The Effect of Exercise Training During Pregnancy to Improve Maternal Vascular Health: Focus on Gestational Hypertensive Disorders

Abstract

Hypertensive disorders of pregnancy, including gestational hypertension and pre-eclampsia, occur in up to 10% of pregnancies and are associated with increased life-long cardiovascular risk. Physical activity improves cardiovascular health in pregnancy and may lower the risk of developing hypertensive disorders of pregnancy. However, a minority of pregnant women comply with the recommended level of physical activity. Adequate knowledge on the physiological effects of exercise in healthy pregnancy could help to overcome potential barriers as pregnancy is a unique window of opportunity to improve health outcomes for both mother and child. In this mini review, we discuss structural and functional vascular adaptations during healthy and hypertensive pregnancies, we elaborate on the effects of exercise on the vasculature and review the safety and existing evidence of exercise training as preventive therapy for gestational hypertensive disorders.

Keywords: exercise; gestational hypertension; pre-eclampsia; pregnancy; vascular adaptation.

FIGURE 1

Pathophysiology of pre-eclampsia (PE). A pre-existing fragile endothelial situation leads to defective placentation and high circulating levels of oxidative stress. This inadequate response to pregnancy results in arterial stiffness and exacerbates generalized endothelial dysfunction. Physical exercise has beneficial effects on multiple components of the model.

FIGURE 2

Beneficial effects of repeated exercise bouts on the vasculature. AT1 receptor, Angiotensin II receptor type 1; eNOS, endothelial nitric oxide synthase; ET1, endothelin-1; NO, nitric oxide; ROS, reactive oxygen species; TGF-β, transforming growth factor beta.