Influence of a physical exercise program, physical activity, sedentarism, body composition and physical fitness during pregnancy on body composition, physical fitness and neurocognition of the offspring: the gestafitos project
In the absence of contraindications, current Guidelines encourage women to perform combined aerobic and resistance exercise (i.e., concurrent exercise) during pregnancy to improve maternal and offspring health outcomes, as it has been shown to contribute positively to a better metabolic intrauterine environment. Body composition is a strong determinant of birth complications and future diseases. Exercise during pregnancy has been shown to contribute positively to a better body composition of both the mother and offspring, as it has been associated with reduced risk of excessive gestational weight gain and a better control of offspring birth weight in healthy ranges. Additionally, the increased prevalence of maternal obesity in recent decades has occurred in parallel with the rise of macrosomia (defined as body weight at birth > 4000 grams) and childhood obesity, suggesting an association between maternal body composition and offspring body composition. Physical fitness is a powerful marker of health in general populations (i.e., childhood, adulthood and elderly) and specific populations (including pregnant women), as higher levels of physical fitness have been related to a better self-rated health, bone and psychological health, cardiovascular or metabolic profile, lower levels of total and abdominal adiposity, higher academic performance and all-cause mortality. Neurocognition evolves from conception to after birth, setting the foundation for lifelong neurodevelopment. Several studies have shown that regular maternal exercise induces benefits for the fetal brain development. Understanding the influence of exercise and maternal body composition during pregnancy on offspring body composition, as well as knowing whether exercise and physical fitness during pregnancy may improve all or some components of offspring physical fitness and their neurocognition might be of great importance for a better design of public health interventions, as it reflects prenatal conditions that can influence future development and may offer a preventive strategy against future disorders. Despite this, physical exercise interventions during pregnancy are often not based on programs specifically tailored to this stage. Moreover, most are designed at very low intensity or focused on aerobic or resistance exercise uniquely, even though current Guidelines recommend concurrent exercise to achieve greater health benefits. Therefore, the general aim of this International Doctoral Thesis was to evaluate the influence of a concurrent physical exercise program during pregnancy on offspring body composition, physical fitness, and neurocognition. Likewise, the specific aims were: (i) to analyze the influence of prenatal exercise on Apgar score and childhood health-related physical fitness and to identify possible differences based on maternal age and pre-pregnancy body mass index (BMI) (study I); (ii) to conduct a post-hoc analysis to examine the effect of a supervised-concurrent exercise training program from the 16th gestational week until delivery on 1-month infant neuromotor skills based on maternal pre-pregnancy BMI (study II); (iii) to compare the effect of different exercise interventions on offspring body weight and adequate values of body weight at birth, 6 and 12 months of age (study III); (iv) to systematically explore the influence of prenatal exercise, maternal physical activity, and physical fitness during pregnancy on offspring neurodevelopment up to 5 years of age (study IV); (v) to investigate the effects of a supervised concurrent exercise training program during pregnancy on children’s intelligence at 4-5 years of age (study V); (vi) to assess the association of maternal sedentary time and physical activity during pregnancy on children’s intelligence at 4-5 years of age, and to explore potential sex-related differences (study VI); and (vii) to assess the influence of maternal morphometrics in late pregnancy on offspring morphometrics at birth, 6, and 12 months of age, and examine variation by infant sex and pre-pregnancy BMI (study VII). The main results showed that: (i) exercise during pregnancy improves Apgar score at 1 and 5 minutes and reduces body weight at birth within normal values; there is limited evidence about the influence of exercise during pregnancy on offspring health-related physical fitness (study I). (ii) Concurrent exercise during pregnancy improves neuromotor skills in infants at 1 month of age in women with normal body weight; we observed limited evidence about the influence of concurrent exercise during pregnancy on infants whose mothers have overweight or obesity, and the potential mechanism behind the role of maternal BMI in the development of infant neuromotor skills (study II). (iii) Aerobic exercise with a meal plan resulted in the most favorable outcomes regarding adequate offspring body weight from birth to 12 months of age, whereas stretching showed the least favorable results (study III). (iv) Maternal exercise and physical activity during pregnancy improve offspring neurodevelopment; no studies were found that assessed the association of maternal physical fitness during pregnancy with offspring neurodevelopment (study IV). (v) A supervised concurrent exercise program during pregnancy had a positive effect on verbal and composite intelligence of children at 4-5 years; concurrent exercise during pregnancy seemed especially effective in verbal intelligence for male and female children, and composite intelligence mainly for males (study V). (vi) Moderate and moderate-to-vigorous physical activity during pregnancy were associated with greater non-verbal and composite intelligence in children at 4-5 years of age, while sedentary time and light physical activity showed no significant associations (study VI). (vii) Maternal weight, BMI, and gestational weight gain in late pregnancy were positively associated with offspring morphometrics at birth, but only gestational weight gain remained associated at 6 and 12 months of age (study VII). This International Doctoral Thesis provides evidence on the positive influence of concurrent exercise during pregnancy on body composition, neuromotor skills (i.e., motor fitness) and neurocognition of the offspring. However, there is limited evidence regarding the influence of concurrent exercise during pregnancy on offspring cardiorespiratory fitness and musculoskeletal fitness. Additionally, maternal morphometrics during pregnancy were directly associated with offspring morphometrics at birth, 6, and 12 months of age, and moderate and moderate-to-vigorous physical activity during pregnancy were associated with greater non-verbal and composite intelligence in children at 4-5 years of age. However, future studies are still necessary to know the influence of maternal physical fitness during pregnancy on neurocognition of the offspring.
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