The onset of Major Depressive Disorder (MDD) during pregnancy, also known as antenatal depression, is neither benign nor uncommon, with an estimated prevalence rate of 10 to 13%.[1
] Prenatal stress is linked to direct and indirect negative influences on various biological mechanisms in human fetal development.[2
] Antenatal depression has been associated with a number of adverse outcomes for both mothers and babies, including poor self-care, premature labor, low birth weight, longer hospital stays, and compromised mother-child bonding. [4
] Depression during pregnancy is also one of the strongest predictors of postpartum depression and, even when undiagnosed during pregnancy, women have retrospectively identified the onset of postpartum depressive symptoms as having occurred during pregnancy. [6
Treatment for depression during pregnancy poses unique challenges, as the baby is an indirect recipient of the mother's treatment.[8
] There are few controlled treatment studies specific to perinatal women; interventions such as psychotropic medications and psychotherapy are assumed efficacious based upon studies of the general population.[10
] In recent years, there have been a number of reports raising questions about the prudent use of psychotropic(s) during pregnancy.[12
] Although medication is an acceptable and rational treatment option for many women, especially those with more severe MDD, many patients and physicians alike continue to prefer the use of non-medication strategies during pregnancy.[12
] Non-medication treatments like psychotherapy are usually recommended, but for a variety of reasons, psychotherapy is not highly utilized in the U.S. [13
] Thus, both clinicians and patients need safe and accessible treatment alternatives for depression during pregnancy.
Exercise for depression in the general population is an active area of research, with a growing number of clinical studies reporting a positive benefit of exercise upon symptoms of MDD.[14
] In other areas of health, research findings consistently suggest that regular exercise offers cardiovascular protection, maintains healthy weight, reduces the risk of cancer, and helps manage diabetes, hypertension, and other chronic conditions. [15
] In fact, regular exercise is usually one of the first lifestyle modification strategies recommended for reductions of morbidity and mortality. Since depression is increasingly being recognized as a chronic disease, it is reasonable to infer that disease management of depression might also benefit from strategies of lifestyle change.
The aims of this review are to: 1) understand the current knowledge of the safety of exercise during pregnancy; 2) identify findings regarding the impact of exercise on obstetric outcomes; 3) investigate potential mood benefits of exercise upon pregnant women such as maternal emotional well-being and depressive symptoms; and 3) provide a scientific rationale for studying exercise as an intervention for Major Depressive Disorder during pregnancy. This review will identify gaps in our knowledge of exercise as an antidepressant intervention and identify future research priorities.
We performed a systematic review of English language articles published from 1985 to present in Medline, PsycINFO, CINAHL, and Cochrane Library. Terms included in the cross-searches were: exercise, physical activity, mood, pregnancy, safety, preterm labor, preeclampsia, gestational diabetes, depression, emotional well-being, anxiety, and aerobic exercise. All studies were categorized according to the level of empirical evidence, operationalized as: Level 1- Randomized controlled studies; Level 2- Cohort studies; Level 3- Case-control studies; Level 4- Case series; Level 5- Expert opinion or commentary. This method has been employed previously in systematic reviews and is outlined in the United States Agency for Health Care Research and Quality.[19
] Study results are further summarized in tables and/or figures.