- 期刊
孕期運動是否會增加健康孕婦的早產發生率
Does exercising during pregnancy increase the risk of preterm birth for pregnant women?
摘要
形成臨床提問：現今社會鼓勵孕婦於孕期適度運動，2020年美國婦產科醫學會提出孕期及產後應每週至少進行150分鐘中等強度的有氧運動，可避免體重增加過多、減少妊娠高血壓、舒緩憂鬱及焦慮等負向情緒、緩解下背痛及骨盆疼痛且可縮短第一產程。臺灣對於孕婦活動觀念相對保守，即便是健康孕婦也被要求孕期多休息、並減少或暫停運動，以維護胎兒健康、避免早產。早產為新生兒死亡及導致嚴重併發症之主因，因此臺灣多數孕婦反而傾向於孕期減少活動或避免運動，與美國婦產科醫學會所推廣理念相悖，故引起筆者想以實證搜尋方式了解孕期運動是否會增加健康孕婦的早產發生率。文獻搜尋的方法與分析：透過PICO架構及MeSH term建立關鍵字「Pregnant woman」、「Exercis*」、「Preterm birth」及其同義字，依據布林邏輯搜尋資料庫PubMed、Cochrane及Medline，共搜索到189篇，刪除重複及標題、摘要不符合條件（n=147）、閱讀內文後篩選排除（n=39），共納入兩篇系統性文獻回顧與統合分析及一篇隨機對照試驗評讀。文獻的品質評讀：收錄兩篇分別為2016及2017年發表之系統性文獻回顧與統合分析，文章使用2011年版牛津大學發展之系統性文獻回顧與整合分析之文獻評析表為評讀工具，另收錄一篇2019年發表之隨機對照試驗文章則採考科藍偏差風險工具2.0版評讀；證據等級則依據牛津實證醫學中心證據等級表進行評估，第一篇系統性文獻回顧與統合分析研究內容嚴謹完整，故證據等級為Level 1，第二篇因非僅收入隨機對照試驗文獻，故證據等級為Level 2，隨機對照試驗因流失資料未加以分析，故證據等級為Level 3，經評讀後確認文獻品質與證據等級佳，可有效應用於臨床參考。結論與建議：綜合三篇實證文獻結果，以Review Manager 5.3版，共納入21篇RCT，進行統合分析綜整結果：孕婦於孕期運動與控制組之間的早產發生率無顯著差異（95% CI: 0.70-1.13, I^2 = 0, p = .92），故健康孕婦於孕期每週做3-5次，30-60分鐘，走路、游泳、踩腳踏車、瑜珈等中等強度有氧運動，不會增加早產發生率。運動為低成本易取得且多元的活動，故建議於門診可針對健康孕婦推廣孕期適度運動，並參照美國婦產科醫學會提出之孕期及產後應每週至少進行150分鐘中等強度的有氧運動為標準執行，期望持續推廣，提升全民健康識能。
並列摘要
Ask an answerable question (PICO): In today's society, there is encouragement for pregnant women to engage in moderate exercise during pregnancy. the American College of Obstetricians and Gynecologists (2020) recommended that pregnant and postpartum women should engage in at least 150 minutes of moderate-intensity aerobic exercise per week. This can help prevent excessive weight gain, reduce the risk of gestational hypertension, alleviate negative emotions, such as depression and anxiety, relieve lower back and pelvic pain, and shorten the first stage of labor. However, in Taiwan, the perception of physical activity for pregnant women is relatively conservative. Even healthy pregnant women are often advised to rest more during pregnancy and reduce or suspend exercise to maintain the health of the fetus and prevent premature birth. Premature birth is a major cause of neonatal mortality and can lead to serious complications. Therefore, the risk and symptoms of premature birth can cause significant stress and anxiety for pregnant women. As a result, many pregnant women in Taiwan tend to reduce their physical activity or avoid exercise during pregnancy, which contradicts the approach promoted by the American College of Obstetricians and Gynecologists. This has led the author to seek empirical evidence to understand whether exercising during pregnancy increases the risk of premature birth among healthy pregnant women. The Method and Analysis of Literature Review: Using the PICO framework and MeSH terms, keywords such as "Pregnant woman," "Exercis*," and "Preterm birth," along with their synonyms, were established. A database search was conducted using Boolean logic on PubMed, Cochrane, and Medline, resulting in the identification of 189 articles. After removing duplicates and articles with titles and abstracts that did not meet the criteria (n=147), and further screening and exclusion based on full-text reading (n=39), two systematic review and meta-analysis (SRMA) and one randomized controlled trial (RCT) were ultimately included for review. Critical Appraisal: Two systematic reviews and meta-analyses(SRMA), published in 2016 and 2017 respectively, were included. The articles used the 2011 version of the Oxford University's Systematic Literature Review and Meta-Analysis Critique Tool as the reading instrument. Additionally, a randomized controlled trial (RCT) article published in 2019 was assessed using the Cochrane Risk of Bias Tool version 2.0. The level of evidence was evaluated based on the Oxford Centre for Evidence-Based Medicine's Levels of Evidence table. The first systematic review and meta-analysis was rigorous and comprehensive, so it was rated as Level 1 evidence. The second study, which did not include only randomized controlled trial literature, was rated as Level 2 evidence. The RCT in the third study was rated as Level 3 evidence due to the failure to analyze missing data. After evaluation, it was confirmed that the quality of the literature and the level of evidence were high, and the results can be effectively applied for clinical reference. Conclusions and Recommendations: Combining the results of three empirical studies using Review Manager 5.3 software, a total of 21 RCTs were included for integrated analysis. The results showed no significant difference in the preterm birth rates between pregnant women who exercised and those in the control group (95% CI: 0.70-1.13, I^2 = 0, p = .92). Therefore, engaging in moderate-intensity aerobic exercise such as walking, swimming, cycling, or yoga for 3-5 times a week, 30-60 minutes per session, during pregnancy does not increase the incidence of preterm birth among healthy pregnant women. All three studies indicated that exercise did not lead to a statistically significant difference in preterm birth rates. Exercise is a low-cost, easily accessible, and diverse activity. Therefore, it is recommended to promote moderate exercise during pregnancy for healthy pregnant women during outpatient visits. Following the guidelines proposed by the American College of Obstetricians and Gynecologists, which suggest engaging in at least 150 minutes of moderate-intensity aerobic exercise per week during pregnancy and postpartum, could potentially change deeply ingrained misconceptions in traditional beliefs.