Influence of Physical Exercise on Endothelial Function in Pregnant Women

• high sensitivity C-Reactive Protein [ Time Frame: Baseline, 16 weeks ] [ Designated as safety issue: No ]
• Nitrates, Nitrites and cyclic GMP [ Time Frame: Baseline, 16 weeks ] [ Designated as safety issue: No ]
• Blood lipid profile [ Time Frame: Baseline, 16 weeks ] [ Designated as safety issue: No ]
• Anthropometric indicators [ Time Frame: Baseline, 8 weeks, 16 weeks ] [ Designated as safety issue: No ]
• Functional capacity (VO2 Max) [ Time Frame: Baseline, 8 weeks, 16 weeks ] [ Designated as safety issue: No ]
• Maternal and neonatal outcomes [ Time Frame: At delivery ] [ Designated as safety issue: Yes ]

The purpose of this study is to determine the effect of regular aerobic exercise on endothelial function in pregnancy.

Preeclampsia is a common maternal disease that complicates 5% to 10% of pregnancies and remains as the major cause of maternal and neonatal mortality, especially in developing countries. Cost-effective interventions aimed to prevent the development of preeclampsia are urgently needed. Ethiopathogenesis of preeclampsia involves multiple mechanisms as oxidative stress, endothelial dysfunction, infections, maternal constitutional factors, and others. Regular aerobic exercise recovers endothelial function, decreases oxidative stress and improves maternal constitutional factors.

The purpose of this Controlled Clinical Trial is to determine the effect of regular aerobic exercise on endothelium-dependent brachial artery flow-mediated dilatation. Furthermore, the effect of exercise on biomarkers on vascular function and perinatal outcomes will be evaluated.

• Pregnancy
• Preeclampsia
• Exercise

• Behavioral: Regular aerobic physical exercise

  Walking (10 minutes), aerobic exercise (30 minutes), stretching (10 minutes) and relaxation exercise (10 minutes). Exercise will be performed at three sessions per week. All sessions will be supervised by a physical therapist and a physical educator.

  The exercise-program follows the ACOG and ACSM exercise prescription. Aerobic activities will be performed at moderate intensity (60-70% of maximal heart rate) measured by the 6-20 Borg's rating scale. Each session starts with a 5 minutes of warm up, followed by 30 minutes of aerobic activity, including 5 minutes cool down. This is followed by 15 minutes of circuit strength training of the upper limbs, lower limbs, and deep abdominal stabilization muscles. The last 5 minutes consists of stretching and relaxation exercises.

• Behavioral: Activities of daily living
  Basic activities of daily living (bathing, dressing, eating, walking) without counseling by a physical therapist.

• Experimental: I
  Intervention: Behavioral: Regular aerobic physical exercise
• Active Comparator: II
  Intervention: Behavioral: Activities of daily living

• Montoya Arizabaleta AV, Orozco Buitrago L, Aguilar de Plata AC, Mosquera Escudero M, Ramirez-Velez R. Aerobic exercise during pregnancy improves health-related quality of life: a randomised trial. J Physiother. 2010;56(4):253-8.
• Ramírez-Vélez R, Aguilar AC, Mosquera M, Garcia RG, Reyes LM, López-Jaramillo P. Clinical trial to assess the effect of physical exercise on endothelial function and insulin resistance in pregnant women. Trials. 2009 Nov 17;10:104.

Inclusion Criteria:

• Primiparous women who have not participated in a structured exercise program, including significant amounts of walking for the past four months are eligible for the trial.
• Live foetus at the routine ultrasound scan and a normal pregnancy.
• Gestational age 16 to 20 weeks
• Written informed consent will be obtained from each woman prior to the inclusion in the study.

Exclusion Criteria:

• History of high blood pressure
• Chronic medical illnesses (cancer, renal, endocrinologic, psychiatric, neurologic, infectious and cardiovascular diseases)
• Persistent bleeding after week 12 of gestation
• Poorly controlled thyroid disease
• Placenta praevia, incompetent cervix, polyhydramnios, oligohydramnios
• History of miscarriage in the last twelve months
• Diseases that could interfere with participation (following recommendations from ACSM 2000, ACOG 2003).