Physical exercise improves cardiovascular function after preeclampsia and reduces the risk of recurrent preeclampsia in the subsequent pregnancy: an echocardiographic prospective cohort study

Background Pregnancy triggers substantial cardiovascular adaptations to support the fetoplacental unit; however, increasing evidence suggests that preeclampsia may unmask underlying, asymptomatic cardiovascular dysfunction. Although physical exercise is well established for improving cardiovascular health and preventing various chronic diseases, its specific role in reducing the risk of adverse outcomes in pregnancy remains uncertain. Objective This study aimed to determine whether structured aerobic exercise performed between pregnancies reduces the recurrence of preeclampsia. Study Design We conducted a prospective cohort study involving 256 normotensive, nonobese (body mass index < 30) women with prior preeclampsia before 34 weeks who were planning a new pregnancy. All participants were invited to adhere to aerobic exercise recommendations starting 6 months after the index pregnancy. Cardiac function was assessed by transthoracic echocardiography before the exercise recommendations and again 8 to 12 months later, prior to the subsequent pregnancy. Pregnancy outcomes were recorded, and data were analyzed using one-way analysis of variance and binary logistic regression. Results 82 of 256 women followed the exercise program, while 174 did not. No differences in baseline cardiovascular characteristics were observed between the groups. After 12 to 18 months of exercise, the exercise group demonstrated significant improvements compared to the nonexercise group, showing higher stroke volume (71±12 vs 65±11 mL, P <.05), increased cardiac output (5.3±1.3 vs 4.8±1.1 L/min, P <.05), a greater left atrial volume index (23.1±4.7 vs 21.7±5.3 mL/m2, P <.05), lower global longitudinal strain (−23.1±1.6 vs −21.9±2.0, P <.05), and reduced total peripheral vascular resistance (1258±295 vs 1427±313 dyne s/cm5, P <.05). In the subsequent pregnancy, recurrent preeclampsia occurred in 12/82 (14.6%) of women who adhered to the exercise program and 48/174 (27.6%) of women who did not; unadjusted odds ratio=0.45 (95% confidence interval, 0.22–0.90; P =.025); relative risk of recurrence in the exercise group was 0.53 (95% confidence interval, 0.30–0.94; P =.031), corresponding to a relative risk reduction of 47%. Conclusion Aerobic exercise performed between pregnancies may markedly enhance the cardiovascular profile of women with a recent history of preeclampsia. The observed improvements in stroke volume, cardiac output, vascular resistance, and global longitudinal strain suggest beneficial cardiovascular adaptations that could reduce the likelihood of recurrent preeclampsia. These findings support the implementation of structured aerobic exercise as an intervention to improve subsequent pregnancy outcomes in this high-risk population.