Content area
Full Text
Correspondence to Dr Margie H Davenport, Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, T6G 2E1, Canada; [email protected]
Introduction
In 2011, the American Heart Association Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women listed pregnancy complications including pre-eclampsia (PE), gestational hypertension (GH) and gestational diabetes mellitus (GDM) as risk factors as strong as smoking for the future development of cardiovascular disease.1 The strength of this relationship is supported by evidence of elevated risk for future type 2 diabetes (risk ratio (RR) 7.43), hypertension (RR 3.70), ischaemic heart disease (RR 2.26) and stroke (RR 1.8) in the 5–15 years following delivery.2 3 Furthermore, GDM, GH and PE are also associated with adverse outcomes in the offspring, such as excessive or inadequate fetal growth, fetal growth restriction, preterm delivery, perinatal death and long-term metabolic and cardiovascular morbidity.4–6 Prevention of these disorders during pregnancy is therefore essential for the future health of two generations.
Gestational diabetes is defined as ‘glucose intolerance with onset or first recognition during pregnancy’ and affects up to 6%–9% of the obstetric population.7 Hypertensive disorders of pregnancy include GH and PE and affect 10% of women.8 Although the disorders are distinct, GDM, GH and PE are often superimposed.9 These disorders have similar risk factors (eg, obesity, insulin resistance, advanced maternal age, excessive gestational weight gain)8 10 and are associated with inflammation, vascular dysfunction, oxidative stress and vascular disease.6 Exercise is a cornerstone for prevention and treatment of hypertension and diabetes in general populations; however, the effectiveness of exercise in prevention during pregnancy is poorly understood.
International and national guidelines for exercise during pregnancy recommend that women without contraindications be physically active throughout pregnancy.11 12 The present systematic review and meta-analysis was conducted as part of a series of reviews which will form the evidence base for the development of the 2019 Canadian guideline for physical activity throughout pregnancy (herein referred to as Guideline).13 The purpose of this review was to evaluate the effect of prenatal exercise on the odds of developing GDM, GH and PE.
Methods
In October 2015, the Guidelines Consensus Panel assembled to identify priority outcomes for the Guidelines...