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

Objective: To evaluate whether regular aerobic exercise during pregnancy reduces the incidence of postpartum depression in women with low-risk singleton pregnancies. Design: Single-centre randomised controlled trial. Setting: Department of Obstetrics and Gynaecology, University of Naples Federico II, Italy. Population or Sample: A total of 398 women with low-risk singleton pregnancies enrolled during the first trimester of pregnancy. Methods: 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. Main Outcome Measures: Incidence of postpartum depression, defined as EPDS ≥ 12 at 3 months postpartum. Results: 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. Conclusions: Regular antenatal aerobic exercise significantly reduced the risk of postpartum depression, supporting its role as a preventive strategy in low-risk pregnancies. Trial Registration: Clinicaltrials.gov identifier: NCT06355375.