This study evaluated a birth preparation programme linked to women’s visits to the clinic for prenatal care that included various interventions: general supervised exercise, information on performing aerobic and local exercises at home and educational activities. The main findings showed that a systematically performed programme with clear objectives exerts a positive effect by reducing complaints of UI and increasing the practice of physical exercise throughout pregnancy.
In relation to the prevention and control of UI during pregnancy, these findings are in agreement with the results of a systematic review  that showed that nulliparous women are able to avoid UI in pregnancy by performing PFMT. Maybe, the fact that women in the BPP group had received information regarding pelvic floor muscle and PFMT resulted in increased awareness and consequently in reduced urinary leakage . Furthermore, PFMT was given at the BPP meetings and the importance of continuing to practice these exercises at home was emphasized.
Regarding the practice of exercise, prevalence studies showed that women do not tend to comply with the guidelines recommended by ACOG for the practice of exercise , perform little exercise during pregnancy and the practice of exercise tends to diminish as pregnancy progresses [26–30]. In accordance with the results of the present study, the energy expenditure improvement with the practice of physical exercise during pregnancy may be associated with encouragement and guidance. Although they had maintained a moderate level of exercise intensity (3.0–6.0 METs) , the women in the control group, who received neither guidance nor encouragement, had a decrease in energy expenditure with the practice of physical exercise during pregnancy.
On the other hand, the BPP had no effect on relieving or preventing lumbopelvic pain. Other studies have shown that specific exercises to reduce pain in the lumbopelvic region were effective when the exercise was supervised and practiced once a week or once a fortnight [31–34]. In the present study, supervised practice occurred only on the days of prenatal medical visits, which were scheduled monthly throughout most of the pregnancy and fortnightly between 31 and 36 weeks of pregnancy and weekly from 37 weeks of pregnancy onwards. In addition, the exercises that the women were instructed to perform at home consisted of only two types of stretching exercise for the lumbopelvic region, which, in our opinion, are those safest and easiest to carry out unsupervised. On the other hand, in previous studies [32, 33], the number of exercises that the women were counseled to perform at home for this purpose was greater. These results lead us to believe that this type of discomfort during pregnancy requires greater attention, with a need for more frequent supervised interventions, a greater number of specific exercises or the practice of different types of exercise at home. It was not possible to evaluate adherence to home exercises for pain in the present study.
At the end of pregnancy, anxiety levels may increase as labor approaches . Nevertheless, in this study anxiety remained low or moderate in both groups. This may be due to the fact that the women participated in routine counseling groups throughout their prenatal care at which timely information was provided on the signs and symptoms of labor and visits were made to the delivery ward. Furthermore, the study population consisted of low-risk pregnant women with access to prenatal care, which may have contributed to their low levels of anxiety.
One limitation of this study was that the attempt to evaluate adherence by asking the women in the study to complete an exercise diary was not successful since women failed to complete their diaries and consequently it was not possible to perform an analysis of adherence. Also another possible limitation was the loss to follow-up due, in some cases, to the fact that some participants delivered their babies at other facilities and in other cases to the loss of contact with some of the participants, which hampered evaluation of the secondary data. Another limitation may lay on the fact that the study was not blinded, what could have resulted in women giving “right answers” to questions regarding urinary incontinence and practice of physical exercise as a courtesy bias. However, if this was the case, the same could be expected for answers concerning lumbopelvic pain and anxiety, but this did not happen at all.
The results of this study may contribute towards improving birth preparation programmes; however, further studies are required to establish the most effective techniques for reducing lumbopelvic pain. Further evaluation also needs to be made of the ideal number of meetings and how frequently they should take place for a programme including different types of interventions.