Efficacy of Regular Exercise During Pregnancy on the Prevention of Postpartum Depression: The PAMELA Randomized Clinical Trial

Effect of different physical activity interventions on perinatal depression: a systematic review and network meta-analysis

BACKGROUND

Perinatal depression can have profound impacts on both families and society. Exercise therapy is gradually becoming a widely used adjunct treatment for perinatal depression. Some studies have already focused on the relationship between physical activity and perinatal depression (PND). However, there is currently a lack of systematic and comprehensive evidence to address the crucial question of making optimal choices among different forms of physical activity. This study aims to compare and rank different physical activity intervention strategies and identify the most effective one for perinatal depression.

METHODS

Four databases, namely PubMed, Cochrane Library, Embase, and Web of Science, were searched for randomized controlled trials assessing the impact of physical activity interventions on perinatal depression. The search covered the period from the inception of the databases until May 2024. Two researchers independently conducted literature screening, data extraction, and quality assessment. Network meta-analysis was performed using Stata 15.1.

RESULTS

A total of 48 studies were included in the analysis. The results indicate that relaxation therapy has the most effective outcome in reducing perinatal depression (SUCRA = 99.4%). Following that is mind-body exercise (SUCRA = 80.6%). Traditional aerobics and aquatic sports were also effective interventions (SUCRA = 70.9% and 67.1%, respectively).

CONCLUSION

Our study suggests that integrated mental and physical (MAP) training such as relaxation therapy and mind-body exercise show better performance in reducing perinatal depression. Additionally, while exercise has proven to be effective, the challenge lies in finding ways to encourage people to maintain a consistent exercise routine.

TRIAL REGISTRATION

This study has been registered on PROSPERO (CRD 42,023,469,537).

Theory-based interventions aimed at promoting physical activity in pregnant women: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVES

The objectives were to assess (i) the quality of theory implementation, (ii) the application of behavior change techniques, and (iii) the effectiveness of theory-based interventions in promoting physical activity in pregnant women and improving maternal and neonatal outcomes.

METHODS

A systematic search was conducted across 8 databases (Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, EMBASE, MEDLINE, APA PsycINFO, PubMed, SPORTDiscus, and Web of Science) to identify randomized controlled trials published from database inception to 8 July 2023. The Cochrane risk-of-bias 2.0 tool was used to evaluate the quality of the included studies. The theory coding scheme was used to measure the quality of theory implementation, and behavior change techniques were coded according to behavior change taxonomy (version 1). The meta-analysis was performed using RevMan 5.3. The Grading of Recommendations, Assessment, Development, and Evaluation Approach was used to assess the certainty of evidence.

RESULTS

Eleven studies met the study criteria. Nine studies were based on one theory, while two studies were based on a combination of two theories. The quality of theory implementation was generally moderate. A total of 24 unique behavior change techniques were extracted. The most commonly used types of behavior change techniques were 'instruction on how to perform the behavior' (n = 9), 'goal setting' (behavior) (n = 8), 'action planning' (n = 7), and 'information about health consequences' (n = 7). Theory-based interventions significantly improved moderate-to-vigorous physical activity (standardized mean difference (SMD) = 0.17, 95 % confidence interval (CI) [0.04, 0.30], P = 0.01; moderate certainty of evidence), reduced the average gestational weight gain per week (mean difference (MD) = -0.06, 95 % CI [-0.11, -0.01], P = 0.02; moderate certainty of evidence), and decreased the incidence of gestational diabetes mellitus (risk ratio (RR) = 0.64, 95 % CI [0.46, 0.89], P = 0.008; high certainty of evidence). However, the effects of theory-based interventions on total physical activity, total gestational weight gain and the incidence of gestational hypertension and preterm delivery were unclear (P > 0.05).

CONCLUSIONS

(i) Most of the studies exhibited a moderate level of theory implementation quality. (ii) The use of theories varies, but common behavior change techniques were found across studies. (iii) Theory-based interventions can improve physical activity and maternal and neonatal outcomes and appear to be safe. Appropriate health behavior theories and behavior change techniques should be fully utilized in future interventions.

REGISTRATION

PROSPERO: CRD42023440886.

TWEETABLE ABSTRACT

Theory-based interventions can improve physical activity and maternal and neonatal outcomes and appear to be safe. Appropriate health behavior theories and behavior change techniques should be fully utilized in the development of future interventions.

Effect of online health training/counseling and progressive muscle relaxation exercise on postpartum depression and maternal attachment: A randomized controlled trial

OBJECTIVE

To evaluate the effect of online health training/counseling and a progressive muscle relaxation exercise (PMRE) program on postpartum depression and maternal attachment.

METHODS

The present study was a randomized, controlled, experimental trial. Participants were asked to complete the Prenatal Attachment Inventory (PAI) and the Edinburgh Postpartum Depression Scale (EPDS) at 35 weeks of pregnancy. Group assignment was done by stratified block randomization according to EPDS score (0-9, 10-30) and parity. Women in the experimental group received training in progressive muscle relaxation, postpartum depression, and maternal attachment via online video calls twice a week starting at 36-37 weeks of pregnancy. They were asked to complete the PMRE program from 36 weeks of pregnancy until 6 months postpartum, and online counseling was provided throughout this period. Participants completed the Maternal Postpartum Attachment Scale (MPAS) and the EPDS at 6 weeks postpartum.

RESULTS

Mean PAI score was 64.24 ± 9.61 in the experimental group before the intervention and 62.14 ± 10.13 in the control group. The mean EPDS score of the experimental group was 9.12 ± 5.05 and the mean score of the control group was 9.77 ± 6.30 (P > 0.05). The mean MPAS score after the intervention was 13.92 ± 5.54 in the experimental group and 17.51 ± 6.12 in the control group. The mean EPDS score of the experimental group was 3.40 ± 3.00 and the mean score of the control group was 11.40 ± 5.91 (P < 0.05).

CONCLUSION

Online health training/counseling and PMRE reduce the risk of postpartum depression and increase maternal attachment.

Meta-analysis of the effect of different exercise modalities in the prevention and treatment of perinatal depression

BACKGROUND

The incidence of perinatal depression is increasing and has become a global public health problem to be addressed.

OBJECTIVE

To explore the prevention and treatment effects of different exercise methods on perinatal depression.

METHODS

A meta-analysis was conducted by searching databases for published "exercise interventions for perinatal depression "related randomized controlled trials, up to July 20, 2022.

RESULTS

48 randomized controlled trials were included, with a total of 5282 pregnant women. (1) Exercise prevention of prenatal depression has a low effective stress intervention effect, ranking from high to low as yoga, aerobic+resistance. (2) Exercise therapy for prenatal depression has a significant intervention effect, followed by gymnastics, pelvic floor muscle training, aerobic exercise, aerobic+resistance, and yoga. (3) Exercise prevention of postpartum depression has a low effective intervention effect, followed by yoga, aerobic exercise, aerobic+resistance, and gymnastics. (4) Exercise has a moderate equivalent stress intervention effect on treating postpartum depression, followed by aerobic exercise, water exercise, yoga, fertility dance, and stroller walking.

LIMITATIONS

Due to the small number of included literature on single exercise modalities, and maternity is a special population, most of the trial procedures included in the text were not blinded, which has a certain risk of bias and affects the accuracy of the Meta-analysis results.

CONCLUSIONS

The therapeutic effect of exercise in the prevention and treatment of perinatal depression is superior to the preventive effect, and the effect of prenatal prevention and treatment is better than that of postpartum, with a moderate effect.

Comparative impact of exercise-based interventions for postpartum depression: A Bayesian network meta-analysis

OBJECTIVE

The current study aimed to address and rank which exercise-based interventions are preferable to standard care/no therapy or another exercise intervention for postpartum depression (PPD) management and provide estimates for future definitive evidence.

METHODS

The authors systematically searched PubMed, Embase, the Web of Science, PsycInfo, and ClinicalTrails.gov for randomized controlled trials (RCTs) on exercise-based interventions for PPD from their inception to May 9, 2023. Included were RCTs of exercise-based interventions for PPD with at least 4 weeks' duration. The pooled effects of intervention comparisons were generated by the Bayesian random-effects model, and the quality of evidence was evaluated by the Grading of Recommendations, Assessment, Development, and Evaluations framework.

RESULTS

Twelve RCTs (1260 women; mean age, 20-35 years) comparing exercise-based interventions with usual care/no therapy were included. Exercise effectively treats depressive symptoms (standard mean difference [SMD], -0.81 [95% confidence interval (CI), -1.20 to -0.42], P < 0.001). Pram walking was significantly associated with a reduction of depressive symptoms during the postpartum period (SMD, -1.00 [95% CI, -2.60 to -0.10], P = 0.020), as well as yoga (SMD, -0.73 [95% CI, -1.84 to -0.43], P < 0.001) and supervised mixed exercise (SMD, -0.77 [95% CI, -1.67 to -0.01], P = 0.041) compared with usual care/no therapy. In indirect comparisons, pram walking (surface under the cumulative ranking curve, 58.9%) was better than yoga (SMD, -0.28 [95% CI, -1.86 to 1.22], P = 0.322) and supervised mixed exercise (SMD, -0.23 [95% CI, -1.59 to 1.12], P = 0.358). However, the difference was not statistically significant. The confidence in evidence was very low to moderate.

CONCLUSION

In women with PPD, all commonly prescribed physical exercises were effective alternative or complementary treatments. However, pram walking may perform better in improving the symptoms of PPD.

Perioperative Adjunctive Esketamine for Postpartum Depression Among Women Undergoing Elective Cesarean Delivery: A Randomized Clinical Trial

Importance

Postpartum depression (PPD) is one of the most common mental health conditions during the perinatal and postpartum periods, which can have adverse effects on both mother and infant.

Objective

To investigate the efficacy of perioperative adjunctive esketamine administration after cesarean deliveries in the prevention of PPD.

Design, Setting, and Participants

A single-center, double-blind, placebo-controlled, randomized clinical trial was conducted from January 1, 2022, to January 1, 2023, at Fujian Provincial Hospital among 298 women aged 18 to 40 years, with an American Society of Anesthesiologists grade I to III classification and singleton full-term pregnancies who were scheduled for elective cesarean deliveries. Primary analyses were performed on a modified intention-to-treat basis.

Interventions

Patients were randomly assigned to the esketamine (n = 148) and control (n = 150) groups. Those in the esketamine group received a single intravenous injection of 0.25 mg/kg of esketamine immediately after fetal delivery, followed by 50 mg of esketamine as an adjuvant in patient-controlled intravenous analgesia for 48 hours after surgery. Saline was given to the control group of patients.

Main Outcomes and Measures

The primary outcome was assessments of PPD symptoms by using the Edinburgh Postnatal Depression Scale (EPDS) at postpartum day 7. Positive screening for PPD was defined as a score of 10 or more points on the EPDS. In addition, the EPDS was analyzed as a continuous variable to evaluate depressive symptoms. Secondary outcomes included the Numeric Rating Scale (NRS) of postoperative pain, along with safety evaluations including adverse events and clinical assessments at postpartum days 14, 28, and 42.

Results

A total of 298 pregnant women were included, with 150 in the control group (median age, 31.0 years [IQR, 29.0-34.0 years]) and 148 in the esketamine group (median age, 31.0 years [IQR, 28.0-34.0 years]). The prevalence of depression symptoms was significantly lower among patients given esketamine compared with controls (23.0% [34 of 148] vs 35.3% [53 of 150]; odds ratio, 0.55; 95% CI, 0.33-0.91; P = .02) on postpartum day 7. In addition, the esketamine group also showed a significantly lower change in EPDS scores (difference of least-squares means [SE], -1.17 [0.44]; 95% CI, -2.04 to -0.31; effect size, 0.74; P = .008). However, there were no differences between the groups in the incidence of positive screening results for PPD or in changes from the baseline EPDS scores at postpartum days 14, 28, and 42. There were no differences in NRS scores at rest and on movement except on movement at 72 hours postoperatively, when scores were significantly lower in the esketamine group (median, 3.0 [IQR, 2.0-3.0] vs 3.0 [IQR, 3.0-3.5]; median difference, 0 [95% CI, 0-0]; P = .03).

Conclusions and Relevance

These results suggest that intravenous administration of esketamine during the perioperative period of elective cesarean delivery can improve depression symptoms during the early postpartum period. However, this antidepression effect may not be universally applicable to patients with low EPDS scores.

Trial Registration

Chinese Clinical Trial Registry Identifier: ChiCTR2100054199.

Prenatal exposure to poly- and perfluoroalkyl substances and postpartum depression in women with twin pregnancies

BACKGROUND

Women with multiple pregnancies are vulnerable to experience postpartum depression (PPD). Emerging evidence indicates an association between poly- and perfluoroalkyl substances (PFAS) exposure and PPD in women delivering singletons. The health risks of PFAS may also be present in women delivering twins.

OBJECTIVE

To estimate the impacts of prenatal PFAS exposure on the risk of PPD in women with twin pregnancies.

METHODS

Our study included 150 mothers who gave birth to twins and were enrolled in the Wuhan Twin Birth Cohort. The concentrations of maternal plasma PFAS were measured in each trimester and averaged. Eight individual PFAS were included in analyses. We used Edinburgh Postnatal Depression Scale to evaluate maternal depression at early pregnancy and 1 and 6 months after childbirth. The outcome was dichotomized using a cutoff value of ≥10 for main analyses. Associations were examined using multiple informant models and modified Poisson regressions. PFAS mixture effects were estimated using quantile g-computation.

RESULTS

Using quantile g-computation models, a quartile increase in the PFAS mixture during the first, second, third, and average pregnancy was significantly associated with a relative risk (RR) of 1.73 (95% CI: 1.42, 2.12), 1.54 (95% CI: 1.27, 1.84), 1.75 (95% CI: 1.49, 2.08), and 1.63 (95% CI: 1.35, 1.97) for PPD at 6 months after childbirth, respectively. The results of the single-PFAS models also indicated significant positive associations between individual PFAS and PPD at both 1 and 6 months.

CONCLUSIONS

The first study of women with twin pregnancies suggests that prenatal exposure to PFAS increases PPD risk up to 6 months postpartum. Twin pregnant women should receive long-term follow-up after delivery and extensive social support.

Risk Factors of Postpartum Depression Among Korean Women: An Analysis Based on the Korean Pregnancy Outcome Study (KPOS)

BACKGROUND

Postpartum depression (PPD) can negatively affect infant well-being and child development. Although the frequency and risk factors of PPD symptoms might vary depending on the country and culture, there is limited research on these risk factors among Korean women. This study aimed to elucidate the potential risk factors of PPD throughout pregnancy to help improve PPD screening and prevention in Korean women.

METHODS

The pregnant women at 12 gestational weeks (GW) were enrolled from two obstetric specialized hospitals from March 2013 to November 2017. A questionnaire survey was administered at 12 GW, 24 GW, 36 GW, and 4 weeks postpartum. Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale, and PPD was defined as a score of ≥ 10.

RESULTS

PPD was prevalent in 16.3% (410/2,512) of the participants. Depressive feeling at 12 GW and postpartum factors of stress, relationship with children, depressive feeling, fear, sadness, and neonatal intensive care unit admission of baby were significantly associated with a higher risk of PPD. Meanwhile, high postpartum quality of life and marital satisfaction at postpartum period were significantly associated with a lower risk of PPD. We developed a model for predicting PPD using factors as mentioned above and it had an area under the curve of 0.871.

CONCLUSION

Depressive feeling at 12 GW and postpartum stress, fear, sadness, relationship with children, low quality of life, and low marital satisfaction increased the risk of PPD. A risk model that comprises significant factors can effectively predict PPD and can be helpful for its prevention and appropriate treatment.

Effects of the enhanced recovery after surgery intervention for preventing postpartum depression: a protocol for systematic review and meta-analysis

INTRODUCTION

Postpartum depression (PPD), a prevalent public health problem, is a debilitating mental disorder for which preventive interventions could yield dramatic benefits. However, viable approach focusing the prevention of PPD for caesarean section (CS) patients remains limited currently. In recent decades, enhanced recovery after surgery (ERAS) has gradually been implemented in CS and appears to be a potential and favourable preventive intervention for PPD, but systematic evidence on this issue is lacking. Therefore, a meta-analysis is designed to systematically explore the potential effect of ERAS on the prevention of PPD in CS patients.

METHODS AND ANALYSIS

Meta-analysis will be performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement. A systematic search across the PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Chinese Scientific Journal Database, grey literature and Wanfang Database will be conducted from inception to July 2023. Relevant studies investigating the association between ERAS and PPD will be included. Two reviewers will independently carry out the literature selection, data extraction and risk of bias assessment. Disagreements will be resolved by group consensus. Statistical analyses will use the RevMan V.5.3 and STATA V.13 software. The Grading of Recommendations Assessment, Development, and Evaluation system will be used to evaluate the strength of evidence.

ETHICS AND DISSEMINATION

This study raises no ethical issues. The pending meta-analysis may provide reliable evidence supporting ERAS as a viable preventive option for PPD in CS patients, further providing a useful reference for the health authorities and promoting the future clinical practice in this field. The formal results of this study will be submitted to a professional journal for publication.

PROSPERO REGISTRATION NUMBER

CRD42023485929.

The Impact of Physical Activity on the Development of Postpartum Depression

Although the benefits of physical activity (PA) on mental well‐being are well established, the vulnerability of women during pregnancy and the postpartum period poses challenges in studying the effects of PA on postpartum depression (PPD). This study investigated the association between total and domain‐specific PA levels during pregnancy and postpartum depressive symptoms. The study included 105 healthy pregnant women whose PA status was evaluated by the Serbian version of the Physical Activity Questionnaire during Pregnancy (PPAQ‐SRB) and their postpartum mental health by the Edinburgh Postnatal Depression Scale. Multivariable logistic regression was used to explore the independent relationship between PPAQ‐SRB scores and the prediction of the PPD symptom occurrence. Our analysis revealed that the development of PPD symptomatology was associated with a lower “Total PPAQ‐SRB score” (odds ratio (OR) 0.81; 95% confidence interval (CI) [0.70–0.93]; p = 0.03) and “Total Activity score” (OR 0.82; 95% CI [0.71–0.93]; p = 0.03) as well as lower scores of light‐intensity PA (OR 0.81; 95% CI [0.69–0.96]; p = 0.013), moderate‐intensity PA (OR 0.82; 95% CI [0.71–0.94]; p = 0.005), “Household/care” (OR 0.85; 95% CI [0.73–0.98]; p = 0.028), and “Occupational” activities (OR 0.80; 95% CI [0.78–0.95]; p = 0.012). Lower levels of light‐to‐moderate‐intensity household and occupational activities appeared to increase the risk of PPD, indicating the importance of circumstances under which PA is performed. Hence, our findings indicate that PA during pregnancy can mitigate mood disorders in postpartum mothers. Moreover, reduced participation in light‐to‐moderate‐intensity household and occupational activities seemed to increase the risk of PPD.

Exploring the Connection between Migraines and Pregnancy: The Impact of Physical Activity on Symptom Management

Migraine is a prevalent neurological disorder that significantly impacts the quality of life for affected individuals. The pathogenesis behind migraines is not yet fully understood, but hormonal changes, especially fluctuations in, estrogen and progesterone levels, have a significant role in the susceptibility of women to migraines. Pregnancy introduces a unique set of challenges for women who experience migraines, as they must navigate the complexities of managing their condition while safeguarding the health of both them and their unborn child. Pharmacological options for treating migraines during pregnancy are limited, and, therefore, there is a growing interest in exploring alternative approaches to migraine symptom relief and management. Physical activity during pregnancy provides a range of benefits, and it has gained attention as a potentially valuable tool for alleviating migraine symptoms in pregnant patients. This review explores the intricate relationship between migraines and pregnancy, emphasizing how physical activity and other alternative approaches may influence the frequency, severity, and overall experience of migraines during pregnancy. Through collaboration with healthcare providers and the adoption of personalized management strategies, women can strike a balance that supports both their own well-being and the healthy development of their unborn child. By examining existing research and emerging insights, we aim to provide a comprehensive understanding of the potential benefits and considerations of incorporating physical activity and other treatment options into migraine management strategies for pregnant women. Further research is needed to elucidate the specific mechanisms linking migraines, pregnancy, and physical activity, enabling the development of more targeted interventions and guidelines.

Effectiveness of aerobic exercise in the prevention and treatment of postpartum depression: Meta-analysis and network meta-analysis

BACKGROUND

Aerobic exercise is widely recognized for improving mental health and reducing negative emotions, including anxiety. However, research on its role in preventing and treating postpartum depression (PPD) has yielded inconsistent results. Some studies show positive effects on PPD symptoms, while others find limited impact, suggesting various factors at play, such as exercise type, intensity, and individual differences. To address this gap, our study aims to comprehensively gather evidence on the preventive and therapeutic effects of aerobic exercise for PPD. We'll focus on differences in exercise program design and implementation, exploring how these factors impact intervention outcomes. By identifying effective exercise approaches, we aim to provide more comprehensive exercise prescription recommendations for this vulnerable population.

METHODS

We conducted a quantitative systematic review of the study in 5 representative databases for the effect of aerobic exercise on PPD. Meta-analysis and network meta-analysis were performed with Review-Manager.5.4 and Stata.16.0 software, respectively. This study has been registered on the official Prospero website, and the registration code is CRD42023398221.

RESULTS

Twenty-six studies with 2,867 participants were eventually included and the efficacy of aerobic exercise in preventing and treating postpartum depression is significant compared to standard care. (MD = -1.90; 95%CL: -2.58 to -1.21; I2 = 86%). Subgroup analysis suggests that the intervention objective (prevention vs. treatment) of exercise could potentially be a source of heterogeneity in this study, as the "Test for subgroup difference" revealed the presence of significant distinctions (p = 0.02<0.05). The "Test for subgroup difference" yielded non-significant results for both the supervised vs. unsupervised subgroup comparison (p = 0.55 > 0.05) and the individual vs. team subgroup comparison (p = 0.78 > 0.05). Nonetheless, when assessing their effect sizes [Subtotal (95%CL)], the supervised exercise group [-1.66 (-2.48, -0.85)] exhibited a slightly better performance than the unsupervised exercise group [-1.37 (-1.86, -0.88)], while the team exercise group [-1.43 (-1.94, -0.93)] slightly outperformed the individual exercise group [-1.28 (-2.23, -0.33)]. Network meta-analysis indicated that moderate intensity (35~45 min) group demonstrated a more pronounced intervention effect compared to low intensity (50~60 min) group [-2.63 (-4.05, -1.21)] and high intensity (20~30 min) group [-2.96 (-4.51, -1.41)], while the 3~4 times/week group had a more significant intervention effect compared to 1~2 times/week groups [-2.91 (-3.99, -1.83)] and 5~6 times/week groups [-3.28 (-4.75, -1.81)]. No significant differences were observed in pairwise comparisons of intervention effects among the five common types of aerobic exercises. (95%CL including 0). The Surface Under the Cumulative Ranking curve (SUCRA) results align with the findings mentioned above and will not be reiterated here.

CONCLUSION

The efficacy of aerobic exercise in preventing and treating postpartum depression is significant compared to standard care, with a greater emphasis on prevention. The optimal prescribed exercise volume for intervention comprises a frequency of 3~4 exercise sessions per week, moderate intensity (35~45 minutes). Currently, several uncharted internal factors influence the optimal intervention effect of aerobic exercise, such as the potential enhancement brought by team-based and supervised exercise. Given the absence of significant differences in certain results and the limitations of the study, it is essential to exercise caution when interpreting the outcomes. Further research is needed in the future to provide a more comprehensive understanding.

Attitudes and Barriers to Physical Activity and Exercise Self-Efficacy Among Chinese Pregnant Women: A Cross-Sectional Study

Background

Most pregnant women do not reach the recommendation for physical activity (PA). As a subcategory of PA, exercise is also essential. Evidence on pregnant women's attitudes and barriers to PA and exercise self-efficacy in China is scarce.

Aim

To explore the levels and influencing factors of attitudes and barriers to PA and exercise self-efficacy among pregnant women.

Methods

A cross-sectional study of 311 pregnant women was conducted from August to December 2022. Individual characteristics, pregnant women's attitudes toward exercise, barriers to prenatal PA and exercise, and exercise self-efficacy were measured using the self-designed demographic questionnaire, pregnant women's attitudes toward exercise questionnaire, barriers to prenatal PA and exercise questionnaire, and the pregnancy exercise self-efficacy scale, respectively.

Results

More than 90% of pregnant women believed exercise benefits themselves and their babies, and 40.8% of pregnant women did not know how to exercise. Women encounter different types of barriers to PA and exercise. Intrapersonal barriers included the proportion of feelings of tiredness (56.6%), low energy (54.7%), lack of interest or motivation (49.2%), feelings of illness and morning sickness (46.6%), and large body weight (43.7%). Interpersonal barriers included pregnant women being advised to avoid PA and exercise (49.2%), lack of clear advice about the intensity and dose of exercise (41.8%), no one to exercise with (38.9%), and lack of advice from healthcare professionals (38.6%). Weather conditions were the most significant environmental barriers (41.2%). The total score of pregnancy exercise self-efficacy was (38.50±7.33). Education level, parity, and attitudes toward exercise independently predict pregnant women's attitudes toward exercise, barriers to prenatal PA and exercise, and exercise self-efficacy, respectively.

Conclusion

Pregnant women have a favorable attitude toward exercise and relatively good exercise self-efficacy but lack knowledge of exercise. They face numerous barriers. Medical professionals should encourage pregnant women with lower levels of education to exercise and assist multipara in overcoming obstacles.

Does regular antenatal exercise promote exclusive breastfeeding during the first 3 months of life? Secondary analyses of a randomized controlled trial

INTRODUCTION

Exclusive breastfeeding (EBF) and antenatal exercise are independently associated with positive short- and long-term health effects for women and their children. The aims of the study were to investigate whether antenatal exercise promotes EBF three months postpartum and further to explore factors associated with EBF at three months postpartum.

METHODS

This study was a follow-up of a Norwegian two-center randomized controlled trial to assess the effect of an antenatal exercise protocol. The recruited pregnant women were randomized to either a 12-week standardized antenatal exercise program with one weekly group training led by a physiotherapist and two weekly home training sessions or standard antenatal care. Women reported breastfeeding status in a questionnaire at three months postpartum.

RESULTS

Of the 726 women, 88% were EBF at three months postpartum. There was no significant difference in EBF rates between the intervention group (87%) and the control group (89%). EBF was positively associated with maternal education (AOR=3.4; 95% CI: 1.7-6.7) and EBF at discharge from the hospital (AOR=22.2; 95% CI: 10-49). Admission to neonatal intensive care unit was identified as a significant barrier to EBF (AOR=0.2; 95% CI: 0.1-0.4). Significantly more women in the non-EBF group had sought professional help compared to women in the EBF group (p≤0.001).

CONCLUSIONS

Regular physical exercise during pregnancy did not influence the exclusive breastfeeding rates at three months postpartum. Considering the health effects of exclusive breastfeeding and antenatal physical exercise, studies with follow-up periods beyond three months postpartum are warranted.

Association of Physical Activity with the Prevention and Treatment of Depression During the Postpartum Period: A Narrative Review

The benefits of physical activity during pregnancy or postpartum are auspicious, especially in preventing and treating postpartum depression. This review aimed to examine the relationship between exercise and postpartum depression in terms of prevention and treatment. The goals were to determine if exercise alone is sufficient for this purpose and to attract attention to the kind, intensity, and duration needed to achieve this purpose. A literature review was conducted in PubMed, PubMed Central, MEDLINE, and Cochrane libraries. The search terms were "physical activity," "postpartum depression," "postnatal depression," and "exercise." Physical activity can be a preventative measure and a treatment aid for pregnant or postpartum women with depressive disorders. However, the exercise protocol should include a support/wellness program to achieve better and more remarkable results.

Treatment of obstructive sleep apnea in high risk pregnancy: a multicenter randomized controlled trial

BACKGROUND

Obstructive sleep apnea (OSA) during pregnancy is a risk factor for preeclampsia possibly through a link to placental physiology. This study evaluates the efficacy of continuous positive airway pressure (CPAP) on the modulation of blood pressure and the reduction in preeclampsia in women with high-risk pregnancy and OSA.

METHODS

A multicenter open-label, randomized controlled trial comparing CPAP treatment versus usual antenatal care was conducted in three academic hospitals in Bangkok, Thailand. Participants included singleton pregnant women aged older than 18 years with any high-risk condition (i.e., chronic hypertension, obesity, history of preeclampsia or gestational diabetes in the previous pregnancy, or diabetes), and OSA (respiratory disturbance index 5-29.99 events/hour by polysomnography), who presented either in the first trimester (gestational age, GA 0-16 weeks) or subsequently developed OSA during the 2nd trimester (GA 24-28 weeks). The primary endpoint was blood pressure during antenatal care. Secondary endpoints included the incidence of preeclampsia. An intention-to-treat analysis was performed with additional per-protocol and counterfactual analyses for handling of nonadherence.

RESULTS

Of 340 participants, 96.5% were recruited during the first trimester. Thirty participants were later excluded leaving 153 and 157 participants in the CPAP and usual-care groups for the modified-intention-to-treat analysis. CPAP adherence rate was 32.7% with average use of 2.5 h/night. Overall, CPAP treatment significantly lowered diastolic blood pressure (DBP) by - 2.2 mmHg [95% CI (- 3.9, - 0.4), p = 0.014], representing approximately - 0.5 mmHg per hour of CPAP use [95%CI (- 0.89, - 0.10), p = 0.013]. CPAP treatment also altered the blood pressure trajectory by continuously lowering DBP throughout pregnancy with mean differences (95% CI) of - 3.09 (- 5.34, - 0.93), - 3.49 (- 5.67, - 1.31) and - 3.03 (- 5.20, - 0.85) mmHg at GA 18-20, 24-28, and 32-34 weeks, respectively compared to 0-16 weeks. Preeclampsia rate was 13.1% (20/153 participants) in the CPAP and 22.3% (35/157 participants) in the usual-care group with a risk difference (95% CI) of - 9% (- 18%, - 1%, p-value = 0.032) and a number-needed-to-treat (95% CI) of 11 (1, 21).

CONCLUSIONS

CPAP treatment in women with even mild-to-moderate OSA and high-risk pregnancy demonstrated reductions in both DBP and the incidence of preeclampsia. CPAP treatment also demonstrated a sustained reduction in DBP throughout gestation. Trial registration ClinicalTrial.GovNCT03356106, retrospectively registered November 29, 2017.

The impact of physical activity intervention on perinatal depression: A systematic review and meta-analysis

BACKGROUND

No meta-analysis has analyzed the effect of physical activity level, period of physical activity intervention, and duration of intervention, on perinatal depression. This study was to evaluate the impact of physical activity intensity, dose, period, and duration on perinatal depression.

METHODS

The literature was searched via the PubMed, Embase, Cochrane Library, and Web of Science databases. Weighted mean difference (WMD) or the risk ratio (RR) was used as the effect indicator, and the effect size was represented by the 95 % confidence interval (CI). Subgroup analysis based on the perinatal stage, physical activity intensity, physical activity equivalent, and intervention duration was performed.

RESULTS

Totally, 35 studies including 5084 women were included. Physical activity could reduce the incidence and severity of depression in perinatal women. Among depressed women with prenatal depression, low-intensity physical activity, with metabolic equivalents (METs)-min/week being <450, was associated with lower levels of depression. In the general population, the risk of postpartum depression was lower in the physical activity group when the duration of intervention was ≥12 weeks, being II, III stage, and ≥450 METs-min/week. Both low and moderate-intensity physical activity were beneficial to an improved depression severity among depressed women with postpartum depression, and moderate exercise intervention could decrease the risk of postpartum depression in general pregnant women.

LIMITATIONS

Different types of physical activities may affect the effectiveness of interventions.

CONCLUSION

Our study indicated physical activity specifically targeted at pregnant women could reduce depression risk and severity.

Physical activity and pregnancy outcomes: an expert review

This expert review aimed to assess current literature on the effect and tracking of physical activity during pregnancy and associated outcomes. Self-reported physical activity may be inaccurate given the subjective nature of the questionnaires. The accelerometer ActiGraph is considered the "gold standard" to objectively measure physical activity. However, other more user-friendly wearable devices are now widely available and may accurately track physical activity. Conclusive data from both validated activity questionnaires and accelerometers indicate that physical activity is safe during pregnancy. In addition, studies of physical activity during pregnancy that evaluate pregnancy outcomes have found reduced risks of preterm birth, preeclampsia, and gestational diabetes mellitus and improved mental health among individuals who regularly engage in physical activity. In the United States, approximately 48% of pregnant individuals gain more than the recommended amount of weight during pregnancy; excessive gestational weight gain is associated with an increased risk of maternal and fetal complications, including preterm birth, preeclampsia, and gestational diabetes mellitus, and corresponding higher adverse short- and long-term maternal and offspring health outcomes. Although physical activity is safe during pregnancy and may reduce excessive gestational weight gain and resultant pregnancy complications, further research is needed to determine the frequency and duration of specific types of physical activity during pregnancy. Providers should encourage physical activity before and during pregnancy and educate patients regarding the benefits and safety of physical activity.

Physical exercise interventions for perinatal depression symptoms in women: A systematic review and meta-analysis

Background

The previous meta-analysis indicated that physical exercise could play a crucially therapeutic role in reducing perinatal depression symptoms in women. However, the efficacy varies across different exercise types, forms, intensities, and duration.

Aim

The purpose of this study was to review and evaluate the effects of different types, forms, intensities, and duration of exercise for improving perinatal depressive symptoms.

Design

A systematic review and meta-analysis.

Methods

Randomized controlled trials until December 2021 were searched from seven databases, including PubMed, EMBASE, Medline, CINAHL, Web of Science, Cochrane Library, and PsycINFO. The risk of bias in eligible trials was evaluated using the Cochrane Risk of Bias tool. When high heterogeneity was tested, we used random-effects models. A funnel plot was used to assess the publication bias. This review was performed under the PRISMA guidelines, Consensus on Exercise Reporting (CERT) checklist and Cochrane Handbook. The certainty of the body of evidence was assessed using the GRADE method.

Results

Of 1,573 records, 20 trials were identified in this study. The results of this review revealed that women with perinatal depression symptoms gained benefits from physical exercise [OR = 0.62, 95% CI (0.45, 0.86), P = 0.004; MD = -0.57, 95% CI (-0.83, -0.30), P < 0.0001]. Type of walking [SMD = -1.06, 95% CI (-1.92, -0.19), P < 0.00001], form of "Individual + group-based"exercise [SMD = -0.91, 95% CI (-0.80, -0.03), P = 0.04], intensity of ≥150 min per week [SMD = -0.84, 95% CI (-1.53, -0.15), P = 0.02], and ≥12 weeks duration [SMD = -0.53, 95% CI (-0.75, -0.31), P < 0.00001] seemed to generate more prominent improvement on perinatal depression symptoms.

Conclusion

Physical exercise showed a significant effect on reducing perinatal depressive symptoms. This meta-analysis provides an important update on exercise's efficacy in treating perinatal depression. Further higher quality and large-scale trials are needed to substantiate our findings.

Systematic review registration

[https://www.crd.york.ac.uk/prospero/], identifier [CRD42022296230].

Factors influencing physical inactivity status among chinese pregnant women: a cross-sectional study

BACKGROUND

Regular prenatal physical activity provides numerous health benefits to both mother and fetus. However, little is known about the physical activity status of pregnant women in China and whether they meet the current guidelines for prenatal physical activity. The aims of the study were to assess physical inactivity status and associated factors among pregnant women in Shanghai, China.

METHODS

A cross-sectional study of 1636 pregnant women were recruited at a tertiary obstetrics and gynecology hospital in Shanghai. Maternal sociodemographic characteristics and health information were obtained using structured questionnaires or from the electronic medical records. Physical inactivity status was assessed using the International Physical Activity Questionnaire-Short Form. Factors pertinent to physical inactivity were identified by binary logistic regression and were reported with adjusted odds ratios (ORs) and 95% confidence intervals (CIs). All statistical analyses were performed using the SPSS software package.

RESULTS

In total, the prevalence of physical inactivity was 47.5%. Walking was the main form of physical activity and only 2.8% of the pregnant women achieved the goal of at least 150 min of moderate-intensity physical activity weekly. Multivariate logistic regression identified a significant negative association of physical inactivity with personal monthly income (adjusted OR 0.648, 95% CI 0.505-0.831), engagement in regular exercise before pregnancy (adjusted OR 0.575, 95% CI 0.464-0.711) and in the second (adjusted OR 0.534, 95% CI 0.411-0.693) or third (adjusted OR 0.615, 95% CI 0.470-0.806) trimester of pregnancy. Women with nausea or vomiting during pregnancy were more likely to be physically inactive during pregnancy (adjusted OR 1.307, 95% CI 1.002-1.705).

CONCLUSION

Physical inactivity is highly prevalent among pregnant women in China. Further efforts should be taken to overcome the barriers to prenatal physical activity and to promote moderate- to vigorous-intensity activities among Chinese pregnant women.

The emotional state and social support of pregnant women attending childbirth classes in the context of physical activity

Childbirth classes combined with elements of psychoprophylaxis and psychoeducation prepare women and their partners for childbirth and influence the level of their perceived stress and mood disorders. Participation in these classes may come as a form of support for pregnant women, or an opportunity to build self-efficacy and commence regular physical activity. The aim of this study was assess the emotional state, social support and self-efficacy of pregnant women attending childbirth classes, in the context of physical activity undertaken. The study included 101 pregnant women. The Berlin Social Support Scale (BSSS), the General Self-Efficacy Scale (GSES), the Perceived Stress Scale (PSS-10) and the State-Trait Anxiety Inventory (STAI) were used during their first day of attendance at the childbirth classes (initial survey; T1) and after 10 weeks of participation in these classes (final survey; T2). After 10 weeks of childbirth classes, there was a statistically significant change in the BSSS, specifically in the area of Perceived Available Support, GSES, PSS-10, and STAI X-2. There was no significant relationship established between the emotional state and the physical activity undertaken before and during pregnancy or with the social support received.

Exercise, Mediterranean Diet Adherence or Both during Pregnancy to Prevent Postpartum Depression-GESTAFIT Trial Secondary Analyses

Targeting lifestyle behaviors during pregnancy is crucial to prevent the highly prevalent postpartum depression and its consequences. In these secondary analyses of an intervention trial to investigate the effects of concurrent exercise training on postpartum depression, we aimed to investigate the potential role of Mediterranean diet (MD) adherence on the exercise effects. A total of 85 pregnant women met the per-protocol criteria (exercise n = 46, control n = 39). The exercise program was delivered in 60 min sessions, 3 days/week, from the 17th gestational week until birth. Women's dietary habits were assessed with a food frequency questionnaire. The Mediterranean Food Pattern (an MD index) was derived from it to assess MD adherence. We used the Edinburgh Postnatal Depression Scale to assess postpartum depression. The postpartum depression score was not statistically different between control and exercise groups (p > 0.05). A higher consumption of fruits (β = -0.242, p = 0.022), lower intake of red meat and subproducts (β = 0.244, p = 0.020), and a greater MD adherence (β = -0.236, p = 0.027) were associated with lower levels of postpartum depression. Greater adherence to the MD during pregnancy was associated with fewer depressive symptoms and a lower risk of postpartum depression. Postnatal depression was not reduced by prenatal exercise. Promoting fruit consumption while controlling the intake of red meat during pregnancy might prevent postnatal depression.

Physical Activity During the Perinatal Period: Guidelines for Interventions During the Perinatal Period from the French National College of Midwives

The aim of this review is to provide an update on the beneficial effects of regular physical activity and/or less sedentary behavior before, during, and after pregnancy, based on data from the scientific literature and the recommendations of expert committees. In the preconception period, it is recommended that women perform 30 minutes to 1 hour of moderate-to-high intensity physical activity per day, at least 5 days a week, and avoid the absence of any physical activity for 2 consecutive days. Pregnant women should: i) start or continue to perform moderate-intensity physical activity (up to 150 min/wk with at least 3 sessions longer than 30 min), ii) start or continue to do muscle strengthening activity involving the large muscle groups (once or twice a week). In the absence of medical contraindications, it is recommended that they continue physical activity (at least 30 min/d) during the postpartum period. Sedentary time must be limited, if possible, to less than 7 hours a day, regardless of the period.

Glucose and oxygen in the early intrauterine environment and their role in developmental abnormalities

The early life environment can have profound impacts on the developing conceptus in terms of both growth and morphogenesis. These impacts can manifest in a variety of ways, including congenital fetal anomalies, placental dysfunction with subsequent effects on fetal growth, and adverse perinatal outcomes, or via effects on long-term health outcomes that may not be detected until later childhood or adulthood. Two key examples of environmental influences on early development are explored: maternal hyperglycaemia and gestational hypoxia. These are increasingly common pregnancy exposures worldwide, with potentially profound impacts on population health. We explore what is known regarding the mechanisms by which these environmental exposures can impact early intrauterine development and thus result in adverse outcomes in the immediate, short, and long term.

The COVID-19 pandemic and mental health in pregnant women: A review article

A rapid spreading of the COVID-19 virus in recent years had a great impact on every single aspect of live and the world faced with unexpected and unpredictable crisis in both physical and mental condition. As with any crisis, vulnerable individuals like pregnant women were the concern of societies. Several physiological and psychological changes occur during pregnancy which put individuals in a risk of mental health problems. During the outbreak of the COVID-19, pregnant women have experienced more psychological stresses, fear, anxiety, and depression. The prenatal mental distresses and psychiatric disorders may cause poor compliance, reduce help-seeking behaviors, and neglect to take the follow up screening visits and risk of harm for mother and others. Addressing the mental health in pregnant women is crucial to prevent the consequences. The purpose of this narrative review was to investigate the available literature on the impact of the COVID-19 pandemic on mental health in pregnant women and provide some recommendations to improve mental health in them. It also shed some light on providing mental health services for women during pregnancy and can be used by health professionals and policymakers.

Longitudinal Changes in Physical Activity during Pregnancy: National Institute of Child Health and Human Development Fetal Growth Studies

INTRODUCTION

Exercise in pregnancy is associated with many perinatal benefits, but patterns of home, work, and commuting activity are not well described. We investigated longitudinal activity in singleton and twin pregnancy by activity domain and maternal characteristics.

METHODS

In the National Institute of Child Health and Human Development Fetal Growth Studies cohorts, 2778 women with singleton and 169 women with twin gestations reported activity using the Pregnancy Physical Activity Questionnaire at up to six or seven study visits, respectively. Metabolic equivalent of task-hours per week (MET-h·wk -1 ) was calculated from reported activity. Baseline measurements (obtained between 10 and 13 wk) reflected past year activity. Linear mixed models estimated MET-h·wk -1 by domain (household/childcare, occupational, inactive, transportation, sports/exercise), self-reported race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, Asian/Pacific Islander), prepregnancy body mass index (<25, 25 to < 30, ≥30 kg·m -2 ), parity (0, ≥1), baseline activity (quartiles), and plurality (singleton, twin).

RESULTS

Household/caregiving activity made up the largest fraction of reported MET-h·wk -1 at baseline (42%), followed by occupational activity (28%). Median summed activity declined 47%, from 297 to 157 MET-h·wk -1 , between 10 and 40 wk, largely driven by changes in household/caregiving (44% decline), and occupational activity (63% decline). Sports/exercise activity declined 55% but constituted only 5% of reported MET-h·wk -1 at baseline. At baseline, non-Hispanic Black women reported significantly higher activity than non-Hispanic White or Hispanic women, but differences did not persist across pregnancy. Across gestation nulliparous women reported significantly lower activity than parous women. Women with singleton gestations reported significantly more activity than women with twins from weeks 26 to 38. Baseline activity level was strongly associated with later activity levels.

CONCLUSIONS

Measuring domains of activity beyond exercise, and collecting longitudinal measurements, is necessary to fully describe activity in diverse populations of pregnant women.

Physical activity during pregnancy: a systematic review for the assessment of current evidence with future recommendations

BACKGROUND

Physical activity is essential to maternal and infant health. Healthcare professionals should inform pregnant women about benefits of physical activity to prevent possible health issues. Those recommendations should elaborate on relevant contemporary evidence. The aim of this study was to review evidence-based recommendations for physical activity during pregnancy.

METHODS

A systematic search, analysis and synthesis of conducted randomised controlled trials (RCTs) was conducted from October 2021 to June 2022 in following databases: PubMed, CINAHL, ScienceDirect and Web of Science. Literature was searched using inclusion and exclusion criteria and following PRISMA recommendations.

RESULTS

Benefits for pregnant-women health and well-being were reported while performing aerobic exercise, lumbar stabilization and stretching exercise, water exercise, nerve and tendon-slip exercise, resistance training and strength training. For all exercise modalities it is recommended to perform moderate intensity activities during the whole time of pregnancy.

CONCLUSIONS

This systematic literature review supplements current knowledge on physical activity of pregnant women. Exercise interventions are listed and suggested in an integrative model with physical-fitness components to contextualize and promote physical activity among pregnant women.

Exercise and yoga during pregnancy and their impact on depression: a systematic literature review

It is well established that exercise can improve depressive symptoms in the general population; however, it is not clear if these benefits are also seen in pregnancy. This review aimed to synthesize the evidence that examines whether exercise during pregnancy impacts depressive and associated symptoms (e.g. anxiety) during the perinatal period. The review was conducted in accordance with PRISMA guidelines and reporting criteria; literature was searched using PubMed, Scopus and Web of Science database engines. Clinical trials published in English evaluating the effects of a defined exercise protocol during pregnancy on depressive and/or anxiety symptoms during the perinatal period were included. Studies without a control group were excluded. Risk of bias was conducted by Cochrane assessment to appraise the quality of the included studies. Twenty-seven articles, between 1994 and 2019, were included. Of these, only 5 specifically recruited women with depression (n = 334), which all assessed a yoga-based intervention; 4 of these studies showed a statistically significant improvement in depressive and/or anxiety symptoms in the intervention group compared to baseline; however, 2 of these studies also showed an improvement in the control group. The remaining 22 studies used various exercise interventions in pregnant women (n = 4808) with 20 studies reporting that exercise during pregnancy has the ability to improve depressive and/or anxiety measures in the perinatal period compared to either baseline or control. The evidence suggests that exercise of various types in pregnancy can reduce depressive and/or anxiety symptoms in the perinatal period in otherwise healthy women. Specifically in women with antenatal depression, the incorporation of yoga in pregnancy can improve depressive/anxiety symptoms in the perinatal period; however, this is based on a small number of studies, and it is not clear whether this is superior to non-exercise controls. Further studies are needed to determine the potential therapeutic effects of exercise of various types during pregnancy on symptoms of antenatal depression.

Maternal Exercise Before and During Pregnancy Facilitates Embryonic Myogenesis by Enhancing Thyroid Hormone Signaling

Background: Maternal exercise (ME) improves fetal and offspring muscle development, but mechanisms remain to be established. Since the thyroid hormone (TH) is critical for cell differentiation during embryonic development, we hypothesized that ME elevates TH receptor (THR) signaling in embryos, which promotes embryonic myogenesis. Methods: Female mice were exercised daily on a treadmill or received a daily TH, triiodothyronine (T3) injection. Embryos (embryonic day 12.5 [E12.5]) and P19 cells were used for studying effects of TH on embryonic myogenesis. TH levels in serum and embryos after ME or T3I were analyzed. Expression of TH signaling related genes and myogenic genes was assessed. THRα binding to the promoters of myogenic genes was investigated by chromatin immunoprecipitation-qantitative polymerase chain reaction (ChIP-qPCR). A CRISPR/CAS9 plasmid was utilized to knock out THRα in P19 cells. Results: ME elevated TH levels in both maternal circulation and embryos, which were correlated with enhanced TH signaling and myogenesis. At E12.5, both myogenic determinants (Pax3, Pax7) and myogenic regulatory factors (Myf5, Myod) were upregulated in ME embryos. ME increased THRα content and elevated messenger RNA (mRNA) expression of TH transporter Slc16a2 and deiodinase Dio2. In addition, the THRα binding to the promoters of Pax3/7 was increased. In P19 embryoid bodies, T3 promoted myogenic differentiation, which was abolished by ablating THRα. Furthermore, maternal daily injection of T3 at a level matching exercised mothers promoted embryonic myogenesis. Conclusions: ME promotes TH delivery to the embryos and enhances embryonic myogenesis, which is partially mediated by enhanced TH signaling in ME embryos.

Can Group Exercise Programs Improve Health Outcomes in Pregnant Women? An Updated Systematic Review

Current scientific evidence supports the recommendation to initiate or continue physical exercise in healthy pregnant women. Group exercise programs have positive effects on improving health, well-being, and social support. In 2015, a systematic review was provided to evaluate the evidence on the effectiveness of group exercise programs in improving pregnant women's and newborns' health outcomes and to assess the content of the programs. This review aims to update this knowledge between 2015 and 2020. The exercise program designs were analyzed with the Consensus of Exercise Reporting Template (CERT) model, the compliance with the current guidelines, and effectiveness in the maternal health and fitness parameters. Three databases were used to conduct literature searches. Thirty-one randomized control trials were selected for analysis. All studies followed a supervised group exercise program including aerobic, resistance, pelvic floor training, stretching, and relaxation sections. Group interventions during pregnancy improved health and fitness outcomes for the women and newborns, although some gaps were identified in the interventions. Multidisciplinary teams of exercise and health professionals should advise pregnant women that group exercise improves a wide range of health outcomes for them and their newborns.

Does Prenatal Physical Activity Affect the Occurrence of Postnatal Anxiety and Depression? Longitudinal Study

The aim of the foregoing study was to assess whether physical activity during pregnancy affects the occurrence of anxiety and depression during pregnancy, postpartum and 6 months following childbirth. This study tried to answer the following questions: How was the incidence of depression and anxiety different in the pre- and postpartum periods? What intensity level of physical activity protects against the symptoms of anxiety and depression? Does the time spent engaged in sedentary activities and MVPA affect the occurrence of depression and anxiety before and after childbirth? The study group under analysis consisted of 187 women aged 19–41 years. The research was conducted between April 2016 and November 2020. The study was divided into four stages: T0—qualification to participate in the study; T1—medical history acquisition, consisting of a short questionnaire and two long questionnaires (the Edinburgh Postnatal Depression Scale (EPDS) and General Anxiety Disorder-7 (GAD-7)), as well as an assessment of 7-day physical activity using Actigraph accelerometers during the pregnancy; T2—the completion of the EPDS and GAD-7 questionnaires after the birth; T3—the completion of the EPDS and GAD-7 questionnaire 6 months after giving birth. The obtained results were statistically processed in the Statistica 13.3 software package. A significance level of p < 0.05 was assumed. The highest percentage of depression occurred immediately after the delivery, followed by 6 months after delivery, and the smallest number of women suffered from depression before the birth (p < 0.001). The analysis of correlations of physical activity with anxiety symptoms did not show significant correlations. However, the situation is different in the case of depression symptoms. Women taking fewer steps before delivery showed a greater tendency to develop depressive symptoms before, immediately after and 6 months after the delivery (p < 0.001). Women who were less active (took fewer steps per day, spent less time in moderate-to-vigorous physical (MVPA) activities or spent more time being sedentary) showed symptoms of depression on the EPDS scale. It appeared that those with severe anxiety symptoms had the highest sedentary time scores before the delivery (p = 0.020). Reduced physical activity promotes the onset of postnatal depression, while being active reduces this risk. Interestingly, even light physical activity “protects” against the occurrence of depression and is better than sedentary activities. Such clear conclusions cannot be drawn in relation to anxiety symptoms. Sedentary behaviour may promote anxiety symptoms immediately after childbirth, but this study should be continued in order to confirm it during other time periods.

Physical exercise in pregnancy: benefits, risks and prescription

OBJECTIVES

The aim of this article is to provide a comprehensive literature review, gathering the strongest evidence about the risks and benefits and the prescription of physical exercise during pregnancy.

CONTENT

Regular physical exercise during pregnancy is associated with numerous benefits. In general women are not adequately advised on this matter. Along with their concerns regarding the potential associated risks, it contributes to the abandonment or refusal to start exercising during pregnancy. A systematic review was conducted in MEDLINE including articles considered to have the highest level of scientific evidence. Fifty-seven articles, including 32 meta-analysis, 9 systematic reviews and 16 randomized controlled trials were included in the final literature review.

SUMMARY

Exercise can help preventing relevant pregnancy related disorders, such as gestational diabetes, excessive gestational weight gain, hypertensive disorders, urinary incontinence, fetal macrosomia, lumbopelvic pain, anxiety and prenatal depression. Exercise is not related with an increased risk of maternal or perinatal adverse outcomes. Compliance with current guidelines is sufficient to achieve the main benefits, and exercise type and intensity should be based on woman's previous fitness level.

OUTLOOK

Exercise in pregnancy is safe for both mother and fetus, contributing to prevent pregnancy related disorders. Exercise type and intensity should be adapted to woman's previous fitness level, medical history and characteristics of the ongoing pregnancy.

Effect of physical activity on prevention of postpartum depression: A dose-response meta-analysis of 186,412 women

BACKGROUND

Physical activity (PA) is considered a favorable preventive intervention for postpartum depression (PPD), but evidence defining a corresponding dose-response relationship is lacking. This meta-analysis was conducted to assess the protective effects of PA on PPD and define a potential dose-response relationship between them.

METHODS

PubMed, Medline, Embase, and Web of Science were searched from 1968 to May 2022. Only randomized control trials (RCTs) and prospective studies were considered, and the PICOS tool was used to identify eligible articles based on the inclusion and exclusion criteria. Effect-size estimates were unified as odds ratio (OR) and 95% confidence interval (CI). We calculated the ORs and their 95% CI for studies that did not report them using the Practical Meta-Analysis Effect Size Calculator.

RESULTS

A total of 23 studies were eligible, including 14 RCTs and 9 prospective cohort studies. The overall analysis showed a statistically significant positive association between PA and PPD prevention (adjusted OR = 0.73; 95% CI: 0.61-0.87; P < 0.001). Subgroup analyses indicated that studies conducted in Europe demonstrated a significant correlation between PA and reduced PPD risk (adjusted OR = 0.85, 95% CI: 0.76-0.95, P = 0.004). Concerning PA type, sports activity was associated with relieving PPD symptoms (adjusted OR = 0.89, 95% CI: 0.78 to 1.00, P < 0.001), while work (adjusted OR = 1.05, 95% CI: 0.37-2.97, P = 0.065) and household activities (adjusted OR = 1.16, 95% CI: 0.89-1.52, P = 0.986) contributed to a greater risk of PPD. Our dose-response analysis revealed a reverse J-shaped trend between ascending PA duration and PPD incidence.

CONCLUSION

This meta-analysis identified PA as a potential intervention to reduce the risk of PPD. The dose-response analysis revealed that at least 90 min of PA per week could efficiently decrease the risk of PPD.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022335731.

Multidimensional analyses of the effect of exercise on women with depression: A meta-analysis

BACKGROUND

The proportion of women is higher than men in depression. This is mainly due to women's physiological regulation is different from men, especially in puberty, menstruation, pregnancy, menopause, among others. Therefore, treating depressive women is still a health challenge. Besides, recent studies of exercise therapy have a more outstanding performance in treating depression, especially in contrast to drug therapy and psychotherapy. Its main advantages are convenience, quickness, no side effects, real-time, and long-term effectiveness.

OBJECTIVE

The aim of this study was to systematically review the clinical efficacy of exercise on women with depressive symptoms.

METHODS

Searching PubMed, The Cochrane Library, and Embase databases to collect randomized controlled trials about exercise in the treatment of depressive women. After literature screening, data extraction, and literature quality evaluation, the meta-analysis of acquirement data was performed with RevMan5.3 software.

RESULTS

A total of 2294 patients were included in 25 different articles totally. Meta-analysis shows that compared with the control group, exercise could relieve female depression (standard mean difference [95% confidence interval, CI] = -0.64 [-0.89 to -0.39], Z = 4.99, P < .001). Subgroup analysis shows that different types of exercise have significant effects in improving depression symptoms. Exercise therapy has better effect on depressive patients induced by physiology or disease than ordinary depressive patients.

CONCLUSION

Exercise can significantly improve depressive symptoms in women.

Effect of aerobic water exercise during pregnancy on epidural use and pain: A multi-centre, randomised, controlled trial

OBJECTIVE

The physical and psychological benefits of exercise during pregnancy are well established. However, the impact of exercise on pain during labour and the use of epidural analgesia has been less explored. The main aim of this study was to analyse the effectiveness and safety of moderate aerobic water exercise by pregnant women on the subsequent use of epidural analgesia during labour, induction of labour, mode of delivery, and pain perception.

DESIGN

A multi-centre, parallel, randomised, evaluator blinded, controlled trial in a primary care setting.

SETTING

Primary care centres in a health district of a tertiary obstetric metropolitan hospital in Mallorca, Spain.

PARTICIPANTS

Pregnant women (14 to 20 weeks' gestation) who had low risk of complications.

METHODS

Three hundred and twenty pregnant women were randomly assigned to two groups: women who practiced moderate aquatic aerobic exercise with usual antenatal care, and those who received usual prenatal care alone. The gynaecologist, anaesthesiologist and midwife who assisted the women during labour were blinded to group allocations. Principal outcome: use of epidural analgesia during labour. Other outcomes: use of epidural analgesia before 6 cm cervical dilation, labour pain, type of delivery, time of active labour, episiotomy or perineal tear, and induction of labour.

RESULTS

The exercise program did not affect the use of epidural analgesia (OR = 0.79, 95% CI = 0.44 to 1.40), vaginal delivery (OR = 1.35, 95% CI = 0.73 to 2.41), or caesarean section (OR = 0.94, 95% CI = 0.47 to 1.89). However, women in the exercise group reported less pain during labour (mean difference: -0.6, 95% CI = -1.11 to -0.09). The two groups (moderate aquatic aerobic exercise versus usual antenatal care) showed no significant differences in maternal or newborn adverse events.

CONCLUSION

Aquatic aerobic exercise during pregnancy had no effect on the use of epidural analgesia during labour, whereas pain perception was lower after aquatic exercise compared to usual care in pregnancy. The intervention was safe for pregnant women and their newborns.

Associations between daily screen time and sleep in a racially and socioeconomically diverse sample of US infants: a prospective cohort study

OBJECTIVE

To determine the associations between screen media use and sleep throughout infancy (3-12 months).

DESIGN

Prospective Nurture birth cohort.

SETTING

North Carolina, USA, 2013-2015.

PARTICIPANTS

Women enrolled in their second to third trimester, completed a phone interview after birth, and completed home visits at 3, 6, 9 and 12 months post partum.

PRIMARY AND SECONDARY OUTCOME MEASURES

Women reported the usual hours their infants slept during the day and night and their infants' usual use of five screen media activities at 3, 6, 9 and 12 months post partum. Adjusted mixed-effects regression analyses modelled the associations between infant screen time and sleep outcomes while disaggregating the between-infant and within-infant effects.

RESULTS

Among 558 mother-infant dyads, 374 (67.0%) infants were black and 304 (54.5%) households earned <$20 000 per year. Half (254, 50.2%) of the infants engaged with screens at 3 months of age, while 326 (72.9%) engaged at 12 months. The median value of the average daily screen time over the study period was 50 (IQR: 10-141) min. Infant screen time was inversely associated with night-time sleep duration only when considering between-infant effects (adjusted beta: -2.9; 95% CI -5.9 to 0.0; p=0.054 for log-transformed screen time). Effects were stronger for television+DVD viewing specifically (adjusted beta: -5.2; 95% CI -9.1 to -1.4; p<0.01 for log-transformed television+DVD time). For example, an infant who averaged 1 hour of television+DVD viewing over the study period slept, on average, 9.20 (95% CI 9.02 to 9.37) hours per night by 12 months compared with 9.60 (95% CI 9.41 to 9.80) hours per night for an infant with no screen time over the study period. There were no significant within-infant effects between screen time and night-time sleep, and screen time was not associated with daytime sleep or night-time awakenings.

CONCLUSIONS

Screen time during infancy was inversely associated with night-time sleep duration; however, causal associations remain uncertain.

TRIAL REGISTRATION NUMBER

NCT01788644.

Effectiveness of Moderate-Intensity Aerobic Water Exercise during Pregnancy on Quality of Life and Postpartum Depression: A Multi-Center, Randomized Controlled Trial

Background: The global prevalence of postpartum depression is about 20%. This disease has serious consequences for women, their infants, and their families. The aim of this randomized clinical trial was to analyze the effectiveness and safety of a moderate-intensity aerobic water exercise program on postpartum depression, sleep problems, and quality of life in women at one month after delivery. Methods: This was a multi-center, parallel, randomized, evaluator blinded, controlled trial in a primary care setting. Pregnant women (14–20 weeks gestational age) who had low risk of complications and were from five primary care centers in the area covered by the obstetrics unit of Son Llatzer Hospital (Mallorca, Spain) were invited to participate. A total of 320 pregnant women were randomly assigned to two groups, an intervention group (moderate aquatic aerobic exercise) and a control group (usual prenatal care). One month after birth, sleep quality (MOS sleep), quality of life (EQ-5D), and presence of anxiety or depression (EPDS) were recorded. Findings: Women in the intervention group were less likely to report anxiety or depression on the EQ5D (11.5% vs. 22.7%; p < 0.05) and had a lower mean EPDS score (6.1 ± 1.9 vs. 6.8 ± 2.4, p < 0.010). The two groups had no significant differences in other outcomes, maternal adverse events, and indicators of the newborn status. Conclusion: Moderate-intensity aquatic exercise during pregnancy decreased postpartum anxiety and depressive symptoms in mothers and was safe for mothers and their newborns.

Universal and Selective Interventions to Prevent Poor Mental Health Outcomes in Young People: Systematic Review and Meta-analysis

BACKGROUND

Much is not known about the efficacy of interventions to prevent poor mental health outcomes in young people by targeting either the general population (universal prevention) or asymptomatic individuals with high risk of developing a mental disorder (selective prevention).

METHODS

We conducted a PRISMA/MOOSE-compliant systematic review and meta-analysis of Web of Science to identify studies comparing post-test efficacy (effect size [ES]; Hedges' g) of universal or selective interventions for poor mental health outcomes versus control groups, in samples with mean age <35 years (PROSPERO: CRD42018102143). Measurements included random-effects models, I2 statistics, publication bias, meta-regression, sensitivity analyses, quality assessments, number needed to treat, and population impact number.

RESULTS

295 articles (447,206 individuals; mean age = 15.4) appraising 17 poor mental health outcomes were included. Compared to control conditions, universal and selective interventions improved (in descending magnitude order) interpersonal violence, general psychological distress, alcohol use, anxiety features, affective symptoms, other emotional and behavioral problems, consequences of alcohol use, posttraumatic stress disorder features, conduct problems, tobacco use, externalizing behaviors, attention-deficit/hyperactivity disorder features, and cannabis use, but not eating-related problems, impaired functioning, internalizing behavior, or sleep-related problems. Psychoeducation had the highest effect size for ADHD features, affective symptoms, and interpersonal violence. Psychotherapy had the highest effect size for anxiety features.

CONCLUSION

Universal and selective preventive interventions for young individuals are feasible and can improve poor mental health outcomes.

The Association of Physical (in)Activity with Mental Health. Differences between Elder and Younger Populations: A Systematic Literature Review

Background: Physical activity is associated with mental health benefits. This systematic literature review summarises extant evidence regarding this association, and explores differences observed between populations over sixty-five years and those younger than sixty-five. Methods: We reviewed articles and grey literature reporting at least one measure of physical activity and at least one mental disorder, in people of all ages. Results: From the 2263 abstracts screened, we extracted twenty-seven articles and synthesized the evidence regarding the association between physical (in)activity and one or more mental health outcome measures. We confirmed that physical activity is beneficial for mental health. However, the evidence was mostly based on self-reported physical activity and mental health measures. Only one study compared younger and elder populations, finding that increasing the level of physical activity improved mental health for middle aged and elder women (no association was observed for younger women). Studies including only the elderly found a restricted mental health improvement due to physical activity. Conclusions: We found inverse associations between levels of physical activity and mental health problems. However, more evidence regarding the effect of ageing when measuring associations between physical activity and mental health is needed. By doing so, prescription of physical activity could be more accurately targeted.

Feasibility of an Intervention Study to Support Families When Their Loved One Has Life-sustaining Therapy Withdrawn

This investigation addressed family member perceptions of preparation for withdrawal of life-sustaining treatment in the intensive care unit. These families are at a high risk for psychosocial and physical sequelae. The quantitative results of this mixed methods study are reported. A control group received usual care and an educational booklet component of the intervention. The experimental group received the above plus exposure to comfort cart items and additional psychological support. Twenty-eight family members enrolled over a 13-month period. Sixty-one percent (10 intervention, 7 control) completed the follow-up. Fourteen family members (82%) recalled the booklet. Some family members reported moderate to severe depression (12.5%), anxiety (12.5%), and stress (12.6%). Satisfaction with care (83.7%-85.2%) and family member well-being (44.1) were within the norm. Short Form-36 physical component score was higher than the norm, and the mental component score was lower than the norm. This study demonstrated feasibility and acceptability of the interventions and follow-up questionnaires when families make the difficult decision to withdraw treatment. Strategies are suggested to strengthen statistical power.

Significance of gastrointestinal tract in the therapeutic mechanisms of exercise in depression: Synchronism between brain and intestine through GBA

Researchers have made considerable progress in elucidating psychological and exercise correlates of major depressive disorder (MDD). However, as the largest immune organ, far less is known about the role of gastrointestinal (GI) tract in the therapeutic mechanisms of exercise in MDD. In addition to the sites of the digestive tract that absorb nutrients, the GI tract also serves as a protective barrier against organisms. Inflammation and other consequences caused by disrupted GI barrier integrity are considered to be one of the mechanisms of depression, and the gut-brain axis (GBA) plays a critical role in this process. In this work, we observed the depression-like behaviors, intestinal barrier, central and peripheral inflammation, and related neurotransmitters through exercise intervention in the chronic unpredictable mild stress (CUMS) model, aiming to clarify the mechanisms of exercise to improve depression through GBA. Our results revealed that, following increased expressions of pro-inflammatory factors in intestine of CUMS mice, the levels of pro-inflammatory factors were all significantly raised in serum and brain simultaneously. Further, glial cells were activated in visceral nervous system and its related brain regions at the same time, accompanied by lower expression of occludin in CUMS mice. Importantly, our findings provide the first evidence that eight weeks of running exercise effectively inhibited neuro-immune interactions along gut-brain-axis and contributed obvious improvement of intestinal epithelial barrier (IEB). Finally, multivariate analysis putatively highlighted the role of exercise-induced IEB protection on depression treatment. We hope that our findings could warrant further study of therapeutic mechanisms of exercise in depression, specifically in disentangling the roles of intestinal function and IEB protection, and for developing more targeted clinical depression interventions.

Effects of physical exercise during pregnancy on mothers' and neonates' health: a protocol for an umbrella review of systematic reviews and meta-analysis of randomised controlled trials

INTRODUCTION

A growing interest has emerged on the effects of exercise during gestation. Several systematic reviews and meta-analyses have shown that prenatal exercise could reduce the mothers' risk for some disorders. Despite this, evidence regarding the risk of caesarean section, birth weight or Apgar score at delivery is still controversial. Furthermore, practitioners are reluctant to recommend exercise to pregnant women suffering from some disorders, such as hypertension, pre-eclampsia or pregnant women with obesity. Moreover, the scarcity of studies addressing the risks and benefits of exercise at higher intensity prevent practitioners from recommending it at higher dosages. Umbrella reviews represent an appropriate design to elucidate the reasons behind the contradictory findings of previous systematic reviews.

METHODS

This protocol was developed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols and the Cochrane Collaboration Handbook. Medline, EMBASE, Web of Science, Cochrane database of systematic reviews, Epistemonikos, Prospero register and SPORTDiscuss databases will be searched to identify systematic reviews, meta-analyses and randomised controlled trials that examine the effect of exercise on pregnancy outcomes from inception to August 2019. Searches will be conducted from September to November 2019.

STATISTICAL ANALYSIS

Methodological quality will be evaluated using the AMSTAR 2 tool. The certainty of evidence and strength of recommendations for meta-analyses will be assessed by the Grading of Recommendations Assessment, Development and Evaluation framework. The summary effect sizes will be calculated through the use of random-effects and fixed-effects models. Heterogeneity among studies will be assessed using the I2 statistic, and evidence of excess significance bias and evidence of small study effects will also be evaluated.

ETHICS AND DISSEMINATION

Ethical approval will not be needed for this review protocol. The results will be disseminated to academic audiences by peer-reviewed publications. Furthermore, results will be disseminated to clinical audiences through professionals' associations and social networks, and may influence guidelines developers in order to improve outcomes in mothers and offspring.

PROSPERO REGISTRATION NUMBER

CRD42019123410.

Physical Activity During Pregnancy is Associated with Improved Breastfeeding Outcomes: A Prospective Cohort Study

Physical activity is important for health, but little is known about associations between physical activity during pregnancy and breastfeeding. The aim of this study was to investigate any association between antenatal physical activity and breastfeeding duration. A prospective cohort of 2030 Vietnamese women, recruited between 24 and 28 week-gestation was followed up to twelve months postpartum. Physical activity was determined using the pregnancy physical activity questionnaire at baseline interview. Data was available for 1715 participants at 12 months, a 15.5% attrition rate. At 12 months 71.8% of mothers were still breastfeeding. A total of 20.9% women met physical activity targets and those mothers undertaking higher levels of physical activity had a lower risk of breastfeeding cessation by twelve months [hazard ratios HR = 0.59 (95% CI 0.47–0.74), p < 0.001, and HR = 0.74 (0.60–0.92), p = 0.006; respectively] when compared to the lowest tertile. Similarly, women with increased levels of physical activity have higher rates of breastfeeding at twelve months, compared to the lowest level [odds ratio OR = 1.71 (95% CI 1.29–2.25) and 1.38 (1.06–1.79)]. Higher levels of physical activity by pregnant women are associated with improved breastfeeding outcomes.