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Pregnancy – Improves mental wellbeing

Up to 20% of women will experience a mental health problem during pregnancy or in the first year after birth (1). Anxiety and depression have been associated with reduced self-care, preterm labour and low birth weight, and can negatively affect the relationship between a mother and her baby. Anxiety and/or depression during pregnancy are predictive of postpartum symptoms, and the risk of another episode of depression within 5 years is doubled after postpartum depression (2).

A large systematic review and meta-analysis of 17 studies (n=93 676) was the first to investigate the effectiveness of physical activity alone to prevent postpartum depression (the effect of any type of physical activity measured at least once during pregnancy, on depression or depressive symptoms in the first year after birth), rather than physical activity and dietary interventions. This demonstrated a small to moderate reduction in postpartum depressive symptoms (overall SMD -0.22, (95%CI -0.42 to -0.01, p=0.04), especially with intervention studies (SMD -0.58, 95%CI -1.09 to -0.08), compared to those who were not active (3). This builds upon other recent evidence that physical activity-only interventions in pregnant women (but not physical activity + co-interventions) reduced the severity of antenatal depressive symptoms (13 RCTs, n=1076, SMD -0.38, 95%CI -0.51 to -0.25). Odds of antenatal depression were reduced by 67% compared to women who did no physical activity (5 RCTs, n=683, OR 0.33, 95%CI 0.21 to 0.53). There was no significant effect on the severity of depressive symptoms, pre- or postnatal anxiety, or any effect on the odds of postpartum depression (4).

Meta-analysis of 12 RCTs demonstrated that effect size for the relationship between physical activity interventions during pregnancy and the postpartum period on postpartum symptoms of depression was 0.41 (95%CI 0.28 to 0.54). Pooled effect sizes were 0.67 (95%CI 0.44 to 0.90) for those who met postpartum depression symptom criteria at baseline and 0.29 (95%CI 0.14 to 0.45) for those who did not. Studies included in this meta-analysis comprised both pre- and postnatal physical activity, therefore limiting the conclusions that may be drawn regarding physical activity specifically during pregnancy (2).

Quality of evidence

High 

Strength of recommendation

Strong 

Conclusion

Physical activity during pregnancy can reduce the severity of depressive symptoms during and after pregnancy, especially in those women who meet criteria for diagnosis of depression before starting a physical activity intervention. 

References

1. Centre for Mental Health. LSE Personal Social Services Research Unit. The costs of perinatal mental health problems – report summary (2015)

2. Poyatos-Leon R et al. Effects of exercise-based interventions on postpartum depression: A meta-analysis of randomised controlled trials Birth 2017 Sep;44(3):200-208 

3. Nakamura A et al. Physical activity during pregnancy and postpartum depression: systematic review and meta-analysis J Affect Disord 2019 Mar 1;246:29-41 

4. Davenport MH et al.  Impact of prenatal exercise on both prenatal and postnatal anxiety and depressive symptoms: a systematic review and meta-analysis Br J Sports Med 2018;52:1376-1385

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