Influence of Physical Activity during Pregnancy on Type and Duration of Delivery, and Epidural Use: Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Eligibility Criteria
2.2. Population
2.3. Intervention
2.4. Comparison
2.5. Outcome
2.6. Data Sources
- English: physical activity OR exercise OR training OR physical exercise OR fitness OR strength training OR physical intervention OR Pilates OR Yoga OR strengthening OR aerobic OR resistance training OR pelvic floor muscle training AND pregnancy OR maternal OR antenatal OR pregnant AND type of delivery OR mode of delivery OR duration of labor OR epidural OR anesthetic AND randomized clinical trial OR randomized controlled trial OR RCT OR Quasi experimental clinical trial.
- Spanish: actividad física O ejercicio O entrenamiento O ejercicio físico O fitness O entrenamiento de fuerza O intervención de actividad física O Pilates O Yoga O fortalecimiento O aeróbico O entrenamiento de resistencia O fortalecimiento del suelo pélvico Y embarazo O materno O antenatal O embarazada Y tipo de parto O modo de parto O duración del parto O epidural O anestesia Y ensayo clínico aleatorizado O ensayo controlado aleatorizado O ECA O cuasiexperimental.
2.7. Study Selection and Data Extraction
2.8. Quality of Evidence and Risk of Bias Assessments
2.9. Statistical Analysis
3. Results
3.1. Certainty of Evidence and Risk of Bias
3.2. Effect of Prenatal Physical Activity on Cesarean Delivery
3.3. Effect of Prenatal Physical Activity on Instrumental Delivery
3.4. Effect of Physical Activity during Pregnancy on Duration of the First Stage of Labor
3.5. Effect of Physical Activity during Pregnancy on Duration of the Second Stage of Labor
3.6. Effect of Physical Activity during Pregnancy on Duration of the Third Stage of Labor
3.7. Effect of Physical Activity during Pregnancy on Epidural Use
4. Discussion
Limitations and Strengths
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Ref | Country | N | IG | CG | Physical Activity Intervention | Main Variables | Secondary Variables | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Freq | Intens | Durat | Type | Superv | Time | Adh | |||||||
Abd et al., 2015 [21] | Egypt | 180 | 110 | 70 | 7 | Low | 10–15 | Perineal massage | No | 4 w | - | Episiotomy Perineal tear | Type of delivery |
5 | Pelvic floor muscle training | ||||||||||||
Aktan et al., 2021 [22] | Turkey | 43 | 21 | 22 | 2 | Mod | 60 | Clinical Pilates exercise | Yes | 8 w | - | General anxiety, gestational weight gain | Type of delivery, birth weight |
Awad et al., 2020 [9] | Egypt | 50 | 25 | 25 | 3 | Mod | 60 | Aerobic, pelvic floor exercises | Yes | 22 w | - | Duration of the second stage labor | Type of delivery and Apgar scores |
3 | 35 | No | |||||||||||
Babbar et al., 2016 [23] | USA | 46 | 23 | 23 | 3 | Mod | 60 | Yoga | Yes | 8 w | 80% | Umbilical artery, type of delivery, birth weight | Gestational weight gain |
Backhausen et al., 2017 [24] | Denmark | 516 | 258 | 258 | 2 | Low | 70 | Water exercises | No | 12 w | 76% | Low back pain, birth weight | Type of delivery |
Barakat et al., 2012 [25] | Spain | 290 | 138 | 152 | 3 | Mod | 40–45 | Aerobic exercise | Yes | 28 w | - | Type of delivery | Gestational weight gain birth weight |
Barakat et al., 2012 [26] | Spain | 83 | 40 | 43 | 3 | Low-Mod | 35–45 | Land aerobic and aquatic activity | Yes | 28 w | - | Gestational weight gain and gestational diabetes | Gestational age, type of delivery, birth weight and Apgar score |
Barakat et al., 2014 [27] | Spain | 200 | 107 | 93 | 3 | Low-Mod | 55–60 | Aerobic exercise, pelvic floor muscle training | Yes | 28 w | 80% | Gestational age, gestational weight gain, type of delivery, gestational diabetes | Birth weight, head circumference |
Barakat et al., 2016 [28] | Spain | 765 | 382 | 383 | 3 | Mod | 50–55 | Aerobic, strength, and flexibility exercise | Yes | 28 w | 80% | Hypertension | Type of delivery, gestational weight gain, birth weight |
Barakat et al., 2018 [29] | Spain | 429 | 227 | 202 | 3 | Mod | 55–60 | Aerobic exercise | Yes | 28 w | 80% | Duration of labor | Type of delivery, use of epidural, birth weight |
Barakat et al., 2018 [30] | Spain | 65 | 33 | 32 | 3 | Mod | 55–60 | Aerobic, pelvic floor strength, and flexibility exercises | Yes | 28 w | 85% | Placenta weight | Gestational age, type of delivery, birth weight |
Barakat et al., 2018 [31] | Spain | 456 | 234 | 222 | 3 | Mod | 50–55 | Aerobic exercise | Yes | 28 w | - | Gestational weight gain | Gestational age, type of delivery, birth weight |
Bhartia et al., 2019 [32] | India | 78 | 38 | 40 | 1 | Mod | 50 | Yoga | Yes | 12 w | - | Maternal Stress, type of delivery, birth weight | - |
2 | No | ||||||||||||
Bjøntegaard et al., 2021 [33] | Norway | 281 | 164 | 117 | 1 | Mod-High | 60 | Aerobic, strength training and balance exercises | Yes | 12 w | - | Type of delivery, birth weight | Physical activity of children at age of seven |
2 | 45 | No | |||||||||||
Bolanthakodi et al., 2018 [34] | India | 150 | 75 | 75 | 3 | Mod | 30 | Yoga | No | 9 w | - | Pain intensity, type of delivery, duration of delivery | Low birth weight, Preterm birth |
Carpenter et al., 2015 [35] | UK | 50 | 16 | 34 | 1 | Low-Mod | 40 | Stationary cycling, pelvic floor exercises and water exercises | Yes | 18 w | - | Hemodynamic function | Type of delivery, birth weight |
Carrascosa et al., 2021 [36] | Spain | 286 | 145 | 141 | 3 | Mod | 45 | Aquatic aerobic exercise | Yes | 20 w | - | Use of epidural analgesia during labor | Type of delivery, time of active labor, episiotomy |
Cordero et al., 2015 [37] | Spain | 257 | 101 | 156 | 1–2 | Low | 50–60 | Aerobics in gym hall and aquatic activity | Yes | 26 w | 80% | Gestational Diabetes | Gestational weight gain, type of delivery, birth weight |
Daly et al., 2017 [38] | Ireland | 88 | 44 | 44 | 3 | Mod | 50–60 | Aerobic, pelvic floor exercises | Yes | 26 w | - | Maternal fasting plasma glucose | Type of delivery, duration of labor, birth weight |
Dias et al., 2011 [39] | Norway | 42 | 21 | 21 | 1 | Low | 30 | Pelvic floor muscle training | Yes | 16 w | 75% | Type of delivery, duration of labor, birth weight | Pelvic floor muscle strength |
6 | No | ||||||||||||
Dieb et al., 2019 [40] | Egypt | 400 | 200 | 200 | 3 | Low | 5 | Pelvic floor muscle training | No | 4 w | - | Episiotomy, perineal tear, type of delivery | Duration of labor, fetal distress, episiotomy, birth weight |
3 | 10 | ||||||||||||
Ellingsen et al., 2020 [41] | Norway | 279 | 164 | 115 | 1 | Mod | 60 | Aerobic and strength exercises | Yes | 12 w | - | Neurodevelopmental in 7-year-old children | Gestational age, birth weight, type of delivery |
2 | 45 | No | |||||||||||
Ferreira et al., 2019 [42] | Portugal | 255 | 99 | 156 | 3 | Mod | 45–60 | Aerobic, strength, coordination and flexibility exercises | Yes | 24 w | - | Duration of labor, type of delivery | Episiotomy, perineal tear |
Fritel et al., 2015 [43] | France | 282 | 140 | 142 | 1 | Low | 20–30 | Pelvic floor training | Yes | 8 w | - | Urinary incontinence | Type of delivery, birth weight |
Gau et al., 2011 [44] | China | 87 | 48 | 39 | 3 | Low | 20 | Ball exercise | No | 8 w | - | Childbirth pain | Duration of labor |
Ghandali et al., 2021 [45] | Iran | 103 | 51 | 52 | 2 | Low-Mod | 35 | Pilates exercise | Yes | 8 | - | Type of delivery, episiotomy, duration of labor | Maternal satisfaction with childbirth process |
Ghodsi et al., 2014 [46] | Iran | 80 | 40 | 40 | 3 | Low | 15 | Stationary cycling | No | 15 w | - | Gestational weight gain, type of delivery, perineal tear | Pregnancy length, first and second stage of labor, Apgar score |
Guelfi et al., 2016 [47] | Australia | 172 | 85 | 87 | 3 | Mod | 20–60 | Stationary cycling program | Yes | 14 w | - | Gestational diabetes | Type of delivery, birth weight |
Haakstad et al., 2020 [48] | Norway | 105 | 52 | 53 | 2 | Mod | 60 | Aerobic dance and strength training | Yes | 12 w | 80% | Birth weight | Gestational age, type of delivery |
1 | 30 | No | |||||||||||
Johannessen et al., 2021 [49] | Norway | 722 | 383 | 339 | 1 | Mod | 55–70 | Aerobic, strength and pelvic floor exercises | Yes | 12 w | - | Urinary incontinence at 3 months postpartum | Type of delivery, episiotomy, epidural, duration of labor, birth weight |
2 | 45 | No | |||||||||||
Karthiga et al., 2022 [50] | India | 234 | 121 | 113 | 7 | Mod | 60 | Yoga | No | 20 w | - | Gestational hypertension, preeclampsia, premature delivery | Type of delivery, duration of labor, birth weight |
León-Larios et al., 2017 [51] | Spain | 466 | 254 | 212 | 5 | Low | 18–23 | Perineal massage and pelvic floor exercises | No | 6 w | - | Perineal tear and episiotomy | Type of delivery, duration of labor, birth weight and epidural |
Miquelutti et al., 2013 [52] | Brazil | 149 | 78 | 71 | 7 | Low | 10–30 | Aerobic and pelvic floor muscle exercises | No | 14 w | - | Urinary incontinence, lumbopelvic pain and anxiety | Type of delivery, duration of labor |
Nascimento et al., 2011 [53] | Brazil | 80 | 39 | 41 | 1 | Low-Mod | 40 | Aerobic exercise and walking | Yes | 17 w | 62.5% | Scoring women on meeting the intervention goals | Gestational weight gain, birth weight, macrosomia, and low birth weight |
5 | No | ||||||||||||
Okido et al., 2015 [54] | Brazil | 59 | 26 | 33 | 7 | Low | 20 | Pelvic floor muscle training | No | 16 w | - | PI of the uterine artery, type of delivery, duration of delivery, birth weight | Episiotomy, urinary incontinence |
Pais et al., 2021 [55] | India | 124 | 61 | 63 | 7 | Low | 45 | Yoga | No | 20 w | - | Preeclampsia and gestational diabetes | Gestational age, duration of labor, type of delivery, birth weight |
Pelaez et al., 2019 [56] | Spain | 345 | 230 | 115 | 3 | Low-Mod | 60–65 | Aerobic and resistance training | Yes | 24 w | 80% | Gestational weight gain | Gestational diabetes, macrosomia, type of delivery |
Perales et al., 2016 [57] | Spain | 166 | 83 | 83 | 3 | Low-Mod | 55–60 | Aerobic, strength exercises, pelvic floor muscle training | Yes | 28 w | - | Duration of labor, gestational age, gestational weight gain, type of delivery, birth weigh | Birth size, head circumference, Apgar score |
Perales et al., 2020 [58] | Spain | 1348 | 668 | 660 | 3 | Low-Mod | 50–55 | Aerobic and pelvic floor exercises | Yes | 30 | 95% | Gestational weight gain, hypertension and diabetes | Type of delivery, birth weight, gestational age |
Pereira et al., 2022 [59] | Portugal | 126 | 63 | 63 | 3 | Low-Mod | 30 | Walking | Yes | 3 w | - | Rate of labor induction | Type of delivery, birth weight |
Pinzón et al., 2012 [60] | Colombia | 64 | 31 | 33 | 3 | Low-Mod | 60 | Aerobic and stretching exercises | Yes | 12 w | - | Gestational age, gestational weight gain, type of delivery | Birth weight, birth size, head circumference, Apgar score |
Price et al., 2012 [61] | USA | 62 | 31 | 31 | 3 | Mod | 45–60 | Aerobic exercise and walk briskly | Yes | 23 w | - | Gestational weight gain. duration of labor, birth weight, postpartum recovery | Length of first and second stage of labor, type of delivery, gestational diabetes |
1 | 30–60 | No | |||||||||||
Rodríguez-Blanque et al., 2019 [62] | Spain | 129 | 65 | 64 | 3 | Mod | 60 | Aquatic physical exercise | Yes | 17 w | - | Laceration and episiotomy rates | Type of delivery, birth weight and anesthesia |
Rodríguez-Blanque et al., 2020 [63] | Spain | 129 | 65 | 64 | 3 | Mod | 60 | Aquatic physical exercise | Yes | 17 w | - | Gestational weight gain, type of delivery | Birth weight, Apgar score |
Rodríguez-Diaz et al., 2017 [64] | Spain | 100 | 50 | 50 | 2 | Mod | 40–45 | Pilates | Yes | 8 w | 90% | Gestational weight gain, blood pressure, strength, flexibility, and spinal curvature | Type of delivery, episiotomy analgesia and birth weight |
Ruiz et al., 2013 [65] | Spain | 962 | 481 | 481 | 3 | Low-Mod | 50–55 | Aerobic and resistance exercises | Yes | 28 w | 97% | Gestational weight gain | Birth weight, duration of labor |
Salvesen et al., 2014 [66] | Sweden | 855 | 427 | 426 | 1 | Low-Mod | 55–70 | Aerobic, strength and pelvic floor exercise | Yes | 12 w | - | Gestational diabetes | Urinary and anal incontinence, lumbopelvic pain, and duration of labor |
2 | 45 | No | |||||||||||
Sanda et al., 2018 [67] | Norway | 589 | 295 | 294 | 3 | Mod | 60 | Aerobic exercises | Yes | 22 w | - | Gestational age, duration of labor, type of delivery | - |
2 | 30 | No | |||||||||||
Seneviratne et al., 2015 [68] | New Zealand | 75 | 38 | 37 | 3–5 | Mod | 15–30 | Stationary cycling program | No | 16 w | 33% | Birth weight, type of delivery | Gestational weight gain, gestational age |
Shojaei et al., 2021 [69] | Iran | 100 | 49 | 51 | 4 | Mod | 40 | Walking | No | 4 w | - | Duration of labor | - |
Silva-Jose et al., 2022 [70] | Spain | 157 | 78 | 79 | 3 | Mod | 55–60 | Aerobic, strength and pelvic floor exercises | Yes | 28 w | 80% | Gestational weight gain | Type of delivery, birth weight |
Sobhgol et al., 2022 [71] | Australia | 200 | 100 | 100 | 1–2 | Low | 10 | Pelvic floor muscle exercises | No | 16 w | 50% | Female Sexual Function | Type of delivery, perineal tear, episiotomy, duration of labor, birth weight |
Stafne et al., 2012 [72] | Norway | 761 | 396 | 365 | 1 | Mod-High | 60 | Aerobic, strength, and pelvic floor exercises | Yes | 12 w | - | Gestational diabetes, insulin resistance | Birth weight, gestational age, Apgar scores |
3 | 45 | No | |||||||||||
Taniguchi et al., 2016 [73] | Japan | 118 | 60 | 58 | 3 | Mod | 30 | Walk briskly | Yes | 6 w | 80% | Duration of labor; type of delivery, birth weight | - |
Tomic et al., 2013 [74] | Croatia | 334 | 166 | 168 | 3 | Low-Mod | 50 | Aerobic exercise | Yes | 28 w | 80% | Macrosomia birth weight, gestational weight gain | Preeclampsia, gestational diabetes, type of delivery |
Uria-Minguito et al., 2022 [75] | Spain | 203 | 102 | 101 | 3 | Mod | 50–60 | Aerobic, strength, and pelvic floor exercises | Yes | 28 w | - | Gestational diabetes | Gestational weight gain, type of delivery, birth weight |
Ussher et al., 2015 [76] | UK | 789 | 394 | 395 | 3–4 | Low | 20 | Exercise on a treadmill | Yes | 6 w | - | Continuous smoking abstinence | Gestational age, preterm birth, type of delivery, birth weight |
Wang et al., 2017 [77] | China | 226 | 112 | 114 | 3 | Mod | 45–60 | Stationary cycling program | Yes | 24 w | 75% | Gestational diabetes | Gestational weight gain, birth weight, macrosomia |
Wang et.al., 2020 [78] | China | 108 | 54 | 54 | 7 | Low | 30 | Pelvic floor muscle training | No | 12 w | - | Stress urinary incontinence, episiotomy | Duration of labor and type of delivery |
Yekefallah et al., 2021 [79] | Iran | 70 | 35 | 35 | 2 | Low -Mod | 75 | Yoga | Yes | 11 w | - | Episiotomy, perineal tear, type of delivery | Birth weight, gestational age, duration of labor |
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Share and Cite
Zhang, D.; Ruchat, S.-M.; Silva-Jose, C.; Gil-Ares, J.; Barakat, R.; Sánchez-Polán, M. Influence of Physical Activity during Pregnancy on Type and Duration of Delivery, and Epidural Use: Systematic Review and Meta-Analysis. J. Clin. Med. 2023, 12, 5139. https://doi.org/10.3390/jcm12155139
Zhang D, Ruchat S-M, Silva-Jose C, Gil-Ares J, Barakat R, Sánchez-Polán M. Influence of Physical Activity during Pregnancy on Type and Duration of Delivery, and Epidural Use: Systematic Review and Meta-Analysis. Journal of Clinical Medicine. 2023; 12(15):5139. https://doi.org/10.3390/jcm12155139
Chicago/Turabian StyleZhang, Dingfeng, Stephanie-May Ruchat, Cristina Silva-Jose, Javier Gil-Ares, Rubén Barakat, and Miguel Sánchez-Polán. 2023. "Influence of Physical Activity during Pregnancy on Type and Duration of Delivery, and Epidural Use: Systematic Review and Meta-Analysis" Journal of Clinical Medicine 12, no. 15: 5139. https://doi.org/10.3390/jcm12155139