Exercise in Pregnancy and Risk of Postpartum Depression: A Randomised Controlled Trial

To evaluate whether regular aerobic exercise during pregnancy reduces the incidence of postpartum depression in women with low-risk singleton pregnancies. Single-centre randomised controlled trial. Department of Obstetrics and Gynaecology, University of Naples Federico II, Italy. A total of 398 women with low-risk singleton pregnancies enrolled during the first trimester of pregnancy. Participants were randomly allocated in a 1:1 ratio to an exercise group or control group. The intervention consisted of a structured aerobic exercise programme (three 60-min sessions per week) from randomisation until 35 weeks' gestation, or earlier if delivery or obstetric complications occurred. The primary outcome was Edinburgh Postnatal Depression Scale (EPDS) score ≥ 12 3 months postpartum. Secondary outcomes included EPDS ≥ 9, clinical diagnosis of postpartum depression (DSM-V), and maternal/perinatal outcomes. Analyses were performed on an intention-to-treat basis, with relative risk (RR) and 95% confidence interval (CI) calculated. Incidence of postpartum depression, defined as EPDS ≥ 12 at 3 months postpartum. Of the 398 participants, 199 were randomised to the exercise group and 199 to the control group. Women in the exercise group had a significantly lower incidence of EPDS ≥ 12 and ≥ 9 at 3 months postpartum compared with controls, as well as lower mean EPDS scores. No significant differences in adverse maternal or perinatal outcomes were observed. Regular antenatal aerobic exercise significantly reduced the risk of postpartum depression, supporting its role as a preventive strategy in low-risk pregnancies. Clinicaltrials.gov identifier: NCT06355375.