A Supervised Hybrid Prenatal Exercise Program Reduces the Incidence of Macrosomia: A Randomized Controlled Trial

Dingfeng Zhang; Miguel Sánchez-Polán; Ángeles Díaz-Blanco; Maia Brik; Paloma Hernando; Taniya S Nagpal; Duan Rui; Hongyou Liu; Ruben Barakat

doi:10.1249/MSS.0000000000004035

A Supervised Hybrid Prenatal Exercise Program Reduces the Incidence of Macrosomia: A Randomized Controlled Trial

Med Sci Sports Exerc. 2026 May 12. doi: 10.1249/MSS.0000000000004035. Online ahead of print.

Authors

Dingfeng Zhang¹, Miguel Sánchez-Polán², Ángeles Díaz-Blanco³, Maia Brik⁴, Paloma Hernando⁵, Taniya S Nagpal⁶, Duan Rui¹, Hongyou Liu¹, Ruben Barakat⁷

Affiliations

¹ School of Physical Education and Sports Science, South China Normal University, Guangzhou, CHINA.
² GICAF Research Group, Department of Education, Research and Evaluation Methods, Universidad Pontificia Comillas. SPAIN.
³ Gynecology and Obstetrics Department, Hospital Universitario Severo Ochoa de Leganés, Leganés, SPAIN.
⁴ Maternal Fetal Medicine Department. Hospital Universitari Vall d'Hebron. Universitat Autonoma de Barcelona. Barcelona, SPAIN.
⁵ Gynecology and Obstetrics Department, Hospital Universitario Puerta de Hierro de Majadahonda, SPAIN.
⁶ Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, CANADA.
⁷ AFIPE Research Group. Faculty of Physical Activity and Sports Science, Universidad Politécnica de Madrid, SPAIN.

PMID: 42118948
DOI: 10.1249/MSS.0000000000004035

Abstract

Purpose: To examine the effects of a supervised hybrid prenatal exercise program (combined in-person and online sessions) on the incidence of macrosomia and excessive gestational weight gain (EGWG).

Methods: A randomized clinical trial (NCT04563065) was conducted. A total of 260 pregnant women were assessed for eligibility and randomized (1:1). This manuscript reports results from a per-protocol analysis including 138 participants (exercise group [EG] n=62; control group [CG] n=76). The EG participated in a supervised moderate-intensity exercise program delivered in a hybrid format (1 in-person session/week at the hospital and 2 online sessions/week via Zoom), from 11 weeks' gestation until delivery. The CG received usual obstetric care, printed lifestyle education materials, and a brief phone-based physical activity interview once per trimester. Macrosomia (>4000 g) and EGWG (Institute of Medicine criteria) were extracted from hospital records and compared between groups.

Results: The incidence of macrosomia was lower in the EG (0%) than in the CG (7.3%; χ²=6.70, p=0.01). The incidence of EGWG did not differ between groups (9.6% vs. 19.4%, p =0.13). Apgar score at 5 minutes was slightly higher in the EG than in the CG (9.91±0.34 vs. 9.82±0.56, p =0.03).

Conclusions: A supervised hybrid prenatal exercise program was associated with a lower incidence of macrosomia and slightly higher 5-minute Apgar scores compared with usual care. These findings support hybrid delivery as a feasible strategy for implementing supervised prenatal exercise.

Keywords: BIRTH WEIGHT; EXCESSIVE GESTATIONAL WEIGHT GAIN; MACROSOMIA; PHYSICAL EXERCISE; PREGNANCY.