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. 2023 May 26;102(21):e33688. doi: 10.1097/MD.0000000000033688

Obstetric, maternal, and neonatal outcomes after Pilates exercise during pregnancy: A systematic review and meta-analysis

Amal Yaseen Zaman a,*
PMCID: PMC10219711  PMID: 37233445

Background:

One of the major exercises to improve the psychological and physical functions of pregnant women is Pilate’s exercises. The aim of this study is to collect evidence about Pilates exercise effects on many consequences in pregnant women, such as maternal and neonatal outcomes and obstetric outcomes.

Methods:

PubMed, Clinical Key, Cochrane Library, Scopus, Embase, and Web of Science were scoured from their inception. Research comparing Pilates during pregnancy to other methods, or to the control was included. For randomized controlled trials (RCTs), The researcher utilized the Cochrane risk of bias tool; for non-RCTs, risk of bias tool to assess non-randomized studies of interventions, was used for cohort studies, and the national heart, lung, and blood institute tool. Meta-analysis was done using the Review manager 5.4. For continuous data, calculated the mean difference and 95% confidence interval (CI), and the risk ratio (RR) and 95% CI for dichotomous data.

Results:

Finally, 13 studies included with a total number of 719 pregnant women. The analysis showed that the Pilates group was significantly more likely to deliver vaginally than the control group (RR = 1.21, 95% CI [1.05 to 1.41], P value = .009). Women in the Pilates group were significantly lower than the control group to have Cesarean delivery (RR = 0.67, 95% CI [0.48–0.94], P value = .02). Moreover, Pilates-treated women were less likely to gain weight during pregnancy than control (mean difference = −3.48, 95% CI [−6.17 to −0.79], P value = .01).

Conclusion:

Pilates exercise improved the outcomes of pregnant women. It decreases the rate of Cesarean delivery and the time of delivery. Moreover, Pilates has a role in decreasing weight gain in pregnant women. As a result, that may improve the pregnancy experience for women. However, more RCTs needed with larger sample sizes to assess the Pilates effect on neonatal outcomes.

Keywords: cesarean delivery, meta-analysis, neonatal, Pilates exercise, pregnancy

1. Introduction

Obstetric care aims to create the ideal circumstances for a safe pregnancy and birth and make them a positive experience.[1] But unfortunately, pregnancy-associated pain is one of the biggest challenges that women experience during labor.[2] Moreover, during pregnancy, the women suffer from uncontrolled circulatory, reproductive, and skeletal changes. These changes lead to weight gain, hyperlipidemia, back pain, and depression associated with obesity.[3] Also, numerous complications arise as a result of long labor and delivery, including fetal tiredness, hypoxia, low Apgar scores, and even fetal death, as well as induction, cesarean and mechanical delivery, uterine atony, and maternal mortality.[4]

Therefore, the nonmedical interventions to limit labor pain and improve some of the mentioned health issues are now acceptable for pregnant women and align with obstetrics management.[5] For Instance, the most recent recommendations advise low-risk pregnancies women to continue or start progressive resistance and aerobic training before and after delivery. However, before beginning an exercise program, pregnant women should have a medical assessment to make sure there are no health problems that would require them to stop.[6]

One of the major exercises to improve the psychological and physical functions of pregnant women is Pilate’s exercises.[7] This exercise consists of several gentle movements that increase the body’s strength and flexibility. Adopting a common breathing technique is crucial when practicing Pilates since it helps stimulate the stabilizing muscles, increasing pelvic and trunk stability, and strength.[8] In addition, Salvesen et al[9] concluded that training programs for pelvic muscles are correlated with preventing a prolonged second stage of delivery. Moreover, there is increasing evidence that exercise like Pilates may enhance various aspects of birthing outcomes and improve maternal health.[10,11]

Pilates during pregnancy and childbirth has been the subject of numerous scientific evaluations of its potential benefits to mother and child. The purpose of this systematic review and meta-analysis is to collect data on the impact of Pilates on a wide range of outcomes for pregnant women, including those for the mother, the baby, and the delivery process as a whole.

2. Methods

This study is designed as a systematic review and meta-analysis, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses updates and Cochrane guidelines reported in their handbook.[12,13]

2.1. Literature search and data collection

The study was performed until Oct 2022 using these search terms: [(Pregnancy OR pregnant OR labor OR Obstetric) AND Pilates]. Moreover, the research was done on the following databases: PubMed, Clinical Key, Cochrane library, Embase, Scopus, and Web of Science.

2.2. Studies selection and eligibility criteria

All studies that met criteria were considered, whether they were randomized controlled trials (RCTs), non-RCTs, or cohort studies; Population: pregnant women; Intervention: Pilates exercise; Comparator: control; Outcomes: obstetric, maternal, and neonatal outcomes. After finishing the search, the duplicates were removed using the End Note program. Screening for relevance was undertaken through the titles and abstracts, then the full texts. Moreover, to find any missed relevant articles, the references were revised of the included studies.

2.3. Quality assessment

The Cochrane risk of bias tool (version 1) has evaluated included RCTs.[14] The following domains make up this tool: Detection selection bias and other biases; Allocation of arms; Participant and investigator blinding; Assessment of outcomes and their blinding; and Randomization of the population. The possibility of bias in judgment can be a high, low, or ambiguous risk of bias. In addition, the Cohort study was assessed by the national heart, lung, and blood institute tool for risk of bias.[15] The tool was composed of 12 questions about population and sample size justification, the research question, control definition, inclusion criteria and cases, event time, blindness, and the reporting of confounders. Not only that, but also a method to evaluate the quality of non-randomized intervention trials (ROBINS-I tool)[16] was used.

2.4. Data extraction

The data extracted into Excel sheets. The extracted data contained the following items: Summary characteristics including; study ID, study arms, age, body weight in kg, height in cm, gestation age at study entry in weeks, and education level; Baseline data including; site of study, study design, inclusion criteria, primary outcomes, and conclusion, and; Outcomes including; Maternal outcomes (body mass index (BMI), body weight gaining in Kg, and visual analog scale (VAS) for pain); Neonatal outcomes (APGAR score at 1 and 5 minutes); Obstetric outcomes [Duration of the active phase of labor, duration of second stage labor, duration of labor (sum of active phase and second stage), and type of delivery].

2.5. Data analysis

Review Manager (RevMan) v5.4 was used to conduct the statistical analysis. The significance level at a P value < .5 level was considered. If the data were continuous, the mean difference (MD) and 95% confidence interval (CI) was calculated. On the other hand, the risk ratio (RR) and 95% CI for the dichotomous data was reported. Finally, the heterogeneity was assessed by the I-square test (I2) and the chi-square test. The data heterogeneous if the P value of chi-square < 0.1 and the I2 value was above 50% was considered. The fixed effect model was used for the analysis of the homogeneous data, while the random effects model was employed for the analysis of the heterogeneous data.

3. Results

3.1. Literature search and study selection

Based on search strategy, 185 articles after removing the duplicates were found. After title and abstract screening, 20 studies were available for full-text screening. Then, 13 studies were suitable for inclusion criteria. Twelve articles were available for the quantitative analysis, and 1 study was available for qualitative evidence only. Figure 1

Figure 1.

Figure 1.

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PRISMA flow chart. PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

3.2. Study characteristics and quality

Nine RCTs included,[17–25] 3 non-RCTs,[11,26,27] and 1 retrospective cohort study[28] with a total sample size of 719 pregnant women. Studies sites varied among many countries, such as Turkey, Brazil, Spain, Iran, Cyprus, South Korea, Australia, and Indonesia. The range of age was between 23 and 39 years old. Moreover, the range of BMI was between 22 and 39. Tables 1 and 2. RCTs had a moderate risk of bias as they were reported in Figure 2. Regarding the non-RCT, they were of low to moderate risk of bias, and the detailed evaluation is attached in Table S1, Supplemental Digital Content, http://links.lww.com/MD/I912, 1 cohort study, and it was of fair quality. Table S2, Supplemental Digital Content, http://links.lww.com/MD/I913.

Table 1.

Summary of the included studies.

Study ID Site Study design Inclusion criteria Primary outcomes/ endpoint Conclusion
Atakan 2021 Turkey RCT 1. Pregnant women younger than 35 yr.
2. Do not have gestational diabetes or any obstacles to participation and complications including Type 1 diabetes, persistent bleeding, membrane rupture, developmental retardation history, chronic systemic vascular disease, or preeclampsia.		 1. The State-Trait Anxiety Inventory (STAI).
2. Visual Analog Scale (VAS).
3. APGAR Score.
4. Borg Scale.
5. Weight gain during pregnancy (kg).
6. Duration of normal delivery.
7. Type of delivery.		 “The study results showed that childbirth training applied with clinical Pilates exercise had a positive effect on pregnant women and their birth outcomes.”
Dias 2017 Brazil RCT 1. Primiparous
2. Older than 18 yr.
3. Medical permission for physical exercise during pregnancy.
4. The absence of gestational complications described in the medical follow-up.
5. Sedentary in the last 4 mo.		 1. Pelvic floor muscle (PFM) strength.
2. Oxford Scale.
3. PFM endurance.
4. PFM repeatability.		 “Pilates exercise program with PFM contraction is not able to change the PFM strength assessed by manometer in pregnant women, but it improved adherence to the intervention”
Feria-Ramírez 2021 Spain Non-RCT 1. Being registered on an antenatal program (AP).
2. Giving written consent for participation.
3. The pregnancy being a singleton.
4. The pregnancy being low-risk.
5. There not being any contraindications for physical exercise
6. Being at least 18 yr old.		 1. Weight gain during pregnancy (kg).
2. Type of delivery.		 “Health center managers should promote the training of midwives in the prevention and treatment of pelvic floor injuries during pregnancy and should consider strategies to enhance adhesion and participation concerning pelvic floor exercise programs throughout pregnancy through Apps and other digital media specifically aimed at this phase.”
Ghandali2021 Iran RCT 1. Age between 18 and 35 yr.
2. First pregnancy.
3. Single pregnancy.
4. Gestational age between 26 and 28 wk.
5. Normal Body mass index.
6. Willingness to participate in the study.		 1. Satisfaction with delivery.
2. Visual Analog Scale (VAS).
3. APGAR Score.
4. Duration of normal delivery.
5. Type of delivery.		 “According to the results of this study, Pilates exercise during pregnancy improved the labor process and increased maternal satisfaction in the childbirth process, without causing complications for the mother and baby. However, studies with larger sample sizes are recommended to prove the efficacy and safety of this practice during labor.”
Guder 2018 Cyprus Non-RCT 1. Be between the ages of 18 and 35 yr.
2. Be 28- to 32 wk pregnant.
3. Have only one fetus.
4. Have no pregnancy complications or systemic diseases.
5. Engaged in no exercises or pregnancy Pilates regularly.
6. Had completed the birth at a hospital between the 37th and 42nd wk of pregnancy.		 1. The Wijma delivery expectancy/experience questionnaire version A (W-DEQ A).
2. Type of delivery		 “The childbirth preparation program had a positive effect on fear of childbirth and neonatal outcomes.”
Hyun 2020 South Korea RCT 1. Who did not have specific diseases or receive specific medications.
2. Had no pregnancy complications.
3. Were expected to have a normal delivery (Destination period: 16 &24 wk).		 1. Body composition.
2. Blood collection and biochemical analyses.
3. Pelvic stabilization muscle strength.
4. Muscle damage and stress markers.		 “The 12-wk Pilates exercise program conducted in this study has a positive effect on body water balance and strengthens the muscles related to pelvic stabilization within the range of reducing muscle damage or causing muscle damage and stress in pregnant women. We think that it has an effective exercise intensity.”
Hyun 2021 Korea RCT 1. Pregnant women under the age of 45 yr.
2. At 20–24 wk of single-fetus pregnancy.
3. They did not receive medications and did not participate in-home training.		 1. Body composition.
2. Pelvic tilt.
3. Muscles of the hip joint.
4. The oswestry disability index (ODI).		 “The 8- wk HTPE program is an effective exercise for pregnant woman that reduces body fat metabolism and strengthens muscles of the hip joint, thus alleviating pregnancy-induced low back pain and insomnia.”
Kim 2022 Korea RCT 1. Pregnant women under the age of 40 yr.
2. Who was at 24–28 wk of single-fetus pregnancy.
3. They did not have a diagnosis of diabetes or hypertension and did not take any medications.
4. All participants had a BMI of < 30.		 1. Body composition.
2. Edinburgh postnatal depression scale (EPDS).
3. Pittsburgh sleep quality index (PSQI).
4. Perceived stress scale (PSS).		 “Pregnant women’s online Pilates in this study was effective at reducing weight and depression in women after childbirth and should be used to promote women’s mental health during COVID-19.”
Mazzarino 2022 Australia RCT 1. Prima gravida women between 18 and 25-wk gestation with a singleton pregnancy.
2. With a normal 18 to 20-wk ultrasound scan, booked for childbirth at a private hospital in Melbourne, Australia		 1. Quality of life.
2. Pain.
3. Weight gain during pregnancy (kg).
4. Duration of normal delivery.
5. Type of delivery.
6. Urinary incontinence.		 “Modified Pilates appears feasible and safe for low-risk pregnant women. Further research is needed in on this topic.”
Oktaviani 2017 Indonesia Non-RCT 1. Pregnant women in the third trimester which was defined by gestational age ≥ 28 wk.
2. Musculoskeletal pain (back and waist) affecting the pregnancy.
3. Maternal age 20–35 yr.
4. Parity ≤ 3; and the absence of heavy lifting in daily activities.		 1. Pain with visual analog scale (VAS). “The results of this study indicated that Pilates is an effective, healthy, and feasible method of reducing pain in pregnancy, and is therefore a beneficial alternative workout for the suppression of pain in the third trimester of pregnancy.”
Rodriguez-Diaz 2017 Spain RCT 1. Being of age.
2. Being in the second trimester of pregnancy.
3. That the pregnancy was not multiple.
4. Not having any contraindication of a medical nature nor any pathologies) not taking any medication which could have affected the program.
5. Not taking part in other physical exercise programs.
6. Not having any contraindication or lesion which would impede undertaking physical exercise.		 1. Type of birth.
2. Muscle strength.
3. BMI.
4. Weight.		 “A physical activity program of 8 wk based on the Pilates method improves functional parameters in pregnant women and benefits delivery.”
Sonmezer 2020 Turkey RCT 1. Pregnant women in wk 22–24 with pregnancy-induced lumbar pain.
2. Maternal age 20–35 yr.
3. Parity equal or <3.
4. The absence of prepregnancy lumbar pain.		 1. Disability.
2.Pain with visual analog scale (VAS).
3. Quality of life.		 “Pilates exercises can be recommended as an effective and safe method for increasing lumbopelvic stabilization, reducing pain and disability, improving physical mobility and sleep problems in pregnant women with LBP.”
Yaman 2020 Turkey Retrospective Cohort 1. Pregnant women in wk 16–18 until 34–36.
2. Patients without systemic diseases, such as hypertension and goiter, and maternal complications, such as preeclampsia, gestational diabetes, membrane rupture, multiple pregnancy and placenta previa.		 1. Type of delivery.
2. Duration of delivery.		 “This study supports the conclusion that pilates performed by pregnant women has a positive effect on delivery outcomes.”
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BMI = body mass index, RCTs = randomized controlled trials.

Table 2.

Baseline characteristics of the included studies.

Study ID Study arms, sample size Age (yr) (mean ± SD) Body weight (kg) BMI (kg/m²) Height (m) Gestation or gestation age at study entry (wk) Education (n, %)
Atakan 2021 Childbirth training with clinical
Pilates exercises, 21		 27.52 ± 3.88 65.66 ± 8.09 25.05 ± 2.84 161.9 ± 5.48 39.38 ± 1.1 1. Elementary School, 0 (0%).
2. High School, 2 (9.6%).
3. University, 19 (90.4%).
Childbirth training, 21 25.85 ± 3.63 67.04 ± 10.21 24.68 ± 3.10 164.7 ± 6.78 39.61 ± 1.11 1. Elementary School, 3 (14.2%).
2. High School, 9 (42.9%).
3. University, 9 (42.9%).
Control group, 22 25.5 ± 4.19 67.31 ± 11.86 26.01 ± 3.6 160.5 ± 6.34 39.05 ± 1.36 1. Elementary School, 4 (18.2%).
2. High School, 15 (68.2%).
3. University, 3 (13.6%).
Dias 2017 Pilates group, 24 29 ± 3.96 - 23.07 ± 2.78 - 15.87 ± 2.59 -
Control group, 13 29.83 ± 3.09 - 23.87 ± 3.20 - 18.5 ± 2.35 -
Feria-Ramírez 2021 Pilates group, 24 32.5 ± 4.8 65.7 ± 10.3 25 ± 4 160 ± 1 27.3 ± 2.6 1. Primary–Secondary, 8 (33.3%).
2. Superior–Further, 16 (66.7%).
Control group, 48 32.4 ± 5.4 67.6 ± 10 25.2 ± 3.8 160 ± 1 27.3 ± 4.1 1. Primary–Secondary, 18 (37.5%).
2. Superior–Further, 30 (62.5%).
Ghandali2021 Pilates group, 51 25.16 ± 4.41 - 22.71 ± 1.57 - 26.71 ± 0.78 1. Did not finish high school, 10 (19.6%).
2. Finished high school, 22 (43.1%).
3. University, 19 (36.5%).
Control group, 52 23.81 ± 4.30 - 22.38 ± 1.52 - 26.67 ± 0.73 1. Did not finish high school, 9 (17.3%).
2. Finished high school, 24 (46.2%).
3. University, 19 (37.3%).
Guder 2018 Pilates group, 54 28.05 ± 2.91 - - - - -
Control group, 54 28.00 ± 3.69 - - - - -
Hyun 2020 Pilates group, 9 31.78 ± 4.68 57.98 ± 7.91 39.57 ± 4.52 - - -
Control group, 7 32.00 ± 3.46 53.67 ± 5.70 37.81 ± 3.37 - - -
Hyun 2021 Pilates group, 7 31.71 ± 3.03 67.44 ± 5.18 25.3 ± 5.1 - - -
Control group, 7 34.14 ± 3.82 63.57 ± 3.57 23.5 ± 1.6 - - -
Kim 2022 Pilates group, 8 39.71 ± 2.01 62.71 ± 4.00 24.25 ± 1.58 164.81 ± 4.43 - -
Control group, 8 38.14 ± 1.39 64.55 ± 2.52 22.88 ± 1.64 163.82 ± 3.71 - -
Mazzarino 2022 Pilates group, 11 - 73.3 ± 12.9 26.1 ± 3.8 167 ± 5.7 39.3 ± 1 -
Control group, 10 - 63.5 ± 7.6 23.3 ± 2.8 164.9 ± 8.7 38 ± 0.71 -
Oktaviani2017 Pilates group, 20 28.70 ± 6.46 - - - 29.65 ± 1.81 -
Regular exercise, 20 26.95 ± 4.94 - - - 29.55 ± 0.98 -
Rodriguez-Diaz 2017 Pilates group, 50 32.87 ± 4.46 76.58 ± 12.14 28.79 ± 4.27 163 ± 1.2 - -
Control group, 55 31.52 ± 4.95 72.82 ± 14.12 26.78 ± 5.04 164 ± 0.5 - -
Sonmezer2020 Pilates group, 20 29.00 ± 2.75 62.83 ± 7.88 23.80 ± 3.16 162.66 ± 4.28 22.70 ± 0.73 -
Control group, 20 28.00 ± 2.10 61.40 ± 7.24 23.26 ± 2.59 162.50 ± 4.18 22.90 ± 0.71 -
Yaman 2020 Pilates group, 26 28.77 ± 4.43 10.6 9 ± 2.24 25.70 ± 1.75 - 39.35 ± 1.23 1. Primary School, 2 (7.7%).
2. High School, 7 (26.9%).
3. University, 17 (65.4%).
Control group, 57 28.18 ± 4.69 14.11 ± 4.39 26 ± 2.54 - 38.88 ± 1.40 1. Primary School, 34 (59.6%).
2. High School, 17 (29.9%).
3. University, 6 (10.5%).
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BMI = body mass index.

Figure 2.

Figure 2.

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Risk of Bias graph for RCTs. RCTs = randomized controlled trials.

3.3. Quantitative analysis

3.3.1. Obstetric outcomes

3.3.1.1. Type of delivery (vaginal)

Five studies reported this outcome with a population of 358 pregnant women. The Pilates group was significantly more likely to deliver vaginally than the control group (RR = 1.21, 95% CI [1.05–1.41], P value = .009). The pooled results were homogenous (P value = .44, I2 = 0%, fixed effect model). Figure 3A

Figure 3.

Figure 3.

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(A) Forest plot of type of delivery (Vaginal). (B). Forest plot of type of delivery (Cesarean).

3.3.1.2. Type of delivery (cesarean)

Five studies reported this outcome, with a total sample size of 358 pregnant women. The Pilates-treated women were significantly lower than the control group to have Cesarean delivery (RR = 0.67, 95% CI [0.48–0.94], P value = .02). The homogeneity was observed in the results with a fixed effect model (P value = .99, I2 = 0%). Figure 3B

3.3.1.3. Duration of the active phase of labor

Pilates exercises significantly declined the time of the active phase with (MD = −49.13, 95% CI [−74.11 to −24.15], P value = .0001), sample size = 207 pregnant women. The pooled estimate was homogenous (P value = .57, I2 = 0%). Figure 4A

Figure 4.

Figure 4.

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(A). Forest plot of duration of the active phase of labor. (B) Forest plot of duration of the second stage of labor. (C) Forest plot of duration of labor (sum of active phase and second stage).

3.3.1.4. Duration of the second stage of labor

Pilates exercises significantly decrease the duration of the second stage of labor for pregnant women (MD = −17.70, 95% CI [−28.84. to −6.57], P value = .002), sample size = 124. The analyzed data were homogeneous (P value = .77, I2 = 0%, fixed effect model). Figure 4B

3.3.1.5. Duration of labor (sum of active phase and second stage) (minutes)

Three articles studied the duration of the labor (sample size = 167 pregnant women), and the Pilates group had a lower time of labor than the control group [(MD = −84.89, 95% CI [−130.89. to −38.90], P value = .0003). The data were homogenous with a fixed effect model (P value = .68, I2 = 0%). Figure 4C

3.3.2. Maternal outcomes

3.3.2.1. BMI

Three studies mentioned this outcome with a total sample size of 135 pregnant women. There was no significant difference between the intervention and control groups (MD = −0.51, 95% CI [−2.07 to 1.05], P value = .52). The results were homogenous with a fixed effect model (P value = .64, I2 = 0%). Figure 5

Figure 5.

Figure 5.

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Forest plot of BMI. BMI = body mass index.

3.3.2.2. Body weight gain in kg

Five studies with a sample size of 248 pregnant women concluded that Pilates-treated women were less likely to gain weight during pregnancy than control (MD = −3.48, 95% CI [−6.17 to −0.79], P value = .01). Fixed effect model was used due to the data homogeneity (P value = .89, I2 = 0%). Figure 6

Figure 6.

Figure 6.

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Forest plot of body weight gain in kg.

3.3.2.3. VAS score for pain

Pilates group and control group results were not significantly different, with sample size = 101 pregnant women (MD = −1.02, 95% CI [−2.57 to −0.53], P value = .20). The results were heterogeneous (P value = .02, I2 = 75%) and the heterogeneity could not be resolved. Figure 7

Figure 7.

Figure 7.

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Forest plot of VAS score for pain. VAS = visual analog scale.

3.3.3. Neonatal outcomes

3.3.3.1. APGAR score at 1 minute

There was a significant effect of Pilates over the control (MD = 0.21, 95% CI [0.07–0.36], P value = .004). The results were homogenous (P value = .59, I2 = 0%). Figure 8A

Figure 8.

Figure 8.

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(A) Forest plot of APGAR score at 1 min. (B) Forest plot of APGAR score at 5 min.

3.3.3.2. APGAR score at 5 minutes

Two studies investigated this outcome with a sample size of 146 pregnant women. The Pilates group and the control group showed no statistically significant differences. (MD = 0.07, 95% CI [−0.04 to 0.18], P value = .23). The pooled results were homogenous (P value = .82, I2 = 0%). Figure 8B

4. Discussion

The results of the analysis indicate that Pilates exercises are beneficial for obstetrics outcomes by reducing the cesarean delivery rate, increasing vaginal delivery rate, and shortening the delivery time. Pilates also plays a significant role in controlling weight gain during pregnancy and improving the APGAR score at 1 minute. However, there was no significant effect on BMI, VAS score for pain, or APGAR score at 5 minutes.

The world suffered from an increasing rate of Cesarean delivery. Betran et al[29] mentioned that about 1 in every 3 women would give birth Cesarean by 2030. Moreover, the World health organization aims to decrease unnecessary Cesarean sections and published guidelines for that.[30] Therefore, many nonclinical interventions have been introduced to reduce the rate of unnecessary Cesarean sections.[31] One of these interventions was the Pilates exercises. However, there was a conflict in the literature about the efficacy of Pilates in the type of delivery.[17,24,32] In addition, the unreported intensity of the exercise may account for the discrepancy between the 2 groups.[33] Nevertheless, the results supported that Pilates decreased Cesarean sections and increased the number of vaginal deliveries.

Furthermore, some studies reported no association between exercise and the duration of pregnancy.[13,32] On the other hand, many studies concluded that exercises might decrease labor time.[34–36] Unfortunately, there was no specific research about the outcomes of Pilates specifically. Instead, they study the effect of exercise on delivery time. Therefore, this study was performed to assess Pilates’ effectiveness and concluded that the period of delivery, the period of the active phase, and the period of the second stage decreased significantly with Pilates exercises.

In addition, Pilates exercises control weight gain in pregnant women, which may lead to preventing hyperlipidemia, back pain, chronic fatigue, and depression.[3] However, the BMI did not affect by Pilates, which may need more weight loss to decrease significantly. Although the weight gain decline was not high, still had a good result that can be combined with other interventions to achieve the target. Regarding neonatal outcomes, only 2 studies reported them. But we cannot rely on any of them because of the small sample size, and we need more studies to show if Pilates can affect neonatal outcomes or not.

The effects of Pilates exercise on expectant mothers and their infants have never before been analyzed in a comprehensive systematic review and meta-analysis. The number of studies and patients is homogenous and large, which leads to a valid and reliable conclusion as possible. On the other hand, the study had some limitations. First, non-RCTs and retrospective studies included liable to selection and reporting bias. Second, the studies did not report the intensity of Pilates which may affect the results of analysis. Finally, some estimates need more studies to evaluate the evidence about it, such as neonatal outcomes

5. Conclusion

Pilates exercise improved the outcomes of pregnant women. Delivery times and rates of cesarean section are shortened. Moreover, Pilates has a role in decreasing weight gain in pregnant women. As a result, that may improve the pregnancy experience for women. More randomized controlled trials with larger sample numbers are still required to evaluate Pilates impact on neonatal outcomes and produce more valid and generalizable results.

Acknowledgements

I like to acknowledge that no individuals or organizations require Acknowledgments for their contributions to this research.

Author contributions

Conceptualization: Amal Yaseen Zaman.

Data curation: Amal Yaseen Zaman.

Formal analysis: Amal Yaseen Zaman.

Methodology: Amal Yaseen Zaman.

Resources: Amal Yaseen Zaman.

Software: Amal Yaseen Zaman.

Validation: Amal Yaseen Zaman.

Writing – original draft: Amal Yaseen Zaman.

Writing – review & editing: Amal Yaseen Zaman.

Supplementary Material

medi-102-e33688-s001.pdf (13.9KB, pdf)
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medi-102-e33688-s002.pdf (8.5KB, pdf)
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Abbreviations:

BMI
body mass index
CI
confidence interval
I2 =
I-square test
MD
mean difference
RCTs
randomized controlled trials
RR
the risk ratio
VAS
visual analog scale

Supplemental Digital Content is available for this article.

The datasets generated during and/or analyzed during the current study are publicly available.

The authors have no funding and conflicts of interest to disclose.

How to cite this article: Zaman AY. Obstetric, maternal, and neonatal outcomes after Pilates exercise during pregnancy: A systematic review and meta-analysis. Medicine 2023;102:21(e33688).

References

  • [1].Sherman DJ, Frenkel E, Tovbin J, et al. Ripening of the unfavorable cervix with extraamniotic catheter balloon: clinical experience and review [in English]. Obstet Gynecol Surv. 1996;51:621–7. [DOI] [PubMed] [Google Scholar]
  • [2].Abushaikha L, Oweis A. Labour pain experience and intensity: a Jordanian perspective [in English]. Int J Nurs Pract. 2005;11:33–8. [DOI] [PubMed] [Google Scholar]
  • [3].Davenport MH, Marchand A-A, Mottola MF, et al. Exercise for the prevention and treatment of low back, pelvic girdle and lumbopelvic pain during pregnancy: a systematic review and meta-analysis [in English]. Br J Sports Med. 2019;53:90–8. [DOI] [PubMed] [Google Scholar]
  • [4].Cheng YW, Hopkins LM, Laros RK, Jr., et al. Duration of the second stage of labor in multiparous women: maternal and neonatal outcomes [in English]. Am J Obstet Gynecol. 2007;196:585.e1–6. [DOI] [PubMed] [Google Scholar]
  • [5].Navas A, Artigues C, Leiva A, et al. Effectiveness and safety of moderate-intensity aerobic water exercise during pregnancy for reducing use of epidural analgesia during labor: protocol for a randomized clinical trial [in English]. BMC Pregnancy Childbirth. 2018;18:94. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [6].ACOG Committee Opinion 650: physical activity and exercise during pregnancy and the postpartum period [in English]. Obstet Gynecol. 2015;126:e135–42. [DOI] [PubMed] [Google Scholar]
  • [7].Mazzarino M, Kerr D, Wajswelner H, et al. Pilates method for women’s health: systematic review of randomized controlled trials [in English]. Arch Phys Med Rehabil. 2015;96:2231–42. [DOI] [PubMed] [Google Scholar]
  • [8].Isacowitz R. Pilates. Human Kinetics; 2022. [Google Scholar]
  • [9].Salvesen KA, Mørkved S. Randomised controlled trial of pelvic floor muscle training during pregnancy [in English]. BMJ. 2004;329:378–80. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [10].Davenport MH, Ruchat S-M, Sobierajski F, et al. Impact of prenatal exercise on maternal harms, labour and delivery outcomes: a systematic review and meta-analysis [in English]. Br J Sports Med. 2019;53:99–107. [DOI] [PubMed] [Google Scholar]
  • [11].Sarpkaya Güder D, Yalvaç M, Vural G. The effect of pregnancy Pilates-assisted childbirth preparation training on childbirth fear and neonatal outcomes: a quasi-experimental/quantitative research. Qual Quant. 2018;52:2667–79. [Google Scholar]
  • [12].Higgins JP, et al. Cochrane Handbook for Systematic Reviews of Interventions. John Wiley & Sons; 2019. [Google Scholar]
  • [13].Page MJ, Moher D. Evaluations of the uptake and impact of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement and extensions: a scoping review. Syst Rev. 2017;6:1–14. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [14].Higgins JP, Altman DG, Gøtzsche PC, et al. The cochrane collaboration’s tool for assessing risk of bias in randomised trials [in English]. BMJ. 2011;343:d5928. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [15].National Heart and Blood Institute L. Quality assessment tool for observational cohort and cross-sectional studiesReturn. 2014.
  • [16].Sterne JA, Hernán MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions [in English]. BMJ. 2016;355:i4919. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [17].Aktan B, Kayikçioğlu F, Akbayrak T. The comparison of the effects of clinical Pilates exercises with and without childbirth training on pregnancy and birth results [in English]. Int J Clin Pract. 2021;75:e14516. [DOI] [PubMed] [Google Scholar]
  • [18].Dias NT, Ferreira LR, Fernandes MG, et al. A Pilates exercise program with pelvic floor muscle contraction: Is it effective for pregnant women? A randomized controlled trial [in English]. Neurourol Urodyn. 2018;37:379–84. [DOI] [PubMed] [Google Scholar]
  • [19].Ghandali NY, Iravani M, Habibi A, et al. The effectiveness of a Pilates exercise program during pregnancy on childbirth outcomes: a randomised controlled clinical trial. BMC Pregnancy Childbirth. 2021;21:480. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [20].Hyun A-H, Jeon Y-J. Effect of mat Pilates on body fluid composition, pelvic stabilization, and muscle damage during pregnancy. Appl Sci. 2020;10:9111.. [Online]. Available at: https://www.mdpi.com/2076-3417/10/24/9111. [Google Scholar]
  • [21].Hyun AH, Cho JY, Koo JH. Effect of home-based tele-Pilates intervention on pregnant women: a pilot study [in English]. Healthcare (Basel). 2022;10:125. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [22].Kim HB, Hyun AH. Psychological and biochemical effects of an online Pilates intervention in pregnant women during COVID-19: a randomized pilot study [in English]. Int J Environ Res Public Health. 2022;19:10931. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [23].Mazzarino M, Kerr D, Morris ME. Feasibility of Pilates for pregnant women: a randomised trial. J Bodyw Mov Ther. 2022;32:207–12. [DOI] [PubMed] [Google Scholar]
  • [24].Rodríguez-Díaz L, Ruiz-Frutos C, Vázquez-Lara JM, et al. Effectiveness of a physical activity programme based on the Pilates method in pregnancy and labour [in English]. Enferm Clin. 2017;27:271–277. [DOI] [PubMed] [Google Scholar]
  • [25].Sonmezer E, Özköslü MA, Yosmaoğlu HB. The effects of clinical Pilates exercises on functional disability, pain, quality of life and lumbopelvic stabilization in pregnant women with low back pain: a randomized controlled study [in English]. J Back Musculoskelet Rehabil. 2021;34:69–76. [DOI] [PubMed] [Google Scholar]
  • [26].Feria-Ramírez C, Gonzalez-Sanz JD, Molina-Luque R, et al. The effects of the Pilates method on pelvic floor injuries during pregnancy and childbirth: a quasi-experimental study [in English]. Int J Environ Res Public Health. 2021;18:6995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [27].Oktaviani I. Pilates workouts can reduce pain in pregnant women [in English]. Complement Ther Clin Pract. 2018;31:349–51. [DOI] [PubMed] [Google Scholar]
  • [28].Yaman S, TulmaÇ O, Canarslan B, et al. Effect of Pilates during pregnancy on delivery outcomes. J Health Sci Med. 2020;3:442–7. [Google Scholar]
  • [29].Betran AP, Ye J, Moller A-B, et al. Trends and projections of caesarean section rates: global and regional estimates. BMJ Global Health. 2021;6:e005671. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [30].W. H. Organization. WHO Recommendations Non-Clinical Interventions to Reduce Unnecessary Caesarean Sections. World Health Organization; 2018. [PubMed] [Google Scholar]
  • [31].Chen I, et al. Non-clinical interventions for reducing unnecessary caesarean section [in English]. Cochrane Database Syst Rev. 2018;9:Cd005528. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [32].Ferreira CLM, Guerra CML, Silva A, et al. Exercise in pregnancy: the impact of an intervention program in the duration of labor and mode of delivery [in English]. Rev Bras Ginecol Obstet. 2019;41:68–75. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [33].Price BB, Amini SB, Kappeler K. Exercise in pregnancy: effect on fitness and obstetric outcomes-a randomized trial [in English]. Med Sci Sports Exerc. 2012;44:2263–9. [DOI] [PubMed] [Google Scholar]
  • [34].Bolanthakodi C, Raghunandan C, Saili A, et al. Prenatal yoga: effects on alleviation of labor pain and birth outcomes [in English]. J Altern Complement Med. 2018;24:1181–8. [DOI] [PubMed] [Google Scholar]
  • [35].Gehan AA, Khadiga S, Amir G, et al. Efficacy of antenatal exercises on maternal and neonatal outcomes in elderly primigravida. Kasr Al Ainy Med J. 2015;21:109. [Google Scholar]
  • [36].Barakat R, Franco E, Perales M, et al. Exercise during pregnancy is associated with a shorter duration of labor. A randomized clinical trial [in English]. Eur J Obstet Gynecol Reprod Biol. 2018;224:33–40. [DOI] [PubMed] [Google Scholar]

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