In reply

The Diagnosis and Treatment of Hypertensive Disorders of Pregnancy: New Findings for Antenatal and Inpatient Care by Prof. Dr. med. Werner Rath, Prof. Dr. med. Thorsten Fischer in volume 45/2009

We thank Dr Korsten-Reck for pointing out the protective effect of physical activity for preventing pre-eclampsia. As with atherosclerosis, reasonable physical activity is likely to improve insulin sensitivity, reduce oxidative stress, and suppress inflammatory cytokines in pre-eclampsia, and to have a positive influence on the endothelial function (1). Two small randomized controlled trials in women with high risk pregnancies have shown a trend towards a preventive effect of aerobic exercise versus normal physical activity without reaching evidence (review by 3). Subsequent case-control studies reported a 34–35% reduction in risk of pre-eclampsia in women who engaged in any regular physical activity during the first 20 weeks of pregnancy and the year before pregnancy compared with inactive women (review by 2). Gavard and Artal critically evaluated these studies (2). Despite bias problems and different study protocols the studies gave evidence for a protective effect of regular physical activity against pre-eclampsia without harmful effects for mother and child. However, to evaluate this problem conclusively, further well-defined, prospective studies are needed.

In any case, exercise of defined intensity and duration should be included in the overall concept for lifestyle changes, especially in pregnant women at risk, preferably before they consider becoming pregnant. This is the task of the general practitioners and gynecologists.

Women with a history of pre-eclampsia have an increased cardiovascular risk in later life. They should be counseled on the protective cardiovascular effect of physical activity.

The reader’s letter by Dr Hein about sleep related breathing disorders in pre-eclampsia is important and highly relevant for medical practice—obstetricians should be aware of this risk and bear it in mind.
DOI: 10.3238/arztebl.2010.0227c

Prof. Dr. med. Werner Rath
Medizinische Fakultät des Universitätsklinikums Aachen (RWTH)
Gynäkologie und Geburtshilfe
Wendlingweg 2
52074 Aachen, Germany
[e-mail]

Prof. Dr. med. Thorsten Fischer
Frauenklinik
Krankenhaus Landshut-Achdorf
mit Perinatalzentrum Niederbayern und Mammazentrum
84036 Landshut, Germany

Conflict of interest statement
The authors of all contributions declare that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.

References

1. Belo L, Santos-Silva A, Quintanilha A, Rebelo I: Similarities between pre-eclampsia and atherosclerosis: a protective effect of physical exercise. Curr Med Chemistry 2008; 15: 2223–9.

2. Gavard JA, Artral R: Effect of exercise on pregnancy outcome. Clin Obstet Gynecol 2008; 51: 467–80.

3. Meads CA, Cnossen JS, Meher S, et al.: Methods of prediction and prevention of preeclampsia: systematic review of accuracy and effectiveness literature with economic modelling. Health Technology Assessment 2008; 12 (6): 1–225.

4. Rath W, Fischer T: The diagnosis and treatment of hypertensive disorders of pregnancy—New findings for antenatal and inpatient care [Diagnostik und Therapie hypertensiver Schwangerschaftserkrankungen – Neue Ergebnisse für Praxis und Klinik].Dtsch Arztebl Int 2009; 106(45): 733–8.