title: Exercise during pregnancy protects against hypertension and macrosomia: randomized clinical trial.
abstract: BACKGROUND
  The prevalence of all pregnancies with some form of hypertension can be up to 10%, with the rates of diagnosis varying according to the country and population studied and the criteria used to establish the diagnosis. Prepregnancy obesity and excessive gestational weight gain (GWG) of all body mass index (BMI) categories have been associated with maternal hypertensive disorders and linked to macrosomia (>4000 g) and low birthweight (<2500 g). No large randomized controlled trial with high adherence to an exercise program has examined pregnancy-induced hypertension and these associated issues. We investigated whether women adherent (≥80% attendance) to an exercise program initiated early showed a reduction in pregnancy-induced hypertension and excessive GWG in all prepregnancy BMI categories, and determined if maternal exercise protected against macrosomia and low birthweight.
  
  
  OBJECTIVE
  We sought to examine the impact of a program of supervised exercise throughout pregnancy on the incidence of pregnancy-induced hypertension.
  
  
  METHODS
  A randomized controlled trial was used. Women were randomized into an exercise group (N = 382) or a control group (N = 383) receiving standard care. The exercise group trained 3 d/wk (50-55 min/session) from gestational weeks 9-11 until weeks 38-39. The 85 training sessions involved aerobic exercise, muscular strength, and flexibility.
  
  
  RESULTS
  High attendance to the exercise program regardless of BMI showed that pregnant women who did not exercise are 3 times more likely to develop hypertension (odds ratio [OR], 2.96; 95% confidence interval [CI], 1.29-6.81, P = .01) and are 1.5 times more likely to gain excessive weight if they do not exercise (OR, 1.47; 95% CI, 1.06-2.03, P = .02). Pregnant women who do not exercise are also 2.5 times more likely to give birth to a macrosomic infant (OR, 2.53; 95% CI, 1.03-6.20, P = .04).
  
  
  CONCLUSIONS
  Maternal exercise may be a preventative tool for hypertension and excessive GWG, and may control offspring size at birth while reducing comorbidities related to chronic disease risk.
authors.affiliation: Physical Activity and Sports in Specific Populations (AFIPE) Research Group, Faculty of Physical Activity and Sports Sciences-Facultad de Ciencias de la Actividad Física y el Deporte, Technical University of Madrid, Madrid, Spain.
authors.forename: Ruben
authors.initials: R
authors.lastname: Barakat
authors.affiliation: Physical Activity and Sports in Specific Populations (AFIPE) Research Group, Faculty of Physical Activity and Sports Sciences-Facultad de Ciencias de la Actividad Física y el Deporte, Technical University of Madrid, Madrid, Spain.
authors.forename: Mireia
authors.initials: M
authors.lastname: Pelaez
authors.affiliation: Catholic University of Murcia, Murcia, Spain.
authors.forename: Yaiza
authors.initials: Y
authors.lastname: Cordero
authors.affiliation: Physical Activity and Sports in Specific Populations (AFIPE) Research Group, Faculty of Physical Activity and Sports Sciences-Facultad de Ciencias de la Actividad Física y el Deporte, Technical University of Madrid, Madrid, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Perales
authors.affiliation: Physical Activity and Sports in Specific Populations (AFIPE) Research Group, Faculty of Physical Activity and Sports Sciences-Facultad de Ciencias de la Actividad Física y el Deporte, Technical University of Madrid, Madrid, Spain.
authors.forename: Carmina
authors.initials: C
authors.lastname: Lopez
authors.affiliation: Physical Activity and Sports in Specific Populations (AFIPE) Research Group, Faculty of Physical Activity and Sports Sciences-Facultad de Ciencias de la Actividad Física y el Deporte, Technical University of Madrid, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Coteron
authors.affiliation: R. Samuel McLaughlin Foundation-Exercise and Pregnancy Laboratory, School of Kinesiology, Faculty of Health Sciences, Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Children's Health Research Institute, University of Western Ontario, London, Ontario, Canada. Electronic address: mmottola@uwo.ca.
authors.forename: Michelle F
authors.initials: MF
authors.lastname: Mottola
mesh_terms: D000328:Adult; D001724:Birth Weight; D016640:Diabetes, Gestational / Q000517:prevention & control; D015444:Exercise; D005260:Female; D005320:Fetal Macrosomia / Q000517:prevention & control*; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000517:prevention & control*; D007231:Infant, Newborn; D011247:Pregnancy; D015430:Weight Gain
keywords: exercise; gestational weight gain; hypertension; intervention; outcome; pregnancy