Introduction: Pregnancy and childbirth involve physiological, physical, emotional, and social changes for women. Until 1985, it was common practice even in developed countries for healthcare professionals to prescribe rest to pregnant women. Today, however, physical activity during pregnancy is recognized as a valuable tool with positive effects on maternal physical and mental health, as well as neonatal health. Nevertheless, the prevalence of physically active women during pregnancy has decreased. The aim of this study was to investigate the association between physical activity during pregnancy and labour outcomes. Methods: A retrospective analysis of anonymized data obtained from the Perinatal Information System of the Republic of Slovenia was conducted, including all singleton pregnancies between 2020 and 2024. We included term singleton pregnancies with foetuses in cephalic presentation. We excluded planned caesarean deliveries from analysis. Registration in the information system at delivery is legally mandatory. Midwives and physicians enter more than 140 variables into the database, including family, medical, gynaecological, and obstetric history, as well as data regarding the current pregnancy, including physical activity during pregnancy, labour, postpartum, and neonatal outcomes. The key variables in this study were physical activity at least twice weekly, emergency caesarean section, vacuum extraction, episiotomy, third- and fourth-degree perineal tears, pharmacological analgesia, and malpresentation. Statistical significance was set at p < 0.05. The chi-square test was used to compare descriptive variables between the groups (pregnant women who were physically active at least twice weekly versus those active less than twice weekly). Multivariate logistic regression analysis was performed to examine the associations between regular physical activity and study outcomes while controlling for potential confounding factors, including parity (primiparous vs. multiparous women), maternal age, and pre-pregnancy body mass index, categorized as underweight (<18.5 kg/m²), normal weight (18.5–24.9 kg/m²), overweight (25.0–29.9 kg/m²), or obesity (≥30.0 kg/m²). Results: Data from 73,942 deliveries showed no statistically significant association between physical activity and emergency caesarean section (odds ratio (OR) 0.98; 95% confidence interval (CI) 0.93–1.03; p = 0.45), fetal malpresentation (OR 0.98; 95% CI 0.92–1.11; p = 0.63), or severe perineal tears (OR 1.03; 95% CI 0.86–1.24; p = 0.73). However, physical activity was associated with a significantly lower use of pharmacological analgesia (OR 0.83; 95% CI 0.80–0.86; p < 0.001), episiotomy (OR 0.87; 95% CI 0.83–0.90; p < 0.001), and vacuum extraction (OR 0.83; 95% CI 0.76–0.91; p < 0.001). Conclusions: The results indicate that physical activity during pregnancy at least twice weekly is associated with fewer obstetric interventions during labour, including pharmacological analgesia, episiotomy, and vacuum extraction. Some studies have also reported a reduction in emergency caesarean section rates, which was not confirmed in the present study. The findings suggest potential benefits of physical activity during pregnancy; however, limitations include imprecisely defined physical activity parameters and unmeasured factors that may have influenced the results, leaving opportunities for further research.
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