Author(s): GRÉAU MARIAS, M., DELPECH, N., DE BISSCHOP, C., ENEA, C., Institution: UNIVERSITY OF POITIERS, Country: FRANCE, Abstract-ID: 1500

INTRODUCTION:
Pregnancy and the postpartum period induce profound cardiovascular (CV) adaptations that may lead to CV complications in some women. These complications are closely associated with increased arterial stiffness, a well-established predictor of long-term CV risk (Kaihara et al., 2025; Khan et al., 2023). With growing interest in exercise as a non-pharmacological strategy for CV risk reduction (Wu et al., 2025), this systematic review aimed to evaluate the effects of exercise on arterial stiffness across the perinatal period.
METHODS:
This systematic review was conducted according to PRISMA 2020 guidelines. A comprehensive literature search was performed in PubMed, Web of Science and the Cochrane Library, complemented by grey literature sources. Eligible studies included controlled trials and longitudinal designs involving pregnant and/or postpartum women undertaking exercise interventions and reporting arterial stiffness outcomes, including pulse wave velocity (PWV), augmentation index (AIx) and carotid intima-media thickness (cIMT). Study selection, data extraction and risk-of-bias assessment were independently performed by two reviewers using ROB2, ROBINS-I and the TESTEX scale.
RESULTS:
Six studies including 269 women were analyzed: four during pregnancy and two postpartum. Exercise interventions included aerobic (n = 3), resistance (n = 1) or combined training (n = 2), with durations ranging from 12 weeks to six months. During pregnancy, studies with appropriate comparison groups reported no significant effect of exercise on PWV or cIMT. In contrast, changes in PWV and AIx were observed only in uncontrolled studies (n=2), with a reduction in PWV (−0.92 m/s; p < 0.001) and a slight increase in AIx (+1.28%; p < 0.02). Postpartum, PWV remained stable, while AIx decreased over time, regardless of exercise participation. Modest improvements in cIMT were reported in one uncontrolled study, in both women with and without history of preeclampsia (−54 vs. -50 µm). Finally, exercise during pregnancy was associated with the absence of an increase in PWV in the early postpartum period.
CONCLUSION:
Current evidence from studies with appropriate comparison groups indicates no clear effect of exercise on arterial stiffness during pregnancy or the postpartum period. Reported changes in arterial stiffness markers are primarily derived from studies without well-defined control groups, limiting causal interpretation. Overall, the small number of studies and limited sample sizes restrict the strength of available evidence. Given the clinical relevance of arterial stiffness as a CV risk marker, high-quality randomized controlled trials are needed, particularly in women with high CV risk, to determine whether exercise confers vascular benefits during and after pregnancy and to identify optimal exercise modalities.