1. Women participating in a structured exercise program were less likely to undergo Cesarean delivery.
2. Women who participated in an exercise program gained less weight during pregnancy than women in control groups.
Evidence Rating Level: 1 (Excellent)
Study Rundown: This study found that women participating in structured exercise programs during pregnancy were less likely to undergo Cesarean delivery (CD). While a number of observational studies suggest that exercise in pregnancy is associated with a decreased risk of CD, few randomized controlled trials (RCT) exist. Mode of delivery has been measured as a secondary outcome in existing RCTs but the sample sizes are small. The present work pools data from RCTs to lend power to investigate the benefit of exercise on mode of delivery.
Limitations include variability in exercise programs across pooled studies. Additionally, it is unclear whether incidence of elective CD varies between exercise and control groups. Future studies might employ an RCT design to evaluate the association between exercise and risk of CD, including assessment of indications for delivery and comparison of types of exercise.
Relevant Reading: Effects of recommended levels of physical activity on pregnancy outcomes
In-Depth [systematic review and meta-analysis]: This study evaluated differences in mode of delivery between women randomized to a structured aerobic or resistance exercise programs (n=1523) or control (n=1543) during pregnancy. Outcomes evaluated include maternal weight gain during pregnancy, Cesarean delivery, instrumental delivery and infant birthweight.
Women randomized to the exercise group were less likely to undergo Cesarean delivery (RR 0.85, CI 0.73-0.99). Participants in programs with ≥30 hours of exercise had a 19% reduction in risk of CD (RR 0.81, CI 0.65-1.00), while those in programs with ≥ 50 hours of exercise experienced a 24% reduction in risk (RR 0.76, CI 0.58-0.99). Women randomized to an exercise group gained less weight during pregnancy compared with the control group (mean difference: 1.13 kg).
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