The Effect of Exercise During Pregnancy on Maternal and Offspring Vascular Outcomes: a Pilot Study

Áine Brislane, Helen Jones, Sophie M Holder, David A Low, Nicola D Hopkins, Áine Brislane, Helen Jones, Sophie M Holder, David A Low, Nicola D Hopkins

Abstract

The aim of this pilot study is to obtain estimates for the change in maternal cerebrovascular (primary) and offspring vascular structure (secondary) during healthy pregnancy that includes structured exercise. Eighteen pregnant women self-assigned to a moderate-intensity aerobic exercise intervention or a control group. Maternal cerebral blood flow (CBF) at the middle cerebral artery, cerebro- and peripheral-vascular function was assessed at the end of each trimester. Offspring carotid artery intima-media thickness (IMT) was measured within 12 weeks of birth. For exploratory purposes, we performed statistical analysis to provide estimates of the change for primary and secondary outcome variables. Maternal CBF reduced (- 8 cm s-1 [- 14 to - 2]) with evidence of change to cerebral autoregulation (normalised gain: 0.12 %cm s-1% mmHg-1mmHg/% [- 0.18 to 0.40]) during pregnancy. Offspring carotid IMT was smaller in the exercise group (- 0.04 mm [- 0.12-0.03]) compared with controls. Based upon this data, a sample size of 33 and 57 in each group is required for low-frequency normalised gain and offspring IMT, respectively. This would provide 90% power to detect statistically significant (P < 0.05) between group differences in a randomised controlled trial. CBF is reduced in pregnancy, possibly due to reduced vascular resistance and altered maternal cerebral autoregulation. Maternal exercise had negligible effects on cerebrovascular adaptation to pregnancy, but we observed lower offspring carotid artery wall thickness following maternal exercise. Our directional findings and sample size estimations should be explored in a fully powered randomised control trial.Clinical trial registration: The trial was registered on March 14th at https://register.clinicaltrials.gov (NCT03079258). Participant enrolment began on 3rd April 2016.

Keywords: Cerebrovascular function; Endothelial function; Exercise; Offspring; Pregnancy.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Schematic of the experimental procedure used. Participants were recruited within 12 weeks of pregnancy for vascular assessments. Participants chose to join an exercise intervention or continue with conventional care and made two subsequent visits at the end of T2 and T3 for vascular measurements. Within 12 weeks post-partum, offspring vascular measurements were obtained
Fig. 2
Fig. 2
Maternal middle cerebral artery velocity during pregnancy. MCAv declined during pregnancy data for trimester 1, 2 and 3 which. *Main effect for time; p < 0.05
Fig. 3
Fig. 3
Femoral artery FMD during pregnancy. fFMD decreased progressively during pregnancy. *Main effect of time; p < 0.05
Fig. 4
Fig. 4
Offspring vascular outcomes data. Offspring cIMT (a) and IMT:lumen (c) are lower in offspring of exercising mothers compared with the control group, while the lumen diameter is larger (b) in exercisers compared with the control group although not significant

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