Student Name: Bianca Rochelle
Email: BLRochelle@uams.edu
Description:
This project evaluated existing evidence on structured, low-impact, adapted prenatal exercise programs for high-risk pregnancies (e.g., patients with obesity, hypertension, or limited mobility) and their impact on outcomes such as gestational diabetes, preeclampsia, and preterm birth. It synthesized current research on the safety, efficacy, and accessibility of modified movement interventions across ability levels. The final deliverable is a written review and presentation summarizing key findings, gaps in the literature, and recommendations for implementing inclusive prenatal exercise programs in clinical practice. The final deliverables included infographics and flyers that could be used to implement a program such as “Move, Mama, Move!”
PDF files:
- Move Mama Move Flyer Example
- Move Mama Move Exercises Infographic Example
- Move Mama Move Provider Flyer Example
- Peer Pregnancy Exercise Program Flyer Example
Literature Review:
Introduction:
Research has shown that exercise in pregnancy can decrease several maternal and fetal outcomes. This includes macrosomia, gestational diabetes, preeclampsia, cesarean delivery, low back pain, pelvic girdle pain, and urinary incontinence (Cooper & Yang, 2023). The WHO recommends that healthy pregnant women have 150 minutes of moderate physical activity weekly (Paulsen et. al, 2023). Contrary to these findings, it has been found that pregnant women decrease their level of physical activity, and this can be a multitude of reasons including lack of energy, time, discomfort, and fear of spontaneous abortion. Inactivity in pregnancy can increase risks of preeclampsia, gestational diabetes mellitus (GDM), gestational hypertension, excessive gestational weight gain, delivery complications, early delivery, postpartum depression, and complications in the newborn without increasing the likelihood of a low-birth weight newborn (Paulsen et. al 2023, Joseph et. al, 2025). Similarly, Adesegun et. al (2019) found that prenatal exercise had no association with an increased risk of adverse maternal or neonatal outcomes.
Exercise:
Ferreira et. al found that implementing a controlled and supervised exercise program in pregnancy was associated with significantly lower odds of induced deliveries. When studied, only 19.3% of women exercised during pregnancy with the majority reporting slow walking (Miranda et. al 2022) Their study further showcased that factors associated with moderate or vigorous activity were education, nulliparity, low anxiety, and unemployment. High risk pregnancies were those most likely to exhibit low activity levels.
Pre-eclampsia:
Pre-eclampsia affects approximately 5% of pregnancies worldwide resulting in serious health implications for both mother and fetus (Paulsen et. al, 2023). Their review found that pre-eclampsia risk reduction was associated with mind-body exercise and low-intensity exercise. In contrast, da Silva et. al (2017) found in their randomized controlled trial that there was no significant difference in the incidence of pre-eclampsia between those receiving exercise intervention and those without.
Gestational Diabetes Mellitus:
According to Paulsen et. al GDM is one of the most common complications during pregnancy with 50% of those patients developing type 2 diabetes mellitus (T2DM) within ten years after birth. Neonates born from GDM pregnancies are at a higher risk of developing obesity, metabolic diseases, and cardiovascular diseases later in life (Davenport et. al, 2018). Problems with GDM include increased incidence of pre-eclampsia, macrosomia, and cesarean delivery. A study done with lifestyle intervention, including lifestyle intervention, diet couns.eling, physical activity, and behavior change found that the relative risk for GDM was 0.59 while compare the intervention group to those with usual antenatal care (Sadiya et. al, 2022). The overall risk reduction was 41% among high-risk pregnant women. Another program intervention focused on nutrition found that women in that cohort were less likely to experience GDM compared with those in the control cohort, only receiving standard antenatal care. In the same study they found that those receiving only an exercise intervention with the lifestyle intervention had the most significant reduction of GDM incidence highlighting it as the most effective way to prevent GDM. In contrast, Davenport et. al (2018) found that exercise only interventions reduced odds of GDM when compared to exercise + co-interventions. Paulsen et. al found that prevention of GDM was substantial with all modalities of exercise e.g. aerobic, resistance, combined, or mind-body exercise. In contrast to the other data sources, a randomized controlled trial from 2017 found no differences in gestational diabetes between groups who had an exercise intervention, and those that did not (da Silva et. al, 2017).
Pre-term Birth:
“Preterm delivery typically increases health risk for neonates and is associated with longer infant hospital stay and financial burden. Prenatal exercise dose (frequency, intensity, type, time, volume) have been shown to influence birth outcomes” (Claiborne et. al, 2025). Cai et. al found that those who participated in physical exercise anywhere from one to five times per week had lower odds of pre-term birth compared to those not involved in any activity. Increasing the physical exercise was associated with lower risk of pre-term birth when exercise was less than 150 minutes per day, the WHO recommended amount for pregnancy (Cai et. al, 2021). Similarly, it was found that women with higher weekly exercise volume had an increased length in gestation with decreased duration of post-delivery hospitalization (Claiborne et. al, 2025). Findings suggested that prenatal exercise held a dose-dependent associated with improvement of APGAR scores. In contrast, Tinloy et. al (2014) and da Silva et. al (2017) found considerably different results in their analyses, this included regular exercise not being associated with late preterm birth.
It is a commonly known fact that non-Hispanic black women have disproportionate experiences with adverse birth outcomes (Raper et. al, 2021). It was proven that prenatal exercise reduced “borderline significant” racial/ethnic disparities in pre-term birth and gestational age. Similarly, it was found that moderate-intensity exercise was associated with decreased pre-term births in African American women (Moyer et. al, 2016). On that same page, leisure-time activity, outside of work activity, was associated with decreased risk of pre-term birth.
Maternal Outcomes:
Research examining prenatal physical activity suggests that maintaining consistent exercise habits during pregnancy may play an important role in both maternal mental health and birth outcomes (Gildner et. al). In a study by Gildner and colleagues, women who experienced interruptions in their normal exercise routines reported higher prenatal depression scores, highlighting the potential psychological impact of reduced activity during pregnancy. Additional evidence summarized by Adesegun et al. (2019) indicated that prenatal exercise was associated with substantially lower odds of cesarean section among women with type 1 diabetes and chronic hypertension, although the overall quality of evidence ranged from low to very low. Similarly, findings from research conducted by Tinloy (2014) showed that women engaging in at least 150 minutes of physical activity per week tended to have lower odds of cesarean delivery compared with those participating in 60 minutes or less, though the association did not reach statistical significance. Research by Cooper and Yang further identified aerobic exercise as one of the most effective forms of physical activity for reducing adverse pregnancy outcomes. Supporting these findings, Shojaei et al. (2021) demonstrated that walking interventions during pregnancy significantly decreased the duration of the third stage of labor as well as rates of spontaneous labor complications, induced labor, cesarean delivery, and instrumental delivery in the intervention group. However, the study did not identify significant differences between groups in the duration of the first and second stages of labor or in neonatal APGAR scores. Broader social and occupational factors also appear to influence pregnancy outcomes, as women from lower socioeconomic backgrounds demonstrate higher rates of preterm birth, particularly when combined with increased physical demands related to work activity.
Discussion:
Research consistently shows that regular physical activity during pregnancy is a safe and effective way to improve outcomes for both mother and baby, including among higher-risk pregnancies. Moderate exercise has been associated with lower rates of gestational diabetes, high blood pressure during pregnancy, preterm birth, cesarean delivery, prolonged infant hospital stays, and delivery complications, while also supporting healthier birth weights, longer gestational age, and improved newborn health measures. Structured exercise programs combined with nutrition and behavioral support appear to provide the greatest benefits and may also help reduce disparities in pregnancy outcomes across different populations. Physical activity during pregnancy has additionally been linked to improved mental well-being, reduced depressive symptoms, and better overall quality of life. Despite these benefits, many pregnant individuals decrease their activity levels because of fatigue, discomfort, limited time, lack of guidance, or concerns about safety. Current evidence supports that low-to-moderate intensity activities such as walking, stretching, aerobic exercise, resistance training, and mindfulness-based movement can be safely performed throughout pregnancy without increasing risks to maternal or neonatal health, highlighting the importance of accessible education and supportive wellness programs.
Intervention:
To achieve at least a 25% reduction in the odds of developing GDM, PE and GH, pregnant women need to accumulate at least 600 MET-min/week of moderate-intensity exercise (eg, 140min of brisk walking, water aerobics, stationary cycling or resistance training) (Davenport et. al, 2018). Among surveyed pregnant patients, nearly 90% of participants reported feeling sufficiently informed about physical exercise during pregnancy, almost 80% still engaged in either no exercise or lower levels of activity compared to their pre-pregnancy routines (Schmidt et. al 2017). Participants who received counseling from physicians, such as gynecologists or general practitioners, were more likely to report feeling adequately informed, and women who perceived themselves as well counseled generally demonstrated higher levels of physical activity. These findings highlight the importance of standardized prenatal exercise counseling delivered by health professionals, ideally incorporating consistent, evidence-based guidance supported by structured materials such as pamphlets and QR codes linking to APGO, WHO, and other guideline-approved instructional videos to improve patient understanding and adherence to recommended activity levels. My intervention would include a new initiative sent out to providers of obstetrics care to counsel all patients on the standardized guidelines with printed pamphlets for patients and posters for patient waiting areas. An important facet would be also including diet-based interventions and peer accountability groups.
