A randomized controlled trial of exercise during pregnancy on maternal and neonatal outcomes: results from the PAMELA study.
A randomized controlled trial of exercise during pregnancy on maternal and neonatal outcomes: results from the PAMELA study.
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DOI：
10.1186/s12966-017-0632-6
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发表时间：
2017-12-22
期刊：
影响因子：
--
通讯作者：
Evenson K
中科院分区：
文献类型：
--
作者：
da Silva SG;Hallal PC;Domingues MR;Bertoldi AD;Silveira MFD;Bassani D;da Silva ICM;da Silva BGC;Coll CVN;Evenson K
鼓励妇女在怀孕期间进行体育活动。尽管现有证据支持产前身体活动对母亲和孩子都有健康益处，但预防某些孕产妇和胎儿结局的最有效方法仍不清楚。本研究的目的是评估运动干预对预防孕产妇和新生儿健康不良结果的有效性。一项随机对照试验（RCT）嵌套在2015年Pelanmar（巴西）出生队列研究中，对639名健康孕妇进行了研究，其中213名为干预组（IG），426名为对照组（CG）。从妊娠16-20周到32-36周，每周进行3次运动干预，共16周。主要结局为早产和先兆子痫。根据几个参数计算胎龄，包括常规超声和/或末次月经，并分类为< 37周和≥ 37周，以评估早产。先兆子痫是自我报告的。次要结局为妊娠期体重增加、妊娠期糖尿病、出生体重、婴儿身长和头围。按意向治疗（ITT）和符合方案（48次计划运动中的70%）进行分析。采用非条件Logistic回归分析得出比值比。基线时IG和CG的平均年龄（27.2 ± 5.3岁vs. 27.1 ± 5.7岁）和平均孕前体重指数（25.1 ± 3.9 vs. 25.2 ± 4.1 kg/m2）无差异。运动干预的平均依从性为27 ± 17.2次（潜在的48次），40.4%的人参加了≥ 70%的推荐运动。共有594例受试者（IG：198; CG：396）被纳入ITT，479例（IG：83; CG：396）被纳入符合方案分析。在ITT和符合方案分析中，两组间早产和先兆子痫的发生率无显著差异。两组在平均妊娠期体重增加、妊娠期糖尿病、出生体重、婴儿身长和头围方面也没有差异。虽然RCT不支持妊娠期间进行运动对先兆子痫和早产的益处，但运动计划也没有对新生儿健康产生不利影响。我们的研究结果可能有助于促进干预策略，激励健康提供者鼓励孕妇更多地进行身体活动。 Clinicaltrials.gov标识符：NCT 02148965，于2014年5月22日注册。本文的在线版本（10.1186/s12966-017-0632-6）包含补充材料，可供授权用户使用。
Women are encouraged to be physically active during pregnancy. Despite available evidence supporting antenatal physical activity to bring health benefits for both the mother and child, the most effective way to prevent some maternal and fetal outcomes is still unclear. The purpose of this study was to evaluate the efficacy of an exercise intervention to prevent negative maternal and newborn health outcomes. A randomized controlled trial (RCT) nested into the 2015 Pelotas (Brazil) Birth Cohort Study was carried-out with 639 healthy pregnant women, 213 in the intervention group (IG) and 426 in the control (CG) group. An exercise-based intervention was conducted three times/week for 16 weeks from 16-20 to 32-36 weeks’ gestation. The main outcomes were preterm birth and pre-eclampsia. Gestational age was calculated based on several parameters, including routine ultrassounds and/or last menstrual period and categorized as < 37 weeks and ≥ 37 weeks for evaluation of preterm birth. Pre-eclampsia was self-reported. Secondary outcomes were gestational weight gain, gestational diabetes, birth weight, infant length, and head circumference. Analyses were performed by intention-to-treat (ITT) and per protocol (70% of the 48 planned exercise sessions). Odds ratio were derived using unconditional logistic regression. The IG and CG did not differ at baseline regarding their mean age (27.2 years ± 5.3 vs. 27.1 years ± 5.7) and mean pre-pregnancy body mass index (25.1 ± 3.9 vs. 25.2 ± 4.1 kg/m2). The mean adherence to the exercise intervention was 27 ± 17.2 sessions (out of a potential 48) with 40.4% attending > = 70% of the recommended exercise sessions. A total of 594 participants (IG:198; CG: 396) were included in the ITT and 479 (IG: 83; CG: 396) were included in the per protocol analyses. There were no significant differences in the incidence of preterm birth and pre-eclampsia between groups in the ITT and per protocol analysis. There were also no differences between the two groups in mean gestational weight gain, gestational diabetes, birth weight, infant length, and head circumference. While the RCT did not support the benefits of exercise performed during pregnancy on preeclampsia and preterm birth, the exercise program also did not present adverse impacts on newborn health. Our findings may contribute to promote intervention strategies that motivate health providers to encourage pregnant women to be more physically active. Clinicaltrials.gov identifier: NCT02148965, registered on 22 May 2014. The online version of this article (10.1186/s12966-017-0632-6) contains supplementary material, which is available to authorized users.
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影响因子：
5.1
作者：
Evenson, Kelly R.;Wen, Fang
通讯作者：
Wen, Fang
影响因子：
7.2
作者：
de Oliveria Melo, Adriana S.;Silva, Joao Luiz P.;Amorim, Melania M. R.
通讯作者：
Amorim, Melania M. R.
影响因子：
2.5
作者：
Domingues MR;Bassani DG;da Silva SG;Coll Cde V;da Silva BG;Hallal PC
通讯作者：
Hallal PC
影响因子：
1.9
作者：
Evenson KR;Barakat R;Brown WJ;Dargent-Molina P;Haruna M;Mikkelsen EM;Mottola MF;Owe KM;Rousham EK;Yeo S
通讯作者：
Yeo S
影响因子：
3.7
作者：
Drehmer M;Duncan BB;Kac G;Schmidt MI
通讯作者：
Schmidt MI