Effectiveness-based guidelines for the prevention of cardiovascular disease in women--2011 update: a guideline from the American Heart Association. A Comparison of Walking versus Stretching Exercises to Reduce the Incidence of Preeclampsia: A Randomized Clinical Trial Regular Exercise to Prevent the Recurrence of Gestational Diabetes Mellitus: A Randomized Controlled Trial 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. Physical activity and gestational diabetes mellitus among Hispanic women. Safety and efficacy of a lifestyle intervention for pregnant women to prevent excessive maternal weight gain: a cluster-randomized controlled trial Safety and efficacy of supervised strength training adopted in pregnancy. Antepartum, Intrapartum, and Neonatal Significance of Exercise on Healthy Low‐Risk Pregnant Working Women The impact of exercise during pregnancy on neonatal outcomes: a randomized controlled trial. Optimizing healthy gestational weight gain in women at high risk of gestational diabetes: a randomized controlled trial. The effect of a personalized intervention on weight gain and physical activity among pregnant women in China. The Association Between Physical Activity and Maternal and Neonatal Outcomes: A Prospective Cohort Effect of a behavioural intervention in obese pregnant women (the UPBEAT study): a multicentre, randomised controlled trial. Effects of a Partially Home‐Based Exercise Program for Women With Gestational Diabetes The Effect of Vigorous Exercise During Pregnancy on Birth‐Weight 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). Does physical activity in leisure time early in pregnancy reduce the incidence of preeclampsia or gestational hypertension? Effect of an Exercise Intervention on Gestational Diabetes Mellitus: A Randomized Controlled Trial Pragmatic controlled trial to prevent childhood obesity in maternity and child health care clinics: pregnancy and infant weight outcomes (The VACOPP Study) Exercise Training and Weight Gain in Obese Pregnant Women: A Randomized Controlled Trial (ETIP Trial) Exercise during pregnancy improves maternal glucose screen at 24–28 weeks: a randomised controlled trial Exercise during pregnancy improves maternal health perception: a randomized controlled trial. Maternal exercise during pregnancy, physical fitness, and fetal growth. Results From a European Multicenter Randomized Trial of Physical Activity and/or Healthy Eating to Reduce the Risk of Gestational Diabetes Mellitus: The DALI Lifestyle Pilot A 12-Week Exercise Program for Pregnant Women with Obesity to Improve Physical Activity Levels: An Open Randomised Preliminary Study Limiting antenatal weight gain improves maternal health outcomes in severely obese pregnant women: findings of a pragmatic evaluation of a midwife-led intervention. 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 Maternal and Perinatal Outcomes of Exercise in Pregnant Women with Chronic Hypertension and/or Previous Preeclampsia: A Randomized Controlled Trial Efficacy of a group-based dietary intervention for limiting gestational weight gain among obese women: a randomized trial Bone mineral density changes during pregnancy in actively exercising women as measured by quantitative ultrasound Comparison of Lifestyles of Women With Gestational Diabetes and Healthy Pregnant Women Effect of lifestyle intervention on dietary habits, physical activity, and gestational weight gain in obese pregnant women: a randomized controlled trial. Supervised exercise-based intervention to prevent excessive gestational weight gain: a randomized controlled trial. Pelvic floor muscle training included in a pregnancy exercise program is effective in primary prevention of urinary incontinence: a randomized controlled trial. Physical activity, sedentary behavior and risk of hypertensive disorders of pregnancy in Hispanic women 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 Wellness intervention with pregnant soldiers. Evaluating effects of self-reported domestic physical activity on pregnancy and neonatal outcomes in "stay at home" military wives. Comparison between the effect of lumbopelvic belt and home based pelvic stabilizing exercise on pregnant women with pelvic girdle pain; a randomized controlled trial. Effect of a Physical Exercise Program During Pregnancy on Uteroplacental and Fetal Blood Flow and Fetal Growth: A Randomized Controlled Trial Effects of human pregnancy and aerobic conditioning on alveolar gas exchange during exercise. Increased body fat percentage and physical inactivity are independent predictors of gestational diabetes mellitus in South Asian women Physical activity, sedentary behaviors and risk of gestational diabetes mellitus: a population-based cross-sectional study in Tianjin, China. Recreational physical activity and the risk of preeclampsia: a prospective cohort of Norwegian women. Assessment of foetal wellbeing in pregnant women subjected to pelvic floor muscle training: a controlled randomised study Regular Exercise During Pregnancy to Prevent Gestational Diabetes: A Randomized Controlled Trial Web-Based Behavioral Intervention Increases Maternal Exercise but Does Not Prevent Excessive Gestational Weight Gain in Previously Sedentary Women. Gestational Diabetes Mellitus Can Be Prevented by Lifestyle Intervention: The Finnish Gestational Diabetes Prevention Study (RADIEL) Prevention of Gestational Diabetes Effect of regular exercise on prevention of excessive weight gain in pregnancy: A randomised controlled trial Preventing Excessive Weight Gain During Pregnancy and Promoting Postpartum Weight Loss: A Pilot Lifestyle Intervention for Overweight and Obese African American Women Efficacy of yoga on pregnancy outcome. Exercise Is Associated with a Reduction in Gestational Diabetes Mellitus. Lifestyle modification program decreases pregnancy weight gain in obese women. 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 Population-based study on occupational risk factors for preeclampsia and gestational hypertension. Association between physical activity in early pregnancy and markers of placental growth and function. 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. Is Swimming During Pregnancy a Safe Exercise? 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. A prospective analysis of recreational physical activity and preeclampsia risk. 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.
Substantial progress has been made in the awareness , treatment , and prevention of  cardiovascular disease ( CVD ) in women since the first women-specific clinical recommendations for the prevention of CVD were published by the American Heart Association ( AHA ) in 1999.1 The myth that heart disease is a “ man 's disease ” has been debunked ; the rate of public awareness of CVD as the leading cause of death among US women has increased from 30 % in 1997 to 54 % in 2009.2 The age-adjusted death rate result ing from  coronary heart disease ( CHD ) in females , which accounts for about half of all CVD deaths in women , was 95.7 per 100 000 females in 2007 , a third of what it was in 1980.3,4 Approximately 50 % of this decline in CHD deaths has been attributed to reducing major risk factors and the other half to treatment of CHD including secondary preventive therapies.4 Major r and omized controlled clinical trials such as the Women 's Health Initiative have changed the practice of CVD prevention in women over the past decade.5 The investment in combating this major public health issue for women has been significant , as have the scientific and medical achievements . Despite the gains that have been made , considerable challenges remain . In 2007 , CVD still caused ≈1 death per minute among women in the United States.6 These represent 421 918 deaths , more women 's lives than were cl aim ed by cancer , chronic lower respiratory disease , Alzheimer disease , and accidents combined.6 Reversing a trend of the past 4 decades , CHD death rates in US women 35 to 54 years of age now actually appear to be increasing , likely because of the effects of the obesity epidemic.4 CVD rates in the United States are significantly higher for black females compared with their white counterparts ( 286.1/100 000 versus Objectives . To compare a walking exercise to a stretching exercise during pregnancy in high-risk women who were sedentary and had previously experienced preeclampsia . Methods . A r and omized clinical trial of the effects of the two types of physical exercises was conducted between November 2001 and July 2006 in Washtenaw County , Michigan . Both groups engaged in the assigned exercise five times a week until the end of pregnancy . Results . Women were r and omized to either the walking group ( n = 41 ) or the stretching group ( n = 38 ) . The walkers exercised an average of 36 ( SD , 6 ) minutes at 18 weeks gestation , 34 ( SD , 7 ) minutes at 28 weeks gestation , and 31 ( SD , 12 ) minutes at the last week of the intervention . On average , they exercised within target heart rate ranges 35 % ( SD , 32 % ) at 18 weeks gestation , 22 % ( SD , 25 % ) at 28 weeks gestation , and 17 % ( SD , 25 % ) at the last week of the intervention . The stretching group engaged in stretching exercises following a 40-minutes videotape . On average , the walking group exercised 4 ( SD , 1 ) times a week at 18 weeks gestation , 4 ( SD , 1 ) time a week at 28 weeks gestation , and 3 ( SD , 1 ) times a week at the last week of the intervention . Equally on average , the stretching group exercised 4 ( SD , 2 ) times a week at 18 weeks gestation , 5 ( SD , 1 ) times a week at 28 weeks gestation , and 3 ( SD , 1 ) times a week at the last week of the intervention . No difference between groups was observed , but both exercised significantly less frequently over the time ( p < 0.0001 ) . Together , participants reported average 7,040 ( SD , 2,612 ) steps at the beginning and 5,711 ( SD , 2,739 ) steps at the end of the study . The walkers tracked an average 8,501 ( SE , 778 ) steps a day at 20 weeks gestation and 7,418 ( SE , 788 ) steps at 34 weeks gestation ( n.s . ) . The stretchers tracked an average 6,189 ( SE , 704 ) steps at 20 weeks gestation and 4,848 ( SE , 452 ) steps at 34 weeks gestation ( p < 0.05 ) . The incidence of preeclampsia was 14.6 % ( 95 % CI , 5.6 to 29.2 ) among the walkers and 2.6 % ( 95 % CI ; 0.07 to 13.8 ) among the stretchers . The incidence of gestational hypertension was 22 % ( 95 % C.I. , 8.7 to 35.2 ) for the walkers and 40 % ( 95 % CI , 23.2 to 55.8 ) for the stretchers . The mean transferrin level , an antioxidant marker , was significantly higher in the stretching group mean ( 412 mg/dL , 95%CI , 389 to 435 ) than the walkers at the time of labor ( mean = 368 mg/dL , 95%CI , 346 to 391 ) ( p < 0.05 ) . No significant group differences were observed in birth outcomes . Conclusion . Regular stretching exercises may promote endogenous antioxidants among women at risk for preeclampsia 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 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 OBJECTIVE Studies in predominantly non-Hispanic white population s have suggested that physical activity during pregnancy is associated with a reduced risk of gestational diabetes mellitus ( GDM ) . There are few such studies in Hispanic women , a group at increased risk for GDM . METHODS We conducted a prospect i ve cohort study of household/caregiving , occupational , sports/exercise , and active living habits and the risk of GDM among 1006 Hispanic ( predominantly Puerto Rican ) prenatal care patients in western Massachusetts from 2000 to 2004 . Prepregnancy , early pregnancy , and midpregnancy physical activity was assessed using the Kaiser Physical Activity Survey . RESULTS A total of 33 women ( 3.3 % ) were diagnosed with GDM , and 119 women ( 11.8 % ) were diagnosed with abnormal glucose tolerance . There were no significant associations between GDM risk and occupational and active living activities  in prepregnancy , early pregnancy , and midpregnancy or with a change in levels of household/caregiving , occupational , and active living activities from prepregnancy to during pregnancy . However , after controlling for age and prepregnancy body mass index ( BMI ) , women in the highest quartile of prepregnancy ( OR = 0.2 , 95 % CI 0.1 - 0.8 , p(trend ) = 0.03 ) and midpregnancy ( OR = 0.2 , 95 % CI 0.1 - 0.8 , p(trend ) = 0.004 ) household/caregiving activities  as well as midpregnancy sports/exercise ( 0.1 , 95 % CI 0.0 - 0.7 , p(trend ) = 0.12 ) had a reduced risk of GDM compared with women in the lowest quartile . CONCLUSIONS Findings in this Hispanic population , although based on small numbers of cases , are consistent with prior research among predominantly non-Hispanic white population 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 OBJECTIVE Describe safety and efficacy of a supervised , low-to-moderate intensity strength training program adopted during pregnancy among women at increased risk for back pain . METHODS 32 women adopted strength training twice per week for 12 weeks . Data on musculoskeletal injuries , symptoms , blood pressure , and the absolute external load used for 5 of 6 exercises were obtained during each session . A submaximal lumbar extension endurance exercise test was performed at weeks 5 , 10 , and 13 . RESULTS The mean ( ± SD ) exercise session attendance rate was 80.5 % ( ± 11.3 % ) . No musculoskeletal injuries occurred . Potentially adverse symptoms ( eg , dizziness ) were infrequent ( 2.1 % of sessions ) . Repeated- measures ANOVA showed large increases in the external load across 12 weeks ( all P values < .001 ) and the percentage increases in external load from weeks 1 to 12 were 36 % for leg press , 39 % for leg curl , 39 % for lat pull down , 41 % for lumbar extension and 56 % for leg extension . Training was associated with a 14 % increase in lumbar endurance . Blood pressure was unchanged following acute exercise sessions and after 12 weeks of exercise training . CONCLUSION The adoption of a supervised , low-to-moderate intensity strength training program during pregnancy can be safe and efficacious for pregnant women OBJECTIVE To evaluate the influence of exercise on maternal and perinatal outcome in a low‐risk healthy obstetric population . METHODS We conducted a prospect i ve observational study of low‐risk healthy women exercising during their pregnancy . An extensive question naire collected antepartum , intrapartum , and postpartum patient information on 750 women . The women were divided into four groups based on exercise level during pregnancy . RESULTS There were no differences among groups for maternal demographic characteristics , antenatal illnesses , stress , social support , or smoking . Heavily exercising women were older ( P = .042 ) , had higher incomes ( P = .001 ) , and were exercising more at conception ( P = .001 ) . Women who did more exercise were more likely to need an induction of labor ( P = .033 , relative risk 1.84 , 95 % confidence interval 1.05 , 3.20 ) , induction or augmentation with oxytocin ( P = .015 , relative risk 1.53 , 95 % confidence interval 1.19 , 1.97 ) , and had longer first‐stage labors ( P = .032 ) result ing in longer total labors ( P = .011 ) . The difference in the length of first‐stage labor was even greater if the no‐exercise group was compared with the strongly exercising group ( P = .009 , relative risk 1.38 , 95 % confidence interval 0.16 , 2.60 ) . Fewer umbilical cord abnormalities ( P = .034 ) were observed with exercise , but exercising women had more colds and flu ( P = .008 ) . Heavily exercising women had smaller infants ( mean difference 86.5 g ) compared with sedentary women . CONCLUSION Exercise  in working women is associated with smaller babies , increased number of inductions and augmentations of labor , and longer labors . Colds and flu are more frequent in exercising women AIM The effect of exercise training during the course of pregnancy on the newborn 's birth weight is unclear . This study examines the effect of aerobic and strength conditioning exercise performed during the second and the third trimester of pregnancy in nulliparous , previously inactive women on the newborn 's outcome . METHODS Sixty-three nulliparous , previously sedentary , were r and omly assigned to either an exercise ( N.=30 ) or a control ( N.=33 ) group . The subjects participated in the exercise group ( EG ) focused on aerobic and strength-conditioning exercise in three sessions for about 20 weeks . We registered the birth weight , birth length , gestational age at time of delivery , Apgar score and head circumference of the newborn . RESULTS There were no statistically significant differences between the two groups in mean birth weight , length , head circumference , and length of gestation . There was a significant difference between two groups in Apgar scores at 1 min ( P=0.036 ) and 5 min ( P=0.015 ) with newborns of the EG scoring higher than the CG . CONCLUSION Supervised , aerobic and strength conditioning exercise performed over the second and third trimester of pregnancy does not have a negative impact on the newborn 's body size and health OBJECTIVE Optimizing gestational weight gain ( GWG ) in early pregnancy is of clinical and public health importance , especially in higher risk pregnancies . DESIGN AND METHODS In a robustly design ed , r and omized controlled trial , 228 pregnant women at risk of developing gestational diabetes mellitus ( GDM ) were allocated to either control ( written health information only ) or intervention ( four-session lifestyle program ) . All women received st and ard maternal care . Measures were completed at 12 - 15 and 26 - 28 weeks gestation . Measures included anthropometrics ( weight and height ) , physical activity ( pedometer and International Physical Activity Question naire ) , question naires ( risk perception ) , and GDM screening . RESULTS The mean ( SD ) age [ 31.7 ( 4.5 ) and 32.4 ( 4.7 ) years ] and body mass index [ BMI ; 30.3 ( 5.9 ) and 30.4 ( 5.6 ) kg/m(2 ) ] were similar between control and intervention groups , respectively . By 28 weeks , GWG was significantly different between control and intervention groups [ 6.9 ( 3.3 ) vs. 6.0 ( 2.8 ) kg , P < 0.05 ] . When stratified according to baseline BMI , overweight women in the control group gained significantly more weight compared to overweight women in the intervention group [ 7.8 ( 3.4 ) vs. 6.0 ( 2.2 ) kg , P < 0.05 ] , yet in obese women , GWG was similar in both groups . Physical activity levels declined by 28 weeks gestation overall ( P < 0.01 ) ; however , the intervention group retained a 20 % higher step count compared to controls [ 5,203 ( 3,368 ) vs. 4,140 ( 2,420 ) steps/day , P < 0.05 ] . Overall , GDM prevalence was 22.8 % [ Corrected ] , with a trend toward less cases in the intervention group ( P = 0.1 ) . CONCLUSIONS Results indicate that a low-intensity lifestyle intervention , integrated with antenatal care , optimizes healthy GWG and attenuates physical activity decline in early pregnancy . Efficacy in limiting weight gain was greatest in overweight women and in high-risk ethnically diverse women OBJECTIVE To examine whether personalized interventions could improve dietary intake and physical activity among pregnant women . METHODS A r and omized controlled trial was conducted at a center in Chengdu , China , between September 2012 and February 2013 . Women with a singleton pregnancy ( aged ≥18years , could underst and written Chinese , did not have pre-existing diabetes ) were enrolled at approximately 12weeks of pregnancy . They were r and omly assigned ( 1:1 ) to an intervention group ( received personalized educational material s ) or a control group ( conventional interventions only ) . Data for dietary intake and physical activity were recorded via question naires . Only pregnant women who completed the study were included in the analysis . RESULTS Analyses included 106 women in the control group and 115 in the intervention group . After intervention , the intake of energy , protein , fruit , milk , seafood , and nuts differed significantly between groups ( P<0.05 ) , with intakes closer to the recommended amounts in the intervention group . Women in the intervention group spent significantly less time resting ( P=0.033 ) and more time doing mild activity ( P=0.016 ) . Mean weight gain per week was significantly lower in the intervention group ( P=0.023 ) , and significantly fewer women in this group developed gestational diabetes ( P=0.043 ) . CONCLUSION Personalized educational interventions can improve dietary behavior and physical activity levels , and reduce prevalence of gestational diabetes among pregnant women in China . Chinese Clinical Trial Register : ChiCTR-IPR-15005809 Some evidence , but not enough to be conclusive , suggests that physical activity in pregnancy reduces the risk of perinatal complications . Our objective was to examine if physical activity in the year before pregnancy and in the first half of pregnancy is associated with maternal and neonatal outcomes . Associations between physical activity and maternal and neonatal outcomes were examined in a prospect i ve cohort ( n = 1,749 ) in Halifax , Canada . The Kaiser Physical Activity Survey , completed at approximately 20 weeks ’ gestation , requested information regarding physical activity during the year before the pregnancy and the first 20 weeks of pregnancy . Outcomes were assessed by medical chart review . Multiple logistic regression was used to estimate odds ratios ( OR ) with 95 % confidence intervals ( CI ) . Women with prepregnancy physical activity levels in the middle and highest tertiles were more likely to have high gestational weight gain relative to women in the lowest tertile [ OR ( CI ) : 1.40 ( 1.06–1.85 ) and 1.57 ( 1.18–2.09 ) , respectively ] . Higher physical activity  in the first half of pregnancy decreased the odds of delivering a macrosomic infant ( p trend = 0.005 ) . Associations were not observed between  total physical activity and gestational diabetes , gestational hypertension , pre-eclampsia , preterm birth , and low birth weight .  Physical activity before , but not in the first half of pregnancy , is associated with high gestational weight gain . Physical activity in the first half of pregnancy may reduce the occurrence of macrosomia without affecting preterm birth or low birth weight 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 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 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 Objective . Assessment of the association of physical activity in leisure time with  preeclampsia and gestational hypertension in nulliparous women . Design . Population based prospect i ve cohort study . Setting . Amsterdam , The Netherl and s. Population . All pregnant women in Amsterdam between January 2003 and March 2004 who were nulliparous with a singleton pregnancy and who delivered after 24 weeks . Design . At their first prenatal care visit , women were invited to fill out a question naire with sociodemographic and psychosocial variables .  Physical activity in leisure time in the past week  was measured using questions about walking , cycling , playing sports and other activities in leisure time .  The amount of minutes and intensity of each activity was studied using four categories : no , low , moderate or high activity . By using multivariate logistic regression , we adjusted for sociodemographic and medical confounders . Main outcome measures . Incidence of preeclampsia and gestational hypertension . Results . A total of 12,377 women were invited with a response rate of 67 % ; 3,679 nulliparous women were included . The incidence of preeclampsia and gestational hypertension was 3.5 % and 4.4 % , respectively . The amount of time or intensity of physical activity in leisure time was not associated with a difference in risk of preeclampsia or gestational hypertension . Conclusion . Physical activity in leisure time early in pregnancy does not reduce the incidence of preeclampsia or gestational hypertension  in an unselected population of nulliparous women 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 According to current evidence , the prevention of obesity should start early in life . Even the prenatal environment may expose a child to unhealthy weight gain ; maternal gestational diabetes is known to be among the prenatal risk factors conducive to obesity . Here we report the effects of antenatal dietary and physical activity counselling on pregnancy and infant weight gain outcomes . Methods The study was a non-r and omised controlled pragmatic trial aim ing to prevent childhood obesity , the setting being municipal maternity health care clinics . The participants ( n = 185 ) were mothers at risk of developing gestational diabetes mellitus and their offspring . The children of the intervention group mothers were born between 2009 and 2010 , and children of the control group in 2008 . The intervention started between 10–17 gestational weeks and consisted of individual counselling on diet and physical activity by a public health nurse , and two group counselling sessions by a dietician and a physiotherapist .  The expectant mothers also received a written information leaflet to motivate them to breastfeed their offspring for at least 6 months . We report the proportion of mothers with pathological glucose tolerance at 26–28 weeks ’ gestation , the mother ’s gestational weight gain ( GWG ) and newborn anthropometry . Infant weight gain from 0 to 12 months of age was assessed as weight-for-length st and ard deviation scores ( SDS ) and mixed effect linear regression models . Results Intervention group mothers had fewer pathological oral glucose tolerance test results ( 14.6 % vs. 29.2 % ; 95 % CI 8.9 to 23.0 % vs. 20.8 to 39.4 % ; p-value 0.016 ) suggesting that the intervention improved gestational glucose tolerance . Mother ’s GWG , newborn anthropometry or infant weight gain did not differ significantly between the groups . ConclusionS ince the intervention reduced the prevalence of gestational diabetes mellitus , it may have the potential to diminish obesity risk in offspring . However , results from earlier studies suggest that the possible effect on the offspring ’s weight gain may manifest only later in childhood . Trial registration Clinical Trials gov : 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 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 The value of exercise during pregnancy is controversial ; both benefits and risks have been hypothesized . As empiric evidence is scant , the issue was investigated in a prospect i ve study that assessed the impact on fetal growth of maternal exercise in each trimester of pregnancy . A cohort of over 800 prenatal patients was recruited from obstetric practice s in Pennsylvania and New York between January 1987 and June 1989 . Subjects were interviewed at entry into care and recontacted at 28 and 36 weeks of gestation . In women with prior adverse outcomes or a lack of conditioning , the associations between maternal exercise and fetal growth were equivocal . In fit , low-risk , prenatal patients , exercise was positively associated with fetal growth . With low-moderate exercise levels , the adjusted mean birth weights were about 100 g higher than in nonexercisers ( 117 g ; 95 % confidence interval 17 to 217 g ) . With heavier exercise , larger birth weight increments were seen , close to 300 g in those who exercised throughout pregnancy at levels of about 2,000 kcal/week in energy expenditure ( 276 g ; 95 % confidence interval 54 to 497 g ) . These results suggest that the guidelines issued by the American College of Obstetricians and Gynecologists may be too stringent for well-conditioned , low-risk , prenatal patients . Additional research to define safe limits more precisely seems warranted OBJECTIVE Ways to prevent gestational diabetes mellitus ( GDM ) remain unproven . We compared the impact of three lifestyle interventions ( healthy eating [ HE ] , physical activity [ PA ] , and both HE and PA [ HE+PA ] ) on GDM risk in a pilot multicenter r and omized trial . RESEARCH DESIGN AND METHODS Pregnant women at risk for GDM ( BMI ≥29 kg/m2 ) from nine European countries were invited to undertake a 75-g oral glucose tolerance test before 20 weeks ' gestation . Those without GDM were r and omized to HE , PA , or HE+PA . Women received five face-to-face and four optional telephone coaching sessions , based on the principles of motivational interviewing . A gestational weight gain ( GWG ) < 5 kg was targeted . Coaches received st and ardized training and an intervention toolkit . Primary outcome measures were GWG , fasting glucose , and insulin sensitivity ( HOMA ) at 35–37 weeks . RESULTS Among the 150 trial participants , 32 % developed GDM  by 35–37 weeks and 20 % achieved GWG < 5 kg . HE women had less GWG ( −2.6 kg [ 95 % CI −4.9 , −0.2 ] ; P = 0.03 ) and lower fasting glucose ( −0.3 mmol/L [ −0.4 , −0.1 ] ; P = 0.01 ) than those in the PA group at 24–28 weeks . HOMA was comparable . No significant differences between HE+PA and the other groups were observed . CONCLUSIONS An antenatal HE intervention is associated with less GWG and lower fasting glucose compared with PA alone . These findings require a larger trial for confirmation but support the use of early HE interventions in obese pregnant women 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 Antenatal obesity in pregnancy is associated with complications of pregnancy and poor obstetric outcomes . Although most guidance on pregnancy weight is focused on the prepregnancy period , pregnancy is widely viewed as a period where women are open to lifestyle change to optimise their health . METHODS The hospital-based Bumps and Beyond intervention invited all pregnant women with a body mass index ( BMI ) > 35 kg m(-2 ) to take part in a programme of health education around diet and exercise , accompanied by one-to-one guidance and monitoring of dietary change . This service evaluation compares 89 women who completed at a programme of seven sessions with healthy lifestyle midwives and advisors ( intervention ) versus a group of 89 women who chose not to attend ( non-intervention ) . RESULTS Mean ( SD ) weight gain in the intervention group [ 4.5 ( 4.6 ) kg ] was less than in the non-intervention group [ 10.3 ( 4.4 ) kg ] between antenatal booking and 36 weeks of gestation ( < 0.001 ) . This was associated with a 95 % reduction in the risk of gestational hypertension during pregnancy and a general reduction in pregnancy complications . There was no effect of the intervention upon gestational diabetes or complications in labour other than post-partum haemorrhage ( reduced by 55 % ) . The impact of the intervention on gestational weight gain was greater in women with BMI > 40 kg m(-2 ) at booking . There were no adverse effects of the intervention , even though 21 % of the intervention group lost weight during their pregnancy . CONCLUSIONS Intensive , personalised weight management intervention may be an effective strategy for the prevention of hypertensive disorders during pregnancy 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 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 Objective Observational studies suggest that minimal gestational weight gain ( GWG ) may optimize pregnancy outcomes for obese women . This trial tested the efficacy of a group-based weight management intervention for limiting GWG among obese women . Methods We r and omized 114 obese women ( BMI [ mean±SD ] 36.7±4.9 kg/m2 ) between 7–21 weeks ’ ( 14.9±2.6 ) gestation to intervention  ( n=56 ) or usual care control conditions  ( n=58 ) . The intervention included individualized calorie goals , advice to maintain weight within 3 % of r and omization and follow the Dietary Approaches to Stop Hypertension dietary pattern without sodium restriction , and attendance at weekly group meetings until delivery . Control participants received one-time dietary advice . Our three main outcomes were maternal weight change from r and omization to 2 weeks postpartum and from r and omization to 34 weeks gestation , and newborn large-for-gestational age ( birth weight > 90th percentile , LGA ) . Results Intervention participants gained less weight from r and omization to 34 weeks gestation ( 5.0 vs 8.4 kg , mean difference=−3.4 kg , 95 % CI [ −5.1 , −1.8 ] ) , and from r and omization to 2 weeks postpartum ( −2.6 vs + 1.2 kg , mean difference=−3.8 kg , 95 % CI [ −5.9 , −1.7 ] ) . They also had a lower proportion of LGA babies ( 9 % vs. 26 % , odds ratio=0.28 , 95 % CI [ 0.09 , 0.84 ] ) . Conclusions The intervention result ed in lower GWG and lower prevalence of LGA newborns Objective To evaluate whether bone mineral density ( BMD ) changes in women engaged in active exercises during pregnancy would be different from non-exercising women . Methods Consecutive patients with singleton pregnancies who were engaged in active exercise training during pregnancy were prospect ively recruited over a period of 6 months . Quantitative USG measurements of the os calcis BMD were performed at 14–20 weeks and at 36–38 weeks . These patients were compared to a control cohort of non-exercising low-risk women . Results A total of 24 physically active women undergoing active physical training of over 10 h per week at 20 weeks gestation and beyond ( mean 13.1 h , SD 3.3 ) were compared to 94 non-exercising low-risk women . A marginal fall in BMD of 0.015 g/cm2 ( SD 0.034 ) was demonstrable from early to late gestation in the exercising women , which was significantly lower than that of non-exercising women ( 0.041 g/cm2 ; SD 0.042 ; p = 0.005 ) . Logistic regression models confirmed that active exercises in pregnancy were significantly associated with the absence of or less BMD loss in pregnancy . Conclusion In women actively engaged in physical training during pregnancy , the physiological fall in BMD during pregnancy was apparently less compared to those who did not regularly exercise Background : Gestational diabetes is the most common medical condition in pregnancy and can be a predisposing factor in incidence of type II diabetes in future . Incorrect lifestyles can predispose people to various diseases , including diabetes , which is a serious health risk . Therefore , this study was conducted to compare lifestyles of women with gestational diabetes and healthy pregnant women attending the health centers affiliated to Shahid Beheshti University of Medical Sciences ( SBMU ) in 2013 . Methods : A comparative-descriptive study was conducted on 100 pregnant women with definite diagnosis of gestational diabetes and 100 healthy pregnant women attending the health centers affiliated to SBMU . Data were collected by a research er-made question naire about lifestyle during pregnancy . Informed consents were obtained , and sampling was performed using convenient multi-stage r and om sampling method . Data were analyzed using SPSS-18 software . Results : Demographic and obstetrics variables were not significantly different in the two groups . However , two groups were significantly different regarding their lifestyles as the mean scores of pregnancy diet were 65.05 in the diabetic group and 74.12 in the healthy group ( P<0.001 ) , and the mean moderate physical activity scores in the two groups were 4.62 and 5.69 , respectively ( P=0.042 ) , the mean pregnancy self-care scores were 71.9 and 81.87 , respectively ( P<0.001 ) , the mean perceived social support in the two groups were 65.75 and 73.88 , respectively ( P<0.001 ) , and the mean scores of perceived stress were 51.57 and 60.27 , respectively ( P<0.001 ) . Conclusion : Women ’s lifestyles were different in some areas . This study further reveals the importance of women ’s diet , self-care , moderate physical activity , and perceived social support during pregnancy . Incidence of gestational diabetes can be prevented through increased awareness and education of pregnant women about having appropriate lifestyles during pregnancy and any intervention that would lead to improved lifestyle 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 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 AIMS To investigate the effect of pelvic floor muscle training ( PFMT ) taught in a general exercise class during pregnancy on the prevention of  urinary incontinence ( UI ) in nulliparous continent pregnant women . METHODS This was a unicenter two armed r and omized controlled trial . One hundred sixty-nine women were r and omized by a central computer system to an exercise group ( EG ) ( exercise class including PFMT ) ( n = 73 ) or a control group ( CG ) ( n = 96 ) . 10.1 % loss to follow-up : 10 from EG and 7 from CG . The intervention consisted of 70 - 75 sessions ( 22 weeks , three times per week , 55 - 60 min/session including 10 min of PFMT ) . The CG received usual care ( which included follow up by midwifes including information about PFMT ) . Questions on prevalence and degree of UI were posed before ( week 10 - 14 ) and after intervention ( week 36 - 39 ) using the International Consultation on Incontinence Question naire-Urinary Incontinence Short Form ( ICIQ-UI SF ) . RESULTS At the end of the intervention , there was a statistically significant difference in favor of the EG . Reported frequency of UI [ Never : CG : 54/60.7 % , EG : 60/95.2 % ( P < 0.001 ) ] . Amount of leakage [ None : CG : 45/60.7 % , EG : 60/95.2 % ( P < 0.001 ) ] . There was also a statistically significant difference in ICIQ-UI SF Score between groups after the intervention period [ CG : 2.7 ( SD 4.1 ) , EG : 0.2 ( SD 1.2 ) ( P < 0.001 ) ] . The estimated effect size was 0.8 . CONCLUSION PFMT taught in a general exercise class three times per week for at least 22 weeks , without former assessment of ability to perform a correct contraction was effective in primary prevention of UI in primiparous pregnant women Objective : Prior studies of the association between physical activity and  hypertensive disorders of pregnancy have been conflicting ; the majority focused on leisure-time activity only , did not use physical activity question naires vali date d for pregnancy , and were conducted in primarily non-Hispanic white population s. Methods : We prospect ively evaluated this association among 1240 Hispanic women in Proyecto Buena Salud . The Pregnancy Physical Activity Question naire , vali date d for use in pregnancy , was used to assess pre- and early pregnancy sports/exercise , household/caregiving , occupational and transportation activity . Diagnoses of hypertensive disorders of pregnancy were based on medical record abstract ion and confirmed by the study obstetrician . Results : A total of 49 women ( 4.0 % ) were diagnosed with a hypertensive disorder of pregnancy , including 32 women ( 2.6 % ) with pre-eclampsia . In age-adjusted analyses , high levels of early pregnancy household/caregiving activity were associated with reduced risk of total hypertensive disorders ( OR = 0.4 , 95 % CI 0.1–0.9 ) and pre-eclampsia ( OR = 0.3 , 95 % CI 0.1–0.9 ) relative to low levels ; however , these findings were no longer statistically significant in multivariable models . Pre-pregnancy activity and pattern of activity from pre- to early-pregnancy were not significantly associated with risk . Finally , sedentary behavior was not significantly associated with hypertensive disorders . Conclusion : Findings from this prospect i ve study of Hispanic women were consistent with those of prior prospect i ve cohorts indicating that physical activity prior to and during early pregnancy does not significantly reduce risk of hypertensive disorders of pregnancy 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 The purpose of this study was to measure the effects that wellness program intervention for pregnant soldiers , exercise and /or education  , had on methods of delivery , pregnancy outcomes , rates of complications , Army Physical Fitness Test scores , and labor and delivery costs . The study consisted of a retrospective review and analysis of 823 active duty Army obstetric and newborn records , 181 Army Physical Fitness Test records , and 411 initial and 148 postpartum subjective question naires . Data were collected from records of soldiers who delivered at Madigan Army Medical Center ( Tacoma , Washington ) between January 1992 and December 1994 . Group I ( N = 211 ) included soldiers who received wellness intervention , group II ( N = 147 ) included those who did not receive wellness intervention .  Limited data from the records of soldiers who delivered before a wellness program was offered on post constituted group III , a historical control group ( N = 413 ) . Group IV included data from a high-risk population ( N = 52 ) collected during the wellness program .  Data were also divided into additional subgroups to ascertain if one aspect of the wellness program ( i.e. , exercise versus education ) influenced any or all of the dependent variables . A soldier 's data were excluded if a pregnancy was terminated before 20 weeks of gestation or if it was a multiple gestation . Demographic data and variables were compared using multivariate methods of analysis to evaluate the effect of the independent variable , wellness intervention . Results indicated that infants of the wellness group participants had proportionately increased gestational age and birth weight , with reduced incidence of the complications fetal bradycardia , hyperbilirubinemia , preeclampsia , and premature labor . Likewise , African-American female soldiers in this study , assessed in other studies as a high-risk group , had a lower incidence of premature delivery and low birth weight when they participated in wellness intervention . Of clinical interest , it appeared as though wellness intervention shortened labor duration and reduced the number of neonatal intensive care unit admissions and the number of neonatal intensive care unit days , which result ed in reduced health care costs OBJECTIVE To determine if an association exists between daily physical activity , and pregnancy/neonatal outcomes in stay at home military wives . METHODS This is a prospect i ve observational study of pregnant military wives who do not work outside the home . Participants completed a vali date d question naire of their daily activity from which the average energy expenditure per day ( kcal/day ) was calculated . Participants were grouped , according to their energy expenditure and assessed for antepartum , intrapartum , and neonatal outcomes . RESULTS There were 55 women ( group 1 ) who expended ≤ 2,200 kcal/day , 77 expended 2,201 to 3,000 kcal/day , and 58 expended ≥ 3,001 kcal/day . Group 1 had the lowest maternal weight at first visit ( p < 0.001 ) and delivery ( p < 0.001 ) and highest percentage of primigravidas ( p = 0.002 ) . After adjusting for key maternal characteristics , women in group 1 were more likely to develop gestational diabetes . Although not significant , the women in group 1 had more intrauterine growth restriction and preterm labor whereas group 3 had a greater risk of antepartum hemorrhage . CONCLUSIONS Primigravida women of low weight not working are most likely to use the least energy compared to the heaviest women who use the most calories and are more likely to develop gestational diabetes OBJECTIVE Pelvic girdle pain is a common complaint of pregnant women . There are limited data on comparison between the effectiveness of stabilizing exercises and lumbopelvic belt on the treatment of these patients . The objective of this study was to compare the effect of lumbopelvic belt plus information , home based pelvic girdle stabilizing exercises plus information and information alone on pain intensity , functional status and quality of life of pregnant women with pelvic girdle pain . METHODS In this r and omized clinical trial pregnant women with pelvic girdle pain ( n=105 ) were r and omly allocated to three groups ; Control group ( n=35 ) that received general information , exercise group ( n=31 ) that in addition to general information were asked to perform specific pelvic stabilizing exercises at home and belt group ( n=31 ) that received non-rigid lumbopelvic belt and the information . The primary outcome variables were pain intensity and functional status of the participants which were measured using visual analogue scale and Oswestry Disability Index ( ODI ) respectively . Quality of life of participants was measured using WHOQOL-BREF question naire . All measurements were performed at baseline , 3 and 6 weeks after the study conduction . RESULTS The pain intensity of patients in belt group in comparison to other groups was decreased significantly at both 3 and 6 weeks follow-ups . The mean score of ODI of patients in belt group was also improved more than exercise and control groups significantly . CONCLUSIONS On base of our results , it can be found that in short term lumbopelvic belt and information in treatment of pregnant women with pelvic girdle pain is superior to exercise plus information or information alone 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 : This study examined the effects of aerobic conditioning during the second and third trimesters of human pregnancy on ventilatory responses to grade d cycling . Previously sedentary pregnant women were assigned r and omly to an  exercise group ( n = 14 ) or a nonexercising control group ( n = 14 ) . Data were collected at 15 - 17 weeks , 25 - 27 weeks and 34 - 36 weeks of pregnancy . Testing involved 20 W.min-1 increases in work rate to a heart rate of 170 beats.min-1 and ( or ) volitional fatigue . Breath-by-breath ventilatory and alveolar gas exchange measurements were compared at rest , a st and ard submaximal .VO2 and peak exercise . Within both groups , resting .V(E ) , .V(A ) , and V(T)/T(I ) increased significantly with advancing gestation . Peak work rate , O2 pulse ( .VO2/HR ) , .V(E ) , .V(A ) respiratory rate , V(T)/T(I ) , .VO2 , .VCO2 , and the ventilatory threshold ( T(vent ) ) were increased after physical conditioning . Chronic maternal exercise has no significant effect on pregnancy-induced changes in ventilation and ( or ) alveolar gas exchange at rest or during st and ard submaximal exercise . Training-induced increases in T(vent ) and peak oxygen pulse support the efficacy of prenatal fitness programs to improve maternal work capacity Objective : This study aims to identify lifestyle predictors of gestational diabetes mellitus ( GDM ) in South Asian women . Pre-gravid body mass index , body composition , rate of weight gain during pregnancy , physical activity ( PA ) and dietary intake  were studied . Design : Prospect i ve cohort study ( n=611 ) of South Asian women at Aga Khan University Hospital antenatal clinic in Karachi , Pakistan . Weight , height and body fat % were measured and data on PA , diet and socio-economic covariates  were collected at baseline . A  glucose screen was performed at 29.8±2.6 weeks . Results : Using logistic regression analysis for the full cohort , the risk of GDM increased with older maternal age ( odds ratio ( OR ) 1.13 , confidence interval ( CI ) 1.06–1.21 ) , increased body fat % ( OR 1.07 , CI 1.03–1.13 ) and the risk was inversely associated with PA ( 100 kcal ) ( OR 0.79–0.99 , CI 0.89 ) . Using a nested case ( n=49 ) control ( n=98 ) design to study dietary intake , the risk of GDM decreased with increasing protein ( % energy ) in the diet ( OR 0.75 , CI 0.60–0.95 ) . Conclusions : Body fat % , physical inactivity and , possibly , diet quality are important modifiable risk factors for GDM OBJECTIVE Physical activity in a nonpregnant state or before pregnancy reduces the risk of  type 2 diabetes  and is also associated with reduced risk of gestational diabetes mellitus ( GDM ) . However , it is uncertain whether physical activity during pregnancy reduces the risk of GDM . DESIGN AND METHODS Using an established universal screening system in Tianjin , China , we prospect ively recruited 11 450 pregnant women within the 12th gestational week from 2010 to 2012 . These women underwent a 50-g 1-h glucose challenge test ( GCT ) at 24 - 28 weeks of gestation and a 75-g 2-h oral glucose tolerance test if GCT glucose ≥7.8mmol/L. GDM was defined according to the International Association of Diabetes and Pregnancy Study Group 's criteria .  Self-reported physical activity  in the last month was collected at GCT time using a vali date d question naire . RESULTS GDM developed in 7.3 % ( n=840 ) of the women . Women with GDM were less likely to be engaged in moderate-to-high physical activity during pregnancy than those without ( 79.8 % vs 81.6 % , P=0.191 ) .  Moderate-to-high physical  activity during pregnancy was associated with decreased risk of GDM ( multivariable odds ratio ( OR ) : 0.81 , 95 % confidence interval ( CI ) : 0.67 - 0.97 ) . Sitting at home for 2 - 4h per day and > 4h per day were associated with significantly increased risk of GDM ( multivariable OR of sitting time for 2 - 4h vs < 2h : 1.59 , 95 % CI : 1.18 - 2.15 ; OR of sitting time for > 4h vs < 2h : 1.73 , 95 % CI : 1.22 - 2.43 ) . CONCLUSIONS Increased physical activity during pregnancy was associated with reduced GDM risk , whereas sedentary lifestyle was associated with increased GDM risk among Chinese pregnant women Previous case-control studies suggest that recreational physical activity protects against  preeclampsia .  Using a prospect i ve design , the authors estimated the risk of preeclampsia for pregnant women according to level of physical activity , taking other variables that influence risk into consideration . The data set comprised 59,573 pregnancies from the Norwegian Mother and Child Cohort Study ( 1999 - 2006 ) . Information on physical activity and other exposures was extracted from question naire responses given in pregnancy weeks 14 - 22 , whereas diagnosis of preeclampsia was retrieved from the Medical Birth Registry of Norway . Estimation and confounder control was performed with multiple logistic regression . About 24 % of pregnant women reported no physical activity , and 7 % reported more than 25 such activities per month . The adjusted odds ratio was 0.79 ( 95 % confidence interval : 0.65 , 0.96 ) for preeclampsia when comparing women who exercised 25 times or more per month with inactive women . The association appeared strongest among women whose body mass index was less than 25 kg/m(2 ) and was absent among women whose body mass index was higher than 30 kg/m(2 ) . These results suggest that the preventive effect of recreational physical activity during pregnancy may be more limited than has been shown in case-control studies and may apply to nonobese women only 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 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 : BACKGROUND Innovative methods are warranted to optimize prenatal outcomes . This study 's objective was to determine if a web-based behavioral intervention ( BI ) can prevent excessive gestational weight gain ( GWG ) by increasing physical activity ( PA ) . METHODS Participants were r and omized to usual care ( UC ; n = 21 ) or BI ( n = 24 ) between 10 to 14 weeks gestation . GWG , PA , and diet were assessed at baseline , mid- , and late pregnancy . RESULTS No differences in GWG or adherence to GWG recommendations presented between groups . Total UC MET-minutes significantly decreased from baseline to late-pregnancy ( 1,234 ± 372 MET-minutes , P = .013 ) . Mid-pregnancy sustained PA was greater for BI than UC ( 20-minute PA bouts : 122 ± 106 vs. 46 ± 48 minutes/week , P = .005 ; 30-minute PA bouts : 74 ± 70 vs. 14 ± 24 minutes/week , P < .001 ) , and greater for BI at mid-pregnancy compared with baseline ( 20-minute PA bouts : 61.3 ± 21.9 ; 30-minute PA bouts : 39.6 ± 14.8 , both P < .05 ) . BI energy intake at mid-pregnancy significantly increased from baseline ( 336 ± 127 kcals , P = .04 ) and was significantly greater than UC ( 2,503 ± 703 vs. 1,894 ± 594 , P = .005 ) . CONCLUSIONS Sedentary pregnant women should increase PA but may need additional dietary counseling to prevent excessive GWG 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 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 To test the feasibility and acceptability of a theory-based lifestyle intervention design ed to prevent excessive weight gain during pregnancy and promote weight loss in the early postpartum period in overweight and obese African American women . Sixteen pregnant women ( ≤18 weeks gestation ) were recruited from prenatal clinics in Columbia , South Carolina in 2011 and assigned to a lifestyle intervention program . The intervention , guided by formative research , consisted of an individual counseling session followed by eight group sessions alternated with telephone counseling contacts that continued through 36 weeks of gestation . At 6–8 weeks postpartum , participants received a home visit and up to three counseling calls through week 12 . Medical charts were review ed for 38 contemporary controls who met the same inclusion criteria and attended the same prenatal clinics . Compared to controls , study participants gained less total weight , had a smaller weekly rate of weight gain across the 2nd and 3rd trimesters ( 0.89 vs. 0.96 lbs ) , and were less likely to exceed weight gain recommendations ( 56.3 vs. 65.8 % ) . At 12 weeks postpartum , study participants retained 2.6 lbs from their prepregnancy weight , half of study participants were at their prepregnancy weight or lower , and only 35 % retained ≥5 lbs . The intervention also demonstrated success in promoting physical activity and reducing caloric intake , and was well-received by participants . The initial results were promising . The lessons learned can help inform future studies . The efficacy of our intervention will be tested in a large r and omized controlled trial OBJECTIVE To study the efficacy of yoga on  pregnancy outcomes . DESIGN AND SETTING Three hundred thirty five ( 335 ) women attending the antenatal clinic at Gunasheela Surgical and Maternity Hospital in Bangalore , India , were enrolled between 18 and 20 weeks of pregnancy in a prospect i ve , matched , observational study ; 169 women in the yoga group and 166 women in the control group . METHODS Women were matched for age , parity , body weight , and Doppler velocimetry scores of umbilical and uterine arteries .  Yoga practice s , including physical postures , breathing , and meditation were practice d by the yoga group one hour daily , from the date of entry into the study until delivery . The control group walked 30 minutes twice a day ( st and ard obstetric advice ) during the study period . Compliance in both groups was ensured by frequent telephone calls and strict maintenance of an activity diary . MAIN OUTCOMES Birth weight and gestational age at delivery were primary outcomes . RESULTS The number of babies with birth weight > or = 2500 grams was significantly higher ( p < 0.01 ) in the yoga group . Preterm labor was significantly lower ( p < 0.0006 ) in the yoga group . Complications such as isolated intrauterine growth retardation ( IUGR ) ( p < 0.003 ) and pregnancy-induced hypertension ( PIH ) with associated IUGR ( p < 0.025 ) were also significantly lower in the yoga group . There were no significant adverse effects noted in the yoga group . CONCLUSIONS An integrated approach to yoga during pregnancy is safe . It improves birth weight , decreases preterm labor , and decreases IUGR either in isolation or associated with PIH , with no increased complications 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 We assessed the impact of a lifestyle modification program ( LMP ) on weight gain in pregnancy  and evaluated its effect on adverse pregnancy outcomes . A prospect i ve matched controlled study design was employed . Inclusion criteria consisted of pregnant women with singleton gestations and body mass index ( BMI ) > or = 30 without underlying medical conditions . In the study group , patients were prospect ively enrolled in the first trimester . Through the LMP , women participated in a comprehensive program on nutrition , exercise , and weight control in pregnancy . The control group consisted of matched patients by starting BMI , parity , and socioeconomic status during the same study period cared for at the same institution . The primary outcome evaluated was weight gain in pregnancy . Adverse pregnancy outcomes including preeclampsia , gestational diabetes , gestational hypertension , and various postpartum complications were evaluated between the two groups . Statistical analysis was performed using nonparametric methods , with p < 0.5 considered significant . Twenty-eight patients were recruited for this study and underwent the intervention . Patient compliance with the LMP was 75 % , two patients were lost to follow-up , one had a preterm delivery , and four had incomplete data due to various reasons . Twenty-one patients completed their pregnancy and were available for analysis . Twenty matched control patients were identified for analysis . Study participants gained significantly less weight in their pregnancies when compared with controls ( mean weight gain 17 versus 34 pounds , respectively ; p = 0.008 ) . Secondary outcomes of preeclampsia , gestational diabetes , cesarean section , as well as infant birth weight did not significantly differ between the groups . This study suggests an effective method of reducing prenatal weight gain in the obese population . This type of comprehensive intervention could be an important , cost-effective risk-reduction strategy 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 OBJECTIVES Preeclampsia is a leading cause of maternal and perinatal morbidity . Work-related factors may influence the occurrence of this disorder . This case-control study estimated the associations between work-related physical and psychosocial factors and the risk of preeclampsia and gestational hypertension .  METHODS The eligible women consisted of a r and om sample of the women who delivered a singleton live birth in 1997 - 1999 in six regions of Quebec and worked during pregnancy . Cases of preeclampsia ( N=102 ) and gestational hypertension ( N=99 ) were compared with normotensive controls ( N=4381 ) . Information on occupational exposures at the onset of pregnancy was collected during phone interviews a few weeks after delivery . Detailed information was obtained on work schedule , postures , physical exertion , work organization , noise , vibration , and extreme temperature . Adjusted odds ratios ( aOR ) were estimated through polytomous logistic regression . RESULTS Women st and ing daily at least 1 hour consecutively without walking experienced a higher risk of preeclampsia [ aOR 2.5 , 95 % confidence interval ( 95 % CI ) 1.4 - 4.6 ] , as well as women climbing stairs frequently ( aOR 2.3 , 95 % CI 1.2 - 4.1 ) and women working more than 5 consecutive days without a day-off ( aOR 3.0 , 95 % CI 1.0 - 9.5 ) . Squatting or kneeling , pushing or pulling objects , whole-body vibration , forced pace , job strain , and no control on breaks were positively , but nonsignificantly , associated with preeclampsia . The associations were weaker for gestational hypertension . CONCLUSIONS These findings suggest that being exposed to physically dem and ing and stressful occupational conditions at the onset of pregnancy increases the risk of preeclampsia OBJECTIVES It has been suggested that physical activity ( PA ) can influence the development of the placenta and the risk of placenta-mediated complications of pregnancy . We evaluated the association between PA and early markers of placental development . METHODS Ninety-four nulliparous women were invited to participate in a prospect i ve observational cohort study . Assessment included measurement of placental growth factor ( PlGF ) and pregnancy-associated plasma protein-A ( PAPP-A ) concentrations ( expressed in multiples of the median ) , an  ultrasound  at 11 to 13 weeks for measurement of placental volume and the mean uterine artery ( UtA ) pulsatility index , and a question naire on  PA .  The association between PA and these markers was evaluated using univariate and multivariate regression analyses . RESULTS We found a significantly lower concentration of PlGF and a trend towards lower placenta volume and lower PAPP-A concentration with increased PA frequency . The negative association between PA frequency and PlGF concentration remained significant after adjustment for potential confounding factors . CONCLUSION Our results suggest that PA in early pregnancy could negatively affect placental development . This finding could explain the association between PA and severe preeclampsia . This finding deserves confirmation in a larger cohort 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 Background : Exercise in pregnancy is recommended in many countries , and swimming is considered by many to be an ideal activity for pregnant women . Disinfection by-products in swimming pool water may , however , be associated with adverse effects on various reproductive outcomes . We examined the association between swimming in pregnancy and preterm and postterm birth , fetal growth measures , small-for-gestational-age , and congenital malformations . Methods : We used self-reported exercise data ( swimming , bicycling , or no exercise ) that were prospect ively collected twice during pregnancy for 74,486 singleton pregnancies . Recruitment to The Danish National Birth Cohort took place 1996–2002 . Using Cox , linear and logistic regression analyses , depending on the outcome , we compared swimmers with physically inactive pregnant women ; to separate a possible swimming effect from an effect of exercise , bicyclists were included as an additional comparison group . Results : Risk estimates were similar for swimmers and bicyclists , including those who swam throughout pregnancy and those who swam more than 1.5 hours per week . Compared with nonexercisers , women who swam in early/mid-pregnancy had a slightly reduced risk of giving birth preterm ( hazard ratio = 0.80 [ 95 % confidence interval = 0.72–0.88 ] ) or giving birth to a child with congenital malformations ( odds ratio = 0.89 [ 0.80–0.98 ] ) . Conclusions : These data do not indicate that swimming in pool water is associated with adverse reproductive outcomes 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 PURPOSE Although literature suggests that physical activity may reduce preeclampsia risk , most prior studies have relied on retrospective exposure assessment . We aim ed to assess prospect ively the relation between recreational physical activity before and during pregnancy and risk of preeclampsia . METHODS We used data from a 1996 - 2003 cohort study of 2241 pregnant western Washington State residents . During structured interviews conducted at 15 wk of gestation , on average , women reported recreational activities during the year before pregnancy and during the previous 7 d.  Preeclampsia diagnosis was established for 111 women using medical record data and st and ard guidelines . RESULTS Recreational activity in the year before pregnancy was nonstatistically significantly associated with reduced preeclampsia risk ( adjusted odds ratio [ OR ] for any vs none 0.55 , 95 % confidence interval [ CI ] 0.30 - 1.02 ) . Any activity during early pregnancy was not strongly associated with preeclampsia risk ( adjusted OR = 1.07 , 95 % CI = 0.67 - 1.69 ) . Compared with women who reported no recreational activity before or during early pregnancy , risk was nonsignificantly lower among those who were active only before pregnancy ( OR = 0.73 , 95 % CI = 0.30 - 1.77 ) and during both periods ( OR = 0.76 , 95 % CI = 0.34 - 1.73 ) . Those who were active only in early pregnancy had nonsignificantly increased preeclampsia risk ( OR = 2.03 , 95 % CI = 0.71 - 5.81 ) . CONCLUSION These results corroborate previous case-control studies suggesting that prepregnancy recreational activity reduces preeclampsia risk . The absence of an association with early-pregnancy recreational activity in this cohort may be due to misclassification of usual early-pregnancy activity 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 Gestational diabetes mellitus ( GDM ) , gestational hypertension ( GH ) and pre-eclampsia ( PE ) are associated with short and long-term health issues for mother and child ; prevention of these complications is critically important .
This study aim ed to perform a systematic review and meta- analysis of the relationships between prenatal exercise and GDM , GH and PE .