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目的:系统评估妊娠期运动干预及Borg主观疲劳程度对预防妊娠期糖尿病(gestational diabetes mellitus，GDM)的有效性，为妊娠期运动管理提供参考。方法:检索PubMed、Cochrane Library Central Register of Controlled Trails、EMBASE、Scopus、中国知网和万方数据库，收集单纯运动对妊娠期妇女血糖控制和妊娠结局影响的随机对照试验。主要结局指标为GDM发病率，次要结局指标包括2 h口服葡萄糖耐量试验(2 hour oral glucose tolerance test，2 h OGTT)、妊娠期增重、终止妊娠孕周及新生儿体质量。利用R 4.0.2软件进行统计分析。通过Cochrane偏倚风险工具进行文献质量评价。结果:共纳入14篇文献，4 509名受试者。Meta分析结果显示，运动干预组GDM发病率( RR＝0.74，95% CI＝0.59～0.93， P<0.01)，2 h OGTT(MD＝－0.27，95% CI＝－0.48～－0.07， P<0.01)，妊娠期增重(MD＝－1.04，95% CI＝－1.91～－0.18， P＝0.02)均低于未运动组；而新生儿体质量(MD＝－27.43，95% CI＝－58.77～3.92， P＝0.09)、终止妊娠孕周(MD＝－0.18，95% CI＝－0.93～0.57， P＝0.64)与未运动组差异无统计学意义。亚组分析结果显示，运动强度Borg主观疲劳程度量表评分高于12分( RR＝0.64，95% CI＝0.46～0.89， P<0.01)，运动以团体方式进行( RR＝0.66，95% CI＝0.46～0.94， P＝0.02)，由健身专家组织开展( RR＝0.73，95% CI＝0.56～0.95， P＝0.02)均有利于降低GDM发病率。此外，Meta回归结果显示，每周运动总时间大于2 h(相关系数＝－1.06，95% CI＝－1.86～－0.27， P<0.01)是研究异质性的主要来源。 结论:妊娠期间进行运动干预，且Borg主观疲劳程度量表评分大于12分对降低GDM发病率有良好效果。

Objective:To systematically estimate the effectiveness of physical activity intervention and Borg perceived exertion on the prevention of gestational diabetes mellitus (GDM), and to provide references for physical activity management during pregnancy.Methods:Databases such as PubMed, Cochrane Library Central Register of Controlled Trails, EMBASE, Scopus, CNKI and Wanfang were searched to collect randomized controlled trials (RCT) focusing on the effect of physical activity intervention on glucose control and pregnancy outcomes in pregnant women. The primary outcome was the incidence of GDM. The secondary outcomes included the 2 hour oral glucose tolerance test (2 h OGTT), gestational weight gain, gestational week of delivery, and neonatal weight. The statistical analysis was performed by R 4.0.2 software. The quality of the literatures was evaluated based on the Cochrane Risk of bias tool.Results:A total of 14 RCTs involving 4 509 participants were included in this meta-analysis. The results of meta-analysis showed that the incidence of GDM ( RR=0.74, 95% CI=0.59-0.93, P<0.01), 2 h OGTT (MD=-0.27, 95% CI=-0.48--0.07, P<0.01), and gestational weight gain (MD=-1.04, 95% CI=-1.91--0.18, P=0.02) in the experimental group were all significantly lower than those in control group, while the neonatal weight (MD=-27.43, 95% CI=-58.77-3.92, P=0.09) and gestational week of delivery (MD=-0.18, 95% CI=-0.93-0.57, P=0.64) showed no significant difference between the two groups. Subgroup analysis showed that Borg rating scale of perceived exertion scored higher than 12 ( RR=0.64, 95% CI=0.46-0.89, P<0.01), physical activity conducted in groups ( RR=0.66, 95% CI=0.46-0.94, P=0.02), intervention organized by fitness specialist ( RR=0.73, 95% CI=0.56-0.95, P=0.02) were associated with the decreased risk of GDM. In addition, the meta-regression result showed that total intervention time more than 2 hours per week (correlation coefficient=-1.06, 95% CI=-1.86--0.27, P<0.01) was the main source of study heterogeneity. Conclusions:Physical activity during pregnancy with Borg rating scale of perceived exertion scored higher than 12 had a positive effect on reducing the incidence of GDM.