Comparative effectiveness of exercise modalities for gestational blood pressure and gestational hypertension: A network meta-analysis of randomized trials.
TL;DR
Structured prenatal exercise lowers BP and reduces GH risk, and mind body and aerobic exercise showed clearer evidence for reducing GH risk, whereas aquatic exercise showed a favorable but preliminary signal for blood pressure control.
Abstract
Objective
To compare prenatal exercise modalities for gestational systolic/diastolic blood pressure (BP) and gestational hypertension (GH).
Methods
We performed a PRISMA 2020/PRISMA-NMA systematic review with random effects pairwise and network meta-analyses. Five databases were initially searched from inception to 31 July 2025, and an updated supplementary search was conducted on 30 November 2025. English-language randomized controlled trials in pregnant women (≥18 years) prescribing structured exercise for ≥4 weeks versus usual care or another eligible modality were included. Pairwise analyses pooled mean differences (MD) for BP and odds ratios (OR) for GH. The network compared aerobic, aquatic, resistance, combined aerobic-resistance, and mind-body exercise and ranked modalities using SUCRA.
Results
Thirty-four trials involving 4565 pregnant participants were included. SBP and DBP outcomes were each reported in 28 trials involving 2480 participants, whereas gestational hypertension was reported in 17 trials involving 3184 participants. Compared with usual care, exercise reduced systolic BP (MD -3.67 mmHg, 95% CI -6.08 to -1.25) and diastolic BP (MD -3.51 mmHg, 95% CI -5.85 to -1.17), and lowered GH risk (OR 0.56, 95% CI 0.40 to 0.78). Benefits were more evident when programs began in the second-third trimester and among older participants. Interventions ≤16 weeks favored reductions in continuous BP, whereas >16 weeks more consistently reduced hypertensive events. In network analyses, aquatic, mind body, and aerobic exercise ranked highest for diastolic control. For GH risk, mind body and aerobic exercise showed statistically significant reductions versus usual care, whereas aquatic exercise ranked favorably but had imprecise, non-significant estimates. Systolic differences between modalities were not statistically significant.
Conclusion
Structured prenatal exercise lowers BP and reduces GH. Mind body and aerobic exercise showed clearer evidence for reducing GH risk, whereas aquatic exercise showed a favorable but preliminary signal for blood pressure control because it was supported by only two trials. Initiating exercise in the second-third trimester and sustaining participation may maximize benefit.