Active Pregnancy, Prevention Against the Effects of COVID-19

Brief Summary

Detailed Description

Hypothesis Aerobic, moderate, and supervised exercise during pregnancy can be an efficient element of prevention of alterations that the situation generated by COVID-19 causes to the healthy pregnant population and their children. Objective Examine the influence of a supervised aerobic exercise program during pregnancy, by non-face-to-face and face-to-face ways, on the prevention of maternal, fetal, newborn and infant alterations during the pandemic state and in the near future. Material and Methods - Study design. A randomized clinical trial (RCT) will be carried out, not masked with healthy pregnant women, giving rise to two study groups: exercise group (EG), pregnant women participating in a regular program of supervised physical exercise and control group ( CG), pregnant women who receive normal obstetric monitoring of their pregnancy, including recommendations regarding dietary-nutritional factors, as well as the benefits of an active pregnancy. All selected pregnant women will sign an Informed Consent before participating in the study. Women randomly assigned to the CG received general advice from their health care provider about the positive effects of physical activity. Participants in the CG had their usual visits with health care providers during pregnancy, which were equal to the exercise group. Women were not discouraged from exercising on their own. However, women in the CG were asked about their exercise once each trimester using a "Decision Algorithm" (by telephone). Intervention General characteristics of the physical exercise program: * The minimum adherence required will be 80% of the total sessions. * Onset: gestational week 9-11, immediately after the first prenatal ultrasound, in order to rule out Obstetric Contraindications for physical exercise. * End: gestational week 38-39. * Frequency: 3 weekly sessions, various possibilities will be offered at different times from which the pregnant woman can choose, in order to promote work and family conciliation. Basic Considerations: 1. All the activity carried out will be aerobic. 2. Avoid working positions in which areas normally overloaded by pregnancy are further affected. 3. The work corresponding to flexibility will be carried out always bearing in mind that these are pregnant women, this forces us once again not to include forced operating positions in the exercises or to excessively maintain the stretching times in each area. 4. An adequate fluid intake will be maintained before and after the activity. 5. Also as a general rule and to eliminate potential risks, the following will be avoided: * Activities that include the Valsalva maneuver. * High ambient temperatures or very humid environments in order to avoid hyperthermia (body temperature higher than 38º C). * Sudden movements. * Positions of extreme muscular tension. Structure: All sessions will begin with a warm-up of 7-8 minutes composed of mild movements and joint mobility of upper and lower limbs exercises. Then a central part of 35-40 minutes, four types of activities will be included (aerobic work, muscle strengthening, coordination/balance tasks, pelvic floor exercises), finally a section of flexibility, relaxation and final talk (comments and sharing) will be performed (12-15 minutes). Below we offer a greater detail of each part: I. Warm-up-General activation. Displacements varied without impact activities (avoiding jumps, falls). Mild work of mobility of the main joints. II. Aerobic section. Exercise to increase intensity up to moderate activities, play with sports equipment (balls, ropes, pikes) or choreographies of different musical styles. III. Muscle strengthening, general toning exercises of the whole body: lower part (calf, quadriceps, hamstrings, adductors, abductors), upper part (abdominal, pectoral, shoulders, paravertebral musculature). Also exercises for the most weakened and needy muscle groups during pregnancy, the aim is to avoid muscular decompensation. IV. Coordination and balance exercises: simple tasks of eye-hand and eye-foot coordination with sports equipment, as well as body axis balance exercises. V. Strengthening the pelvic floor muscles, Kegel exercises will be applied and is basically composed of contractions (slow and fast) of the different structures of the pelvic floor musculature. VI. Cool down section during 7-8 minutes, aiming to gradually lower the intensity of work with flexibility-stretching and relaxation exercises. VII. Final Talk. This part is intended for pregnant women to express clearly and openly the sensations and perceptions experienced during the session. The reflection of each participant on the effect of physical practice is sought, not only in the physical or physiological aspect, but also in the psychic and emotional section. The exchange of impressions between the pregnant women, enhances the role of a correctly designed and conducted physical exercise program, as a social mobile of maintenance and improvement of the quality of life of the pregnant woman.

Primary Outcomes

Secondary Outcomes

• Lipidic profile(measured at 24-25 weeks and at 34-35 weeks)
• Maternal pains during pregnancy (headache, back pain, pelvic pain, paravertebral, scapular, etc.)(9 months)
• fetal growth and development(9 months)
• Delivery tears(1 month)
• performing episiotomy during childbirth(1 month)
• Apgar Score(1 month)
• length(1 month)
• cranial perimeter(1 month)
• Landau reflexes test(1 month)
• neonatal intensive care unit (NICU)(1 month)
• Postpartum recovery of pre-pregnancy weight(12 months)
• Edinburgh Postpartum Depression Scale (EPDS)(12 months)
• umbilical cord Ph(1 month)
• Fetal development(9 months, once a trimester)
• Carotid intima-media thickness (CIMT)(9 months)
• Maternal sleep habits(9 months)
• maternal body self-perception(9 months)
• Newborn sleep habits(24 months)
• Placental angiogenic factors(measured at 24-25 weeks and at 34-35 weeks)