Dear Editor,
The article by Alhajiri et al. (2025), which examines the knowledge, attitudes, and practices of antenatal exercise among pregnant women in KSA, provides a significant empirical contribution to the development of modern obstetrics. The finding that only 15.5 percent of respondents adhered to the American College of Obstetricians and Gynecologists (ACOG) recommendations confirms a significant gap between maternal health knowledge, attitudes, and practices, even though the majority of respondents demonstrated relatively good knowledge and attitudes toward physical exercise during pregnancy.1 From a midwifery perspective, these results highlight a fundamental issue in antenatal care practice: that knowledge transfer alone is insufficient to drive behavior change. The logistic regression analysis, which showed attitude as the most consistent predictor of adherence, conveys an important message: the role of midwives needs to go beyond informative education to a transformative counseling approach oriented toward changing the meaning of health for pregnant women. Global literature consistently demonstrates that midwives, through ongoing therapeutic relationships, are strategically positioned to influence women's attitudes, motivation, and self-confidence during pregnancy.2,3
Furthermore, the finding that most women obtain antenatal exercise information from social media, while the proportion of counseling from health professionals is relatively low, has serious implications for the midwifery care system. This situation indicates that evidence-based health messages are potentially overshadowed by information that is not scientifically curated. In this context, midwives need to be positioned as primary reference sources who not only convey ACOG recommendations but also help mothers interpret, personalize, and integrate antenatal exercise into their daily lives. Evidence from international studies indicates that physical exercise during pregnancy contributes to a reduced risk of gestational diabetes, operative delivery, and faster postpartum recovery.4 However, as Alhajiri et al. (2025) point out, these benefits will not be achieved if adherence remains low. Therefore, strengthening midwives' competencies in behavioral counseling, empathetic communication, and shared decision-making is a crucial agenda in contemporary midwifery education and practice.
Furthermore, the context of the transforming health system in KSA highlighted in this article reinforces the relevance of promotive and preventive approaches in maternity care. A culturally sensitive, community-based midwifery model emphasizing continuity of care has the potential to bridge the gap between positive attitudes and actual practice, particularly in communities with strong family values and social norms.5,6 In closing, the article by Alhajiri et al. (2025) not only presents an empirical overview of antenatal exercise but also serves as a reflective call for the midwifery profession to reposition physical exercise counseling as a core competency in antenatal care. Further research with longitudinal and interventional designs is urgently needed to test the effectiveness of attitude-based midwifery counseling models in improving adherence and maternal health outcomes sustainably.
Ethics approval
This manuscript is a scientific response to previously published research and does not involve human or animal subjects directly. Therefore, ethics approval is not required.
Declaration of Generative AI and AI-assisted technologies in the writing process
During the preparation of this work the author(s) used Chat GPT in order as tools were used to assist in the structuring, clarity of language, and coherence of arguments in this paper. After using this tool/service, the author reviewed and edited the content as necessary and took full responsibility for the content of the publication.
Source of funding
This research did not receive any special grants from funding agencies in the public, commercial, or not-for-profit sectors.
Conflicts of interest
The authors declare no conflicts of interest. The study discussed in this correspondence was conducted independently and without any financial or personal relationships that could inappropriately influence or bias the content of the work. The views expressed in this letter are solely those of the authors and are not influenced by any external parties or institutions.
Acknowledgement
This research was fully supported by Universitas Terbuka through its Publications Unit for their invaluable support, which provided essential assistance in the preparation of this manuscript. We are deeply grateful to the institution for their unwavering support, which has played a crucial role in the success of this research.
Footnotes
Peer review under responsibility of Taibah University.
References
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