ABSTRACT
INTRODUCTION: 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. OBJECTIVES: 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). CONCLUSION: 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.
ABSTRACT
INTRODUCTION: 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 preeclampsia (PE) and its complications. PA is recommended during pregnancy because it may be beneficial to maternal health. However, some studies relate the difficulty in adherence to exercise during pregnancy. OBJECTIVES: The objective of this study was to evaluate the adherence to exercise with bicycle in pregnant women with risk of preeclampsia development and characterize these pregnants. METHODS: This is a secondary analysis of a randomized clinical trial at the Women's Hospital Dr. José Aristodemo Pinotti - CAISM/Unicamp, Brazil. We enrolled 116 pregnant women presenting with chronic hypertension (CH), previous PE or both factors associated (risk of PE development). 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 exercise using stationary bicycle (horizontal bench model) during 30min, once a week, under a physical therapist supervision. The HR was maintained at 20% above resting heart rate and up to 140 beats per minute, and the BP was evaluated before and after exercise. The NIG followed regular prenatal routine with weekly returns for HR and BP measurements. We analyzed the adherence of the SG to exercise with bicycle and their sociodemographic and clinical characteristics. RESULTS: We invited 152 pregnants to participate and 33 (21.7%) refused. 116 pregnants were randomized and 58 were allocated to the SG. The mean age was 31.7±6.2 and mean of Body Mass Index (BMI) was 34.9±7.9kg/m(2). Previous PE were prevalent in 16 (27.6%) pregnant, CH in 51 (87.9%) pregnant and 9 (15.5(10.5%) pregnants relate to exercise before pregnancy. The average sessions performed by the SG using stationary bicycle were 9.24±7.03. That those who realized less than the mean session of the SG 14 had discontinued, 3 changed the prenatal city, 4 had TPP, 3 had difficulty in controlling blood pressure, 1 had autoimmune hepatitis diagnosis and 1 had fetal malformation. Considering the sociodemographic and clinical characteristics of these 27 the majority were obese and had had CH, they were not used to practice any type of exercise before pregnancy. Most of them were not primiparous, also had more children at home and found difficul to find time for exercise. The majority did not live next to our center. CONCLUSION: The majority of our population were obese, sedentary before pregnancy and with CH. In this study exercise, performed once a week, using stationary bicycle in pregnant women of high risk PE, seems to be difficult.
