临床研究

2016年7月11日 讯 /生物谷BIOON/ --近日，发表于国际杂志the American Journal of Obstetrics & Gynecology上的一篇研究报告中，来自托马斯杰斐逊大学的研究人员在女性怀孕期间收集并且检测和锻炼相关的临床数据，并且揭示怀孕期间进行锻炼在婴儿早产过程中所扮演的角色，结果研究者发现，女性在怀孕期间锻炼非常安全，而且并不会增加婴儿早产的风险，此外，相比不锻炼的孕妇而言，锻炼的孕妇或许并不太可能进行剖腹产。

过去，女性在怀孕期间并不被鼓励进行剧烈的锻炼，因为这会增加婴儿早产的风险，该观点认为，锻炼会促进机体中去甲肾上腺素的释放，去甲肾上腺素可以刺激子宫收缩从而引发早产。研究者Vincenzo Berghella说道，包括最新荟萃分析研究在内的大量研究都表明，锻炼并不会有害于婴儿，反而对于母亲和即将出生的婴儿会带来一定的益处。

文章中，研究者将来自9项随机对照研究的数据进行混合研究分析，其中一项最有力的研究就是对人类受试者的研究，研究者将孕妇分为两组，共对2059名孕妇进行研究，其中一半孕妇（1022名）每周锻炼3-4次，每次锻炼35-90分钟，连续锻炼10周或者直到其分娩，而另外一半孕妇（1037名）则参与到不锻炼的研究组中。

早产被定为为孕妇在37周之前分娩，研究者发现，相比不锻炼组的孕妇而言，锻炼组的孕妇在婴儿早产率上并没有明显增加，反而锻炼还会带来一定好处，锻炼的女性更容易正常分娩，73%的锻炼女性都通过阴道进行了婴儿的正常分娩，相比而言，67%的未锻炼孕妇是通常正常分娩方式来生产婴儿的。同时在怀孕期间锻炼的孕妇剖腹产的发生率降低了，锻炼的孕妇剖腹产比率为17%，而未锻炼孕妇剖腹产的比率为22%，研究者还发现，孕期锻炼的女性患妊娠糖尿病、高血压的风险都降低了。

最后研究者Berghella表示，本文的研究结果支持了当前美国妇产科医师协会(American College of Obstetrics and Gynecology，ACOG)相关的指南建议，然而目前有很多原因会影响女性在怀孕期间进行锻炼，比如机体不适、疲倦感增加或者气力不足等，本文研究结果表明，锻炼对于怀孕女性和婴儿都非常有益，而且并不会增加婴儿早产的风险。（生物谷Bioon.com）

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doi:10.1016/j.ajog.2016.06.014
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Exercise during pregnancy in normal-weight women and risk of preterm birth: a systematic review and meta-analysis of randomized controlled trials

Daniele Di Mascio, MD, Elena Rita Magro-Malosso, MD, Gabriele Saccone, MD, Gregary D. Marhefka, MD, Vincenzo Berghella, MD

Background Preterm birth is the major cause of perinatal mortality in the United States. In the past, pregnant women have been recommended to not exercise because of presumed risks of preterm birth. Physical activity has been theoretically related to preterm birth because it increases the release of catecholamines, especially norepinephrine, which might stimulate myometrial activity. Conversely, exercise may reduce the risk of preterm birth by other mechanisms such as decreased oxidative stress or improved placenta vascularization. Therefore, the safety of exercise regarding preterm birth and its effects on gestational age at delivery remain controversial. Objective The objective of the study was to evaluate the effects of exercise during pregnancy on the risk of preterm birth. Data Sources MEDLINE, EMBASE, Web of Sciences, Scopus, ClinicalTrial.gov, OVID, and Cochrane Library were searched from the inception of each database to April 2016. Study Design Selection criteria included only randomized clinical trials of pregnant women randomized before 23 weeks to an aerobic exercise regimen or not. Types of participants included women mainly of normal weight with uncomplicated, singleton pregnancies without any obstetric contraindication to physical activity. The summary measures were reported as relative risk or as mean difference with 95% confidence intervals. The primary outcome was the incidence of preterm birth <37 weeks. Tabulation, Integration, and Results Of the 2059 women included in the meta-analysis, 1022 (49.6%) were randomized to the exercise group and 1037 (50.4%) to the control group. Aerobic exercise lasted about 35–90 minutes 3–4 times per week. Women who were randomized to aerobic exercise had a similar incidence of preterm birth of <37 weeks (4.5% vs 4.4%; relative risk, 1.01, 95% confidence interval, 0.68–1.50) and a similar mean gestational age at delivery (mean difference, 0.05 week, 95% confidence interval, –0.07 to 0.17) compared with controls. Women in the exercise group had a significantly higher incidence of vaginal delivery (73.6% vs 67.5%; relative risk, 1.09, 95% confidence interval, 1.04–1.15) and a significantly lower incidence of cesarean delivery (17.9% vs 22%; relative risk, 0.82, 95% confidence interval, 0.69–0.97) compared with controls. The incidence of operative vaginal delivery (12.9% vs 16.5%; relative risk, 0.78, 95% confidence interval, 0.61–1.01) was similar in both groups. Women in the exercise group had a significantly lower incidence of gestational diabetes mellitus (2.4% vs 5.9%; relative risk, 0.41, 95% confidence interval, 0.24–0.68) and a significantly lower incidence of hypertensive disorders (1.9% vs 5.1%; relative risk, 0.36, 95% confidence interval, 0.19–0.69) compared with controls. No differences in low birthweight (5.2% vs 4.7%; relative risk, 1.11, 95% confidence interval, 0.72–1.73) and mean birthweight (mean difference, –10.46 g, 95% confidence interval, –47.10 to 26.21) between the exercise group and controls were found. Conclusion Aerobic exercise for 35–90 minutes 3–4 times per week during pregnancy can be safely performed by normal-weight women with singleton, uncomplicated gestations because this is not associated with an increased risk of preterm birth or with a reduction in mean gestational age at delivery. Exercise was associated with a significantly higher incidence of vaginal delivery and a significantly lower incidence of cesarean delivery, with a significantly lower incidence of gestational diabetes mellitus and hypertensive disorders and therefore should be encouraged.