Resistance training in pregnancy: systematic review and meta-analysis of pregnancy, delivery, fetal and pelvic floor outcomes and call to action.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis composed predominantly of randomized controlled trials (45 of 50 included studies).
PubMed 40610191 · doi:10.1136/bjsports-2024-109123
What was done
Authors searched six databases through March 15, 2024, for studies examining resistance training (RT) alone or within multicomponent exercise programmes in pregnant individuals compared to usual care or non-RT controls. Risk of bias was evaluated using the Joanna Briggs Institute tool. Evaluated outcomes included pregnancy outcomes (gestational hypertension, pre-eclampsia, gestational diabetes, perinatal mood disorders), delivery outcomes (caesarean section, perineal tearing, instrumented delivery, length of labour), fetal outcomes (birth mass, microsomia, macrosomia, gestational age), and pelvic floor disorder rates.
What was found
Across 50 included studies (45 randomized controlled trials, 3 non-randomized interventions, 2 observational studies; 47,619 participants), RT interventions were associated with significant reductions in: - Gestational hypertension: OR 0.42 (95% CI 0.27 to 0.66; I² = 0%) - Gestational diabetes: OR 0.62 (95% CI 0.48 to 0.79; I² = 0%) - Perinatal mood disorders: OR 0.48 (95% CI 0.32 to 0.73; I² = 0%) - Macrosomia: OR 0.67 (95% CI 0.50 to 0.88; I² = 23%) Quantitative results were not reported in the abstract for pre-eclampsia, delivery outcomes, pelvic floor disorders, birth mass, microsomia, or gestational age.
Why it matters
This review demonstrates that resistance training in pregnancy is associated with meaningful risk reductions for major hypertensive, metabolic, and mood-related maternal conditions as well as macrosomia.
Limits
Ninety percent of the included studies evaluated RT only as part of multicomponent programmes (often alongside aerobic training), confounding the isolated effect of resistance exercise. The RT interventions generally used low-to-moderate dosages with poor reporting of load prescription and progression. Only 16 of 50 studies were at low risk of bias (27 moderate, 7 high risk).
Cited by
- supports Strength training during pregnancy is well-researched and improves pregnancy and delivery outcomes.