Rubén Barakat

Introduction The complex process of pregnancy and childbirth significantly influences the well‐being of both mother and child. Today all pregnant women without medical contraindications are recommended to start or continue regular aerobic and strength training for at least 150 min per week to prevent pregnancy‐related diseases and conditions. Urinary incontinence in pregnancy, episiotomy and third‐ or fourth‐degree perineal tear during labor can greatly impact womens’ health, quality of life and ability to be physically active. The aim of this study was to examine the efficacy of pelvic floor muscle training (PFMT) during pregnancy in the prevention of urinary incontinence, episiotomy, and third‐ or fourth‐degree perineal tear. Material and methods A systematic review and meta‐analysis (CRD42022370600) was performed. Only randomized clinical trials published between 2010 and 2023 were included. The following databases were examined: EBSCO (including Academic Search Premier, Education Resources Information Center, MEDLINE, SPORTDiscus and OpenDissertations databases), Clinicaltrials.gov , Web of Science, Scopus, Cochrane Database of Systematic Reviews and Physiotherapy Evidence Database (PEDro). Three meta‐analyses to investigate the effect of PFMT exclusively or implemented as a section within a physical activity program during pregnancy on urinary incontinence, episiotomy, and third‐ or fourth‐degree perineal tear were conducted. Results Thirty studies were analyzed ( N = 6691). An effective preventive action of PFMT was found for urinary incontinence ( z = 3.46; p < 0.0005; relative risk [RR] = 0.72, 95% confidence interval [CI]: 0.59, 0.87, I 2 = 59%) and third‐ or fourth‐degree perineal tear ( z = 2.89; p = 0.004; RR = 0.50, 95% CI: 0.31, 0.80, I 2 = 48%) but not for episiotomy ( z = 0.80; p = 0.42; RR = 0.95, 95% CI: 0.85, 1.07, I 2 = 75%). Conclusions PFMT during pregnancy proves to be an effective preventive intervention for reducing the risk of urinary incontinence and the occurrence of third‐ or fourth‐degree perineal tears. These findings highlight the importance of incorporating PFMT into antenatal care and training programs to improve maternal well‐being and overall childbirth outcomes.

Cesarean delivery may increase the need for anesthesia administration, thereby causing potential risks to both maternal and fetal health. This article aimed to investigate the effect of physical activity during pregnancy on the type of delivery, the duration of labor, and the use of epidurals (registration No.: CRD42022370646). Furthermore, 57 RCTs (n = 15301) were included showing that physical activity could decrease the risk of cesarean section (z = 3.22, p = 0.001; RR = 0.87, 95% CI = 0.79, 0.95, I2 = 37%, Pheterogeneity = 0.004), and 32 RCTs (n = 9468) showed significant decreases in instrumental delivery through performing physical activity (z = 3.48, p < 0.001; RR = 0.84, 95% CI = 0.76, 0.93, I2 = 0%, Pheterogeneity = 0.63). A significant decrease in the 15 RCTs’ (n = 4797) duration of first stage labor was found in physically active pregnant women (z = 2.09, p = 0.04; MD = −62.26, 95% CI = −120.66, −3.85, I2 = 93%, Pheterogeneity < 0.001) compared to those not active. Prenatal physical activity could decrease the risk of cesarean section and instrumental delivery and the duration of first stage labor.