The effect of pilates on sleep quality in pregnancy: a systematic review and meta-analysis

Abstract

Sleep disturbances are common during pregnancy and are associated with adverse maternal and fetal outcomes. Non-pharmacological interventions, particularly exercise, are increasingly recommended to improve sleep quality. This study aimed to evaluate the effect of Pilates exercise during pregnancy on sleep quality. A systematic search of PubMed, Scopus, Cochrane Library, and Web of Science was conducted from inception to September 08, 2025. Randomized controlled trials and prospective controlled clinical trials involving pregnant women and assessing the effects of Pilates on sleep quality were included. Study selection, data extraction, and risk of bias assessment (Cochrane Risk of Bias Tool 2) were performed independently by two reviewers. Between-group standardized mean differences in the pre-to-post change score (Hedges’ g) were pooled using a random-effects model, with a positive value indicating improved sleep quality. Six studies were included in the systematic review, of which five (186 participants) were pooled in the meta-analysis. Pilates interventions (clinical, traditional, online, and modified forms) were associated with improved sleep quality compared with controls (Hedges’ g = 0.91, 95% CI 0.18–1.64, p = 0.015), with high heterogeneity (I² = 81.9%). The certainty of evidence was rated as low because of serious inconsistency and imprecision. Pilates may improve sleep quality during pregnancy; however, the low certainty of evidence, wide confidence interval, and substantial heterogeneity warrant cautious interpretation. Pilates appears feasible and potentially safe, although adverse-event reporting was insufficient for firm safety conclusions. Further high-quality randomized trials with standardized protocols are required to confirm these findings.