Physical activity and the risk of preeclampsia: a systematic review and meta-analysis.
BACKGROUND
Physical activity has been hypothesized to reduce the risk of preeclampsia, but epidemiologic studies have not shown consistent results. Therefore, we conducted a systematic review and dose-response meta-analysis of epidemiologic studies.


METHODS
PubMed, Embase, and Ovid databases were searched for case-control and cohort studies of physical activity and preeclampsia up to 2 November 2012. We estimated summary relative risks (RRs) using a random effects model.


RESULTS
Fifteen studies were included. The summary RR for high versus low prepregnancy physical activity was 0.65 (95% confidence interval [CI] = 0.47-0.89, I = 0%; n = 5). In the dose-response analysis, the summary RR was 0.72 (0.53-0.99; I = 0%; n = 3) per 1 hour per day and 0.78 (0.63-0.96; I = 0%; n = 2) per 20 metabolic equivalent task (MET)-hours per week. The summary RR for high versus low physical activity in early pregnancy was 0.79 (0.70-0.91; I = 0%; n = 11). In the dose-response analysis, the summary RR per 1 hour per day was 0.83 (0.72-0.95; I = 21%; n = 7) and 0.85 (0.68-1.07; I = 69%; n = 3) per 20 MET-hours per week. A nonlinear association was observed for physical activity before pregnancy and risk of preeclampsia (test for nonlinearity, P = 0.03), but not for physical activity in early pregnancy (test for nonlinearity, P = 0.37), with a flattening of the curve at higher levels of activity. Both walking and greater intensity of physical activity were inversely associated with preeclampsia.


CONCLUSIONS
Our analysis suggests a reduced risk of preeclampsia with increasing levels of physical activity before pregnancy and during early pregnancy.
From the aDepartment of Preventive Cardiology, Oslo University Hospital Ullevål, Oslo, Norway; bDepartment of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; cDepartment of Epidemiology and Biostatistics, Imperial College, London, United Kingdom; dDepartment of Pediatric Research, Rikshospitalet, Oslo University Hospital, University of Oslo, Oslo, Norway; eSection of obstetrics, Division of Obstetrics and Gynaecology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; and fDepartment of Health Promotion and Education, Loma Linda University, Loma Linda, CA.
Dagfinn
D
Aune
Ola Didrik
OD
Saugstad
Tore
T
Henriksen
Serena
S
Tonstad
D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D016001:Confidence Intervals; D015444:Exercise / Q000502:physiology*; D005260:Female; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D009043:Motor Activity / Q000502:physiology*; D011225:Pre-Eclampsia / Q000453:epidemiology* / Q000517:prevention & control; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000379:methods; D012016:Reference Values; D018570:Risk Assessment; D055815:Young Adult