Advertisement

Physical activity and pregnancy outcomes: an expert review

Published:September 25, 2022DOI:https://doi.org/10.1016/j.ajogmf.2022.100758
      This expert review aimed to assess current literature on the effect and tracking of physical activity during pregnancy and associated outcomes. Self-reported physical activity may be inaccurate given the subjective nature of the questionnaires. The accelerometer ActiGraph is considered the “gold standard” to objectively measure physical activity. However, other more user-friendly wearable devices are now widely available and may accurately track physical activity. Conclusive data from both validated activity questionnaires and accelerometers indicate that physical activity is safe during pregnancy. In addition, studies of physical activity during pregnancy that evaluate pregnancy outcomes have found reduced risks of preterm birth, preeclampsia, and gestational diabetes mellitus and improved mental health among individuals who regularly engage in physical activity. In the United States, approximately 48% of pregnant individuals gain more than the recommended amount of weight during pregnancy; excessive gestational weight gain is associated with an increased risk of maternal and fetal complications, including preterm birth, preeclampsia, and gestational diabetes mellitus, and corresponding higher adverse short- and long-term maternal and offspring health outcomes. Although physical activity is safe during pregnancy and may reduce excessive gestational weight gain and resultant pregnancy complications, further research is needed to determine the frequency and duration of specific types of physical activity during pregnancy. Providers should encourage physical activity before and during pregnancy and educate patients regarding the benefits and safety of physical activity.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology MFM
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Warburton DER
        • Bredin SSD.
        Health benefits of physical activity: a systematic review of current systematic reviews.
        Curr Opin Cardiol. 2017; 32: 541-556
        • Piercy KL
        • Troiano RP
        • Ballard RM
        • et al.
        The physical activity guidelines for Americans.
        JAMA. 2018; 320: 2020-2028
        • Hosker DK
        • Elkins RM
        • Potter MP.
        Promoting mental health and wellness in youth through physical activity, nutrition, and sleep.
        Child Adolesc Psychiatr Clin N Am. 2019; 28: 171-193
        • Vankim NA
        • Nelson TF.
        Vigorous physical activity, mental health, perceived stress, and socializing among college students.
        Am J Health Promot. 2013; 28: 7-15
        • Sampasa-Kanyinga H
        • Colman I
        • Goldfield GS
        • et al.
        Combinations of physical activity, sedentary time, and sleep duration and their associations with depressive symptoms and other mental health problems in children and adolescents: a systematic review.
        Int J Behav Nutr Phys Act. 2020; 17: 72
        • Warburton DE
        • Nicol CW
        • Bredin SS.
        Health benefits of physical activity: the evidence.
        CMAJ. 2006; 174: 801-809
        • Rasmussen KM
        • Catalano PM
        • Yaktine AL.
        New guidelines for weight gain during pregnancy: what obstetrician/gynecologists should know.
        Curr Opin Obstet Gynecol. 2009; 21: 521-526
        • Syed H
        • Slayman T
        DuChene Thoma K. ACOG Committee Opinion No. 804: physical activity and exercise during pregnancy and the postpartum period.
        Obstet Gynecol. 2021; 137: 375-376
        • Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion
        Weight gain during pregnancy.
        Centers for Disease Control and Prevention, 2022 (Available at:) (Accessed March 30, 2021)
        • American College of Obstetricians and Gynecologists
        ACOG Committee Opinion No. 548: weight gain during pregnancy.
        Obstet Gynecol. 2013; 121: 210-212
        • Hedderson MM
        • Weiss NS
        • Sacks DA
        • et al.
        Pregnancy weight gain and risk of neonatal complications: macrosomia, hypoglycemia, and hyperbilirubinemia.
        Obstet Gynecol. 2006; 108: 1153-1161
        • Johnson J
        • Clifton RG
        • Roberts JM
        • et al.
        Pregnancy outcomes with weight gain above or below the 2009 Institute of Medicine guidelines.
        Obstet Gynecol. 2013; 121: 969-975
        • Crane JM
        • White J
        • Murphy P
        • Burrage L
        • Hutchens D.
        The effect of gestational weight gain by body mass index on maternal and neonatal outcomes.
        J Obstet Gynaecol Can. 2009; 31: 28-35
        • Wilson BJ
        • Watson MS
        • Prescott GJ
        • et al.
        Hypertensive diseases of pregnancy and risk of hypertension and stroke in later life: results from cohort study.
        BMJ. 2003; 326: 845
        • Brown DW
        • Dueker N
        • Jamieson DJ
        • et al.
        Preeclampsia and the risk of ischemic stroke among young women: results from the Stroke Prevention in Young Women Study.
        Stroke. 2006; 37: 1055-1059
        • Smith GC
        • Pell JP
        • Walsh D.
        Pregnancy complications and maternal risk of ischaemic heart disease: a retrospective cohort study of 129,290 births.
        Lancet. 2001; 357: 2002-2006
        • Wichmann JL
        • Takx RAP
        • Nunez JH
        • et al.
        Relationship between pregnancy complications and subsequent coronary artery disease assessed by coronary computed tomographic angiography in black women.
        Circ Cardiovasc Imaging. 2019; 12e008754
        • Kestenbaum B
        • Seliger SL
        • Easterling TR
        • et al.
        Cardiovascular and thromboembolic events following hypertensive pregnancy.
        Am J Kidney Dis. 2003; 42: 982-989
        • Bellamy L
        • Casas JP
        • Hingorani AD
        • Williams DJ.
        Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis.
        BMJ. 2007; 335: 974
        • Mongraw-Chaffin ML
        • Cirillo PM
        • Cohn BA.
        Preeclampsia and cardiovascular disease death: prospective evidence from the child health and development studies cohort.
        Hypertension. 2010; 56: 166-171
        • Sanders J
        • Channon S
        • Cannings-John R
        • et al.
        Pregnancy and weight monitoring: a feasibility study of weight charts and midwife support.
        Matern Child Nutr. 2020; 16: e12996
        • Nascimento SL
        • Surita FG
        • Godoy AC
        • Kasawara KT
        • Morais SS.
        Physical activity patterns and factors related to exercise during pregnancy: a cross sectional study.
        PLoS One. 2015; 10e0128953
        • Kianfard L
        • Niknami S
        • SHokravi FA
        • Rakhshanderou S.
        Facilitators, barriers, and structural determinants of physical activity in nulliparous pregnant women: a qualitative study.
        J Pregnancy. 2022; 20225543684
        • Flannery C
        • McHugh S
        • Anaba AE
        • et al.
        Enablers and barriers to physical activity in overweight and obese pregnant women: an analysis informed by the theoretical domains framework and COM-B model.
        BMC Pregnancy Childbirth. 2018; 18: 178
        • Briend A.
        Maternal physical activity, birth weight and perinatal mortality.
        Med Hypo. 1980; 6: 1157-1170
        • Briend A.
        Fetal malnutrition–the price of upright posture?.
        Br Med J. 1979; 2: 317-319
        • Szymanski LM
        • Kogutt BK.
        Uterine artery Doppler velocimetry during individually prescribed exercise in pregnancy.
        Obstet Gynecol. 2018; 132: 1026-1032
        • Szymanski LM
        • Satin AJ.
        Exercise during pregnancy: fetal responses to current public health guidelines.
        Obstet Gynecol. 2012; 119: 603-610
        • Mittelmark RA
        • Wiswell RA.
        Exercise in pregnancy.
        Williams & Wilkins, Baltimore, MD1986
        • Brown MW.
        Prenatal care.
        US Government Printing Office, Washington, DC1962
        • American College of Obstetricians and Gynecologists
        Exercise during pregnancy and the postpartum period.
        American College of Obstetricians and Gynecologists, Washington, DC1985
        • American College of Obstetricians and Gynecologists
        Exercise during pregnancy and the postpartum period.
        Int J Gynaecol Obstet. 1994; 45: 65-70
        • American College of Obstetricians and Gynecologists
        Exercise during pregnancy and the postpartum period.
        Clin Obstet Gynecol. 2003; 46: 496-499
      1. ACOG Committee Opinion No. 650: physical activity and exercise during pregnancy and the postpartum period.
        Obstet Gynecol. 2015; 126: e135-e142
      2. Physical activity and exercise during pregnancy and the postpartum period: ACOG Committee Opinion Summary, Number 804.
        Obstet Gynecol. 2020; 135: 991-993
        • Mota P
        • Bø K.
        ACOG Committee Opinion No. 804: physical activity and exercise during pregnancy and the postpartum period.
        Obstet Gynecol. 2021; 137: 376
      3. Exercise during pregnancy and the postpartum period. ACOG Technical Bulletin Number 189–February 1994.
        Int J Gynaecol Obstet. 1994; 45: 65-70
        • ACOG Committee Obstetric Practice
        ACOG Committee Opinion. Number 267, January 2002: exercise during pregnancy and the postpartum period.
        Obstet Gynecol. 2002; 99: 171-173
      4. Physical activity and exercise during pregnancy and the postpartum period: ACOG Committee Opinion, Number 804.
        Obstet Gynecol. 2020; 135: e178-e188
        • Bull FC
        • Al-Ansari SS
        • Biddle S
        • et al.
        World Health Organization 2020 guidelines on physical activity and sedentary behaviour.
        Br J Sports Med. 2020; 54: 1451-1462
        • Evenson KR
        • Chasan-Taber L
        • Symons Downs D
        • Pearce EE
        Review of self-reported physical activity assessments for pregnancy: summary of the evidence for validity and reliability.
        Paediatr Perinat Epidemiol. 2012; 26: 479-494
        • Çırak Y
        • Yılmaz GD
        • Demir YP
        • Dalkılınç M
        • Yaman S.
        Pregnancy physical activity questionnaire (PPAQ): reliability and validity of Turkish version.
        J Phys Ther Sci. 2015; 27: 3703-3709
        • Fjeldsoe BS
        • Marshall AL
        • Miller YD.
        Measurement properties of the Australian Women's Activity Survey.
        Med Sci Sports Exerc. 2009; 41: 1020-1033
        • Schmidt MD
        • Freedson PS
        • Pekow P
        • Roberts D
        • Sternfeld B
        • Chasan-Taber L.
        Validation of the Kaiser Physical Activity Survey in pregnant women.
        Med Sci Sports Exerc. 2006; 38: 42-50
        • Evenson KR
        • Siega-Riz AM
        • Savitz DA
        • Leiferman JA
        • Thorp Jr., JM
        Vigorous leisure activity and pregnancy outcome.
        Epidemiology. 2002; 13: 653-659
        • Lindseth G
        • Vari P.
        Measuring physical activity during pregnancy.
        West J Nurs Res. 2005; 27: 722-734
        • Melanson Jr, EL
        • Freedson PS.
        Physical activity assessment: a review of methods.
        Crit Rev Food Sci Nutr. 1996; 36: 385-396
        • Kavanagh JJ
        • Menz HB.
        Accelerometry: a technique for quantifying movement patterns during walking.
        Gait Posture. 2008; 28: 1-15
        • Bell R
        • Tennant PW
        • McParlin C
        • et al.
        Measuring physical activity in pregnancy: a comparison of accelerometry and self-completion questionnaires in overweight and obese women.
        Eur J Obstet Gynecol Reprod Biol. 2013; 170: 90-95
        • Jetté M
        • Sidney K
        • Blümchen G.
        Metabolic equivalents (METS) in exercise testing, exercise prescription, and evaluation of functional capacity.
        Clin Cardiol. 1990; 13: 555-565
        • Aparicio-Ugarriza R
        • Mielgo-Ayuso J
        • Benito PJ
        • et al.
        Physical activity assessment in the general population; instrumental methods and new technologies.
        Nutr Hosp. 2015; 31: 219-226
        • Borg GA.
        Psychophysical bases of perceived exertion.
        Med Sci Sports Exerc. 1982; 14: 377-381
        • St-Laurent A
        • Mony MM
        • Mathieu MÈ
        • Ruchat SM.
        Validation of the Fitbit Zip and Fitbit Flex with pregnant women in free-living conditions.
        J Med Eng Technol. 2018; 42: 259-264
      5. ActiGraph. Academic research. 2022. Available at: https://actigraphcorp.com/research-database-access/, https://nam11.safelinks.protection.outlook.com/?url=https%3A%2F%2Factigraphcorp.com%2Fresearch-database-access%2F&data=05%7C01%7Ccorrectionsaptara%40elsevier.com%7Ce8ea63132a4e4131527e08dab8dda1ba%7C9274ee3f94254109a27f9fb15c10675d%7C0%7C0%7C638025559283392327%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=8j3r5XqwOIYr3p%2Bj826rdvxQejmn0V%2BnZMaeCdzaasc%3D&reserved=0. Accessed October 25, 2022.

        • O'Brien WJ
        • Shultz SP
        • Firestone RT
        • George L
        • Breier BH
        • Kruger R.
        Exploring the challenges in obtaining physical activity data from women using hip-worn accelerometers.
        Eur J Sport Sci. 2017; 17: 922-930
        • Choi J
        • Lee JH
        • Vittinghoff E
        • Fukuoka Y
        mHealth physical activity intervention: a randomized pilot study in physically inactive pregnant women.
        Matern Child Health J. 2016; 20: 1091-1101
        • Price K
        • Bird SR
        • Lythgo N
        • Raj IS
        • Wong JY
        • Lynch C.
        Validation of the Fitbit One, Garmin Vivofit and Jawbone UP activity tracker in estimation of energy expenditure during treadmill walking and running.
        J Med Eng Technol. 2017; 41: 208-215
        • Zhang P
        • Godin SD
        • Owens MV.
        Measuring the validity and reliability of the Apple Watch as a physical activity monitor.
        J Sports Med Phys Fitness. 2019; 59: 784-790
        • Bai Y
        • Tompkins C
        • Gell N
        • Dione D
        • Zhang T
        • Byun W
        Comprehensive comparison of Apple Watch and Fitbit monitors in a free-living setting.
        PLoS One. 2021; 16e0251975
        • Evenson KR
        • Goto MM
        • Furberg RD.
        Systematic review of the validity and reliability of consumer-wearable activity trackers.
        Int J Behav Nutr Phys Act. 2015; 12: 159
        • Grisso JA
        • Main DM
        • Chiu G
        • Synder ES
        • Holmes JH.
        Effects of physical activity and life-style factors on uterine contraction frequency.
        Am J Perinatol. 1992; 9: 489-492
        • Aune D
        • Schlesinger S
        • Henriksen T
        • Saugstad OD
        • Tonstad S.
        Physical activity and the risk of preterm birth: a systematic review and meta-analysis of epidemiological studies.
        BJOG. 2017; 124: 1816-1826
        • Di Mascio D
        • Magro-Malosso ER
        • Saccone G
        • Marhefka GD
        • Berghella V.
        Exercise during pregnancy in normal-weight women and risk of preterm birth: a systematic review and meta-analysis of randomized controlled trials.
        Am J Obstet Gynecol. 2016; 215: 561-571
        • Grobman WA
        • Gilbert SA
        • Iams JD
        • et al.
        Activity restriction among women with a short cervix.
        Obstet Gynecol. 2013; 121: 1181-1186
        • Zemet R
        • Schiff E
        • Manovitch Z
        • et al.
        Quantitative assessment of physical activity in pregnant women with sonographic short cervix and the risk for preterm delivery: a prospective pilot study.
        PLoS One. 2018; 13e0198949
        • Schwartz N
        • Green MS
        • Yefet E
        • Nachum Z.
        Modifiable risk factors for gestational diabetes recurrence.
        Endocrine. 2016; 54: 714-722
        • Tobias DK
        • Zhang C
        • van Dam RM
        • Bowers K
        • Hu FB.
        Physical activity before and during pregnancy and risk of gestational diabetes mellitus: a meta-analysis.
        Diabetes Care. 2011; 34: 223-229
        • Nasiri-Amiri F
        • Bakhtiari A
        • Faramarzi M
        • Adib Rad H
        • Pasha H
        The association between physical activity during pregnancy and gestational diabetes mellitus: a case-control study.
        Int J Endocrinol Metab. 2016; 14: e37123
        • do Nascimento GR
        • Borges MDC
        • Figueiroa JN
        • Alves LV
        • Alves JG.
        Physical activity pattern in early pregnancy and gestational diabetes mellitus risk among low-income women: a prospective cross-sectional study.
        SAGE Open Med. 2019; 7 (2050312119875922)
        • Geller SE
        • Koch AR
        • Garland CE
        • MacDonald EJ
        • Storey F
        • Lawton B.
        A global view of severe maternal morbidity: moving beyond maternal mortality.
        Reprod Health. 2018; 15: 98
        • Bahadoran P
        • Pouya F
        • Zolaktaf V
        • Taebi M.
        The effect of stretching exercise and walking on changes of blood pressure in nulliparous women.
        Iran J Nurs Midwifery Res. 2015; 20: 205-210
        • Aune D
        • Saugstad OD
        • Henriksen T
        • Tonstad S.
        Physical activity and the risk of preeclampsia: a systematic review and meta-analysis.
        Epidemiology. 2014; 25: 331-343
        • Magro-Malosso ER
        • Saccone G
        • Di Tommaso M
        • Roman A
        • Berghella V.
        Exercise during pregnancy and risk of gestational hypertensive disorders: a systematic review and meta-analysis.
        Acta Obstet Gynecol Scand. 2017; 96: 921-931
        • Khoram S
        • Loripoor M
        • Pirhadi M
        • Beigi M.
        The effect of walking on pregnancy blood pressure disorders in women susceptible to pregnancy hypertension: a randomized clinical trial.
        J Educ Health Promot. 2019; 8: 95
        • Coll CVN
        • Domingues MR
        • Stein A
        • et al.
        Efficacy of regular exercise during pregnancy on the prevention of postpartum depression: the PAMELA randomized clinical trial.
        JAMA Netw Open. 2019; 2e186861
        • Navas A
        • Carrascosa MDC
        • Artigues C
        • et al.
        Effectiveness of moderate-intensity aerobic water exercise during pregnancy on quality of life and postpartum depression: a multi-center, randomized controlled trial.
        J Clin Med. 2021; 10: 2432
        • Marín-Jiménez N
        • Castro-Piñero J
        • Rodríguez-Ayllón M
        • Marchán-Rubio A
        • Delgado-Fernández M
        • Aparicio VA.
        The favourable association of self-reported physical fitness with depression and anxiety during pregnancy. The GESTAFIT project.
        Eur J Sport Sci. 2021; ([Epub ahead of print])
        • Currie S
        • Sinclair M
        • Liddle DS
        • Nevill A
        • Murphy MH.
        Application of objective physical activity measurement in an antenatal physical activity consultation intervention: a randomised controlled trial.
        BMC Public Health. 2015; 15: 1259
        • Ruart S
        • Sinnapah S
        • Hue O
        • Janky E
        • Antoine-Jonville S
        Prenatal counseling throughout pregnancy: effects on physical activity level, perceived barriers, and perinatal health outcomes: a quasi-experimental study.
        Int J Environ Res Public Health. 2020; 17: 8887
        • Haakstad LAH
        • Vistad I
        • Sagedal LR
        • Lohne-Seiler H
        • Torstveit MK.
        How does a lifestyle intervention during pregnancy influence perceived barriers to leisure-time physical activity? The Norwegian fit for delivery study, a randomized controlled trial.
        BMC Pregnancy Childbirth. 2018; 18: 127
        • Hoffmann J
        • Günther J
        • Geyer K
        • et al.
        Effects of a lifestyle intervention in routine care on prenatal physical activity - findings from the cluster-randomised GeliS trial.
        BMC Pregnancy Childbirth. 2019; 19: 414
        • Eggen MH
        • Stuge B
        • Mowinckel P
        • Jensen KS
        • Hagen KB.
        Can supervised group exercises including ergonomic advice reduce the prevalence and severity of low back pain and pelvic girdle pain in pregnancy? A randomized controlled trial.
        Phys Ther. 2012; 92: 781-790
        • Stafne SN
        • Salvesen KÅ
        • Romundstad PR
        • Stuge B
        • Mørkved S.
        Does regular exercise during pregnancy influence lumbopelvic pain? A randomized controlled trial.
        Acta Obstet Gynecol Scand. 2012; 91: 552-559
        • Haakstad LA
        • Bø K.
        Effect of a regular exercise programme on pelvic girdle and low back pain in previously inactive pregnant women: a randomized controlled trial.
        J Rehabil Med. 2015; 47: 229-234
        • Kluge J
        • Hall D
        • Louw Q
        • Theron G
        • Grové D.
        Specific exercises to treat pregnancy-related low back pain in a South African population.
        Int J Gynaecol Obstet. 2011; 113: 187-191
        • Sklempe Kokic I
        • Ivanisevic M
        • Biolo G
        • Simunic B
        • Kokic T
        • Pisot R
        Combination of a structured aerobic and resistance exercise improves glycaemic control in pregnant women diagnosed with gestational diabetes mellitus. A randomised controlled trial.
        Women Birth. 2018; 31: e232-e238
        • Mottola MF
        • Davenport MH
        • Ruchat SM
        • et al.
        2019 Canadian guideline for physical activity throughout pregnancy.
        Br J Sports Med. 2018; 52: 1339-1346
        • Evenson KR
        • Barakat R
        • Brown WJ
        • et al.
        Guidelines for physical activity during pregnancy: comparisons from around the world.
        Am J Lifestyle Med. 2014; 8: 102-121
        • Hesketh KR
        • Evenson KR.
        Prevalence of U.S. Pregnant Women Meeting 2015 ACOG Physical Activity Guidelines.
        Am J Prev Med. 2016; 51: e87-e89
        • Newton ER
        • May L.
        Adaptation of maternal-fetal physiology to exercise in pregnancy: the basis of guidelines for physical activity in pregnancy.
        Clin Med Insights Womens Health. 2017; 10 (1179562X17693224)