title: Exercise during pregnancy and risk of gestational hypertensive disorders: a systematic review and meta-analysis.
abstract: BACKGROUND
  Gestational hypertensive disorders, including gestational hypertension and preeclampsia, are one of the leading causes of maternal morbidity and mortality. The aim of our study was to evaluate the effect of exercise during pregnancy on the risk of gestational hypertensive disorders.
  
  
  METHODS
  Electronic databases were searched from their inception to February 2017. Selection criteria included only randomized controlled trials of uncomplicated pregnant women assigned before 23 weeks to an aerobic exercise regimen or not. The summary measures were reported as relative risk with 95% confidence intervals. The primary outcome was the incidence of gestational hypertensive disorders, defined as either gestational hypertension or preeclampsia.
  
  
  RESULTS
  Seventeen trials, including 5075 pregnant women, were analyzed. Of them, seven contributed data to quantitative meta-analysis for the primary outcome. Women who were randomized in early pregnancy to aerobic exercise for about 30-60 min two to seven times per week had a significant lower incidence of gestational hypertensive disorders (5.9% vs. 8.5%; relative risk 0.70, 95% confidence interval 0.53-0.83; seven studies, 2517 participants), specifically a lower incidence of gestational hypertension (2.5% vs. 4.6%; relative risk 0.54, 95% confidence interval 0.40-0.74; 16 studies, 4641 participants) compared with controls. The incidence of preeclampsia (2.3% vs. 2.8%; relative risk 0.79, 95% confidence interval 0.45-1.38; six studies, 2230 participants) was similar in both groups. The incidence of cesarean delivery was decreased by 16% in the exercise group.
  
  
  CONCLUSIONS
  Aerobic exercise for about 30-60 min two to seven times per week during pregnancy, as compared with being more sedentary, is associated with a significantly reduced risk of gestational hypertensive disorders overall, gestational hypertension, and cesarean delivery.
authors.affiliation: Department of Health Science, Division of Pediatrics, Obstetrics and Gynecology, Careggi Hospital University of Florence, Florence, Italy.
authors.forename: Elena R
authors.initials: ER
authors.lastname: Magro-Malosso
authors.affiliation: Department of Neuroscience Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.
authors.forename: Gabriele
authors.identifier: http://orcid.org/0000-0003-0078-2113
authors.initials: G
authors.lastname: Saccone
authors.affiliation: Department of Health Science, Division of Pediatrics, Obstetrics and Gynecology, Careggi Hospital University of Florence, Florence, Italy.
authors.forename: Mariarosaria
authors.initials: M
authors.lastname: Di Tommaso
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Roman
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Vincenzo
authors.identifier: http://orcid.org/0000-0001-7420-1807
authors.initials: V
authors.lastname: Berghella
mesh_terms: D015444:Exercise; D005260:Female; D014943:Global Health; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D000068097:Maternal Health; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors
keywords: Physical activity; exercise in pregnancy; hypertension; obesity; preterm birth