Appendix 1. Search Strategy Employed

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Wiebe HW, Boulé NG, Chari R, and Davenport MH. Association of prenatal exercise with fetal growth: a meta-analysis.

Obstet Gynecol 2015;125.

The authors provided this information as a supplement to their article.

Appendix 1. Search Strategy Employed

Ovid MEDLINE In‐Process & Other Non‐Indexed Citations and Ovid MEDLINE 1946 to Present 1. exp Exercise/

2. (exercise or physical* activ* or running or plyometric* or weight training or resistance training or (weight* adj2 lift*) or walk or walking or swim*).ti,ab.

3. exp motor activity/

4. exp Sports/

5. (sport* or athlet*).ti,ab.

6. 2 or 3 or 4 or 5

7. exp birth weight/ or fetal weight/

8. exp Infant, Small for Gestational Age/ or exp Fetal Growth Retardation/

9. ((birth adj2 (weight or length)) or birthweight or macrosomia or fetal growth or intra uter*

growth or intrauter* growth or ((infant* or neonat* or fetus or fetal) adj2 size) or (growth adj2 (restrict* or retard*)) or ((large or small or weight) adj2 (for date or gestational age))).ti,ab.

10. ((pregnancy or perinatal or postnatal or fetal or fetus or neonatal or obstetric*) adj2 (outcome* or complication*)).ti,ab.

11. pregnancy outcome/ or pregnancy complications/

12. 7 or 8 or 9 or 10 or 11 13. 6 and 12

14. limit 13 to humans 15. limit 13 to animals 16. 14 or 15

17. 13 not 16 18. 14 or 17

19. (trial or random* or quasi experimental or intevention).mp,pt.

20. 18 and 19

Ovid EMBASE 1974 to Present 1. exp Exercise/

3. exp physical activity/

4. exp Sport/

6. 2 or 3 or 4 or 5

7. exp birth weight/ or fetus weight/

8. exp small for date infant/ or exp intrauterine growth retardation/

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11. pregnancy outcome/ or pregnancy complication/

12. 7 or 8 or 9 or 10 or 11 13. 6 and 12

14. limit 13 to (clinical trial or randomized controlled trial or controlled clinical trial or multicenter study)

15. (trial or random* or quasi experimental or intervention).mp.

16. 13 and 15 17. 14 or 16

18. limit 17 to human

19. limit 17 to animal studies 20. 18 or 19

21. 17 not 20 22. 18 or 21

23. exp *Exercise/ or exp *physical activity/ or exp *Sport/ or (exercise or physical activity or running or plyometric* or weight training or resistance training or (weight* adj2 lift*) or walk or walking or swim* or sport* or athlet*).ti.

24. exp *birth weight/ or *fetus weight/ or exp *small for date infant/ or exp *intrauterine growth retardation/

growth or intrauter* growth or (growth adj2 (restrict* or retard*)) or ((large or small or weight) adj2 (for date or gestational age))).ti.

26. ((pregnancy or perinatal or postnatal or fetal or fetus or neonatal or obstetric*) adj2 (outcome* or complication*)).ti.

27. *pregnancy outcome/ or *pregnancy complication/

28. or/23‐27 29. 22 and 28

Ovid All EBM Reviews (includes the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, the Cochrane Methodology Register, the Database of Abstracts of Reviews of Effect, the Health Technology Assessment Database, the Economic Evaluation Database, and ACP [American College of Physicians] Journal Club)

1. exp Exercise/

3. exp motor activity/

4. exp Sports/

6. 2 or 3 or 4 or 5

7. exp birth weight/ or fetal weight/

8. exp Infant, Small for Gestational Age/ or exp Fetal Growth Retardation/

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11. pregnancy outcome/ or pregnancy complications/

12. 7 or 8 or 9 or 10 or 11 13. 6 and 12

CINAHL Plus with Full‐text

S1 ( (MH "Physical Activity") OR (MH "Exercise+") OR (MH "Sports+") ) OR ( exercise or

"physical* activ*" or running or plyometric* or "weight training" or "resistance training" or weight* n2 lift* or walk* or swim* ) OR ( sport* or athlet* )

S2 ( ( (MH "Birth Weight") OR (MH "Fetal Weight") OR (MH "Infant, Small for Gestational Age") OR (MH "Infant, Large for Gestational Age") OR (MH "Fetal Growth Retardation") ) OR ( birth n2 (weight or length) or birthweight or macrosomia or "fetal growth" or "intrauter* growth" or

"intra uter* growth" or growth n2 (restrict* or retard*) or (large or small) n2 ("for date" or

"gestational age") or (infant* or neonat* or fetus or fetal) n2 size) ) OR ( (pregnancy or perinatal or postnatal or fetal or fetus or neonatal or obstetric*) n2 (outcome* or complication*) or MH "pregnancy outcome" or MH "pregnancy complications" ) S3 S1 AND S2

S4 ( S1 AND S2 ) AND ( random* or trial or intervention or "quasi experimental" ) Sport Discus

S1 exercise or "physical* activ*" or running or walk* or swim* or plyometric* or "weight training" or "resistance training" or weight* n2 lift* or sport* or athlet*

S2 birth n2 (weight or length) or birthweight or macrosomia or "fetal growth" or "intrauter*

growth" or "intra uter* growth" or growth n2 (restrict* or retard*) or (large or small) n2 ("for date" or "gestational age") or (infant* or neonat* or fetus or fetal) n2 size OR (pregnancy or perinatal or postnatal or fetal or fetus or neonatal or obstetric*) n2 (outcome* or

complication*) S3 S1 AND S2

S4 random* or intervention or trial or "quasi experimental"

S5 S3 AND S4 Clinicaltrials.gov

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Search Terms:

pregnancy OR pregnant OR gestational OR fetus OR fetal OR birthweight OR birth weight OR prenatal OR perinatal OR postnatal OR obstetric OR intrauterine

Interventions: exercise OR physical activity OR running OR plyometrics OR weight training OR resistance training OR weight lifting OR walking OR swimming OR sports OR sport OR athletics OR athlete OR athletes

Recruitment: Closed Studies Study Results: Studies with Results

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Appendix 2. Study Flow Diagram

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Wiebe HW, Boulé NG, Chari R, and Davenport MH. Association of prenatal exercise with fetal growth: a meta-analysis. Obstet Gynecol 2015;125.

Appendix 3. Study Characteristics

Author, year,

country Sample

Size, n Age, y Pre‐

pregnancy BMI, kg/m²

Exercise Intervention Co‐Interventions

Frequency,

per week Intensity Time,

minutes Type Average

weeks Adherence

Avery 1997,

USA(20) EG: 15

CG: 14 32.2 (4.9)

30.4 (5.1) 28.4 (7.6)

25.5 (5.5) 3‐4 70% HRmax 30 Aerobic 6 minimum Average of 3x per

week Nutrition

Baciuk 2008,

Brazil(23) EG: 34

CG:37 25.8 (4.6)

24.4 (5.8) 24.1 (4.5)

23.4 (3.8) 3 70% HRmax 50 Aerobic 16 N/A None

Barakat 2009, Spain(47)

EG: 72

CG: 70 30.4 (2.9)

29.5 (3.7) 24.4 (0.5)

23.5 (0.5) 3 <80% HRmax 35‐40 Resistance 26 >90% None

EG: 34

CG: 33 31 (3)

30 (3) 23.9 (3.0)*

24.8 (4.0)* 3 <70% HRmax 35‐45 Aerobic +

Resistance 31 >90% None

Barakat 2012a, Spain(35)

EG: 40

CG: 43 32 (4)

31 (3) 23.0 (2.9)

22.7 (2.8) 3 <70% HRmax 35‐45 Aerobic +

Resistance 31 85%

Barakat 2012b, Spain(24)

EG: 138

CG: 152 31.4 (3.2)

31.7 (4.5) 24.0 (4.3)#

23.6 (4.0)# 3 < 70%

HRmax

40‐45 Aerobic 31 87% None

EG: 210

CG: 218 31 (3)

31 (4) 24.1 (4.1)

23.7 (3.8) 3 < 70%

HRmax

50‐55 Aerobic +

Resistance 27.5 > 95% None

Barakat 2014, Spain (43)

EG: 93

CG: 107 31.6 (3.9)

31.5 (3.9) 23.8 (4.4)#

24.1 (4.3)# 3 55‐60%

HRmax

55‐60 Aerobic +

Resistance 28.5 > 95% None

Clapp 2000, USA(25)

EG: 22

CG: 24 31 (1)

31 (1) N/A 3‐5 55‐60%

VO2max

20 Aerobic 32 All subjects exercised

a minimum 3 x/week None Cordero 2014,

Spain (44)

EG: 101

CG: 156 33.6 (4.1)

32.9 (4.5) 22.5 (3.2)

23.6 (4.0) 3 <60% HRR 50‐60 Aerobic +

resistance 27.5 >80% None

de Oliveria Melo 2000, Brazil(26)

EG*: 62 EG*: 63 CG: 62

24 (5.8) 26 (5.3) 24 (5.4)

24.7 (4.3)#

23.4 (3.8)#

23.5 (3.5)#

3 60‐80%

HRmax

15

minimum Aerobic 27

20 >85%

Garshasbi 2004, Iran(27)

EG: 107

CG: 105 26.3 (4.9)

26.5 (4.4) 27.0 (4.8)*

25.6 (5.1)* 3 <140 BPM 60 Aerobic 12 >94% None

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Appendix 3 (cont’d). Study Characteristics

Author, year,

country Sample

Frequency,

weeks Adherence

Haakstad 2011, Norway(37)

EG: 52

CG: 53 31.2 (3.7)

30.3 (4.4) 23.8 (3.8)

23.9 (4.7) 5 12‐14 on

Borg Scale 55 Aerobic +

Resistance 12 40.4% attended

>80% of sessions None Hopkins 2010,

New Zealand(28)

EG: 47

CG: 37 31 (3)

29 (4) 25.5 (4.3)#

25.4 (2.9)# 3‐5 65% VO2max 30‐40 Aerobic 14.5 75% None

Hui 2004

Canada(39) EG: 24

CG: 21 26.2 (5.4)

26.2 (5.7) 23.4 (3.9)

25.7 (6.3) 3‐5 N/A 30‐45 Aerobic +

Resistance 9 87% completed the

program Nutrition

Hui 2012,

Canada(38) EG: 102

CG: 88 30.1 (5.2)

28.7 (5.9) 24.9 (5.4)

25.7 (5.1) 3‐5 N/A 30‐45 Aerobic +

Resistance 13 100% self‐reported Nutrition Kasawara 2013,

Brazil(29) EG: 58

CG: 58 N/A N/A 1 HR 20%

above resting

30 Aerobic 21 44% None

Khaledan 2010,

Iran(30) EG: 18

CG: 21 24.9 (4.2)

25.0 (5.8) 27.7 (4.7)#

28.9 (3.7)# 3 60% HRmax 30‐45 Aerobic 8 N/A None

Kihlstrand 1999,

Sweden(31) EG: 129

CG: 129 28 (n/a)

29 (n/a) N/A 1 N/A 60 Aerobic 20 55.2% participated

in >75% of sessions 30 minutes relaxation Marquez‐

Sterling 2000, USA(32)

EG: 9

CG: 6 31.3 (3.1)

27.8 (3.1) 22.8 (4.0)#

24.5 (4.5)# 3 120‐156

BPM 60 Aerobic 15 N/A None

Murtezani 2014

Kosovo (46) EG: 30

CG: 33 26.9 (4.7)

25.7 (5.1) 23.0 (2.6)

22.4 (2.2) 3 12‐14 on

Borg Scale 40‐45 Aerobic +

Resistance 20 >85% None

Nascimento

2011, Brazil(40) EG: 40

CG: 42 29.7 (6.8)

30.9 (5.9) 34.8 (6.6)

36.4 (6.9) 1 <140 BPM 40 Resistance

+ Optional Walking

12.3 62.5% Nutrition

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Netherlands(13) EG: 49

CG: 52 30.8 (5.2)

30.1 (4.5) 33.0 (3.7)

33.9 (5.6) 2 60‐80%

VO2max

60 Aerobic +

Resistance 25 16.3% attended at

least half of training sessions

None

Appendix 3 (cont’d). Study Characteristics

Author, year,

country Sample

Frequency,

weeks Adherence

Pinzon 2012,

Columbia (33) EG: 18

CG: 17 19.2 (2.6)

19.5 (3.4) N/A 3 Light‐

moderate 60 Aerobic 16 N/A None

Price 2012,

USA(17) EG: 31

CG: 31 30.5 (5.0)

27.6 (7.3) 26.6 (3.1)

28.7 (5.4) 4 12‐14 on

Resistance 23 93% None

Ruiz 2013

Spain (45) EG: 481

CG: 481 31.6 (4.0)

31.9 (4.0) 23.7 (3.9)

23.5 (4.2) 3 10‐12 on

Resistance 29.5 >97% None

Stafne 2012,

Norway(42) EG: 429

CG: 426 30.5 (4.4)

30.4 (4.3) 24.7 (3.0)#

25.0 (3.4)# 3 13‐14 on

Resistance 14 55% None

Tomic 2013,

Croatia(19) EG: 166

CG: 168 28.9 (n/a)

29.2 (3.2) 23.1 (4.1)

22.8 (4.5) 3 60‐75%

HRmax

50 Aerobic 33 >80% None

EG: exercise group, CG: control group, y: years, BMI: body mass index, kg/m²: kilograms per meter squared, HRmax: maximal heart rate, VO2max: maximum oxygen consumption, BPM: heart beats per minute, *unclear if pre‐pregnancy or study entry BMI, #BMI at study entry.

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Appendix 4. Summary of Risk of Bias Evaluation

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Appendix 5. Effects of Prenatal Exercise Compared With Standard Care Alone (Control)

on Mean Difference in Gestational Weight Gain (kg). Analyses conducted with a random

effects model. WMD, weighted mean difference; GWG, gestational weight gain; GDM,

gestational diabetes mellitus; 95% confidence interval = [95% CI].

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Appendix 6. Effects of Prenatal Exercise Compared With Standard Care Alone (Control) on Odds Ratio of Cesarean Delivery. Analyses conducted with a fixed effects model. OR, odds ratio; GDM, gestational diabetes mellitus; 95% confidence interval = [95% CI].