Cookies Notification

We use cookies to improve your website experience. To learn about our use of cookies and how you can manage your cookie settings, please see our Cookie Policy.

Low-intensity physical activity may protect pregnant women against spontaneous preterm labour: a prospective case-control study

Publication: Applied Physiology, Nutrition, and Metabolism
25 September 2020


The innate immune system plays a significant role in onset of parturition. Maternal antenatal physical activity can influence immune function and timing of labour. We examined physical activity patterns and concentration of 19 cytokines at 16 and 27 weeks gestational age (GA), in peripheral plasma of 28 asymptomatic women who later had spontaneous preterm labour (SPTL, <37 weeks GA) and 52 women who later delivered at term (TL; ≥37 weeks GA). This nested case-control study used data from the Ontario Birth Study cohort. Exercise was assessed using the International Physical Activity Questionnaire, and cytokines were analyzed using Luminex assays. There was no significant difference in exercise patterns between SPTL and TL subjects. Plasma concentration of interleukin (IL)-10 was significantly higher in SPTL women at 16 and 27 weeks, while tumour necrosis factor alpha (TNF-α), IL-8, and monocyte chemoattractant protein (MCP)-1 concentrations were increased at 27 weeks GA (p < 0.05). Concentration of IL-10 was negatively correlated with the amount of reported walking (ρ = −0.264, p = 0.03). Women should be encouraged to partake in low-intensity exercise throughout pregnancy, as it may confer a protective effect against SPTL through IL-10–mediated pathways. Additionally, plasma cytokine analysis at 27 weeks GA may be useful for predicting SPTL in asymptomatic women.
In women that delivered preterm, plasma levels of anti-inflammatory cytokine IL-10 were significantly elevated at 16 and 27 weeks of gestation.
Plasma levels of IL-10 were negatively correlated with the amount of reported walking.
Concentration of IL-8, MCP-1 and TNF-α were increased in plasma of asymptomatic women that subsequently deliver preterm.


Le système immunitaire inné joue un rôle important dans le début de la parturition. L’activité physique prénatale maternelle peut influencer la fonction immunitaire et le moment du travail. Nous examinons à 16 et 27 semaines d’âge gestationnel (« GA ») les schémas d’activité physique et la concentration de 19 cytokines dans le plasma périphérique de 28 femmes asymptomatiques qui ont par la suite un travail prématuré spontané (« SPTL », <37 semaines de GA) et 52 femmes qui accouchent plus tard à terme (« TL », ≥37 semaines de GA). Cette étude cas-témoins imbriquée utilise des données de la cohorte de l’étude sur les naissances en Ontario. L’exercice est évalué à l’aide du questionnaire international sur l’activité physique et les cytokines sont analysées à l’aide des dosages Luminex. Il n’y a pas de différence significative dans les schémas d’exercice entre les sujets SPTL et TL. La concentration plasmatique d’interleukine (« IL-10 ») est significativement plus élevée chez les femmes SPTL à 16 et 27 semaines; les concentrations de facteur de nécrose tumorale alpha (« TNF-α », IL-8 et MCP-1 sont augmentées à la 27e semaine de GA (p < 0,05). La concentration d’IL-10 est négativement corrélée avec la quantité de marche rapportée (ρ = −0,264, p = 0,03). Les femmes doivent être encouragées à participer à des exercices de faible intensité tout au long de la grossesse, car cela peut conférer un effet protecteur contre le SPTL via les voies médiées par IL-10. De plus, l’analyse des cytokines plasmatiques à 27 semaines de GA peut être utile pour prédire le SPTL chez les femmes asymptomatiques. [Traduit par la Rédaction]
Les nouveautés :
Chez les femmes qui accouchent avant terme, la concentration plasmatique de cytokine anti-inflammatoire IL-10 est significativement élevée aux 16e et 27e semaines de gestation.
La concentration plasmatique d’IL-10 est corrélée négativement avec la quantité de marche rapportée.
La concentration d’IL-8, de MCP-1 et de TNF-α augmente dans le plasma des femmes asymptomatiques qui accouchent par la suite avant terme.

Get full access to this article

View all available purchase options and get full access to this article.


Ainsworth B.E., Haskell W.L., Whitt M.C., Irwin M.L., Swartz A.M., Strath S.J., et al. 2000. Compendium of physical activities: an update of activity codes and MET intensities. Med. Sci. Sports Exerc. 32(9): 498–504.
Amorim M.M., Franca-Neto A.H., Tavares J.S., Melo A.S., Leite S.F., and Leal N.V. 2014. Maternal hemodynamic responses during two types of moderate-intensity physical exercise in pregnancy. Obstet. Gynecol. 123: 37S–38S.
Andersen C.S., Juhl M., Gamborg M., Sorensen T.I.A., and Nohr E.A. 2012. Maternal recreational exercise during pregnancy in relation to children’s BMI at 7 years of age. Int. J. Pediatr. 2012: 920583.
Anderson L.N., Knight J.A., Hung R.J., Hewko S.L., Seeto R.A., Martin M.J., et al. 2018. The Ontario Birth Study: A prospective pregnancy cohort study integrating perinatal research into clinical care. Paediatr. Perinat. Epidemiol. 32(3): 290–301.
Avery M.D., Leon A.S., and Kopher R.A. 1997. Effects of a partially home-based exercise program for women with gestational diabetes. Obstet. Gynecol. 89: 10–15.
Baciuk E.P., Pereira R.I., Cecatti J.G., Braga A.F., and Cavalcante S.R. 2008. Water aerobics in pregnancy: cardiovascular response, labor and neonatal outcomes. Reprod. Health. 5: 10.
Barakat Carballo R., Stirling J.R., Zakynthinaki M., and Alejandro L. 2008. Acute maternal exercise during the third trimester of pregnancy, influence on foetal heart rate. Rev. Int. Cienc. Deporte. 4: 33–43.
Barry J.C., Simtchouk S., Durrer C., Jung M.E., Mui A.L., and Little J.P. 2018. Short-term exercise training reduces anti-inflammatory action of interleukin-10 in adults with obesity. Cytokine, 111: 460–469.
Bertolotto A., Volpe L., Calianno A., Pugliese M.C., Lencioni C., Resi V., et al. 2010. Physical activity and dietary habits during pregnancy: effects on glucose tolerance. J. Matern. Fetal Neonatal Med. 23(11): 1310–1314.
Bgeginski R., Almada B.P., and Kruel L.F. 2015a. Fetal heart rate responses during maternal resistance exercise: A pilot study. Rev. Bras. Ginecol. Obstet. 37: 133–139.
Bgeginski R., Almada B.P., and Martins Kruel L.F. 2015b. Cardiorespiratory responses of pregnant and non-pregnant women during resistance exercise. J. Strength Cond. Res. 29: 596–603.
Brown J., Ceysens G., and Boulvain M. 2017. Exercise for pregnant women with gestational diabetes for improving maternal and fetal outcomes. Cochrane Database Syst. Rev. 6: CD012202.
Chapman N.R., Smyrnias I., Anumba D.O., Europe-Finner G.N., and Robson S.C. 2005. Expression of the GTP-Binding protein (Galphas) is repressed by the nuclear factor kappaB RelA subunit in human myometrium. Endocrinology, 146(11): 4994–5002.
Coll C.V., Domingues M.R., Gonçalves H., and Bertoldi A.D. 2017. Perceived barriers to leisure-time physical activity during pregnancy: A literature review of quantitative and qualitative evidence. J. Sci. Med. Sport. 20(1): 17–25.
Craig C.L., Marshall A.L., Sjostrom M., Bauman A.E., Booth M.L., Ainsworth B.E., et al. 2003. International physical activity questionnaire: 12-country reliability and validity. Med. Sci. Sports Exerc. 35(8): 1381–1395.
Cullen T., Thomas A.W., Webb R., and Hughes M.G. 2016. Interleukin-6 and associated cytokine responses to an acute bout of high-intensity interval exercise: the effect of exercise intensity and volume. Appl. Physiol. Nutr. Metab. 41(8): 803–808.
Curry A.E., Vogel I., Drews C., Schendel D., Skogstrand K., Flanders W.D., et al. 2007. Mid-pregnancy maternal plasma levels of interleukin 2, 6, and 12, tumor necrosis factor-alpha, interferon-gamma, and granulocyte-macrophage colony-stimulating factor and spontaneous preterm delivery. Acta. Obstet. Gynecol. Scand. 86(9): 1103–1110.
Della Gatta P.A., Garnham A.P., Peake J.M., and Cameron-Smith D. 2014. Effect of exercise training on skeletal muscle cytokine expression in the elderly. Brain Behav. Immun. 39: 80–86.
Denison F.C., Kelly R.W., Calder A.A., and Riley S.C. 1998. Cytokine secretion by human fetal membranes, decidua and placenta at term. Hum. Reprod. 13(12): 3560–3565.
Elliott C.L., Loudon J.A., Brown N., Slater D.M., Bennett P.R., and Sullivan M.H. 2001. IL-1beta and IL-8 in human fetal membranes: Changes with gestational age, labor, and culture conditions. Am. J. Reprod. Immunol. 46(4): 260–267.
Esplin M.S., Romero R., Chaiworapongsa T., Kim Y.M., Edwin S., Gomez R., et al. 2005. Monocyte chemotactic protein-1 is increased in the amniotic fluid of women who deliver preterm in the presence or absence of intra-amniotic infection. J. Matern. Fetal Neonatal Med. 17(6): 365–373.
Evenson K.R., Barakat R., Brown W.J., Dargent-Molina P., Haruna M., Mikkelsen E.M., et al. 2014. Guidelines for physical activity during pregnancy: Comparisons from around the world. Am. J. Lifestyle Med. 8(2): 102–121.
Febbraio M.A., Steensberg A., Starkie R.L., McConell G.K., and Kingwell B.A. 2003. Skeletal muscle interleukin-6 and tumor necrosis factor-α release in healthy subjects and patients with type 2 diabetes at rest and during exercise. Metabolism, 52: 939–944.
Ferguson K.K., McElrath T.F., Chen Y.H., Mukherjee B., and Meeker J.D. 2014. Longitudinal profiling of inflammatory cytokines and C-reactive protein during uncomplicated and preterm pregnancy. Am. J. Reprod. Immunol. 72: 326–336.
Fiers W. 1991. Tumor necrosis factor: Characterization at the molecular, cellular and in vivo level. FEBS Lett. 285: 199–212.
Ghafourian M., Ashtary-Larky D., Chinipardaz R., Eskandary N., and Mehavaran M. 2016. Inflammatory biomarkers’ response to two different intensities of a single bout exercise among soccer players. Iran. Red. Crescent Med. J. 18(2): e21498.
Gleeson M., Bishop N.C., Stensel D.J., Lindley M.R., Mastana S.S., and Nimmo M.A. 2011. The anti-inflammatory effects of exercise: mechanisms and implications for the prevention and treatment of disease. Nat. Rev. Immunol. 11(9): 607–615.
Golightly E., Jabbour H.N., and Norman J.E. 2011. Endocrine immune interactions in human parturition. Mol. Cell Endocrinol. 335(1): 52–59.
Gomez-Lopez N., Estrada-Gutierrez G., Jimenez-Zamudio L., Vega-Sanchez R., and Vadillo-Ortega F. 2009. Fetal membranes exhibit selective leukocyte chemotaxic activity during human labor. J. Reprod. Immunol. 80(1–2): 122–131.
Gu L., Rutledge B., Fiorillo J., Ernst C., Grewal I., Flavell R., et al. 1997. In vivo properties of monocyte chemoattractant protein-1. J. Leukoc. Biol. 62(5): 577–580.
Hagberg H., Mallard C., and Jacobsson B. 2005. Role of cytokines in preterm labour and brain injury. BJOG. 112: 1: 16–8.
Hagströmer M., Oja P., and Sjöström M. 2006. The international physical activity questionnaire (IPAQ): A study of concurrent and construct validity. Public Health Nutr. 9(6): 755–762.
Halse R.E., Wallman K.E., Dimmock J.A., Newnham J.P., and Guelfi K.J. 2015. Home-based exercise improves fitness and exercise attitude and intention in women with GDM. Med. Sci. Sports Exerc. 47: 1698–1704.
Harizopoulou V.C., Kritikos A., Papanikolaou Z., Saranti E., Vavilis D., Klonos E., et al. 2010. Maternal physical activity before and during early pregnancy as a risk factor for gestational diabetes mellitus. Acta. Diabetol. 47(Suppl. 1): 83–89.
International Weight Management in Pregnancy (i-WIP) Collaborative Group. 2017. Effect of diet and physical activity based interventions in pregnancy on gestational weight gain and pregnancy outcomes: Meta-analysis of individual participant data from randomized trials. BMJ, 358: j3119.
Jacobsson B., Holst R.M., Wennerholm U.B., Andersson B., Lilja H., and Hagberg H. 2003. Monocyte chemotactic protein-1 in cervical and amniotic fluid: Relationship to microbial invasion of the amniotic cavity, intra-amniotic inflammation, and preterm delivery. Am. J. Obstet. Gynecol. 189(4): 1161–1167.
Jakicic J.M., Polley B.A., and Wing R.R. 1998. Accuracy of self-reported exercise and the relationship with weight loss in overweight women. Med. Sci. Sports Exerc. 30(4): 634–638.
Juhl M., Andersen P.K., Olsen J., Madsen M., Jørgensen T., Nøhr E.A., et al. 2008. Physical exercise during pregnancy and the risk of preterm birth: a study within the Danish National Birth Cohort. Am. J. Epidemiol. 167(7): 859–866.
Jürimäe J., Tillmann V., Purge P., and Jürimäe T. 2017. Body composition, maximal aerobic performance and inflammatory biomarkers in endurance-trained athletes. Clin. Physiol. Funct. Imaging. 37(3): 288–292.
Keelan J.A., Marvin K.W., Sato T.A., Coleman M., McCowan L.M., and Mitchell M.D. 1999. Cytokine abundance in placental tissues: evidence of inflammatory activation in gestational membranes with term and preterm parturition. Am. J. Obstet. Gynecol. 181(6): 1530–1536.
Kemp B., Menon R., Fortunato S., Winkler M., Maul H., and Rath W. 2002. Quantitation and localization of inflammatory cytokines interleukin-6 and interleukin-8 in the lower uterine segment during cervical dilatation. J. Assist. Reprod. Genet. 19(5): 215–219.
Kokic S., Ivanisevic M., Kokic T., Simunic B., and Pisot R. 2018. Acute responses to structured aerobic and resistance exercise in women with gestational diabetes mellitus. Scan. J. Med. Sci. Sports. 28(7): 1793–1800.
Kraemer W.J., Hatfield D.L., Comstock B.A., Fragala M.S., Davitt P.M., Cortis C., et al. 2014. Influence of HMB supplementation and resistance training on cytokine responses to resistance exercise. J. Am. Coll. Nutr. 33(4): 247–255.
Laham N., Van Dunné F., Abraham L.J., Farrugia W., Bendtzen K., Brennecke S.P., et al. 1997. Tumour necrosis factor-beta in human pregnancy and labor. J. Reprod. Immunol. 33(1): 53–69.
Laudanski P., Lemancewicz A., Kuc P., Charkiewicz K., Ramotowska B., Kretowska M., et al. 2014. Chemokines profiling of patients with preterm birth. Mediators Inflamm. 2014: 185758.
Lye S.J., Ou C.-W., Teoh T.-G., Erb G., Stevens Y., Casper R., et al. 1998. The molecular basis of labour and tocolysis. Fet. Matern. Med. Rev. 10(3): 121–136.
Matthys P., Mitera T., Heremans H., Van Damme J., and Billiau A. 1995. Anti-gamma interferon and anti-interleukin-6 antibodies affect staphylococcal enterotoxin B-induced weight loss, hypoglycaemia and cytokine release in D-galactosamine-sensitized and unsensitized mice. Infect. Immun. 63: 1158–1164.
May L.E., Allen J.J., and Gustafson K.M. 2016. Fetal and maternal cardiac responses to physical activity and exercise during pregnancy. Early Hum. Dev. 94: 49–52.
Mbongo L.I., Devi A.Y., Zain S., Omar S.Z., and Mohamed Z. 2015. Protein profiling of women with spontaneous preterm birth. Pharmacology, 96: 44–48.
Mendelson C.R. 2009. Minireview: fetal-maternal hormonal signaling in pregnancy and labor. Mol. Endocrinol. 23(7): 947–954.
Mizuhara H., O'Neill E., Seki N., Ogawa T., Kusunoki C., Otsuka K., et al. 1994. T cell activation-associated hepatic injury: Mediation by tumor necrosis factors and protection by interleukin 6. J. Exp. Med. 179(5): 1529–1537.
Mobini M., Mortazavi M., Nadi S., Zare-Bidaki M., Pourtalebi S., and Arababadi M.K. 2016. Significant roles played by interleukin-10 in outcome of pregnancy. Iran J. Basic Med. Sci. 19(2): 119–124.
Mottola M.F., Davenport M.H., Ruchat S.-M., Davies G.A., Poitras V., Gray C., et al. 2018. No. 367-2019 Canadian guideline for physical activity throughout pregnancy. J Obstet Gynaecol Can. 40(11): 1528–1537.
Muglia L.J. and Katz M. 2010. The enigma of spontaneous preterm birth. N. Engl. J. Med. 362(6): 529–535.
Petersen A.M. and Pedersen B.K. 2005. The anti-inflammatory effect of exercise. J. Appl. Physiol. 98: 1154–1162.
Petrov Fieril K., Glantz A., and Fagevik O.M. 2016. Hemodynamic responses to single sessions of aerobic exercise and resistance exercise in pregnancy. Acta. Obstet. Gynecol. Scand. 95: 1042–1047.
Ramos B.R.A., Mendes N.D., Tanikawa A.A., Amador M.A.T., Santos N.P.C., Santos S.E.B., et al. 2016. Ancestry informative markers and selected single nucleotide polymorphisms in immunoregulatory genes on preterm labor and preterm premature rupture of membranes: a case control study. BMC Pregnancy Childbirth. 16: 30.
Riemann M.K. and Kanstrup Hansen I.L. 2000. Effects on the foetus of exercise in pregnancy. Scand. J. Med. Sci. Sports. 10: 12–19.
Robledo-Colonia A.F., Sandoval-Restrepo N., Mosquera-Valderrama Y.F., Escobar-Hurtado C., and Ramírez-Vélez R. 2012. Aerobic exercise training during pregnancy reduces depressive symptoms in nulliparous women: a randomized trial. J. Physiother. 58: 9–15.
Romero R., Ceska M., Avila C., Mazor M., Behnke E., and Lindley I. 1991. Neutrophil attractant/activating peptide-1/interleukin-8 in term and preterm parturition. Am. J. Obstet. Gynecol. 165(4): 813–820.
Romero R., Espinoza J., Goncalves L.F., Kusanovic J.P., Friel L.A., and Nien J.K. 2006a. Inflammation in preterm and term labour and delivery. Semin. Fetal Neonatal Med. 11(5): 317–326.
Romero R., Espinoza J., Kusanovic J.P., Gotsch F., Hassan S., Erez O., et al. 2006b. The preterm parturition syndrome. BJOG, 113(3): 17–42.
Romero R., Gomez R., Ghezzi F., Yoon B.H., Mazor M., Edwin S.S., et al. 1998. Fetal systemic inflammatory response is followed by the spontaneous onset of preterm parturition. Am. J. Obstet. Gynecol. 179(1): 186–193.
Ross K.M., Miller G., Culhane J., Grobman W., Simhan H.N., Wadhwa P.D., et al. 2016. Patterns of peripheral cytokine expression during pregnancy in two cohorts and associations with inflammatory markers in cord blood. Am. J. Reprod. Immunol. 76(5): 406–414.
Saito S., Kasahara T., Kato Y., Ishihara Y., and Ichijo M. 1993. Elevation of amniotic fluid interleukin 6 (IL-6), IL-8 and granulocyte colony stimulating factor (G-CSF) in term and preterm parturition. Cytokine, 5(1): 81–88.
Sanda B., Vistad I., Haakstad L.A.H., Berntsen S., Sagedal L.R., Lohne-Seiler H., et al. 2017. Reliability and concurrent validity of the International Physical Activity Questionnaire short form among pregnant women. BMC Sports Sci. Med. Rehabil. 9: 7.
Santos P.C., Abreu S., Moreira C., Lopes D., Santos R., Alves O., et al. 2014. Impact of compliance with different guidelines on physical activity during pregnancy and perceived barriers to leisure physical activity. J. Sport Sci. 32(14): 1398–1408.
Sciscione A.C. 2010. Maternal activity restriction and the prevention of preterm birth. Am. J. Obstet. Gynecol. 202: 232e1–232e5.
Shepherd E., Gomersall J.C., Tieu J., Han S., Crowther C.A., and Middleton P. 2017. Combined diet and exercise interventions for preventing gestational diabetes mellitus. Cochrane Datbase Syst. Rev. 11: CD010443.
Shynlova O., Sabra S., and Lye S. 2011. A cytokine signature associated with the onset of term and preterm labour. Reprod Sci. 18: 151A.
Shynlova O., Tsui P., Dorogin A., and Lye S.J. 2008. Monocyte chemoattractant protein-1 (CCL-2) integrates mechanical and endocrine signals that mediate term and preterm labor. J. Immunol. 181(2): 1470–1479.
Sivarajasingam S.P., Imami N., and Johnson M.R. 2016. Myometrial cytokines and their role in the onset of labour. J. Endocrinol. 231(3): R101–R119.
Steensberg A., Hall G., Osada T., Sacchetti M., Saltin B., and Pedersen B.K. 2000. Production of interleukin-6 in contracting human skeletal muscles can account for the exercise-induced increase in plasma interleukin-6. J. Physiol. 529(1): 237–242.
Straughen J.K., Bazydlo M., Havstad S., Shafie-Khorassani F., and Misra D.P. 2018a. Maternal body weight trajectories across the life course and risk of preterm delivery. J. Dev. Orig. Health Dis. 9(2): 143–150.
Straughen, J.K., Sealy-Jefferson, S., Bazydlo, M., Helmkamp, L., and Misra, D.P. 2018b. Physical activity and risk of preterm birth in a cohort of African American women. 28(6): 488–494.
Tang M.X., Hu X.H., Liu Z.Z., Kwak-Kim J., and Liao A.H. 2015. What are the roles of macrophages and monocytes in human pregnancy? J. Reprod. Immunol. 112: 73–80.
The IPAQ Group. 2015. Guidelines for Data Processing and Analysis of the International Physical Activity Questionnaire. Available from
Tinloy J., Chuang C.H., Zhu J., Pauli J., Kraschnewski J.L., and Kjerulff K.H. 2014. Exercise during pregnancy and risk of late preterm birth, caesarean delivery, and hospitalizations. Women’s Health Issues. 24(1): e99–e104.
Voltolini C., Torricelli M., Conti N., Vellucci F.L., Severi F.M., and Petraglia F. 2013. Understanding spontaneous preterm birth: from underlying mechanisms to predictive and preventive interventions. Reprod. Sci. 20(11): 1274–1292.
Yakeu G., Butcher L., Isa S., Webb R., Roberts A.W., Thomas A.W., et al. 2010. Low-intensity exercise enhances expression of markers of alternative activation in circulating leukocytes: Roles of PPARγ and Th2 cytokines. Atherosclerosis, 212(2): 668–673.
Yuen H.K., Wang E., Holthaus K., Vogtle L.K., Sword D., Breland H.L., et al. 2013. Self-reported versus objectively assessed exercise adherence. Am. J. Ocup. Ther. 67(4): 484–489.
Zhao N., Chen H.I., Chen Z.Z., Jing L., and Chen Z.B. 2017. IL-10-592 polymorphism is associated with IL-10 expression and severity of enterovirus 71 infection in Chinese children. J. Clin. Virol. 95: 42–46.

Supplementary Material

Supplementary data (apnm-2019-0911suppla.docx)

Information & Authors


Published In

cover image Applied Physiology, Nutrition, and Metabolism
Applied Physiology, Nutrition, and Metabolism
Volume 46Number 4April 2021
Pages: 337 - 345


Received: 29 November 2019
Accepted: 16 September 2020
Accepted manuscript online: 25 September 2020
Version of record online: 25 September 2020


Request permissions for this article.

Key Words

  1. physical exercise
  2. pregnancy
  3. labour
  4. prematurity
  5. cytokines


  1. exercice physique
  2. grossesse
  3. travail
  4. prématurité
  5. cytokines



Valerie Steckle*
Lunenfeld Tanenbaum Research Institute, Sinai Health System, Toronto, ON M5T 3H7, Canada.
Department of Physiology, University of Toronto, Toronto, ON M5S 3G5, Canada.
Oksana Shynlova* [email protected]
Lunenfeld Tanenbaum Research Institute, Sinai Health System, Toronto, ON M5T 3H7, Canada.
Department of Physiology, University of Toronto, Toronto, ON M5S 3G5, Canada.
Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, ON M5G 1Z5, Canada.
Stephen Lye
Lunenfeld Tanenbaum Research Institute, Sinai Health System, Toronto, ON M5T 3H7, Canada.
Department of Physiology, University of Toronto, Toronto, ON M5S 3G5, Canada.
Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, ON M5G 1Z5, Canada.
Alan Bocking
Lunenfeld Tanenbaum Research Institute, Sinai Health System, Toronto, ON M5T 3H7, Canada.
Department of Physiology, University of Toronto, Toronto, ON M5S 3G5, Canada.
Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, ON M5G 1Z5, Canada.


These authors contributed equally.
Copyright remains with the author(s) or their institution(s). Permission for reuse (free in most cases) can be obtained from

Metrics & Citations


Other Metrics


Cite As

Export Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.

Cited by

1. The Association Between Exercise During Pregnancy and the Risk of Preterm Birth
2. Elucidating the interaction between maternal physical activity and circulating myokines throughout gestation: A scoping review

View Options

Get Access

Login options

Check if you access through your login credentials or your institution to get full access on this article.


Click on the button below to subscribe to Applied Physiology, Nutrition, and Metabolism

Purchase options

Purchase this article to get full access to it.

Restore your content access

Enter your email address to restore your content access:

Note: This functionality works only for purchases done as a guest. If you already have an account, log in to access the content to which you are entitled.

View options


View PDF

Full Text

View Full Text





Share Options


Share the article link

Share on social media