Molecular and Physiological Mechanisms of Antenatal Exercise for Preventing Hypertensive Disorders in Pregnancy
A Systematic Review
Keywords:
Antenatal exercise, Hypertensive disorders, Physiological, Pregnancy, Molecular mechanismAbstract
Hypertensive Disorders in Pregnancy (HDP) is a complex vascular complication associated with impaired placental angiogenesis and endothelial dysfunction. Globally, HDP represents a significant cause of adverse outcomes for both mothers and newborns. This systematic review aims to explore the molecular and physiological mechanisms contributing to the prevention of HDP through antenatal exercise. Research articles published between 2015 and 2025 were systematically identified from PubMed, ScienceDirect, and Google Scholar databases, resulting in 10 studies meeting the inclusion criteria. Findings indicate that regular exercise during pregnancy improves endothelial function, balances angiogenic activity, and reduces oxidative stress and inflammation. Molecular mechanisms include increases in vascular endothelial growth factor (VEGF) and nitric oxide (NO), as well as decreases in inflammatory markers. This supports improved placental perfusion and decreased vascular resistance, leading to lower systolic and diastolic blood pressure. This review concludes that antenatal exercise provides multifactorial protection through physiological and molecular pathways, potentially becoming a safe, accessible, and affordable non-pharmacological strategy to mitigate HDP risk and promote maternal health.
References
Awad, M. A., Hasanin, M. E., Taha, M. M., & Gabr, A. A. (2019). Effect of stretching exercises versus
autogenic training on preeclampsia. Journal of Exercise Rehabilitation, 15(1), 109–113.
https://doi.org/10.12965/jer.1836524.262
Barakat, R., Pelaez, M., Cordero, Y., Perales, M., Lopez, C., Coteron, J., & Mottola, M. F. (2016). Exercise
during pregnancy protects against hypertension and macrosomia: Randomized clinical trial. American
Journal of Obstetrics and Gynecology, 214(5), 649.e1-649.e8.
https://doi.org/10.1016/j.ajog.2015.11.039
Bhattacharjee, J., Mohammad, S., Goudreau, A. D., & Adamo, K. B. (2021). Physical activity differentially
regulates VEGF, PlGF, and their receptors in the human placenta. Physiological Reports, 9(2).
https://doi.org/10.14814/phy2.14710
Catov, J. M., Parker, C. B., Gibbs, B. B., Bann, C. M., Carper, B., Silver, R. M., Simhan, H. N., Parry, S.,
Chung, J. H., Haas, D. M., Wapner, R. J., Saade, G. R., Mercer, B. M., Bairey-Merz, C. N., Greenland,
P., Ehrenthal, D. B., Barnes, S. E., Shanks, A. L., Reddy, U. M., & Grobman, W. A. (2018). Patterns of
leisure-time physical activity across pregnancy and adverse pregnancy outcomes. International Journal
of Behavioral Nutrition and Physical Activity, 15(1). https://doi.org/10.1186/s12966-018-0701-5
Cox, C. E. (2017). Role of physical activity for weight loss and weight maintenance. Diabetes Spectrum, 30(3),
157–160. https://doi.org/10.2337/ds17-0013
Danielli, M., Gillies, C., Thomas, R. C., Melford, S. E., Baker, P. N., Yates, T., Khunti, K., & Tan, B. K.
(2022). Effects of Supervised Exercise on the Development of Hypertensive Disorders of Pregnancy: A
Systematic Review and Meta‐Analysis. In Journal of Clinical Medicine (Vol. 11, Issue 3). MDPI.
https://doi.org/10.3390/jcm11030793
Davenport, M. H., Ruchat, S. M., Poitras, V. J., Jaramillo Garcia, A., Gray, C. E., Barrowman, N., Skow, R.
J., Meah, V. L., Riske, L., Sobierajski, F., James, M., Kathol, A. J., Nuspl, M., Marchand, A. A., Nagpal,
T. S., Slater, L. G., Weeks, A., Adamo, K. B., Davies, G. A., … Mottola, M. F. (2018). Prenatal exercise
for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: A systematic
review and meta-analysis. In British Journal of Sports Medicine (Vol. 52, Issue 21, pp. 1367–1375). BMJ
Publishing Group. https://doi.org/10.1136/bjsports-2018-099355
Do, N. C., Vestgaard, M., Ásbjörnsdóttir, B., Nichum, V. L., Ringholm, L., Andersen, L. L. T., Jensen, D. M.,
Damm, P., & Mathiesen, E. R. (2020). Physical activity, sedentary behavior and development of
preeclampsia in women with preexisting diabetes. Acta Diabetologica, 57(5), 559–567.
https://doi.org/10.1007/s00592-019-01459-7
Garovic, V. D., Dechend, R., Easterling, T., Karumanchi, S. A., Baird, S. M. M., Magee, L. A., Rana, S.,
Vermunt, J. V., & August, P. (2022). Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and
Pharmacotherapy: A Scientific Statement From the American Heart Association. In Hypertension (Vol.
79, Issue 2, pp. E21–E41). Lippincott Williams and Wilkins.
https://doi.org/10.1161/HYP.0000000000000208
Genest, D. S., Falcao, S., Gutkowska, J., & Lavoie, J. L. (2012). Impact of Exercise Training on Preeclampsia:
Potential Preventive Mechanisms. Hypertension, 60(4), 1104–1109.
https://doi.org/https://doi.org/10.1161/HYPERTENSIONAHA.112.194050
Haakstad, L. A. H., Edvardsen, E., & Bø, K. (2016). Effect of regular exercise on blood pressure in
normotensive pregnant women. A randomized controlled trial. Hypertension in Pregnancy, 35(2), 170–
180. https://doi.org/10.3109/10641955.2015.1122036
Hailu, M., Amare Tesfa, N., Nigatu, A., Tunta, A., Seyoum, Z., & Derbew, T. (2025). Physical activity during
pregnancy and pregnancy related complication. Scientific Reports, 15(1).
https://doi.org/10.1038/s41598-025-94492-2
Jaatinen, N., Ekholm, E., Laivuori, F. I. N. N. P. E. C. H., & Jääskeläinen, T. (2024). Impact of physical activity
on preeclampsia and angiogenic markers in the Finnish Genetics of Pre-eclampsia Consortium
(FINNPEC) cohort. Annals of Medicine, 56(1). https://doi.org/10.1080/07853890.2024.2325480
Jiang, L., Tang, K., Magee, L. A., von Dadelszen, P., Ekeroma, A., Li, X., Zhang, E., & Bhutta, Z. A. (2022).
A global view of hypertensive disorders and diabetes mellitus during pregnancy. In Nature Reviews
Endocrinology (Vol. 18, Issue 12, pp. 760–775). Nature Research. https://doi.org/10.1038/s41574-022-
00734-y
Karthiga, K., Pal, G. K., Dasari, P., Nanda, N., Velkumary, S., Chinnakali, P., Renugasundari, M., &
Harichandrakumar, K. T. (2022). Effects of yoga on cardiometabolic risks and fetomaternal outcomes
are associated with serum nitric oxide in gestational hypertension: a randomized control trial. Scientific
Reports, 12(1). https://doi.org/10.1038/s41598-022-15216-4
Khedagi, A. M., & Bello, N. A. (2021). Hypertensive Disorders of Pregnancy. In Cardiology Clinics (Vol. 39,
Issue 1, pp. 77–90). W.B. Saunders. https://doi.org/10.1016/j.ccl.2020.09.005
Kılıçlı, A., & Zeyneloğlu, S. (2025). Mindfulness-Based Breathing Exercise on Health Profile, Vital Signs,
and Fetal Heart Rate in Pregnant Women Diagnosed With Pre-Eclampsia: A Randomized Control Trial.
Florence Nightingale Journal of Nursing, 33(1). https://doi.org/10.5152/FNJN.2025.24136
Korsager Larsen, M., & Matchkov, V. V. (2016). Hypertension and physical exercise: The role of oxidative
stress. In Medicina (Lithuania) (Vol. 52, Issue 1, pp. 19–27). Elsevier.
https://doi.org/10.1016/j.medici.2016.01.005
Kumar, A., Palfrey, H. A., Pathak, R., Kadowitz, P. J., Gettys, T. W., & Murthy, S. N. (2017). The metabolism
and significance of homocysteine in nutrition and health. In Nutrition and Metabolism (Vol. 14, Issue 1).
BioMed Central Ltd. https://doi.org/10.1186/s12986-017-0233-z
Luger, R. K., & Kight, B. P. (2022). Hypertension In Pregnancy. StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK430839/
Magee, L. A., Brown, M. A., Hall, D. R., Gupte, S., Hennessy, A., Karumanchi, S. A., Kenny, L. C., McCarthy,
F., Myers, J., Poon, L. C., Rana, S., Saito, S., Staff, A. C., Tsigas, E., & von Dadelszen, P. (2022). The
2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis &
management recommendations for international practice. Pregnancy Hypertension, 27, 148–169.
https://doi.org/10.1016/j.preghy.2021.09.008
Mathew, R., Devanesan, B. P., Srijana, & Sreedevi, N. S. (2023). Prevalence of hypertensive disorders of
pregnancy, associated factors and pregnancy complications in a primigravida population. Gynecology
and Obstetrics Clinical Medicine, 3(2), 119–123. https://doi.org/10.1016/j.gocm.2023.01.002
Nagpal, T. S., & Mottola, M. F. (2020). Physical activity throughout pregnancy is key to preventing chronic
disease. REPRODUCTION, 160(5), 111–118. https://doi.org/10.1530/REP
Pahlavani, H. A., Laher, I., Weiss, K., Knechtle, B., & Zouhal, H. (2023). Physical exercise for a healthy
pregnancy: the role of placentokines and exerkines. In The journal of physiological sciences : JPS (Vol.
73, Issue 1, p. 30). https://doi.org/10.1186/s12576-023-00885-1
Phoswa, W. N., Khaliq, O. P., & Eche, S. (2023). A Review on Inflammasomes and Immune Checkpoints in
Pre-Eclampsia Complicated with Tuberculosis and Human Immune Deficiency Virus. International
Journal of Environmental Research and Public Health, 20(17), 6627.
https://doi.org/10.3390/ijerph20176627
Poon, L. C., Shennan, A., Hyett, J. A., Kapur, A., Hadar, E., Divakar, H., McAuliffe, F., da Silva Costa, F.,
von Dadelszen, P., McIntyre, H. D., Kihara, A. B., Di Renzo, G. C., Romero, R., D’Alton, M., Berghella,
V., Nicolaides, K. H., & Hod, M. (2019). The International Federation of Gynecology and Obstetrics
(FIGO) initiative on pre-eclampsia: A pragmatic guide for first-trimester screening and prevention.
International Journal of Gynecology and Obstetrics, 145(S1), 1–33. https://doi.org/10.1002/ijgo.12802
Preda, A., Preda, S.-D., Mota, M., Iliescu, D. G., Zorila, L. G., Comanescu, A. C., Mitrea, A., Clenciu, D.,
Mota, E., & Vladu, I. M. (2024). Dyslipidemia in Pregnancy: A Systematic Review of Molecular
Alterations and Clinical Implications. Biomedicines, 12(10), 2252.
https://doi.org/10.3390/biomedicines12102252
Qin, X., Ai, F., Zhou, Q., Zhang, Y., & Yan, X. (2025). Pre-eclampsia, gestational hypertension, and lipid
levels during pregnancy: a systematic review and meta-analysis. Archives of Gynecology and Obstetrics,
312(2), 385–402. https://doi.org/10.1007/s00404-025-08052-0
Ramírez-Vélez, R., Bustamante, J., Czerniczyniec, A., Aguilar de Plata, A. C., & Lores-Arnaiz, S. (2013).
Effect of Exercise Training on Enos Expression, NO Production and Oxygen Metabolism in Human
Placenta. PLoS ONE, 8(11), e80225. https://doi.org/10.1371/journal.pone.0080225
Reynolds, L. J., Twiddy, H. M., Mlynarczyk, M., & Wilson, P. B. (2022). The association of physical activity
on homocysteine in pregnant women. Journal of Maternal-Fetal and Neonatal Medicine, 35(25), 7073–
7080. https://doi.org/10.1080/14767058.2021.1941855
Singh, G. K., Siahpush, M., Liu, L., & Allender, M. (2018). Racial/Ethnic, Nativity, and Sociodemographic
Disparities in Maternal Hypertension in the United States, 2014-2015. International Journal of
Hypertension, 2018. https://doi.org/10.1155/2018/7897189
Skow, R. J., King, E. C., Steinback, C. D., & Davenport, M. H. (2017). The influence of prenatal exercise and
pre-eclampsia on maternal vascular function. In Clinical Science (Vol. 131, Issue 17, pp. 2223–2240).
Portland Press Ltd. https://doi.org/10.1042/CS20171036
Sun, S., Li, W., Zhang, X., Aziz, A. ur R., & Zhang, N. (2025). Publisher Correction: Trends in global and
regional incidence and prevalence of hypertensive disorders in pregnancy (1990–2021): an age-period-
cohort analysis. Scientific Reports, 15(1), 16334. https://doi.org/10.1038/s41598-025-00192-2
von Dadelszen, P., & Magee, L. A. (2016). Preventing deaths due to the hypertensive disorders of pregnancy.
In Best Practice and Research: Clinical Obstetrics and Gynaecology (Vol. 36, pp. 83–102). Bailliere
Tindall Ltd. https://doi.org/10.1016/j.bpobgyn.2016.05.005
Wei, X., & Yang, X. (2023). The central role of natural killer cells in preeclampsia. Frontiers in Immunology,
Downloads
Published
How to Cite
Issue
Section
Abstract views: 29
,
PDF Downloads: 15
The Journal of Research in Midwifery and Healthcare (JRMH), published by the 