Effects of prenatal exercise interventions on physical activity, sedentary behaviour, maternal health, and pregnancy outcomes: A systematic review and meta-analysis.

BACKGROUND

Global maternal and child health initiatives urgently prioritise physical activity and limit sedentary behaviour. Although prenatal exercise interventions have shown promise, their effectiveness remains inconsistent.

OBJECTIVES

This systematic review and meta-analysis were conducted to evaluate the effects of prenatal exercise interventions on physical activity during pregnancy and identify potential associated intervention characteristics, and examine the intervention effects on sedentary behaviour during pregnancy, maternal health, and pregnancy outcomes.

METHODS

Eight databases were searched from inception to 1 April 2026 to identify randomised controlled trials (RCTs) of exercise interventions. Trial quality was assessed using the Cochrane Risk of Bias 2.0 tool. Meta-analyses were performed using RevMan 5.4. Standardised mean differences (SMDs) for continuous outcomes and risk ratios (RRs) for dichotomous outcomes were calculated using random effects models.

RESULTS

Eighty-eight randomised controlled trials were included in the review. The majority of studies were rated as having some concerns about bias. It was found that exercise interventions significantly increased total physical activity (SMD: 0.62, 95% confidence interval [CI] [0.30, 0.94]), moderate-to-vigorous physical activity (SMD: 0.32, 95% CI [0.08, 0.57]), exercise activity (SMD: 1.04, 95% CI [0.63, 1.46]), and step count (SMD: 0.33, 95% CI [0.12, 0.55]) in pregnant women. Exploratory subgroup analyses showed differences in intervention effects on physical activity by theoretical underpinning, exercise type, delivery format, and population characteristics. Further, the interventions significantly reduced the incidence of gestational diabetes (RR: 0.75, 95% CI [0.63, 0.88]), hypertensive disorders of pregnancy (RR: 0.67, 95% CI [0.54, 0.83]), caesarean section (RR: 0.86, 95% CI [0.80, 0.93]), total gestational weight gain (SMD: -0.28, 95% CI [-0.36, -0.19]), fasting blood glucose levels (SMD: -0.67, 95% CI [-1.01, -0.34]), and 2-hour postprandial blood glucose levels (SMD: -0.48, 95% CI [-0.65, -0.30]). Exercise interventions had no significant effects on sedentary behaviour, prenatal depression, birthweight, or the incidence of preterm birth.

CONCLUSIONS

Exercise interventions appear to increase physical activity during pregnancy. Certain intervention characteristics (e.g., combined aerobic and strength training, individualised or unsupervised formats, and mHealth-supported approaches) are found to be potentially associated with larger effects. Exercise interventions may also improve maternal health and pregnancy outcomes; however, there was little or no intervention effect observed on sedentary behaviour, prenatal depression, birthweight, or preterm birth.

REGISTRATION: This protocol is registered in PROSPERO (CRD420251231458).