Original article| Volume 24, ISSUE 1, e99-e104, January 2014

Exercise during Pregnancy and Risk of Late Preterm Birth, Cesarean Delivery, and Hospitalizations



      Federal physical activity guidelines recommend at least 150 minutes of moderate-intensity exercise per week during pregnancy. We studied whether regular exercise during pregnancy is associated with preterm birth, cesarean delivery, and hospitalization during pregnancy.


      Self-reported weekly exercise was ascertained in 3,006 women during the third trimester of pregnancy. Using multivariable logistic regression, we report the relationship between regular exercise (≥150 min/wk) and late preterm birth, cesarean delivery, and hospitalization during pregnancy, controlling for age, race, marital status, education, poverty status, prepregnancy body mass index weight category, gestational weight gain, and prepregnancy diabetes or hypertension.


      Nearly one third of women reported meeting current federal physical activity recommendations during pregnancy. Five percent had late preterm birth, 29% had cesarean deliveries, and 20% reported hospitalization during pregnancy. In multivariable analysis, regular exercise during pregnancy was not associated with late preterm birth or hospitalization during pregnancy. Physical activity of 150 or more minutes per week was associated with reduced odds of cesarean delivery compared with less than 60 minutes per week, but the finding was not significant (adjusted odds ratio, 0.86; 95% confidence interval, 0.69–1.07).


      In the First Baby Study, physical activity was not associated with late preterm birth or hospitalizations, and may be associated with decreased odds of cesarean delivery.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Women's Health Issues
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • American College of Obstetricians and Gynecologists
        ACOG Committee opinion. Number 267, January 2002: Exercise during pregnancy and the postpartum period.
        Obstetrics and Gynecology. 2002; 99: 171-173
        • Amorim A.R.
        • Rossner S.
        • Neovius M.
        • Lourenco P.M.
        • Linne Y.
        Does excess pregnancy weight gain constitute a major risk for increasing long-term BMI?.
        Obesity (Silver Spring). 2007; 15: 1278-1286
        • Bacak S.J.
        • Callaghan W.M.
        • Dietz P.M.
        • Crouse C.
        Pregnancy-associated hospitalizations in the United States, 1999-2000.
        American Journal of Obstetrics and Gynecology. 2005; 192: 592-597
        • Barakat R.
        • Pelaez M.
        • Lopez C.
        • Montejo R.
        • Coteron J.
        Exercise during pregnancy reduces the rate of cesarean and instrumental deliveries: Results of a randomized controlled trial..
        Journal of Maternal, Fetal, and Neonatal Medicine. 2012; 25: 2372-2376
        • Barakat R.
        • Stirling J.R.
        • Lucia A.
        Does exercise training during pregnancy affect gestational age? A randomised controlled trial.
        British Journal of Sports Med. 2008; 42: 674-678
        • Bennett T.A.
        • Kotelchuck M.
        • Cox C.E.
        • Tucker M.J.
        • Nadeau D.A.
        Pregnancy-associated hospitalizations in the United States in 1991 and 1992: A comprehensive view of maternal morbidity.
        American Journal of Obstetrics and Gynecology. 1998; 178: 346-354
        • Bovbjerg M.L.
        • Siega-Riz A.M.
        Exercise during pregnancy and cesarean delivery: North Carolina PRAMS, 2004-2005.
        Birth. 2009; 36: 200-207
        • Brunner Huber L.R.
        Validity of self-reported height and weight in women of reproductive age.
        Maternal and Child Health Journal. 2007; 11: 137-144
        • Clapp 3rd, J.F.
        The course of labor after endurance exercise during pregnancy.
        American Journal of Obstetrics and Gynecology. 1990; 163: 1799-1805
        • Domingues M.R.
        • Barros A.J.
        • Matijasevich A.
        Leisure time physical activity during pregnancy and preterm birth in Brazil.
        International Journal of Gynaecology and Obstetrics. 2008; 103: 9-15
        • Downs D.S.
        • DiNallo J.M.
        • Kirner T.L.
        Determinants of pregnancy and postpartum depression: Prospective influences of depressive symptoms, body image satisfaction, and exercise behavior.
        Annals of Behavioral Medicine. 2008; 36: 54-63
        • Dumith S.C.
        • Domingues M.R.
        • Mendoza-Sassi R.A.
        • Cesar J.A.
        Physical activity during pregnancy and its association with maternal and child health indicators. Revista de Saúde Pública.
        . 2012; 46: 327-333
        • Erdelyi G.J.
        Gynecological survey of female athletes.
        Journal of Sports Medicine and Physical Fitness. 1962; 2: 174-179
        • Gavard J.A.
        • Artal R.
        Effect of exercise on pregnancy outcome.
        Clinical Obstetrics and Gynecology. 2008; 51: 467-480
        • Gazmararian J.A.
        • Petersen R.
        • Jamieson D.J.
        • Schild L.
        • Adams M.M.
        • Deshpande A.D.
        • et al.
        Hospitalizations during pregnancy among managed care enrollees.
        Obstetrics and Gynecology. 2002; 100: 94-100
        • Godin G.
        • Shephard R.J.
        A simple method to assess exercise behavior in the community.
        Canadian Journal of Applied Sport Sciences. 1985; 10: 141-146
        • Haakstad L.A.
        • Bo K.
        Exercise in pregnant women and birth weight: A randomized controlled trial.
        BMC Pregnancy Childbirth. 2011; 11: 66
        • Hall D.C.
        • Kaufmann D.A.
        Effects of aerobic and strength conditioning on pregnancy outcomes.
        American Journal of Obstetrics and Gynecology. 1987; 157: 1199-1203
        • Hatch M.
        • Levin B.
        • Shu X.O.
        • Susser M.
        Maternal leisure-time exercise and timely delivery.
        American Journal of Public Health. 1998; 88: 1528-1533
        • IOM (Institute of Medicine) and NRC (National Research Council)
        Weight gain during pregnancy: Reexamining the guidelines.
        The National Academies Press, Washington, DC2009
        • Kjerulff K.H.
        • Velott D.L.
        • Zhu J.
        • Chuang C.H.
        • Hillemeier M.M.
        • Paul I.M.
        • et al.
        Mode of first delivery and women's intentions for subsequent childbearing: findings from the First Baby Study.
        Paediatric and Perinatal Epidemiology. 2013; 27: 62-71
        • Kraschnewski J.L.
        • Chuang C.H.
        • Downs D.S.
        • Weisman C.S.
        • McCamant E.L.
        • Baptiste-Roberts K.
        • et al
        Association of prenatal physical activity and gestational weight gain: Results from the First Baby Study.
        Women's Health Issues. 2013; 23: e233-e238
        • Linne Y.
        • Dye L.
        • Barkeling B.
        • Rossner S.
        Weight development over time in parous women–the SPAWN study–15 years follow-up.
        International Journal of Obesity and Related Metabolic Disorders. 2003; 27: 1516-1522
        • Mamun A.A.
        • Kinarivala M.
        • O'Callaghan M.J.
        • Williams G.M.
        • Najman J.M.
        • Callaway L.K.
        Associations of excess weight gain during pregnancy with long-term maternal overweight and obesity: Evidence from 21 y postpartum follow-up.
        American Journal of Clinical Nutrition. 2010; 91: 1336-1341
        • Martin C.L.
        • Brunner Huber L.R.
        Physical activity and hypertensive complications during pregnancy: findings from 2004 to 2006 North Carolina Pregnancy Risk Assessment Monitoring System.
        Birth. 2010; 37: 202-210
        • Melzer K.
        • Schutz Y.
        • Soehnchen N.
        • Othenin-Girard V.
        • Martinez de Tejada B.
        • Irion O.
        • et al.
        Effects of recommended levels of physical activity on pregnancy outcomes.
        American Journal of Obstetrics and Gynecology. 2010; 202: 266.e1-266.e6
        • Pereira M.A.
        • Rifas-Shiman S.L.
        • Kleinman K.P.
        • Rich-Edwards J.W.
        • Peterson K.E.
        • Gillman M.W.
        Predictors of change in physical activity during and after pregnancy: Project Viva.
        American Journal of Preventive Medicine. 2007; 32: 312-319
        • Physical Activity Guidelines Advisory Committee
        Physical Activity Guidelines Advisory Committee Report, 2008.
        U.S. Department of Health and Human Services, Washington, DC2008
        • Rooney B.L.
        • Schauberger C.W.
        • Mathiason M.A.
        Impact of perinatal weight change on long-term obesity and obesity-related illnesses.
        Obstetrics and Gynecology. 2005; 106: 1349-1356
        • Saftlas A.F.
        • Logsden-Sackett N.
        • Wang W.
        • Woolson R.
        • Bracken M.B.
        Work, leisure-time physical activity, and risk of preeclampsia and gestational hypertension.
        American Journal of Epidemiology. 2004; 160: 758-765
        • Sorensen T.K.
        • Williams M.A.
        • Lee I.M.
        • Dashow E.E.
        • Thompson M.L.
        • Luthy D.A.
        Recreational physical activity during pregnancy and risk of preeclampsia.
        Hypertension. 2003; 41: 1273-1280
        • Stengel M.R.
        • Kraschnewski J.L.
        • Hwang S.W.
        • Kjerulff K.H.
        • Chuang C.H.
        “What my doctor didn't tell me”: Examining health care provider advice to overweight and obese pregnant women on gestational weight gain and physical activity.
        Womens Health Issues. 2012; 22: e535-e540
        • Sternfeld B.
        • Quesenberry Jr., C.P.
        • Eskenazi B.
        • Newman L.A.
        Exercise during pregnancy and pregnancy outcome.
        Medicine and Science in Sports and Exercise. 1995; 27: 634-640
        • Stuebe A.M.
        • Oken E.
        • Gillman M.W.
        Associations of diet and physical activity during pregnancy with risk for excessive gestational weight gain.
        American Journal of Obstetrics and Gynecology. 2009; 201: 58.e1-58.e8


      Jennifer Tinloy, DO, is an Internal Medicine physician at MidState Medical Center in Meriden, CT. This work was completed while she was an Internal Medicine resident at the Penn State College of Medicine/Hershey Medical Center.


      Cynthia Chuang, MD, MSc, is Associate Professor of Medicine and Public Health Sciences at the Penn State College of Medicine. Her research focuses on reproductive and contraceptive health care for women with chronic medical conditions.


      Junjia Zhu, PhD, is Assistant Professor of Public Health Sciences at the Penn State College of Medicine. He is a biostatistician with expertise with statistical applications in reproductive health and cancer-related research.


      Jaimey Pauli, MD, is Assistant Professor of Obstetrics and Gynecology at the Penn State College of Medicine. She is a Maternal-Fetal Medicine specialist.


      Jennifer Kraschnewski, MD, MPH, is Assistant Professor of Medicine and Public Health Sciences at the Penn State College of Medicine. She is a general internist with research interests in weight control interventions.


      Kristen Kjerulff, MA, PhD, is Professor of Public Health Sciences and Obstetrics and Gynecology at the Penn State College of Medicine and has been conducting research in women's health for over 20 years.