María Perales - Academia.edu (original) (raw)

Papers by María Perales

International Journal of Obesity, 2020

Pregnancy exercise can prevent excessive gestational weight gain (EGWG), gestational diabetes mel... more Pregnancy exercise can prevent excessive gestational weight gain (EGWG), gestational diabetes mellitus (GDM) and hypertension (GH), but inter-individual variability has not been explored. We aimed to analyze the prevalence––and potential sociodemographic and medical predictors of––non-responsiveness to gestational exercise, and the association of non-responsiveness with adverse pregnancy outcomes. Among 688 women who completed a supervised light-to-moderate intensity exercise program (three ~1-h sessions/week including aerobic, resistance, and pelvic floor muscle training) until near-term, those who showed EGWG, GDM or GH were considered ‘non-responders’. A low prevalence of non-responders was observed for GDM (3.6%) and GH (3.4%), but not for EGWG (24.2%). Pre-pregnancy obesity was the strongest predictor of non-responsiveness for GH (odds ratio 8.40 [95% confidence interval 3.10–22.78] and EGWG (5.37 [2.78–10.39]), whereas having a highest education level attenuated the risk of being non-responder for GDM (0.10 [0.02–0.49]). Non-responsiveness for EGWG was associated with a higher risk of prolonged labor length, instrumental/cesarean delivery, and macrosomia, and of lower Apgar scores. No association with negative delivery outcomes was found for GDM/GH. In summary, women with pre-pregnancy obesity might require from additional interventions beyond light-to-moderate intensity gestational exercise (e.g., diet and/or higher exercise loads) to ensure cardiometabolic benefits.

Journal of Clinical Medicine, 2020

We studied the influence of pregnancy exercise on maternal/offspring cardiometabolic health until... more We studied the influence of pregnancy exercise on maternal/offspring cardiometabolic health until delivery and at follow-up. We pooled data from two randomized controlled trials from our group that were performed following the same methodology (one unpublished). We also collected follow-up data de novo from the participants of both trials and their offspring. In total, 1348 women with uncomplicated, singleton gestations were assigned to an intervention (n = 688, performing a supervised, moderate-intensity exercise program (three sessions/week)) or control group (n = 660). Maternal outcomes were excessive gestational weight gain (EGWG), gestational hypertension/diabetes and, at follow-up, return to pre-pregnancy weight within six months, hypertension, overweight/obesity, and other cardiometabolic conditions. Offspring outcomes were macrosomia and low-birthweight and, at follow-up, overweight/obesity, low-weight, and cardiometabolic conditions. Adherence to the intervention, which pro...

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2018

Objective: to examine the influence of an exercise program throughout pregnancy on the duration o... more Objective: to examine the influence of an exercise program throughout pregnancy on the duration of labor in healthy pregnant women. Study Desig n: A randomized clinical trial was used (Identifier: NCT02109588). In all, 508 healthy pregnant women were randomly assigned between 9 to 11 weeks of gestation to either a Control Group (CG, N= 253) or an Exercise Group (EG, N= 255). A moderate aerobic exercise program throughout pregnancy (three weekly sessions) was used as the intervention. Mann-Whitney and Pearson χ 2 tests were performed to analyze differences between groups. Survival techniques through the Kaplan-Meier method were used to estimate the median time to delivery of each group; and Gehan-Breslow-Wilcoxon tests were performed to compare survival distribution betwe en the two arms. The primary o utcome studied was the length of the stages of labor. Secondary outcomes included m ode of delivery, gestational age, maternal weight gain, preterm delivery, use of epidural, birthweight, Apgar scores and arterial cord pH. Results : Women randomized to the EG had shorter first stage of labor (409 vs 462 minutes, p= 0 .01), total duration of labor (450 vs 507 minutes, p= 0 .01) as well as combined duratio n of first and second stages of labor (442 vs 499 minutes, p= 0.01). The probab ilities of a wo man being delivered at 250 minutes and 500 minutes (median times) were 19.1 % and 62.5% in the experimental group vs 13.7% and 5 0.8% in the control group (Z =-2.37, p=0.0 18). Results also revealed that women in the intervention gro up were le ss likely to use an epidural; and that the prevalence of neonate macrosomia was higher in the control group. C onclusion: A supervised physical exercise program throughout pregnancy decreased the duration of the first phase of labor as well as total time of the first two phases together, leading to a decrease in total labor time.

JAMA, 2017

Historically, pregnant women were advised to refrain from exercise because of concerns about feta... more Historically, pregnant women were advised to refrain from exercise because of concerns about fetal risk. Simultaneously, they were advised to increase their caloric intake during pregnancy. However (in part because of these misguided recommendations), some of the weight gained during pregnancy was usually retained. Elevated maternal weight is associated with a higher birth weight of offspring and contributes to the intergenerational transmission of obesity.1 Consequently, pregnancy has evolved as a major contributor to the worldwide obesity epidemic and multiple related maternal and fetal comorbidities, some of which have potential lifelong consequences.

Annals of Translational Medicine, 2016

Scarce evidence is available on the potential cardiovascular abnormalities associated with some c... more Scarce evidence is available on the potential cardiovascular abnormalities associated with some common gestational complications. We aimed to analyze the potential maternal cardiac alterations related to gestational complications, including body mass index (BMI) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;25 kg/m(2), gaining excessive weight, or developing antenatal depression. The design of this study was a secondary analysis of a randomized controlled trial. Echocardiography was performed to assess cardiovascular indicators of maternal hemodynamic, cardiac remodeling and left ventricular (LV) function in 59 sedentary pregnant women at 20 and 34 weeks of gestation. Starting pregnancy with a BMI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;25 kg/m(2), gaining excessive weight, and developing antenatal depression had no cardiovascular impact on maternal health (P value &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.002). Depressed women were more likely to exceed weight gain recommendations than non-depressed women (P value &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.002). The evaluated gestational complications seem not to induce cardiovascular alterations in hemodynamic, remodeling and LV function indicators. However, developing antenatal depression increases the risk of an excessive weight gain. This finding is potentially important because excessive weight gain during pregnancy associates with a higher risk of cardiovascular diseases (CVD) later in life.

Current Pharmaceutical Design, 2016

Depression is a major medical and social problem. Here we review current body of knowledge on the... more Depression is a major medical and social problem. Here we review current body of knowledge on the benefits of exercise as an effective strategy for both the prevention and treatment of this condition. We also analyze the biological pathways involved in such potential benefits, which include changes in neurotrophic factors, oxidative stress and inflammation, telomere length, brain volume and microvessels, neurotransmitters or hormones. We also identify major caveats in this field of research: further studies are needed to identify which are the most appropriate types of exercise interventions (intensity, duration, or frequency) to treat and prevent depression.

Medicine & Science in Sports & Exercise, 2016

Introduction: Scarce evidence exists regarding the effects of regular pregnancy exercise on mater... more Introduction: Scarce evidence exists regarding the effects of regular pregnancy exercise on maternal cardiovascular health. We aimed to study, using a randomized controlled trial design, the effects of pregnancy exercise on echocardiographic indicators of hemodynamics, cardiac remodeling, left ventricular (LV) function, and cardiovascular disease (CVD) risk factors. Methods: Two hundred forty-one healthy pregnant women were assigned to a control (standard care) or intervention (exercise) group (initial n = 121/120). The intervention (weeks 9-11 to 38-39) included three supervised sessions per week (55-60 min, with lightmoderate intensity aerobic and strength exercises). Results: The main findings were as follows: (i) the proportion of women with excessive weight gain at end pregnancy was lower in the exercise group compared with controls (18% vs 40%, P = 0.005), and (ii) there was a tendency toward lower prevalence of depression at end pregnancy in the former (P = 0.029, threshold P value set at 0.013). No significant exercise training effect was essentially found for echocardiographic variables, CVD risk factors, type/duration of labor, or newborn_s outcomes (weight, height, head circumference, Apgar scores, and umbilical cord pH). Conclusions: Light-moderate intensity supervised exercise is safe for healthy pregnant women and does not impose an additional cardiac overload beyond gestation or affect the main pregnancy outcomes. Such intervention might help decrease, at least partly, the risk of two CVD-associated conditions, excessive weight gain and depression.

Revista Internacional de Medicina y Ciencias de la Actividad Física y del Deporte, 2015

gestante. Material y métodos; Se desarrolló un ensayo clínico aleatorizado controlado. 101 mujere... more gestante. Material y métodos; Se desarrolló un ensayo clínico aleatorizado controlado. 101 mujeres primíparas fueron distribuidas aleatoriamente en dos grupos (grupo control (GC) n=51, grupo intervención (GI) n=50, muestra perdida 13, 11.4%). El GI participó en un programa de ejercicio físico desde la semana de gestación 10-14 hasta el final de la gestación (70-75 sesiones de 55-60 min, tres veces por semana). El GC recibió la atención médica regular. Todas las gestantes rellenaron dos cuestionarios validados sobre salud percibida e incontinencia urinaria, antes y después de la intervención. Resultados; Se encontraron diferencias estadísticamente significativas entre grupos en la salud percibida al final de la intervención [muy buena: GI 35, 70% vs. GC 5, 9.8%; buena: GI 15, 30% vs. GC 16, 31%; regular GI 0, 0.0% vs. GC 26, 51%; mala GI 0, 0.0% vs. GC 3, 5.9%; muy mala: GI 0, 0.0% vs. GC 1, 2% (p<.001)]. Además el GI padeció menos incontinencia urinaria [Puntuación ICIQ-SF GI 0.30 (SD1.3) vs. GC 3.1 (SD4.1), p<.001]. Conclusiones; Un programa de ejercicio físico supervisado, de intensidad moderada realizado durante toda la gestación que incluya ejercicios de fortalecimiento del suelo pélvico, mejora la percepción de la salud en las gestantes y es efectivo en la prevención primaria de la incontinencia urinaria. Palabras clave: ejercicio físico; embarazo; percepción salud; incontinencia urinaria.

Archivos de Medicina del Deporte

Objective: To assess the effectiveness of a regular physical exercise program on the prevention o... more Objective: To assess the effectiveness of a regular physical exercise program on the prevention of depression in overweight and obese pregnant women. Material/methods: A randomised controlled trial was conducted at Hospital Universitario de Fuenlabrada in Madrid. A total of 106 overweight and obese healthy pregnant women (32.70±3.90 years), with uncomplicated and singleton gestation were analyzed (52 to the exercise group (EG) and 54 to the control group (CG)). Women from EG participated in a physical conditioning program throughout pregnancy, which included a total of 55- to 60-minute weekly sessions, 3 days per week. The main outcome measure was the patients’ depression level, assessed by the Center for Epidemiological Studies Depression scale (CES-D). Other pregnancy outcomes were measured. Results: A smaller percentage of depressed women were identified in the EG compared to the CG in the third trimester: entire group EG: 17.8% vs. CG: 47.2% p=0.002, overweight EG: 16.2% vs. CG:...

British Journal of Sports Medicine, 2015

Although there is no consensus with respect to whether exercise is beneficial during pregnancy, m... more Although there is no consensus with respect to whether exercise is beneficial during pregnancy, most studies report it to pose no risk to either the mother or the fetus, and many suggest it to be beneficial to both. This review, which examines the evidence available in this respect, also reveals the many differences in study design followed, the type of exercise undertaken and the variables measured, which make it difficult to compare results and perform meta-analyses. Advances in our understanding of the effects of exercise during pregnancy might best be made by undertaking randomised clinical trials with standardised protocols. However, most of the studies examining the relationship between exercise and pregnancy report no complications on maternal or fetal well-being. This is also in line with recent review studies advising that the pregnant population without obstetric contraindications should be encouraged to exercise during pregnancy. Therefore, the results of the present review stimulate those responsible for the healthcare of the pregnant woman to recommend moderate exercise throughout pregnancy without risk to maternal and fetal health.

Revista Andaluza de Medicina del Deporte, 2015

American Journal of Health Promotion, 2016

Purpose. The aim of the present study was to examine the influence of moderate physical exercise ... more Purpose. The aim of the present study was to examine the influence of moderate physical exercise throughout pregnancy on the duration of labor stages. Design. Study was a randomized controlled trial. Setting. The study took place at Hospital Puerta de Hierro and Hospital Severo Ochoa in Madrid, Spain. Subjects. We examined 166 pregnant women (31.6 ± 3.8 years), and all had uncomplicated and singleton gestation. Of these 83 were allocated to the exercise group (EG) and 83 to the control group (CG). Intervention. Women from the EG participated in a physical conditioning program throughout pregnancy, which included 55- to 60-minute sessions, 3 days per week. Measures. Pregnancy outcomes were measured: duration of labor stages, gestational age, weight gain, type of delivery, birth weight, birth size, head circumference, Apgar score, pH of umbilical cord. Analysis. Student's unpaired t-tests and χ2 tests were used; p values of < .05 indicated statistical significance. Cohen's ...

RICYDE. Revista internacional de ciencias del deporte, 2012

El presente trabajo pretendió conocer la eficacia de un programa de ejercicio físico moderado des... more El presente trabajo pretendió conocer la eficacia de un programa de ejercicio físico moderado desarrollado durante todo el embarazo en el control de la excesiva ganancia de peso materno, la tolerancia materna a la glucosa y el desarrollo de la Diabetes Gestacional (DG). Se realizó un ensayo clínico, aleatorizado, no apareado, no enmascarado mediante una colaboración entre el

Progresos de Obstetricia y Ginecología, 2012

Embarazo; Ejercicio físico; Sistema cardiovascular Resumen Objetivo: Analizar la seguridad del ej... more Embarazo; Ejercicio físico; Sistema cardiovascular Resumen Objetivo: Analizar la seguridad del ejercicio aeróbico para el sistema cardiovascular de las mujeres gestantes y valorar las posibles mejoras cardiovasculares producidas. Sujetos y métodos: Se diseñó un ensayo clínico aleatorizado, no apareado, no enmascarado. El registro de datos se realizó en las semanas 20 y 34 de gestación. En la semana 20, se estudió a 45 gestantes del grupo de ejercicio (GE), de las cuales completaron el estudio 35. Del grupo de control (GC), en la semana 20 participaron 14, y completaron el estudio 9. Resultados: En la semana 20 hubo mejoras en el índice de masa corporal (GE: 25,1 AE 4,3/GC: 27,9 AE 4,5) (p = 0,04) y en la presión arterial sistólica (GE: 104,7 AE 10,9/GC: 112,5 AE 11,3) (p = 0,02). En el GC hubo presencia de hipertrofia concéntrica (n = 2, 14,3%). En la semana 34, el GE presentó un mayor volumen sistólico (GE: 52,33 AE 10,42/GC: 43,69 AE 9,48) (p = 0,03). Conclusión: El ejercicio aeróbico durante el embarazo es seguro para el sistema cardiovascular, mejorando incluso algunos parámetros.

Mayo Clinic Proceedings, 2013

Objective: To study the effect on maternal weight gain of a supervised light-to moderate-intensit... more Objective: To study the effect on maternal weight gain of a supervised light-to moderate-intensity exerciseebased intervention performed from the ninth week of pregnancy. Participants and Methods: A total of 962 healthy pregnant women were randomly assigned to a standard care or exercise intervention group conducted between September 1, 2007, and January 31, 2011. The intervention included light-to moderate-intensity aerobic and resistance exercises performed 3 days a week (50-55 minutes per session). Excessive gestational weight gain was calculated on the basis of the 2009 Institute of Medicine (IOM) recommendations. Gestational body weight gain was calculated on the basis of the weight measured at the first prenatal visit (fifth to sixth weeks of gestation) and weight measured at the last visit to the clinic before delivery. Women were categorized into normal weight or overweight or obese. Results: Women in the intervention group gained less weight (adjusted mean difference, 1.039 kg; 95% CI, 0.534-1.545 kg; P<.001) and were less likely to gain weight above the IOM recommendations (odds ratio, 0.625; 95% CI, 0.461-0.847) compared with those in the standard care group. The main treatment effects according to body mass index category were that normal weight women in the intervention group gained less weight (adjusted mean difference, 1.393 kg; 95% CI, 0.813-1.972 kg; P<.001) and were less likely to gain weight above the IOM recommendations (odds ratio, 0.508; 95% CI, 0.334-0.774) than normal weight women who received standard care. No significant treatment effect was observed in overweight or obese women. Conclusion: Supervised exercise of light to moderate intensity can be used to prevent excessive gestational weight gain, especially in normal weight women. Trial registration: clinicaltrials.gov Identifier: NCT01790347

American Journal of Health Promotion, 2014

Purpose. The aim of the present study was to examine the influence of a program of moderate physi... more Purpose. The aim of the present study was to examine the influence of a program of moderate physical exercise throughout pregnancy on maternal and fetal parameters. Design. The study design was a randomized controlled trial. Setting. The study took place at the Hospital of Fuenlabrada in Madrid, Spain. Sample. Analyzed were 200 pregnant women (31.54 ± 3.86 years), all of whom had uncomplicated and singleton gestation. Of these subjects, 107 were allocated to the exercise group (EG) and 93 to the control group (CG). Intervention. Women from EG participated in a physical conditioning program throughout pregnancy, which included a total of 55- to 60-minute weekly sessions, 3 days per week. Measures. Pregnancy outcomes. Maternal: gestational age, weight gain, type of delivery, blood pressure during pregnancy, gestational diabetes (n/%). Fetal: birth weight, birth size, head circumference, Apgar score, pH of umbilical cord. Analysis. Student's unpaired t-test and χ2 test were used; p...