Supervised Multicomponent Exercise During Pregnancy Reduces Cesarean Section Rates Without Increasing Miscarriage Risk: A Randomized Clinical Trial

OBJECTIVE: To evaluate the effectiveness and safety of a supervised multicomponent exercise program performed throughout uncomplicated pregnancy on delivery outcomes, with particular emphasis on cesarean section rates and miscarriage risk. METHODS: A randomized clinical trial (NCT04563065) was conducted. A total of 400 pregnant women were assessed for eligibility, and data from 256 participants were analyzed, including 120 women in the exercise group (EG) and 136 in the control group (CG). Women allocated to the EG participated in a supervised, moderate-intensity, multicomponent hybrid (face-to-face and online) group exercise program performed three times per week (60 min/session) from 8 to 10 until 38-40 weeks of gestation. A minimum adherence of 75% was required for inclusion in the final per-protocol analysis. RESULTS: = 10.42, p = 0.005). Exercise participation was not associated with an increased risk of miscarriage (p = 1.000), and no significant differences were observed between groups in instrumental vaginal delivery or other maternal and neonatal outcomes. CONCLUSIONS: Participation in a supervised, moderate-intensity multicomponent exercise program throughout pregnancy reduced cesarean section rates without increasing miscarriage risk, supporting its incorporation into routine prenatal care as a safe and effective non-pharmacological strategy for improving delivery outcomes.