Institutional members access full text with Ovid®

Share this article on:

Physical Activity and the Risk of Preeclampsia: A Systematic Review and Meta-Analysis

Aune, Dagfinna,b,c; Saugstad, Ola Didrikd; Henriksen, Toree; Tonstad, Serenaa,f

doi: 10.1097/EDE.0000000000000036

Background: Physical activity has been hypothesized to reduce the risk of preeclampsia, but epidemiologic studies have not shown consistent results. Therefore, we conducted a systematic review and dose–response meta-analysis of epidemiologic studies.

Methods: PubMed, Embase, and Ovid databases were searched for case–control and cohort studies of physical activity and preeclampsia up to 2 November 2012. We estimated summary relative risks (RRs) using a random effects model.

Results: Fifteen studies were included. The summary RR for high versus low prepregnancy physical activity was 0.65 (95% confidence interval [CI] = 0.47–0.89, I 2 = 0%; n = 5). In the dose–response analysis, the summary RR was 0.72 (0.53–0.99; I 2 = 0%; n = 3) per 1 hour per day and 0.78 (0.63–0.96; I 2 = 0%; n = 2) per 20 metabolic equivalent task (MET)-hours per week. The summary RR for high versus low physical activity in early pregnancy was 0.79 (0.70–0.91; I 2 = 0%; n = 11). In the dose–response analysis, the summary RR per 1 hour per day was 0.83 (0.72–0.95; I 2 = 21%; n = 7) and 0.85 (0.68–1.07; I 2 = 69%; n = 3) per 20 MET-hours per week. A nonlinear association was observed for physical activity before pregnancy and risk of preeclampsia (test for nonlinearity, P = 0.03), but not for physical activity in early pregnancy (test for nonlinearity, P = 0.37), with a flattening of the curve at higher levels of activity. Both walking and greater intensity of physical activity were inversely associated with preeclampsia.

Conclusions: Our analysis suggests a reduced risk of preeclampsia with increasing levels of physical activity before pregnancy and during early pregnancy.

Supplemental Digital Content is available in the text.

From the aDepartment of Preventive Cardiology, Oslo University Hospital Ullevål, Oslo, Norway; bDepartment of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; cDepartment of Epidemiology and Biostatistics, Imperial College, London, United Kingdom; dDepartment of Pediatric Research, Rikshospitalet, Oslo University Hospital, University of Oslo, Oslo, Norway; eSection of obstetrics, Division of Obstetrics and Gynaecology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; and fDepartment of Health Promotion and Education, Loma Linda University, Loma Linda, CA.

The authors report no conflicts of interest.

Supported by a grant (project number 554.04/11) from the Norwegian SIDS and Stillbirth Society (Landsforeningen Uventet Barnedød), Oslo, Norway.

Supplemental digital content is available through direct URL citations in the HTML and PDF versions of this article ( This content is not peer-reviewed or copy-edited; it is the sole responsibility of the author.

Correspondence: Dagfinn Aune, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary’s Campus, Norfolk Place, Paddington, London W2 1PG, United Kingdom. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc