The Effect of a Supervised Exercise Program Throughout Pregnancy on Longitudinal Lipid Profile Changes: A Randomized Clinical Trial

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Abstract Objective: To investigate whether a supervised exercise program during pregnancy induces modifications in the maternal lipid profile. Methods: This unplanned secondary analysis of a multicenter randomized controlled trial (March 2021–June 2023) was conducted at Hospital Universitario de Torrejón, the only participating center with routine lipid profiling during all three trimesters and postpartum. Eligible women had a singleton pregnancy < 14 +3 weeks without complications. Participants were randomized (1:1) to a supervised exercise program (three 55–60 min sessions/week, virtual or onsite) or control (usual activity). Exercise adherence was defined as ≥ 80% session attendance. Maternal characteristics, blood pressure, and weight were recorded at baseline and follow-up visits in the second and third trimesters and 6–12 months postpartum. Venous blood samples were collected for lipid profiling, including total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). Between-group differences were tested with Wilcoxon signed-rank tests, and repeated measures were analyzed with generalized estimating equations including gestational age, intervention group, delivery status, and obesity interaction. Both intention-to-treat and per-protocol analyses were performed. Statistical significance was considered at P < 0.05. Results: A total of 202 pregnant women were enrolled, and 182 were included in the final analysis (90 in the control group and 92 in the intervention group). No significant between-group differences were observed in lipid profiles at the second trimester, third trimester, or postpartum. Longitudinal analysis showed higher HDL-C levels in the IG (+3.24 mg/dl; 95% confidence interval ( CI ): 0.13–6.35, P = 0.041), persisting postpartum, and a nonsignificant trend toward lower LDL-C (−6.02 mg/dl; 95% CI : −13.18 to 1.14, P = 0.099). These effects were not confirmed in the per-protocol analysis, and no interaction with obesity was observed. Conclusion: A supervised exercise program throughout pregnancy may increase HDL-C levels and potentially reduce LDL-C, thereby improving the maternal lipid profile. Further studies are needed to confirm and expand upon these findings. Registration: No. NCT04563065 (Randomized Controlled Clinical Trial).

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