title: OS020. Effects of exercise on maternal and neonatal outcomes in pregnantwomen with chronic hypertension and/or previous preecampsia: A randomized clinical trial.
abstract: BACKGROUND
  Chronic hypertension (CH) and previous preeclampsia (PE) are considered risk factors for developing PE. Physical activity (PA) has been proposed as an important part of hypertension's treatment and has been studied as a possibility for the prevention of PE and its complications.PA is recommended during pregnancy because it may be beneficial to maternal health.Furthermore, it is considered a safe activity for the mother and fetus.
  
  
  OBJECTIVE
  The objective of this study was to assess the association between exercise in pregnant women with CH and/or previous PE and type of delivery, maternal and neonatal outcomes.
  
  
  METHODS
  Randomized clinical trial performed between January, 2008 and November, 2011, at the Women's Hospital Dr.José Aristodemo Pinotti-CAISM/Unicamp, Brazil, enrolled 116 pregnant women presenting CH, previous PE or both factors associated.Women from 12 to 20 gestational weeks were selected from the prenatal outpatient clinic and randomly allocated to the study (SG) or non-interventional group (NIG). Women at the SG performed physical exercise using stationary bicycle (horizontal bench model) during 30min, once a week, under physical therapist supervision.The HR was maintained at 20% above resting heart rate and up to 140 beats per minute.The NIG followed regular prenatal routine.After birth the data related to type of delivery, maternal and neonatal outcomes were collected from medical records and analyzed comparing groups.The statistical analyzes was performed by Chi-square test and Fisher'sexact test.The program was SAS 9.1 version.Significance was assumed as p<0.5%.
  
  
  RESULTS
  We had 6 drop-outs and 7 that did not deliver at our hospital and we could not retrieve the data.A total of 103 pregnant women were analyzed (53 in the SG and 50 in the NIG). The mean age was 31.4±5.9 and mean of Body Mass Index (BMI) was 34.9±7.9kg/m(2).Considering the sociodemographic and clinical characteristics the SG and NIG were similar and homogeneous.The average exercise sessions conducted by the SG was 10.11 sessions.The cesarean rate was 69.9% in this study, and the most prevalent indication was cephalopelvic disproportion with 34.3%.However, no statistical differences was observed between groups on type of delivery (p= 0.1901), indications for cesarean delivery and maternal outcomes, including maternal morbidity, rate of PE events and admission in the Intensive Unit Care (ICU). The neonatal outcomes were no significant differences:newborn weigh (p=0.69), adequacy for gestational age (p=0.40), gestational age by recent ultrasound (p=0.20), Apgar 1 min scores (p=0.12), Apgar 5 min score (p=0.24), admission to the ICU (p=0.95) and neonatal morbidity (p=0.39).
  
  
  CONCLUSIONS
  Exercise using stationary bicycle in pregnant women of high risk for PE (CH and/or previous PE) performed once a week, under physical therapist supervision does not seem to interfere in the type of delivery or maternal and neonatal outcomes. This study suggests that exercise with controlled intensity is safe, with no additional harm towards newborn health and with possible benefits to women's future health.
authors.affiliation: Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil.
authors.forename: K T
authors.initials: KT
authors.lastname: Kasawara
authors.affiliation: Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil.
authors.forename: C S G
authors.initials: CS
authors.lastname: Burgos
authors.affiliation: Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil.
authors.forename: S L
authors.initials: SL
authors.lastname: Nascimento
authors.affiliation: Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil.
authors.forename: M L
authors.initials: ML
authors.lastname: Costa
authors.affiliation: Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil.
authors.forename: F
authors.initials: F
authors.lastname: Surita
authors.affiliation: Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil.
authors.forename: J L Pinto
authors.initials: JL
authors.lastname: E Silva