 and IIQ-7 scores ; their self-report rate of urinary incontinence was also less than the control group . Additionally , we found whether in PFME or control , women who delivered vaginally were more likely to develop postpartum urinary leakage than women who delivered by cesarean section . Conclusions PFME applied in pregnancy is effective in the treatment and prevention of urinary incontinence during pregnancy , and this effect may persist to postpartum period BACKGROUND : The Institute of Medicine ( IOM ) recommends that normal‐weight women ( BMI ( body mass index ) of 19.8–26.0 ) gain 25–35 lb ( 11.4–15.9 kg ) during pregnancy , and that overweight women ( BMI of 26.1–29.0 ) gain 15–25 lbs ( 6.8–11.4 kg ) . A significant number of normal‐weight women and an even greater proportion of overweight women exceed these guidelines , which increases postpartum weight retention and may contribute to the development of obesity . OBJECTIVE : To determine whether a stepped care , behavioral intervention will decrease the percentage of women who gain more than the IOM recommendation . DESIGN : R and omized controlled trial comparing a stepped-care behavioral intervention with usual care .  Women ( n=120 ) who had a BMI > 19.8 , age>18 and < 20 weeks gestation were recruited from a hospital-based clinic serving low-income women and r and omized by race and BMI category to the intervention or control group . The intervention group received education about weight gain , healthy eating , and exercise and individual graphs of their weight gain . Those exceeding weight gain goals were given more intensive intervention . Women were followed through pregnancy to their first postpartum clinic visit . The main outcome measure was weight gain during pregnancy categorized as above the IOM recommendations vs below or within the IOM recommendations . RESULTS : The intervention significantly decreased the percentage of normal-weight women who exceeded the IOM recommendations ( 33 vs 58 % , P<0.05 ) . There was a non-significant ( P=0.09 ) effect in the opposite direction among overweight women ( 59 % of intervention and 32 % of control gained more than recommended ) . Postpartum weight retention was strongly related to weight gain during pregnancy ( r=0.89 ) . CONCLUSIONS : The intervention reduced excessive weight gain during pregnancy among normal weight women We examined the effects of home-based walking on sedentary Japanese women 's pregnancy outcomes and mood .  A r and omized controlled trial was conducted , involving 118 women aged 22 - 36 years . Participants were r and omly assigned to walking intervention ( n = 60 ) or control ( n = 58 ) groups . The walking group was instructed to walk briskly for 30 min , three times weekly from 30 weeks ' gestation until delivery . Both groups counted their daily steps using pedometers .  Pregnancy and delivery outcomes were assessed , participants completed the Profile of Mood States , and we used the intention-to-treat principle . Groups showed no differences regarding pregnancy or delivery outcomes . The walking group exhibited decreased scores on the depression-dejection and confusion subscales of the Profile of Mood States . Five of the 54 women in the intervention group who remained in the study ( 9.2 % ) completed 100 % of the prescribed walking program ; 32 ( 59.3 % ) women completed 80 % or more . Unsupervised walking improves sedentary pregnant women 's  mood , indicating that regular walking during pregnancy should be promoted in this group Objective To examine the effect of regular moderate-intensity exercise ( three training sessions/week ) on the incidence of  gestational diabetes mellitus ( GDM  , primary outcome ) . We also examined if the exercise intervention modifies the association between GDM and birth weight and risk of macrosomia , gestational age , risk of caesarean delivery and maternal weight gain ( secondary outcomes ) . Methods We r and omly assigned 510 healthy gravida to either an exercise intervention or a usual care ( control ) group ( n=255 each ) . The exercise programme focused on moderate-intensity resistance and aerobic exercises ( three times/week , 50–55 min/session ) . GDM diabetes was diagnosed according to the WHO criteria and the International Association for Diabetes in Pregnancy Study Group ( IADPSG ) . Results The intervention did not reduce the risk of developing GDM ( OR 0.84 , 95 % CI 0.50 to 1.40 ) when using the WHO criteria . We observed that the intervention reduced by 58 % the GDM-related risk ( WHO criteria ) of having a newborn with macrosomia ( OR 1.76 , 95 % CI 0.04 to 78.90 vs 4.22 , 95 % CI 1.35 to 13.19 ) in exercise and control groups , respectively ) , and by 34 % the GDM-related risk of having acute and elective caesarean delivery ( OR 1.30 , 95 % CI 0.44 to 3.84 vs 1.99 , 95 % CI 0.98 to 4.06 in exercise and control groups , respectively ) . Gestational age was similar across the treatment groups ( control , exercise ) and GDM category ( GDM or non-GDM ) , and maternal weight gain was ∼12 % lower in the exercise group independent of whether women developed GDM . The results were similar when the IADPSG criteria were used instead . Conclusions Regular moderate-intensity exercise performed over the second-third trimesters of pregnancy can be used to attenuate important GDM-related adverse outcomes 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 This article introduces the approach of GRADE to rating  quality of evidence .  GRADE specifies four categories-high , moderate , low , and very low-that are applied to a body of evidence , not to individual studies . In the context of a systematic review , quality reflects our confidence that the estimates of the effect are correct . In the context of recommendations , quality reflects our confidence that the effect estimates are adequate to support a particular recommendation . R and omized trials begin as high- quality evidence , observational studies as low quality . " Quality " as used in GRADE means more than risk of bias and so may also be compromised by imprecision , inconsistency , indirectness of study results , and publication bias . In addition , several factors can increase our confidence in an estimate of effect . GRADE provides a systematic approach for considering and reporting each of these factors . GRADE separates the process of assessing quality of evidence from the process of making recommendations . Judgments about the strength of a recommendation depend on more than just the quality of evidence The objective of this study was to test the hypothesis that a woman 's dietary carbohydrate mix modifies the glucose and insulin response to both mixed caloric intake and exercise . Either a prospect i ve r and omized or a prospect i ve r and omized crossover design was used to examine the effects of two isocaloric , high-carbohydrate diets on the whole-blood glucose and insulin responses to mixed caloric intake and exercise in healthy nonpregnant ( n = 14 ) and pregnant ( n = 12 ) women . The diets differed only in the type of carbohydrate ingested . Those in one had low glycemic indexes and those in the other had high glycemic indexes . In nonpregnant women , the blood glucose response to a meal containing low-glycemic carbohydrate was half that seen with high-glycemic carbohydrate , and the effect of exercise on blood glucose was more pronounced while eating the high-glycemic carbohydrate diet . During pregnancy , women on the low-glycemic carbohydrate diet experienced no significant change in their glycemic response to mixed caloric intake , whereas those who switched to the high-glycemic carbohydrate diet experienced a 190 % increase in their response . In conclusion , the type of dietary carbohydrate in a healthy , physically active woman 's diet influences both her postpr and ial blood glucose profile and her blood sugar response to exercise 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 Introduction and hypothesisThe objective was to assess foetal wellbeing in pregnant women subjected to pelvic floor muscle training ( PFMT )  by evaluating the acute and chronic effects of the procedure using the Doppler method . Methods Ninety-six primigravidae with singleton pregnancies and at a low risk of pregnancy complications were r and omised to either intervention with PFMT or no intervention . The final analysis included 26 women in the intervention group and 33 in the control group . Women from the intervention group were subjected to a daily PFMT program . Evidence of possible foetal risk was assessed by Doppler and the control group received st and ard care . The protocol was conducted from 20 to 36 weeks ’ gestation . The pulsatility indices ( PI ) of the uterine , umbilical and middle cerebral arteries were determined at 28 , 32 and 36 weeks ’ gestation . The acute effects were determined by comparing the values obtained before and after exercise in the group subjected to PFMT and the chronic effects were determined by comparing the resting values of the trained group with those of the control group . Results The results obtained showed normal values for the three gestational ages in both groups , with no difference between groups . Comparison before and after exercise showed a significant decline in the PI of uterine artery at 36 weeks without changes in the flow of umbilical and middle cerebral arteries . Conclusion Pelvic floor muscle training in low-risk primigravidae with singleton pregnancies was associated with a significant decline in PI of the uterine artery after exercise , while no significant changes in the flow of the middle cerebral and umbilical arteries were found . The PFMT may be recommended to women as a first-line measure to prevent of urinary incontinence during pregnancy BACKGROUND Pelvic floor muscle exercises ( PFME ) are commonly recommended during pregnancy and after birth for both prevention and treatment of lower urinary tract symptoms ( LUTS ) . Stress urinary incontinence has long been presumed to be associated with urethral hypermobility . Pregnancy and delivery are known cause of increasing bladder neck descent ( BND ) . OBJECTIVE The present study aim ed to determine the effect of antenatal PFME on bladder neck descent in nulliparous pregnancy . MATERIAL AND METHOD 219 nulliparous women pregnant between 8 - 12 weeks were interviewed and then underwent transperineal ultrasound . Of the total , 108 women were r and omly assigned to a PFMT group , while 111 women to a control group .  The latter group received routine antenatal care . For the intervention group , patients were taught about PFMT using visual biofeedback by transperineal ultrasound . The PFMT regimen comprised a series of 15 contractions , and each contraction was heldfor 5 seconds , with 5 seconds rest between each contraction . Patients were asked to repeat this regimen for 3 times after each meal . At second trimester , third trimester , 3-month postpartum and 6-month postpartum , the subjects in both groups were interviewed and then underwent another ultrasound assessment . Transperineal ultrasound was performed after bladder emptying , with the patient in the supine position . Bladder neck position was measured at rest and on maximal valsava , and the differences yielded a numerical valueforBND . The sample size was calculated with apower of80 % p<0.05 was considered significant . SPSS 15 . Ofor windows ( SPSS Inc. , Chicago , Illinois ) was used for statistical analyses . RESULTS Demographic characteristics did not differ significantly between PFMT and control groups , showing effective r and omization . Mean age was 26.95±3.94 and 26.51±5.41 years for PFMT and control group , respectively ( p = 0.49 ) . There were no significant differences in bladder symptoms between the two groups at the first visit . In the first trimester , the average BND of the PFMT group was slightly higher than BND of the control group ( 14.1±6.9 mm and 12.2±6.7 mm respectively ( p = 0.04 ) ) . When comparing delivery mode by using Pearson 's Chi-square test , there was no statistically significant difference between two groups ( p = 0.35 ) . The mean fetal birth weight of women in the PFMTgroup was 3,084 grams and in the control group was 3,093 grams ( p = 0.88 ) . At 6 monthspostpartum , 80 women of the PFMT group and 65 women of the control group returned for follow-up . There were no differences regarding the prevalence ofL UTS between the groups at 6 months after delivery . Women in the control group had a higher BND ( 16.4±6.6 mm ) than those in the PFMT group ( 13.9±7.3 mm , p = 0.03 ) . This difference was also found in the subgroup of the women who delivered vaginally ( BND = 17.5±6.7 mm in the control group and 13.2±7.4 mm in the PFMTgroup , p = 0.006 ) . CONCLUSION Although postpartum prevalence of LUTS was no different between groups , this study has demonstrated that antenatal pelvic floor muscle exercises may reduce bladder neck mobility at 6 months after childbirth . The significance of such an effect remains to be determined 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 : To assess whether exercise during pregnancy can prevent gestational diabetes and improve insulin resistance . METHODS : A total of 855 women in gestational week 18–22 were r and omly assigned to receiving a 12-week st and ard exercise program ( intervention group ) or st and ard antenatal care ( control group ) . The exercise program followed st and ard recommendations and included moderate-intensity to high-intensity activity 3 or more days per week . Primary outcomes were gestational diabetes and insulin resistance estimated by the homeostasis model assessment method . For the power calculation , we assumed a gestational diabetes prevalence of 9 % in the control group and a prevalence of 4 % in the exercise group ( risk difference of 5 % ) . Under these assumptions , a two- sample comparison with a 5 % level of significance and power of 0.80 gave a study population of 381 patients in each group . RESULTS : At 32–36 weeks of gestation there were no differences between groups in prevalence of gestational diabetes : 25 of 375 ( 7 % ) in the intervention group compared with 18 of 327 ( 6 % ) in the control group ( P=.52 ) . There were no differences in insulin resistance between groups when adjusting for baseline values . Only 55 % of women in the intervention group managed to follow the recommended exercise protocol . No serious adverse events related to physical exercise were seen , and the outcomes of pregnancy were similar in the two groups . CONCLUSION : There was no evidence that offering women a 12-week st and ard exercise program during the second half of pregnancy prevents gestational diabetes or improves insulin resistance in healthy pregnant women with normal body mass indexes . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00476567 . LEVEL OF EVIDENCE : OBJECTIVE To assess whether gestational diabetes mellitus ( GDM ) can be prevented by a moderate lifestyle intervention in pregnant women who are at high risk for the disease . RESEARCH DESIGN AND METHODS Two hundred ninety-three women with a history of GDM and /or a prepregnancy BMI of ≥30 kg/m2 were enrolled in the study at < 20 weeks of gestation and were r and omly allocated to the intervention group ( n = 155 ) or the control group ( n = 138 ) . Each subject in the intervention group received individualized counseling on diet , physical activity , and weight control from trained study nurses , and had one group meeting with a dietitian . The control group received st and ard antenatal care . The diagnosis of GDM was based on a 75-g , 2-h oral glucose tolerance test at 24–28 weeks of gestation . RESULTS A total of 269 women were included in the analyses .  The incidence of GDM was 13.9 % in the intervention group and 21.6 % in the control group ( [ 95 % CI 0.40–0.98 % ] ; P = 0.044 , after adjustment for age , prepregnancy BMI , previous GDM status , and the number of weeks of gestation ) . Gestational weight gain was lower in the intervention group ( −0.58 kg [ 95 % CI −1.12 to −0.04 kg ] ; adjusted P = 0.037 ) . Women in the intervention group increased their leisure time physical activity more and improved their dietary quality compared with women in the control group . CONCLUSIONS A moderate individualized lifestyle intervention reduced the incidence of GDM by 39 % in high-risk pregnant women . These findings may have major health consequences for both the mother and the child 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 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 Objectives To assess whether a 12-week supervised exercise-programme with an additional 30 min of moderate self-imposed physical activity on the non-supervised weekdays prevents excessive weight gain in pregnancy  , as well as postpartum weight retention . Methods One hundred and five sedentary , nulliparous pregnant women with a mean age of 30.7 ± 4.0 years and a pre-pregnancy body mass index of 23.8 ± 4.3 kg/m2 were r and omised to either an exercise group ( EG , n = 52 ) or a control group ( CG , n = 53 ) . The exercise programme consisted of 60 min supervised aerobic dance and strength training for 60 min , at least twice per week for a minimum of 12 weeks . Results Drop-out rates were 19 % and 21 % in the EG and CG , respectively . Fewer women in the EG than in the CG exceeded the Institute of Medicine recommendations ; however , only EG participants who attended 24 exercise sessions ( n = 14 ) differed significantly from controls ( p = 0.006 ) with regard to weight gain during pregnancy ( 11.0 ± 2.3 vs. 13.8 ± 3.8 kg , p < 0.01 ) and postpartum weight retention ( 0.8 ± 1.7 vs. 3.3 ± 4.1 kg , p < 0.01 ) . Conclusions Regular participation in aerobic dance exercise can contribute to significantly reduce weight gain during pregnancy Regular physical activity is an established therapeutic adjunct in diabetes , but has not been offered to pregnant diabetics in the past ; for sports might induce significant cardiovascular and hormonal changes that are able to reduce blood flow to the uterus and thus limit oxygen transfer to the fetus . Study ing the impact of a medically supervised exercise program on gestational diabetes mellitus [ GDM ) in a r and omised prospect i ve longitudinal study , this paper aims to assess the effects of maternal moderate and strenuous exercise on the fetus . By evaluating shortterm fetal responses as reflected in heart rate patterns ( FHR ) and longterm-pregnancy complications and neonatal outcome , our results suggest that -- in absence of ominous FHR changes or significant changes in uterine activity following the exercise sessions or increased diabetes-related peri- and neonatal morbidity --  regular physical activity seems to be a safe therapeutic option for the fetus of GDM mothers 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 BACKGROUND The main factor for the appearance of urinary stress incontinence in almost all women is pregnancy and vaginal childbirth . The pelvic floor exercises have been described for the treatment of urinary stress incontinence . OBJECTIVE To determine with a r and omized controlled trial if the pelvic floor exercises during pregnancy and late puerperium diminish the prevalence of urinary stress incontinence at 28 and 35 gestational week and at 6 weeks after childbirth . MATERIAL AND METHODS The study was made with nulliparous , pregnant women who realized pelvic floor exercises during pregnancy and after birth . 72 women were studied , 52.7 % realized pelvic floor exercises and 47.2 % did not . RESULTS The urinary stress incontinence frequency at the 28 gestational week in the no exercises group was 17.2 % , and at the 35 gestational week of 47 % and at 6 weeks after childbirth was of 47 % , while in the exercises group was 0 , 0 and 15 % , respectively . Moreover there were statistically significant differences between both groups regarding the presence of urinary stress incontinence , that is , the group that realized exercises presented less incontinence at the 28 and 35 gestational weeks and at 6 weeks after childbirth . CONCLUSIONS The results of this study concluded that the pelvic floor exercises during pregnancy and after childbirth prevent the urinary stress incontinence at this time 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 Eighty-four prenatally depressed women were r and omly assigned to yoga , massage therapy or st and ard prenatal care control groups to determine the relative effects of yoga and massage therapy on prenatal depression and neonatal outcomes . Following 12 weeks of twice weekly yoga or massage therapy sessions ( 20 min each ) both therapy groups versus the control group had a greater decrease on depression , anxiety and back and leg pain scales and a greater increase on a relationship scale . In addition , the yoga and massage therapy groups did not differ on neonatal outcomes including gestational age and birthweight , and those groups , in turn , had greater gestational age and birthweight than the control group To assess the longitudinal changes in insulin release and insulin sensitivity in nonobese normal women during gestation , six women were evaluated with oral glucose tolerance testing , body composition analysis , intravenous glucose tolerance tests , and the hyperinsulinemic-euglycemic clamp before conception , at 12 to 14 weeks , and at 34 to 36 weeks ' gestation . There was a significant increase in the insulin/glucose ratio ( p = 0.028 ) during the oral glucose tolerance test during gestation . There was also a significant 3.0- to 3.5-fold increase throughout gestation in first-phase ( p = 0.001 ) and second-phase ( p = 0.0001 ) insulin release during the intravenous glucose tolerance test . Peripheral insulin sensitivity was estimated as the glucose infusion rate ( in milligrams per kilogram fat-free mass per minute ) during the hyperinsulinemic-euglycemic clamp . There was a significant ( p = 0.0003 ) 56 % decrease in insulin sensitivity through 36 weeks ' gestation . These results are the first to prospect ively evaluate the longitudinal changes in maternal carbohydrate metabolism from the time before conception through late gestation with newer methods such as the hyperinsulinemic-euglycemic clamp BACKGROUND Smoking during pregnancy is the main preventable cause of poor birth outcomes . Improved methods are needed to help women to stop smoking during pregnancy . Pregnancy provides a compelling rationale for physical activity ( PA ) interventions as cessation medication is contraindicated or ineffective , and an effective PA intervention could be highly cost-effective . OBJECTIVE To examine the effectiveness and cost-effectiveness of a PA intervention plus st and ard behavioural support for smoking cessation relative to behavioural support alone for achieving smoking cessation at the end of pregnancy . DESIGN Multicentre , two-group , pragmatic r and omised controlled trial and economic evaluation with follow-up at the end of pregnancy and 6 months postnatally . R and omisation was stratified by centre and a computer-generated sequence was used to allocate participants using a 1 : 1 ratio . SETTING 13 hospitals offering antenatal care in the UK . PARTICIPANTS Women between 10 and 24 weeks ' gestation smoking five or more cigarettes a day before pregnancy and one or more during pregnancy . INTERVENTIONS Participants were r and omised to behavioural support for smoking cessation ( control ) or behavioural support plus a PA intervention consisting of supervised treadmill exercise plus PA consultations . Neither participants nor research ers were blinded to treatment allocation . MAIN OUTCOME MEASURES The primary outcome was self-reported , continuous smoking abstinence between a quit date and end of pregnancy , vali date d by expired carbon monoxide and /or salivary cotinine . Secondary outcomes were maternal weight , depression , birth outcomes , withdrawal symptoms and urges to smoke . The economic evaluation investigated the costs of the PA intervention compared with the control intervention . RESULTS In total , 789 women were r and omised ( n = 394 PA , n = 395 control ) . Four were excluded post r and omisation ( two had been enrolled twice in sequential pregnancies and two were ineligible and r and omised erroneously ) . The intention-to-treat analysis comprised 785 participants ( n = 392 PA , n = 393 control ) . There was no significant difference in the rate of abstinence at the end of pregnancy between the PA group ( 7.7 % ) and the control group ( 6.4 % ) [ odds ratio for PA group abstinence 1.21 , 95 % confidence interval ( CI ) 0.70 to 2.10 ] . For the PA group compared with the control group , there was a 33 % ( 95 % CI 14 % to 56 % ) , 28 % ( 95 % CI 7 % to 52 % ) and 36 % ( 95 % CI 12 % to 65 % ) significantly greater increase in self-reported minutes of moderate- and vigorous-intensity PA from baseline to 1 week , 4 weeks and 6 weeks respectively . Accelerometer data showed that there was no significant difference in PA levels between the groups . There were no significant differences between the groups for change in maternal weight , depression , withdrawal symptoms or urges to smoke . Adverse events and birth outcomes were similar between the groups except for there being significantly more caesarean births in the control group than in the PA group ( 28.7 % vs. 21.3 % ; p < 0.023 ) . The PA intervention was less costly than the control intervention by £ 35 per participant . This was mainly attributable to increased health-care usage in the control group . However , there was considerable statistical uncertainty around this estimate . CONCLUSIONS During pregnancy , offering an intervention combining supervised exercise and PA counselling does not add to the effectiveness of behavioural support for smoking cessation . Only 10 % of participants had PA levels accessed by accelerometer and it is , therefore , unclear whether or not the lack of an effect on the primary outcome is the result of insufficient increases in PA . Research is needed to identify the smoking population s most suitable for PA interventions and methods for increasing PA adherence . TRIAL REGISTRATION Current Controlled Trials IS RCT N48600346 . FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol . 19 , No. 84 . See the NIHR Journals Library website for further project information 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 The interaction between maternal endurance exercise at or above a minimal conditioning level , prior to and during pregnancy , and pregnancy outcome was examined prospect ively in our obstetrical populace using epidemiologic techniques . Over a 3-month interval all women registering for antepartum care were interviewed . Those planning to continue exercise during pregnancy were re-interviewed between the 28th and 34th gestational weeks . A detailed review of clinical records was used for outcome assessment . Women who continued endurance exercise at or near preconceptual levels during pregnancy gained less weight ( -4.6 kg ) , delivered earlier (-8 d ) , and had lighter-weight offspring ( -500 g ) than those who stopped exercising prior to the 28th week . The latter group gained 2.2 kg more weight but delivered similar birthweight infants at a similar gestational age as their sedentary controls Objective Theoretical concerns regarding the supine position at rest due to the gravid uterus obstructing aorta and vena caval flow may impinge uterine blood flow ( UBF ) to the fetus and maternal venous return . Design Systematic review . Data sources Online data bases up to 11 December 2017 . Study criteria Eligible population ( pregnant without contraindication to exercise ) , intervention ( frequency , intensity , duration , volume or type of supine exercise ) , comparator ( no exercise or exercise in left lateral rest position , upright posture or other supine exercise ) , outcomes ( potentially adverse effects on maternal blood pressure , cardiac output , heart rate , oxygen saturation , fetal movements , UBF , fetal heart rate ( FHR ) patterns ; adverse events such as bradycardia , low birth weight , intrauterine growth restriction , perinatal mortality and other adverse events as documented by study authors ) , and study design ( except case studies and review s ) published in English , Spanish , French or Portuguese . Results Seven studies ( n=1759 ) were included . ‘ Very low ’ to ‘ low ’ quality evidence from three r and omised controlled trials indicated no association between supervised exercise interventions that included supine exercise and low birth weight compared with no exercise . There was ‘ very low ’ to ‘ low ’ quality evidence from four observational studies that showed no adverse events in the mother ; however , there were abnormal FHR patterns ( as defined by study authors ) in 20 of 65 ( 31 % ) fetuses during an acute bout of supine exercise . UBF decreased ( 13 % ) when women moved from left lateral rest to acute dynamic supine exercise . Conclusion There was insufficient evidence to ascertain whether  maternal exercise in the supine position is safe or should be avoided during pregnancy Background — Preterm birth leads to an early switch from fetal to postnatal circulation before completion of left ventricular in utero development . In animal studies , this results in an adversely remodeled left ventricle . We determined whether preterm birth is associated with a distinct left ventricular structure and function in humans . Methods and Results — A total of 234 individuals 20 to 39 years of age underwent cardiovascular magnetic resonance . One hundred two had been followed prospect ively since preterm birth ( gestational age=30.3±2.5 week ; birth weight=1.3±0.3 kg ) , and 132 were born at term to uncomplicated pregnancies . Longitudinal and short-axis cine images were used to quantify left ventricular mass , 3-dimensional geometric variation by creation of a unique computational cardiac atlas , and myocardial function . We then determined whether perinatal factors modify these left ventricular parameters . Individuals born preterm had increased left ventricular mass ( 66.5±10.9 versus 55.4±11.4 g/m2 ; P<0.001 ) with greater prematurity associated with greater mass ( r = −0.22 , P=0.03 ) . Preterm-born individuals had short left ventricles with small internal diameters and a displaced apex . Ejection fraction was preserved ( P>0.99 ) , but both longitudinal systolic ( peak strain , strain rate , and velocity , P<0.001 ) and diastolic ( peak strain rate and velocity , P<0.001 ) function and rotational ( apical and basal peak systolic rotation rate , P = 0.05 and P = 0.006 ; net twist angle , P=0.02 ) movement were significantly reduced . A diagnosis of preeclampsia during the pregnancy was associated with further reductions in longitudinal peak systolic strain in the offspring ( P=0.02 , n=29 ) . Conclusions — Individuals born preterm have increased left ventricular mass in adult life . Furthermore , they exhibit a unique 3-dimensional left ventricular geometry and significant reductions in systolic and diastolic functional parameters . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT01487824 The benefits of exercise and behavioural recommendations in gestational diabetes mellitus ( GDM ) are controversial . In a r and omized trial with a 2 × 2 factorial design , we examined the effect of exercise and behavioural recommendations on metabolic variables , and maternal/neonatal outcomes in 200 GDM patients . All women were given the same diet : group D received dietary recommendations only ; group E was advised to briskly walk 20‐min/day ; group B received behavioural dietary recommendations ; group BE was prescribed the same as B + E.  Dietary habits improved in all groups . In a multivariable regression model , fasting glucose did not change . Exercise , but not behavioural recommendations , was associated with the reduction of postpr and ial glucose ( p < 0001 ) , glycated haemoglobin ( HbA1c ; p < 0.001 ) , triglycerides ( p = 0.02 ) and C‐reactive protein ( CRP ; p < 0.001 ) and reduced any maternal/neonatal complications ( OR = 0.50 ; 95%CI=0.28–0.89;p = 0.02 ) . In GDM patients  a simple exercise programme reduced maternal postpr and ial glucose , HbA1c , CRP , triglycerides and any maternal/neonatal complications , but not fasting glucose values OBJECTIVE The objective of the study was to assess physical activity intervention assessed by a pedometer with or without dietary intervention on gestational weight gain ( GWG ) in obese pregnant women by comparing with a control group . STUDY DESIGN This study was a r and omized controlled trial of 425 obese pregnant women comparing 3 groups : ( 1 ) PA plus D , physical activity and dietary intervention ( n = 142 ) ; ( 2 ) PA , physical activity intervention ( n = 142 ) ; and ( 3 ) C , a control group receiving st and ard care ( n = 141 ) . All participants routinely in gestational weeks 11 - 14 had an initial dietary counseling session and were advised to limit GWG to less than 5 kg . Physical activity intervention included encouragement to increase physical activity , aim ing at a daily step count of 11,000 , monitored by pedometer assessment on 7 consecutive days every 4 weeks . Dietary intervention included follow-up on a hypocaloric Mediterranean-style diet . Instruction was given by a dietician every 2 weeks . The primary outcome measure was GWG , and the secondary outcome measures were complications of pregnancy and delivery and neonatal outcome . RESULTS The study was completed by 389 patients ( 92 % ) .  Median values of GWG ( ranges ) were lower in each of the intervention groups ( PA plus D , 8.6 [ -9.6 to 34.1 ] kg , and group PA , 9.4 [ -3.4 to 28.2 ] kg ) compared with the control group ( 10.9 [ -4.4 to 28.7 ] kg [ PA+D vs C ] ; P = .01 ; PA vs C ; P = .042 ) . No significant difference was found between the 2 intervention groups . In a multivariate analysis , physical activity intervention decreased GWG by a mean of 1.38 kg ( P = .040 ) . The Institute of Medicine 's recommendations for GWG were more frequently followed in the intervention groups . CONCLUSION Physical activity intervention assessed by pedometer with or without dietary follow-up reduced GWG compared with controls in obese pregnant women OBJECTIVE The level of  physical activity ( PA ) of pregnant women in Finl and is unknown . Even more limited is our knowledge of PA of women at high risk for gestational diabetes mellitus ( GDM ) . METHODS The women ( n=54 ) were r and omly assigned to a lifestyle intervention group ( n=27 ) including exercise advice by a physiotherapist six times during pregnancy or to a control group ( n=27 ) without additional exercise advice . Outcomes of the present study were required sample size , timing of counselling and change of PA . PA was retrospectively reported during 12 months before pregnancy and recorded one week monthly during pregnancy . RESULTS Individualized counselling by a physiotherapist result ed in small changes of  recreational PA  ( 2.7 MET hours/week , p=0.056 ) up to gestational week 25 compared with the similar decreasing tendency of PA in the control group . The women decreased recreational PA  after week 30 . Sample size of 550 women at high risk for GDM per group would be needed for a PA study . CONCLUSIONS The optimal time window for increasing PA  must be earlier than in the last trimester of pregnancy . Sample size for a study to increase PA  by 2.7 MET hours/week on pregnant women at high risk of GDM should be about 550 per group In a cluster-r and omized trial , Riitta Luoto and colleagues find that counseling on diet and activity can reduce the birthweight of babies born to women at risk of developing  gestational diabetes mellitus ( GDM  ) , but fail to find an effect on GDM Abstract Objectives : To determine whether changes in lifestyle in women with BMI > 25 could decrease gestational weight gain and unfavorable pregnancy outcomes . Methods : Women with BMI > 25 were r and omized at 1st trimester to no intervention or a Therapeutic Lifestyle Changes ( TLC ) Program including diet  ( overweight : 1700 kcal/day , obese : 1800 kcal/day ) and mild physical activity ( 30 min/day , 3 times/week ) . At baseline and at the 36th week women filled-in a Food Frequency Question naire . Outcomes : gestational weight gain , gestational diabetes mellitus , gestational hypertension , preterm delivery . Data stratified by BMI categories . Results : Socio-demographic features were similar between groups ( TLC : 33 cases , Controls : 28 cases ) . At term , gestational weight gain in obese women r and omized to TLC group was lower ( 6.7 ± 4.3 kg ) versus controls ( 10.1 ± 5.6 kg , p = 0.047 ) . Gestational diabetes mellitus , gestational hypertension and preterm delivery were also significantly lower . TLC was an independent factor in preventing gestational weight gain , gestational diabetes mellitus , gestational hypertension . Significant changes in eating habits occurred in the TLC group , which increased the number of snacks , the intake of fruits – vegetables and decreased the consumption of sugar . Conclusions : A caloric restriction associated to changes in eating behavior and constant physical activity , is able to reduce gestational weight gain and related pregnancy complications in obese women BACKGROUND Excessive weight gain during pregnancy is a major risk factor for  postpartum weight retention and future weight gain and obesity in women , but few adequately powered r and omized controlled trials have examined the efficacy of a behavioral weight-control intervention during pregnancy . OBJECTIVE This study examined whether a behavioral intervention during pregnancy could decrease the proportion of women who exceeded the 1990 Institute of Medicine ( IOM ) recommendations for gestational weight gains and increase the proportion of women who returned to pregravid weights by 6 mo postpartum . DESIGN This study was a r and omized , assessor-blind , controlled trial . Participants were pregnant ( 13.5 wk gestation ) , normal-weight ( NW ; n = 201 ) and overweight or obese ( OW/OB ; n = 200 ) women whose average age was 28.8 y. Participants were r and omly assigned within the 1990 IOM weight category ( NW compared with OW/OB ) to st and ard care ( n = 200 ) or to a behavioral intervention to prevent excessive gestational weight gain ( n = 201 ) . The intervention included one face-to-face visit ; weekly mailed material s that promoted an appropriate weight gain , healthy eating , and exercise ; individual graphs of weight gain ; and telephone-based feedback . The retention at the 6-mo postpartum assessment was 82 % . RESULTS Intent-to-treat analyses showed that the intervention , compared with st and ard care , decreased the percentage of NW women who exceeded IOM recommendations ( 40.2 % compared with 52.1 % ; P = 0.003 ) and increased the percentages of NW and OW/OB women who returned to their pregravid weights or below by 6 mo postpartum ( 30.7 % compared with 18.7 % ; P = 0.005 ) . CONCLUSION A low-intensity behavioral intervention during pregnancy reduced excessive gestational weight gains in NW women and prevented postpartum weight retention in NW and OW/OB women . This trial was registered at clinical trials.gov as NCT01117961
Objective We aim ed to identify the relationship between maternal prenatal exercise and birth complications , and neonatal and childhood morphometric , metabolic and developmental outcomes .