{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:57:56Z","timestamp":1792173476210,"version":"4.4.0"},"reference-count":53,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2024,4,11]],"date-time":"2024-04-11T00:00:00Z","timestamp":1712793600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) are the most common medical complications in pregnancy. Physical exercise is considered to be safe and beneficial during pregnancy. Moreover, pregnancy could be considered as an opportunity for healthcare providers to promote positive lifestyle behavior and optimize the well-being of pregnant women. Since there are few up-to-date reviews evaluating the role of exercise and the risks of developing obstetrical complications, we performed a review to investigate the effects of physical activity and exercise during pregnancy compared to a control group, focusing on the risk of development of HDP and GDM. We searched Medline and Web of Science, including only randomized controlled trials (RCTs) and systematic reviews. This review supports a beneficial effect of exercise and provides evidence that it significantly decreases the risk of HDP and GDM.<\/jats:p>","DOI":"10.3390\/jcm13082198","type":"journal-article","created":{"date-parts":[[2024,4,11]],"date-time":"2024-04-11T03:29:04Z","timestamp":1712806144000},"page":"2198","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Effect of Physical Activity during Pregnancy on the Risk of Hypertension Disorders and Gestational Diabetes: Evidence Generated by New RCTs and Systematic Reviews"],"prefix":"10.3390","volume":"13","author":[{"given":"Cristina","family":"Taliento","sequence":"first","affiliation":[{"name":"Department of Medical Sciences, Obstetrics and Gynecology Unit, University Hospital \u201cSant\u2019Anna\u201d, 44121 Ferrara, Italy"},{"name":"Department of Development and Regeneration\u2014Woman and Child, KU Leuven, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Piccolotti","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Obstetrics and Gynecology Unit, University Hospital \u201cSant\u2019Anna\u201d, 44121 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arianna","family":"Sabattini","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Obstetrics and Gynecology Unit, University Hospital \u201cSant\u2019Anna\u201d, 44121 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4988-9114","authenticated-orcid":false,"given":"Mara","family":"Tormen","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Obstetrics and Gynecology Unit, University Hospital \u201cSant\u2019Anna\u201d, 44121 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3254-6043","authenticated-orcid":false,"given":"Rosaria","family":"Cappadona","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Obstetrics and Gynecology Unit, University Hospital \u201cSant\u2019Anna\u201d, 44121 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pantaleo","family":"Greco","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Obstetrics and Gynecology Unit, University Hospital \u201cSant\u2019Anna\u201d, 44121 Ferrara, Italy"},{"name":"Department of Medical Sciences, Institute of Obstetrics and Gynecology, University of Ferrara, Via Fossato di Mortara, 64\/B, 44121 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gennaro","family":"Scutiero","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Obstetrics and Gynecology Unit, University Hospital \u201cSant\u2019Anna\u201d, 44121 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,4,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"51","DOI":"10.3810\/psm.1999.08.947","article-title":"Exercise during pregnancy: Safe and beneficial for most","volume":"27","author":"Artal","year":"1999","journal-title":"Phys. Sportsmed."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/S0146-0005(96)80018-8","article-title":"Maternal and fetal cardiovascular response to exercise during pregnancy","volume":"20","author":"Veille","year":"1996","journal-title":"Semin. Perinatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/S0146-0005(96)80017-6","article-title":"Cardiovascular responses to aerobic exercise during pregnancy and postpartum","volume":"20","author":"Pivarnik","year":"1996","journal-title":"Semin. Perinatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/S0146-0005(96)80019-X","article-title":"A comparison of the ventilatory responses to exercise in pregnant, postpartum, and nonpregnant women","volume":"20","author":"Wiswell","year":"1996","journal-title":"Semin. Perinatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/S0146-0005(96)80024-3","article-title":"Prolonged exercise in pregnancy: Glucose homeostasis, ventilatory and cardiovascular responses","volume":"20","author":"Soultanakis","year":"1996","journal-title":"Semin. Perinatol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Davenport, M.H., Kathol, A.J., Mottola, M.F., Skow, R.J., Meah, V.L., Poitras, V.J., Garcia, A.J., Gray, C.E., Barrowman, N., and Riske, L. (Br. J. Sports Med., 2018). Prenatal exercise is not associated with fetal mortality: A systematic review and meta-analysis, Br. J. Sports Med., Epub ahead of print.","DOI":"10.1136\/bjsports-2018-099773"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1136\/bjsports-2018-099355","article-title":"Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: A systematic review and meta-analysis","volume":"52","author":"Davenport","year":"2018","journal-title":"Br. J. Sports Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"229","DOI":"10.3109\/14767050903550899","article-title":"Hypertension in gestational diabetes mellitus: Pathophysiology and long-term consequences","volume":"23","author":"Sibai","year":"2010","journal-title":"J. Matern.-Fetal Neonatal Med."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"(2020). Physical Activity and Exercise During Pregnancy and the Postpartum Period: ACOG Committee Opinion, Number 804. Obstet. Gynecol., 135, e178\u2013e188.","DOI":"10.1097\/AOG.0000000000003772"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Wang, W., Xie, X., Yuan, T., Wang, Y., Zhao, F., Zhou, Z., and Zhang, H. (2021). Epidemiological trends of maternal hypertensive disorders of pregnancy at the global, regional, and national levels: A population-based study. BMC Pregnancy Childbirth, 21.","DOI":"10.1186\/s12884-021-03809-2"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1161\/HYPERTENSIONAHA.117.10803","article-title":"Hypertensive Disorders of Pregnancy: ISSHP Classification, Diagnosis, and Management Recommendations for International Practice","volume":"72","author":"Brown","year":"2018","journal-title":"Hypertension"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"S844","DOI":"10.1016\/j.ajog.2021.11.1356","article-title":"The etiology of preeclampsia","volume":"226","author":"Jung","year":"2022","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/j.preghy.2013.07.003","article-title":"Clinical risk factors for gestational hypertensive disorders in pregnant women at high risk for developing preeclampsia","volume":"3","author":"Wong","year":"2013","journal-title":"Pregnancy Hypertens"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1901","DOI":"10.1016\/j.jacc.2022.03.335","article-title":"Cardiovascular Risk Factors Mediate the Long-Term Maternal Risk Associated With Hypertensive Disorders of Pregnancy","volume":"79","author":"Stuart","year":"2022","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"649.e1","DOI":"10.1016\/j.ajog.2015.11.039","article-title":"Exercise during pregnancy protects against hypertension and macrosomia: Randomized clinical trial","volume":"214","author":"Barakat","year":"2016","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1111\/aogs.13151","article-title":"Exercise during pregnancy and risk of gestational hypertensive disorders: A systematic review and meta-analysis","volume":"96","author":"Saccone","year":"2017","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1111\/j.1600-0412.2012.01483.x","article-title":"Exercise and physical activity in the prevention of pre-eclampsia: Systematic review","volume":"91","author":"Kasawara","year":"2012","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"261","DOI":"10.3109\/00016340903433982","article-title":"Does physical activity in leisure time early in pregnancy reduce the incidence of preeclampsia or gestational hypertension?","volume":"89","author":"Vollebregt","year":"2010","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Al-Huda, F., Shapiro, G.D., Davenport, M.H., Bertagnolli, M., and Dayan, N. (2022). Association between Cardiorespiratory Fitness and Hypertensive Disorders of Pregnancy: A Systematic Review and Meta-Analysis. J. Clin. Med., 11.","DOI":"10.3390\/jcm11154364"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Danielli, M., Gillies, C., Thomas, R.C., Melford, S.E., Baker, P.N., Yates, T., Khunti, K., and Tan, B.K. (2022). Effects of Supervised Exercise on the Development of Hypertensive Disorders of Pregnancy: A Systematic Review and Meta-Analysis. J. Clin. Med., 11.","DOI":"10.3390\/jcm11030793"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Oteng-Ntim, E., Varma, R., Croker, H., Poston, L., and Doyle, P. (2012). Lifestyle interventions for overweight and obese pregnant women to improve pregnancy outcome: Systematic review and meta-analysis. BMC Med., 10.","DOI":"10.1186\/1741-7015-10-47"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Lee, K.W., Ching, S.M., Ramachandran, V., Yee, A., Hoo, F.K., Chia, Y.C., Wan Sulaiman, W.A., Suppiah, S., Mohamed, M.H., and Veettil, S.K. (2018). Prevalence and risk factors of gestational diabetes mellitus in Asia: A systematic review and meta-analysis. BMC Pregnancy Childbirth, 18.","DOI":"10.1186\/s12884-018-2131-4"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.diabres.2018.02.023","article-title":"IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045","volume":"138","author":"Cho","year":"2018","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1007\/s00592-018-1146-7","article-title":"The post-HAPO situation with gestational diabetes: The bright and dark sides","volume":"55","author":"Lapolla","year":"2018","journal-title":"Acta Diabetol."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"HAPO Study Cooperative Research Group, Metzger, B.E., Lowe, L.P., Dyer, A.R., McIntyre, H.D., Oats, J.J., Persson, B., Rogers, M.S., and Sacks, D.A. (2008). Hyperglycemia and adverse pregnancy outcomes. N. Engl. J. Med., 358, 1991\u20132002.","DOI":"10.1056\/NEJMoa0707943"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.dsx.2013.10.017","article-title":"Feto-maternal outcomes in women with and without gestational diabetes mellitus according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria","volume":"7","author":"Nayak","year":"2013","journal-title":"Diabetes Metab. Syndr."},{"key":"ref_27","first-page":"CD010443","article-title":"Diet and exercise interventions for preventing gestational diabetes mellitus","volume":"4","author":"Bain","year":"2015","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_28","first-page":"CD009021","article-title":"Exercise for pregnant women for preventing gestational diabetes mellitus","volume":"7","author":"Han","year":"2012","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1016\/j.ajog.2017.01.037","article-title":"A randomized clinical trial of exercise during pregnancy to prevent gestational diabetes mellitus and improve pregnancy outcome in overweight and obese pregnant women","volume":"216","author":"Wang","year":"2017","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1093\/aje\/kwh091","article-title":"Prospective study of gestational diabetes mellitus risk in relation to maternal recreational physical activity before and during pregnancy","volume":"159","author":"Dempsey","year":"2004","journal-title":"Am. J. Epidemiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"108371","DOI":"10.1016\/j.diabres.2020.108371","article-title":"Physical activity in pregnancy prevents gestational diabetes: A meta-analysis","volume":"168","author":"Doi","year":"2020","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1097\/AOG.0000000000000691","article-title":"Physical Activity Interventions in Pregnancy and Risk of Gestational Diabetes Mellitus: A Systematic Review and Meta-analysis","volume":"125","author":"Russo","year":"2015","journal-title":"Obstet. Gynecol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"223","DOI":"10.2337\/dc10-1368","article-title":"Physical Activity Before and During Pregnancy and Risk of Gestational Diabetes Mellitus: A meta-analysis","volume":"34","author":"Tobias","year":"2011","journal-title":"Diabetes Care"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1111\/1471-0528.15476","article-title":"Associations between maternal physical activity in early and late pregnancy and offspring birth size: Remote federated individual level meta-analysis from eight cohort studies","volume":"126","author":"Pastorino","year":"2018","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1038\/s41574-022-00734-y","article-title":"A global view of hypertensive disorders and diabetes mellitus during pregnancy","volume":"18","author":"Jiang","year":"2022","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Plows, J.F., Stanley, J.L., Baker, P.N., Reynolds, C.M., and Vickers, M.H. (2018). The Pathophysiology of Gestational Diabetes Mellitus. Int. J. Mol. Sci., 19.","DOI":"10.3390\/ijms19113342"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"15557","DOI":"10.1038\/ncomms15557","article-title":"Exercise induces cerebral VEGF and angiogenesis via the lactate receptor HCAR1","volume":"8","author":"Morland","year":"2017","journal-title":"Nat. Commun."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Piani, F., Tossetta, G., Cara-Fuentes, G., Agnoletti, D., Marzioni, D., and Borghi, C. (2023). Diagnostic and Prognostic Role of CD93 in Cardiovascular Disease: A Systematic Review. Biomolecules, 13.","DOI":"10.3390\/biom13060910"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1655","DOI":"10.1016\/j.ajog.2004.03.074","article-title":"The association between preeclampsia and the severity of gestational diabetes: The impact of glycemic control","volume":"191","author":"Yogev","year":"2004","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1111\/j.1365-2265.2011.04234.x","article-title":"Leptin, adiponectin and other adipokines in gestational diabetes mellitus and pre-eclampsia","volume":"76","author":"Miehle","year":"2012","journal-title":"Clin. Endocrinol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1055\/s-0032-1333276","article-title":"Activated translation signaling in placenta from pregnant women with gestational diabetes mellitus: Possible role of leptin","volume":"45","author":"Gambino","year":"2013","journal-title":"Horm. Metab. Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1007\/s001250051595","article-title":"Increased plasma leptin in gestational diabetes","volume":"44","author":"Pacini","year":"2001","journal-title":"Diabetologia"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1016\/j.jaci.2005.02.023","article-title":"Adipose tissue, adipokines, and inflammation","volume":"115","author":"Fantuzzi","year":"2005","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2488","DOI":"10.2337\/diacare.27.10.2488","article-title":"Leptin-to-adiponectin ratio as a potential atherogenic index in obese type 2 diabetic patients","volume":"27","author":"Satoh","year":"2004","journal-title":"Diabetes Care"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"108041","DOI":"10.1016\/j.diabres.2020.108041","article-title":"Maternal circulating leptin profile during pregnancy and gestational diabetes mellitus","volume":"161","author":"Xiao","year":"2020","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"726861","DOI":"10.1155\/2014\/726861","article-title":"Exercise induced adipokine changes and the metabolic syndrome","volume":"2014","author":"Golbidi","year":"2014","journal-title":"J. Diabetes Res."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1161\/HYPERTENSIONAHA.114.03979","article-title":"Serum leptin measured in early pregnancy is higher in women with preeclampsia compared with normotensive pregnant women","volume":"65","author":"Taylor","year":"2015","journal-title":"Hypertension"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"115","DOI":"10.2165\/00007256-200131020-00004","article-title":"The cytokine response to physical activity and training","volume":"31","author":"Moldoveanu","year":"2001","journal-title":"Sports Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1055\/s-2007-1021132","article-title":"The cytokine response to strenuous exercise","volume":"15","author":"Northoff","year":"1994","journal-title":"Int. J. Sports Med."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1111\/j.1469-7793.1999.287ad.x","article-title":"Pro- and anti-inflammatory cytokine balance in strenuous exercise in humans","volume":"515","author":"Ostrowski","year":"1999","journal-title":"J. Physiol."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Acosta-Manzano, P., Coll-Risco, I., Van Poppel, M.N.M., Segura-Jim\u00e9nez, V., Femia, P., Romero-Gallardo, L., Borges-Cosic, M., D\u00edaz-Castro, J., Moreno-Fern\u00e1ndez, J., and Ochoa-Herrera, J.J. (2019). Influence of a Concurrent Exercise Training Intervention during Pregnancy on Maternal and Arterial and Venous Cord Serum Cytokines: The GESTAFIT Project. J. Clin. Med., 8.","DOI":"10.3390\/jcm8111862"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1136\/bjsports-2018-100056","article-title":"2019 Canadian guideline for physical activity throughout pregnancy","volume":"52","author":"Mottola","year":"2018","journal-title":"Br. J. Sports Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/j.preghy.2014.03.008","article-title":"Exercise in pregnancy\u2014UK women\u2019s views and experiences: Results of an online survey","volume":"4","author":"Atkinson","year":"2014","journal-title":"Pregnancy Hypertens"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/8\/2198\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:26:04Z","timestamp":1760106364000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/8\/2198"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,11]]},"references-count":53,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2024,4]]}},"alternative-id":["jcm13082198"],"URL":"https:\/\/doi.org\/10.3390\/jcm13082198","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,11]]}}}