Guiding Questions
- D1.
What is the association between physical activity and health-related outcomes?
Is there a dose response association (volume, duration, frequency, intensity)?
Does the association vary by type or domain or timing (pre-pregnancy, antenatal or postnatal) of physical activity?
Inclusion Criteria
Population: Pregnant women and postpartum mothers
Exposure: Greater volume, duration, frequency or intensity of physical activity
Comparison: No physical activity or lesser volume, duration, frequency, or intensity of physical activity
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Outcomes | Importance |
---|
Excessive weight gain | Critical |
Gestational diabetes mellitus | Critical |
Gestational hypertension/pre-eclampsia | Critical |
Mental health (e.g., anxiety symptoms, depressive symptoms, post-partum depression) | Critical |
Fetal outcomes (e.g., preterm birth, birthweight) | Critical |
Adverse outcomes (e.g., miscarriage, stillbirth) | Critical |
Delivery complications | Important |
Evidence identified
The GRADE Evidence Profiles (EPs) developed for the Canadian Guideline for Physical Activity Throughout Pregnancy (1) were used as a basis for this update, given the rigor in methods and recency in included evidence. The original EPs can be found in the supplemental materials of seven systematic reviews prepared to inform the guideline (2–8). Five additional reviews were conducted to inform the Canadian Guideline but are not included here given the outcomes addressed(i.e., urinary incontinence (9), glucose response (10), fetal heart rate and umbilical and uterine blood flow (11), low back pain, pelvic girdle and lumbopelvic pain (12)) and type of exercise (i.e., supine exercise (13)).
Given the recency of the systematic reviews that were conducted to inform the Canadian Guideline, we compared the included studies within each of those systematic reviews with that of any new systematic reviews. In cases where the bodies of evidence were entirely overlapping, we only included the Canadian review (exclusions are noted in ).
Seven reviews that informed the development of the Canadian guideline were included (2–8). Ten additional reviews (published in 2018 or 2019) were identified by the WHO team that examined the association between physical activity and health-related outcomes among pregnant or postpartum women (14–23). Four of these reviews were excluded because they were duplicative and less comprehensive than the reviews that were published to inform the Canadian Guideline (15, 18, 22, 23). One additional review was excluded because it was a review of reviews which included outdated literature (17) and another publication was excluded because it was an RCT that updated the point estimate from a 2011 review with their study results (21). presents the 6 reviews that were excluded and their reason for exclusion. presents the 4 reviews that were included and the outcomes they each reported.
presents the ratings for each included review according to all the AMSTAR 2 main domains. None of the systematic reviews were rated as having high credibility based on the AMSTAR 2 instrument. Three were rated as having moderate credibility and 1 was rated as having low credibility.
Table D1.1Excluded Systematic Reviews, with Reasons for Exclusion
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Author, Year | Reason for Exclusion | Rationale |
---|
Bennett 2018 (15) | Redundancy | All included evidence is included in reviews by Davenport (5) |
Farpour-Lambert 2018 (17) | Design | Review of reviews |
Guo 2018 (18) | Redundancy | All included evidence is included in the review by Davenport (5) |
Nobles 2018 (21) | Design | Not a systematic review |
Syngelaki 2019 (22) | Redundancy | All included evidence is included in reviews by Ruchat (8) and Davenport (5) |
Yu 2018 (23) | Redundancy | All included evidence is included in reviews by Davenport (5) |
Table D1.2Included Systematic Reviews
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Author, Year | Excessive weight gain | GDM | Gestational HYP/preeclampsia | Mental health outcomes | Fetal outcomes (e.g., preterm birth, birth-weight) | AEs (e.g., miscarriage, stillbirth) | Delivery complications | Last Search Date | # of Included Studies | AMSTAR 2 |
---|
Beetham 2019 (14) | ✕ | | | | ✕ | | | Nov-2018 | 15 | Moderate |
Du 2018 (16) | ✕ | ✕ | ✕ | | ✕ | | ✕ | Apr-2018 | 13 | Low |
Mijatovic-Vukas 2018 (19) | | ✕ | | | | | | Feb-2017 | 17 | Moderate |
Nakamura 2019 (20) | | | | ✕ | | | | Oct-2017 | 21 | Moderate |
Abbreviations: AE = adverse event; GDM = gestational diabetes mellitus; HYP = hypertension
Table D1.3Credibility Ratings (AMSTAR 2)
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Author, Year | PICO1 | Apriori Methods2 | Study Design Selection3 | Lit Search Strategy4 | Study Selection5 | Data Extraction6 | Excluded Studies7 | Included Studies8 | RoB Assessment9 | Funding Sources10 | Statistical Methods11 | Impact of RoB12 | RoB Results13 | Hetero-geneity14 | Publication Bias15 | COI16 | Overall Rating17 |
---|
Beetham 2019 (14) | Y | Y | Y | PY | Y | Y | N | Y | Y | N | Y | Y | N | N | N | Y | Moderate |
Du 2018 (16) | Y | PY | N | PY | Y | Y | N | Y | Y | N | Y | N | N | Y | N | N | Low |
Mijatovic-Vukas 2018 (19) | Y | Y | Y | PY | Y | Y | N | Y | Y | N | Y | N | Y | Y | Y | Y | Moderate |
Nakamura 2019 (20) | Y | PY | N | PY | Y | Y | N | PY | PY | N | Y | N | Y | Y | Y | Y | Moderate |
Abbreviations: COI = conflict of interest; N = no; PICO = population, intervention, comparator, outcome; PY = partial yes; RoB = risk of bias; Y = yes
- 1
Did the research questions and inclusion criteria for the review include the components of PICO?
- 2
Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justify any significant deviations from the protocol?
- 3
Did the review authors explain their selection of the study designs for inclusion in the review?
- 4
Did the review authors use a comprehensive literature search strategy?
- 5
Did the review authors perform study selection in duplicate?
- 6
Did the review authors perform data extraction in duplicate?
- 7
Did the review authors provide a list of excluded studies and justify the exclusions?
- 8
Did the review authors describe the included studies in adequate detail?
- 9
Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review?
- 10
Did the review authors report on the sources of funding for the studies included in the review?
- 11
If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results?
- 12
If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or other evidence synthesis?
- 13
Did the review authors account for RoB in individual studies when interpreting/ discussing the results of the review?
- 14
Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review?
- 15
If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss its likely impact on the results of the review?
- 16
Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review?
- 17
Shea et al. 2017. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. (24)
D.1. Physical Activity
Table D.1.a. Excessive weight gain and physical activity, pregnant and postpartum women (PDF, 94K)
Black font is from original GRADE Evidence Profile from the systematic review (Ruchat 2018 (8)) to support the 2019 Canadian Guideline for Physical Activity Throughout Pregnancy. Red font denotes additions based on WHO update using review of existing systematic reviews. Two systematic reviews were identified that addressed the relationship between physical activity and excessive weight gain (14, 16).
Table D.1.b. Gestational diabetes mellitus and physical activity, pregnant and postpartum women (PDF, 77K)
Black font is from original GRADE Evidence Profile from the systematic review (Davenport 2018 (5)) to support the 2019 Canadian Guideline for Physical Activity Throughout Pregnancy. Red font denotes additions based on WHO update using review of existing systematic reviews. Two systematic reviews were identified that addressed the relationship between physical activity and gestational diabetes (16, 19).
Table D.1.c. Gestational hypertension/pre-eclampsia and physical activity, pregnant and postpartum women (PDF, 94K)
Black font is from original GRADE Evidence Profile from the systematic review (Davenport 2018 (5)) to support the 2019 Canadian Guideline for Physical Activity Throughout Pregnancy. Red font denotes additions based on WHO update using review of existing systematic reviews. One systematic review was included that addressed the relationship between physical activity and gestational hypertension and pre-eclampsia (16).
Table D.1.d. Mental health outcomes and physical activity, pregnant and postpartum women (PDF, 131K)
Black font is from original GRADE Evidence Profile from the systematic review (Davenport 2018 (3)) to support the 2019 Canadian Guideline for Physical Activity Throughout Pregnancy. Red font denotes additions based on WHO update using review of existing systematic reviews. One systematic review was identified that addressed the relationship between physical activity and postpartum depression (20).
Table D.1.e. Fetal health outcomes and physical activity, pregnant and postpartum women (PDF, 104K)
Black font is from original GRADE Evidence Profiles from two systematic reviews (Davenport 2018 (4) and Davenport 2019 (7)) to support the 2019 Canadian Guideline for Physical Activity Throughout Pregnancy. Red font denotes additions based on WHO update using review of existing systematic reviews. Two systematic reviews were identified that addressed the relationship between physical activity and fetal health outcomes (14, 16).
Table D.1.f. Adverse effects and physical activity, pregnant and postpartum women (PDF, 82K)
Black font is from original GRADE Evidence Profile from the systematic review (Davenport 2019 (2)) to support the 2019 Canadian Guideline for Physical Activity Throughout Pregnancy. No new systematic reviews were identified that addressed the relationship between physical activity and delivery complications.
Table D.1.g. Delivery complications and physical activity, pregnant and postpartum women (PDF, 81K)
Black font is from original GRADE Evidence Profile from the systematic review (Davenport 2019 (6)) to support the 2019 Canadian Guideline for Physical Activity Throughout Pregnancy. One systematic review was included that addressed the relationship between physical activity and risk of caesarean delivery (16).
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