Prenatal exercise and cardiometabolic risk in mothers and infants: Exercise mode, volume, and early-life programming

Pregnancy is characterized by substantial cardiovascular and metabolic adaptations that resemble cardiometabolic dysfunction. As such, it functions as a physiological stress test that may reveal underlying susceptibility to future disease. Maternal obesity, physical inactivity, and gestational weight gain are associated with adverse cardiometabolic profiles in mothers. These alterations may translate to the offspring, highlighting pregnancy as a critical window for early prevention. Cardiometabolic risk (CMR) reflects the clustering of interrelated risk factors, including blood pressure, lipid metabolism, glycemic control, and adiposity. While composite CMR scores are widely used in non-pregnant populations, their application during pregnancy and early life remains limited due to dynamic physiological changes and the lack of standardized definitions. Nevertheless, continuous risk score approaches may provide a more sensitive method for capturing cardiometabolic variation across these periods. Exercise during pregnancy is a modifiable behavior consistently associated with improvements in individual cardiometabolic markers, including blood pressure, lipid profiles, and glucose regulation. However, limited evidence exists regarding how specific exercise characteristics – particularly mode (aerobic, resistance, or combined) and volume – influence CMR in both mothers and offspring. Limited but growing evidence suggests that the intrauterine environment plays a key role in early cardiometabolic programming; however, the impact of prenatal exercise on composite infant CMR remains poorly understood. Clarifying these relationships is essential to inform evidence-based exercise prescription and reduce intergenerational cardiometabolic disease risk.