Effects of different types of physical exercises on gestational weight gain: a systematic review and network meta-analysis.

Background: Excessive gestational weight gain (GWG) is common and associated with multiple adverse maternal and neonatal outcomes. Although physical activity during pregnancy can help control weight gain, evidence on the optimal exercise modality remains limited. Objective: To evaluate and compare the effects of different types of physical exercises on GWG using a systematic review and network meta-analysis. Methods: We systematically searched nine databases, including PubMed, Embase, Cochrane Library, CINAHL, Web of Science, Wan Fang, VIP, CNKI, and CMB from database inception to June 2025. All randomized controlled trials (RCTs) evaluating the effects of different exercise modalities on GWG were included. The quality of the included studies was assessed using the RoB 2.0 tool, and statistical analyses were performed with Stata 15.1. Result: A total of 15 studies involving 3,489 pregnant women were included, encompassing eight intervention categories: resistance exercise, aerobic exercise, combined exercise, virtual exercise, supervised exercise training, Pilates training, childbirth training, and usual care. Quality assessment indicated that five studies were at high risk of bias, four raised some concerns, and six were judged as low risk of bias. Network meta-analysis showed that no exercise modality demonstrated a statistically significant reduction in gestational weight gain compared with usual care. According to SUCRA rankings, Pilates training (84.7%), aerobic exercise (79.0%), and virtual exercise (59.1%) were ranked as the top three interventions in the primary analysis. However, sensitivity analysis excluding studies with a high risk of bias resulted in changes in treatment rankings, with aerobic exercise becoming the highest-ranked intervention. Conclusion: Current evidence does not support the superiority of any specific exercise modality for reducing gestational weight gain. Although Pilates training and aerobic exercise achieved relatively favorable rankings, these findings should be interpreted cautiously because of the limited evidence base and sensitivity of treatment rankings to study quality. Further high-quality randomized controlled trials are needed to establish the comparative effectiveness of different exercise modalities during pregnancy. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251073342, identifier CRD420251073342.