Physical activity during pregnancy is associated with a lower prevalence of gestational diabetes mellitus in Vietnam

Evaluation of the mediating role of physical activity self-efficacy in the relationship between knowledge, social support, and physical activity in pregnant women with a high risk for gestational diabetes

OBJECTIVE

This study aimed to examine the associations between knowledge, social support, and physical activity and explore the mediating role of physical activity self-efficacy in pregnant women with a high risk for gestational diabetes mellitus (GDM).

METHODS

A cross-sectional study was conducted in Guangzhou, China, from July 2022 to May 2023. Five hundred thirty-seven pregnant women with a high risk for GDM completed the Pregnancy Physical Activity Questionnaire, Pregnancy Physical Activity Self-Efficacy Scale, Pregnancy Physical Activity Knowledge Scale, Physical Activity Social Support Scale, and a socio-demographic data sheet. The mediation effect was tested using structural equation modeling (SEM) and the bootstrap method.

RESULTS

42.5% of pregnant women did not meet the current physical activity guidelines. Physical activity self-efficacy (β, 0.16; P<0.001), knowledge (β, 0.15; P = 0.001), social support (β, 0.10; P = 0.019), education, and type of conception were predictors of physical activity. The SEM results found that physical activity self-efficacy mediated the association between physical activity and knowledge (β, 0.24; 95% CI, 0.17 to 0.32) and social support (β, 0.30; 95% CI, 0.20 to 0.39). The data fit of the model (RMSEA = 0.067, CFI = 0.851, TLI = 0.828, χ2/df = 3.440) was acceptable.

CONCLUSION

This study found that the prevalence of being physically inactive was high in pregnant women with a high risk for GDM. The present study's findings suggested that healthcare providers should try to enhance physical activity self-efficacy, knowledge, and social support of pregnant women with a high risk for GDM to improve their physical activity with a focus on physical activity self-efficacy.

Association between physical activity and sedentary behavior and gestational diabetes mellitus: a Mendelian randomization analysis

Introduction

The evidence of association between physical activity (PA), sedentary behavior (SB) and gestational diabetes mellitus (GDM) remains controversial in observational studies, this study aimed to generate new hypotheses between PA, SB and GDM.

Methods

Our study performed Mendelian randomization (MR) analysis to explore the effects of three types of PA (moderate physical activity (MPA), moderate to vigorous physical activity (MVPA), accelerometer-based physical activity (ABPA)), three types of SB (television watching (TV), leisure computer use (PC), driving (DR)) on GDM and the mediating effect of body mass index (BMI). The inverse variance weighted method was used for the major analysis.

Results

In univariate MR analysis, we found that genetically predicted TV and PC among SB were associated with GDM (OR = 1.61, 95%CI 1.21-2.14, P = 0.001; OR = 0.71, 95%CI 0.51-0.98, P = 0.037), whereas DR and MP were not (OR = 1.68, 95%CI 0.21-13.3, P = 0.623; OR = 1.20, 95%CI 0.87-1.65, P = 0.271). However, no association was found between physical activity and GDM: MPA (OR = 0.40, 95%CI 0.08-2.06, P = 0.273), MVPA (OR = 0.96, 95%CI 0.58-1.57, P = 0.861), and ABPA (OR = 0.99, 95%CI 0.90-1.09, P = 0.838). Multivariate MR analysis found DM (OR = 1.64, 95%CI 1.13-2.36, P = 0.008) and that BMI was a mediating factor with a 62% mediating effect.

Conclusions

This study proposes a new hypothesis for the association between TV and GDM, which is mediated by BMI, providing evidence for reducing the risk of GDM during pregnancy by reducing television watching time.

Association of overweight and obesity with gestational diabetes mellitus among pregnant women attending antenatal care clinics in Addis Ababa, Ethiopia: a case-control study

OBJECTIVE

Maternal obesity and gestational diabetes mellitus (GDM) are becoming major public health concerns in developing countries. Understanding their relationship can help in developing contextually appropriate and targeted prevention strategies and interventions to improve maternal and infant health outcomes. This study aimed to determine the association of maternal overweight and obesity with GDM among pregnant women in Ethiopia.

DESIGN

Case-control study.

SETTING

The study was conducted in selected public hospitals in Addis Ababa, Ethiopia, from 10 March to 30 July 2020.

PARTICIPANTS

159 pregnant women with GDM (cases) and 477 pregnant women without GDM (controls).

OUTCOME MEASURES AND DATA ANALYSIS

Screening and diagnosis of GDM in pregnant women was done by a physician using the 2013 WHO criteria of 1-hour plasma glucose level of 10.0 mmol/L (180 mg/dL) or 2-hour plasma glucose level of 8.5-11.0 mmol/L (153-199 mg/dL) following a 75 g oral glucose load. Overweight and obesity were measured using mid-upper arm circumference (MUAC). Binary logistic regression with bivariate and multivariable models was done to measure the association of overweight and obesity with GDM. Adjusted ORs (AORs) with a 95% CI were computed, and statistical significance was determined at a value of p=0.05.

RESULTS

GDM was associated with obesity (MUAC≥31) (AOR 2.80; 95% CI 1.58 to 4.90), previous history of caesarean section (AOR 1.91; 95% CI 1.14 to 3.21) and inadequate Minimum Dietary Diversification Score <5 (AOR 3.55; 95% CI 2.15 to 5.86). The AOR for overweight (MUAC≥28 and MUAC<31) was 1.51 (95% CI 0.71 to 3.21). The odds of developing GDM were 72% lower in pregnant women who were engaging in high-level physical activity (AOR 0.28; 95% CI 0.12 to 0.67).

CONCLUSION

Obesity, but not overweight, was significantly associated with the development of GDM. Screening for GDM is recommended for pregnant women with obesity (MUAC≥31) for targeted intervention. Antenatal care providers should provide information for women of childbearing age on maintaining a healthy body weight before and in-between pregnancies and the need for healthy, diversified food and high-level physical activity.

Physical activity during pregnancy and the risk of gestational diabetes mellitus: a systematic review and dose-response meta-analysis

BACKGROUND

Previous research has indicated the inverse association between physical activity (PA) and gestational diabetes mellitus (GDM). However, the dose-response relationship currently remains undetermined. This study aims to explore the dose-response relationship between PA during the first and second trimesters of pregnancy and GDM risk.

METHODS

Studies on the relationship between PA during pregnancy and GDM risk published before April 25, 2023, were searched for in six databases. According to the inclusion and exclusion criteria, all literature was screened for eligibility. The Newcastle-Ottawa Scale (NOS) was used to assess risk of bias. Publication bias was examined using funnel plots, Begg's and Egger's tests, as well as trim-and-fill analysis. We harmonized exposure estimates of PA during pregnancy to the common unit of the metabolic equivalent of task (MET)-h/week. Restricted cubic splines were used to model the dose-response relationship. The criteria from the World Cancer Research Fund were used to assess the certainty of evidence across outcomes. All analyses were performed using Stata 15.1.

RESULTS

The results indicated that in contrast with the lowest level of PA, promoting the highest PA level lowers the risk of GDM by 36% (RR = 0.64, 95%CI: 0.53 ~ 0.78). We found a curvilinear dose-response association between PA during the first trimester and incident GDM (Pnonlinearity = 0.012). Compared to inactive pregnant women, for those who achieved the guidelines-suggested minimum level (10 MET-h/week) of PA during the first trimester, the GDM risk was decreased by 13% (RR = 0.87, 95%CI: 0.79 ~ 0.96). A linear relationship was found between PA during the second trimester and the GDM risk (Pnonlinearity = 0.276). The results with a restricted cubic spline model suggested that pregnant women who accumulate 10 MET-h/week have a 1% reduced risk of GDM compared to completely inactive individuals. Twice (20 MET-h/week) or a higher amount of PA (50 MET-h/week) contributed to further reductions in GDM risk.

CONCLUSION

There is a dose-response relationship between higher levels of PA in both the first and second trimesters and reduced risk of GDM; the relationship is stronger in the first trimester. Increasing PA during pregnancy can prevent the development of GDM.

PROSPERO REGISTRATION NUMBER

CRD42023420564.

Determination of Pregnant Women's Physical Activity and Exercise Status During Pregnancy and Affecting Factors

Objective: This study aims to determine pregnant women's physical activity and exercise status during pregnancy and affecting factors. Methods: The research was conducted in a cross-sectional design with 220 low-risk pregnant women who were in their third trimester between March 3 and June 29 2022 at Training and Research Hospital. Research data were collected by face-to-face interview method using the forms developed by the authors. Results: It was seen that among the pregnant women who participated in the research, 35.9% exercised regularly before pregnancy and 25.9% regularly exercised during pregnancy. The most common exercises performed during pregnancy were walking and pilates. The assessment of the physical activity of pregnant women revealed that 80.5% were sedentary. The rate of exercising during pregnancy was 4.04 times (aOR 4.04, 95% CI 1.33-12.27) higher in women with planned pregnancies compared to unplanned pregnancies and 30.57 times higher in women who exercised regularly before pregnancy compared to those who did not do so (aOR 30.57, 95% CI 12.53-74.55). Likewise, compared to those who were obese during pregnancy, non-obese ones were 0.36 times more physically active (aOR 0.36, 95% CI 0.16-0.84). Similarly, it was established that women who exercised before pregnancy were 10.51 times more physically active than those who did not (aOR 10.51, 95% CI 4.60-24.02). Conclusion: In the research, it was concluded that the rates of exercising and being physically active during pregnancy were low, that planned pregnancy and regular exercise before pregnancy increased exercise behavior during pregnancy, and that obesity decreases physical activity.

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.

Physical inactivity in early pregnancy and the determinants in an urban city setting of Kuala Lumpur, Malaysia

BACKGROUND

Physical inactivity in pregnancy has been associated with excessive gestational weight gain, hypertensive disorders, gestational diabetes mellitus and postpartum depression. Despite these risks, physical inactivity level remains high especially in higher income countries. The prevalence of physical inactivity among women in Malaysia aged ≥16 years was 28.2% in 2019 exceeding men by 6.1%. However, little is known regarding the subpopulation of pregnant women especially in Kuala Lumpur which is the most urbanized and highly populated city in Malaysia. Therefore, the aim of this study is to measure the physical inactivity prevalence among first trimester pregnant women in Kuala Lumpur and to identify its determining factors.

METHODS

This was a cross-sectional study in which 339 first trimester pregnant women were sampled from 13 maternal and child health clinics located in all four parliament districts of Kuala Lumpur. Self-administered questionnaires which contained the Malay version of the pregnancy physical activity questionnaire (PPAQ) were used. Descriptive analysis was conducted to determine the physical inactivity prevalence followed by simple and multiple logistic regression to identify the determinants of physical inactivity with significant level of 5%.

RESULTS

The prevalence of physical inactivity was 38.3%. The highest activity was seen in the household activity domain, despite only 24.8% of the respondents were housewives/unemployed. There was little to no participation observed in the vigorous intensity category. The determinants of physical inactivity were primigravida (aOR 3.54 95% CI 1.40, 8.97), education level (aOR 3.77 95% CI 1.35, 10.52) and body mass index (aOR 0.88 95% CI 0.80, 0.97) which explained 22.6% variation of physical inactivity in the final adjusted model.

CONCLUSION

The prevalence of physical inactivity among first trimester pregnant mothers in this study was 38.3%, and the highest activity was seen in the household category. Health education on physical activity in pregnancy should be focused on those who are primigravida and have no tertiary education. The educational content should be updated and tailored to current pandemic situation where self-isolation is the new norm, by advocating for home-based, moderate to vigorous intensity physical activities.

The Influence of Practising Physical Activity on the Prevention and Treatment of Gestational Diabetes: A Systematic Review

BACKGROUND

During pregnancy, maintaining an inadequate lifestyle (bad eating habits, stress, consumption of toxic substances, etc.) generates complications such as pre-eclampsia, overweight, lumbar pain and Gestational Diabetes.

OBJECTIVE

This review was carried out with the objective to determine the influence of practising physical activity on the prevention and treatment of Gestational Diabetes; and to evaluate the efficacy of interventions based on therapeutic exercise in the management of such diseases.

METHOD

A systematic review of the publications of the last five years in Medline, Pubmed, Web of Science and Cinahl databases was conducting with the terms Exercise and Gestational Diabetes.

RESULTS

25 articles were found, 9 were observational studies that analysed physical activity habits through questionnaires, and other 16 applied an intervention. With respect to the frequency of the sessions, most of these studies applied their interventions three times per week, with all of them obtaining positive results. Regarding intensity, all the studies that referred to it concluded that it must be at least moderate, highlighting that, at all times, the limitations of pregnant women must be taken into account.

CONCLUSION

Both for the prevention and treatment of this disease, the physical activity must be performed for a minimum of three times per week, at least in moderate intensity, and must be based on aerobic, resistance and strength exercises.

Sedentary behaviors and gestational diabetes mellitus: A systematic review

AIM

Sedentary behaviors are activities that expend less energy than 1.5 metabolic equivalents, such as watching TV, sitting. We aim to systematically review the evidence to determine the association of sedentary behavior (SB) with the risk of gestational diabetes mellitus, and the associations of SB with health outcomes in pregnant women with gestational diabetes mellitus (GDM) and women at high risk of gestational diabetes mellitus.

METHODS

Two researchers independently performed a literature search using PubMed, Medline, EMBASE, CINAHL, the Cochrane Library, the Rehabilitation and Sports Medicine Source, and the Sedentary Behavior Research Database for studies published up to January 27, 2021. Randomized controlled trials, quasi-experimental studies, and observational studies were screened and selected if SB was assessed in the context of gestational diabetes mellitus. Two reviewers extracted the relevant information and independently assessed the included studies for quality and bias.

RESULTS

Eighteen studies were included, involving 60 804 patients, and the timeline of the original study included was from 2006 to 2021. Our review showed that SB before pregnancy was not associated with the risk of gestational diabetes mellitus, while SB during pregnancy was uncertain about the risk of gestational diabetes mellitus. In addition, there were significant associations between SB time and metabolic outcomes. In addition, SB may cause some adverse maternal and fetal outcomes.

CONCLUSION

SB is likely to be the intermediary variable between occurrence of GDM and adverse maternal and infant outcome, rather than a direct influencing factor. Limited by the quantity and quality of included studies, the above conclusions need to be verified by more high-quality studies.

Physical Activity Advice and Counselling by Healthcare Providers: A Scoping Review

Background: Despite scientific evidence on prenatal physical activity and exercise, synthesized evidence is lacking on the provision of prenatal physical activity and exercise advice and counselling by prenatal healthcare providers. The scoping review seeks to fill this gap by synthesizing available literature on the provision of prenatal physical activity and exercise advice and counselling by prenatal healthcare providers to women during antenatal visits. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) search framework for scoping reviews was applied to retrieve original research articles on the prenatal physical activity and exercise practices of healthcare providers with pregnant women, published between 2010-2020, and available in English. The search databases included Google Scholar, PubMed, Science Direct, Scopus, EMBASE, The Cumulative Index for Nursing and Allied Health Literature (CINAHL), BIOMED Central, Medline and African Journal Online. Studies that fulfilled the eligibility criteria were retrieved for analysis. Results: Out of the 82 articles that were retrieved for review, 13 met the eligibility criteria. Seven of the articles were quantitative, four qualitative, one mixed-method and one controlled, non-randomised study, respectively. Three themes emerged as major findings. Healthcare providers affirmed their responsibility in providing prenatal physical activity advice and counselling to pregnant women; however, they seldom or rarely performed this role. Major barriers to prenatal physical activity and exercise included insufficient time, lack of knowledge and skills, inadequate or insufficient training, and lack of resources. Conclusion: This review highlights salient features constraining the uptake of prenatal physical activity and exercise advice/counselling by prenatal healthcare providers in both community and clinical settings. Prenatal physical activity advice and counselling are key components to the promotion of physical activity adherence during and post-partum pregnancy; this requires adequate knowledge of physical activity prescriptions and recommendations, which are personalised and contextual to environment. Research is needed to examine the prenatal physical activity advice and counselling from prenatal healthcare providers on issues hindering effective delivery of the aforementioned in the context of promoting prenatal physical activity in clinical or community settings.

Gestational Diabetes Mellitus in Southeast Asia: A Scoping Review

A rapid increase in the prevalence of gestational diabetes mellitus (GDM) has been associated with various factors such as urbanization, lifestyle changes, adverse hyperglycemic intrauterine environment, and the resulting epigenetic changes. Despite this, the burden of GDM has not been well-assessed in Southeast Asia. We comprehensively reviewed published Southeast Asian studies to identify the current research trend in GDM in this region. Joanna Briggs Institute's methodology was used to guide the scoping review. The synthesis of literature findings demonstrates almost comparable clinical evidence in terms of risk factors and complications, challenges presented in diagnosing GDM, and its disease management, given the similarities of the underlying population characteristics in Southeast Asia. Evidence suggests that a large proportion of GDM risk in women may be preventable by lifestyle modifications. However, the GDM burden across countries is expected to rise, given the heterogeneity in screening approaches and diagnostic criteria, mainly influenced by economic status. There is an urgent need for concerted efforts by government and nongovernmental sectors to implement national programs to prevent, manage, and monitor the disease.

Movement Behavior during Pregnancy and Adverse Maternal-Fetal Outcomes in Women with Gestational Diabetes: A Pilot Case-Control Study

Gestational diabetes mellitus (GDM) is a major complication in pregnancy. GDM is associated with a higher risk for adverse maternal–fetal outcomes. Associations between movement behavior, including physical activity (PA) and sedentary behavior (SB), and maternal–fetal outcomes are still unclear. The objective of this study was to investigate associations between movement behavior and adverse maternal–fetal outcomes in women with GDM. A total of 68 women with GDM (20–35 weeks, 32.1 ± 5.8 years) were included in this pilot case-control study. The cases were defined by the presence of an adverse composite maternal–fetal outcome (preterm birth, newborn large for gestational age, and neonatal hypoglycemia). Controls were defined as no adverse maternal–fetal outcome. PA intensities and domains, steps/day (pedometer), and SB were analyzed. A total of 35.3% of participants showed adverse maternal–fetal outcomes (n = 24). The controls showed a higher moderate-intensity PA level than the cases (7.5, 95%CI 3.6–22.9 vs. 3.1, 95%CI 0.4–10.3 MET-h/week; p = 0.04). The moderate-intensity PA level was associated with a lower risk for adverse maternal–fetal outcomes (OR 0.21, 95%CI 0.05–0.91). No significant associations were observed for other PA and SB measures (p > 0.05). In conclusion, moderate-intensity PA during pregnancy seems to have a protective role against adverse maternal–fetal outcomes in women with GDM.

Physical Exercise is Associated with Glycemic Control among Women with Gestational Diabetes Mellitus: Findings from a Prospective Cohort in Shanghai, China

OBJECTIVE

Physical exercise during pregnancy is beneficial to women with gestational diabetes mellitus (GDM), but evidence on the association between physical exercise and glycemic control among women with GDM is limited in China. We conducted this study to understand the total exercise times, the percentage of abnormal plasma glucose (PG), and to explore if longer physical exercise is positively associated with a lower percentage of abnormal PG among GDM women.

METHODS

During 2019 and 2020, we established a prospective cohort with 1,050 GDM women recruited. GDM was confirmed by a diagnostic 75g OGTT, and plasma glucose in over 10 hours overnight fasting and 2-hour after breakfast was implemented during a routine antenatal checkup. Information for demographic features and physical exercises among GDM women were collected by questionnaire interviews, and abnormal PG percentage was calculated as abnormal PG times divided by total PG test times.

RESULTS

Among 1,050 GDM women, the percentage of exercise times <150 minutes/week, <30 minutes/day and <60 minutes/day was 17.33%, 26.57%, and 54.10%, respectively. The median percentage of abnormal PG was 40% (IQR=20-70%). GDM women with less exercise had a higher abnormal PG percentage (y=0.0049x²-1.20x+88.96), ORs for women with exercise <150 minutes/week were 3.78 (95% CI=1.33-8.25), 6.97 (3.45-14.07), and 6.39 (3.61-11.33) compared with ≥ 150 minutes/week, and ORs for women with exercise <60 minutes/day were 4.62 (2.71-8.14), 3.58 (2.60-4.93), and 7.28 (4.31-12.30) compared with ≥60 minutes/day in groups divided by quartiles of P₂₅, P₅₀ and P₇₅, respectively.

CONCLUSION

This study indicated high physical exercise times and abnormal PG percentage among women with GDM in Shanghai, China. GDM women with more exercise times had a lower percentage of abnormal PG, especially when exercise times were ≥60 minutes/day, and supplementary treatments should be provided for women with over 70% abnormal plasma glucose.

Physical activity and exercise during pregnancy in Africa: a review of the literature

BACKGROUND

Pregnancy is an important phase in a woman's life, with health status at this stage affecting both the woman and her child's life. Global evidence suggests that many women engage in low levels of physical activity (PA) and exercise during pregnancy despite its beneficial effects. This is particularly the case in Africa.

METHODS

This article reviews the literature on levels of PA and exercise among pregnant women in Africa, highlighting the level of PA or exercise participation during pregnancy in Africa, including types of PA, factors affecting PA, beliefs about and benefits of prenatal activity, advice or counselling on PA during pregnancy in Africa, and PA interventions proposed to promote the uptake of prenatal PA. Electronic search databases used were Google Scholar, Science Direct, Scopus, EMBASE, ERIC, Medline, Web of Science, EBSCOhost, PubMed, BIOMED Central, and African Journal Online. The basic search terms were: 'Physical activity', 'Exercise', 'Pregnancy', 'Pregnant women' and 'Africa'. A total of 40 references were found. On the basis of an analysis of titles, abstracts and the language of publication (other than English), 11 articles were rejected, and 29 articles were fully read, although two had to be rejected due to a lack of access to the full version. Finally, 27 references were included in the review.

RESULTS

Few studies exist on PA during pregnancy in Africa. The limited data available suggests that, compared to the Western world, pregnant women in Africa do not adhere to the recommendations for PA during pregnancy. Levels of participation in PA during pregnancy are low and decline as the pregnancy progresses. The majority of the studies used direct, objective measures to assess PA during pregnancy. Personal and environmental factors such as lack of time, lack of knowledge, inadequate information from healthcare providers, feelings of tiredness and an absence of social support constituted the main barriers to PA during pregnancy. The types of PA participation among pregnant women varied across studies and geographical settings.

CONCLUSIONS

While published data is limited, it seems clear that the participation of pregnant women in PA during pregnancy in Africa is low and declines with advancing pregnancy. There is a need for more studies to examine the dynamics of PA during pregnancy in Africa to guide contextual interventions to improve and promote maternal health on the continent.

High physical activity and high sedentary behavior increased the risk of gestational diabetes mellitus among women with excessive gestational weight gain: a prospective study

Background

Although physical activity (PA) in pregnancy benefits most women, not much is known about pregnancy-related changes in PA and its association with gestational diabetes mellitus (GDM) risk. The aim of this study was to identify the trajectory of PA during pregnancy and possible associations with the risk of GDM.

Methods

This was a prospective cohort study of 452 pregnant women recruited from 3 health clinics in a southern state of Peninsular Malaysia. PA levels at the first, second, and third trimester were assessed using the Pregnancy Physical Activity Questionnaire. GDM was diagnosed at 24–28 weeks of gestation following the Ministry of Health Malaysia criteria. Group-based trajectory modeling was used to identify PA trajectories. Three multivariate logistic models were used to estimate the odds of trajectory group membership and GDM.

Results

Two distinct PA trajectories were identified: low PA levels in all intensity of PA and sedentary behavior (Group 1: 61.1%, n = 276) and high PA levels in all intensity of PA as well as sedentary behavior (Group 2: 38.9%, n = 176). Moderate and high intensity PA decreased over the course of pregnancy in both groups. Women in group 2 had significantly higher risk of GDM in two of the estimated logistic models. In all models, significant associations between PA trajectories and GDM were only observed among women with excessive gestational weight gain in the second trimester.

Conclusions

Women with high sedentary behavior were significantly at higher risk of GDM despite high PA levels by intensity and this association was significant only among women with excessive GWG in the second trimester. Participation in high sedentary behavior may outweigh the benefit of engaging in high PA to mitigate the risk of GDM.

Developing a Physical Activity Intervention Strategy for Pregnant Women in Buffalo City Municipality, South Africa: A Study Protocol

Despite global awareness about the importance and health benefits of physical activity (PA) during pregnancy, several studies have reported a low prevalence of PA participation among pregnant women in both developed and developing countries. This means that most pregnant women do not meet the current PA recommended guideline of 150 min of moderate intensity PA per week. The global call to prioritise PA participation levels in the general population necessitates evaluating the factors affecting PA practice. Seemingly, pregnant women mostly from low-to-middle income countries like South Africa are often predisposed to adverse pregnancy outcomes, possibly because of limited access to, and knowledge of, improved pregnancy and health outcomes as a result of PA participation. Physical activity has been sparsely studied among pregnant South African women, and specifically, there is no known study that assesses the PA levels, patterns, beliefs, sources of information, perceived benefits, barriers, attitudes of pregnant women concerning PA and exercise participation; nor one that explores the perspectives of healthcare providers regarding prenatal PA in the Eastern Cape Province. In addition, no PA intervention strategy exists to promote PA participation in the region. This study, in attempting to fill these gaps in knowledge, adopts two phases. In Phase I, a concurrent mixed-method (quantitative and qualitative) approach assesses the following factors related to PA participation in pregnant women: participation levels, beliefs, attitudes, perceived benefits, barriers to uptake and sources of information. It further ascertains if healthcare professionals are sufficiently informed about PA and if they are advising pregnant women about the need for PA participation during pregnancy. Data will be collected through a structured questionnaire, interviews and focus group discussions. Information on socio-demographic and maternal characteristics will be obtained, and the Pregnancy Physical Activity Questionnaire (PPAQ) will assess PA during pregnancy. A sample size of 384 pregnant women is the required minimum sample for an infinite population at a confidence level of 95%, a precision level of ± 5% and at a prevalence of PA or exercise during pregnancy of 50% (p < 0.05); however, a sample size larger than the minimum number necessary will be recruited to account for possible attrition and to protect against possible data loss. Data will be analysed using a multiple logistic regression to determine the factors that predict sedentary or moderate PA levels and chi-squared analysis to determine the associations between the PA levels of the participants and socio-demographic and clinical variables. The study will assess the data collected on the above-mentioned variables and draw conclusions based on patterns and themes that emerge during analysis. Phase II of the study focuses on strategy development and validation to facilitate the promotion of PA during pregnancy. The developed strategy will be validated through the application of the Delphi technique and the administration of a checklist to selected key stakeholders through organised workshops. Understanding the level and correlates of PA participation among this special population is fundamental to designing intervention strategies to enhance their understanding of, and participation in, PA and exercise. Furthermore, this study's findings will inform facility-based healthcare providers about the need to integrate health education on PA and pregnancy into antenatal and postnatal care visits in the setting.

Physical Activity During Pregnancy and Postpartum Low Back Pain: A Prospective Cohort Study in Vietnam

Low back pain (LBP) is a universal public health problem for all age groups, related to the upright stance of humans. Postpartum LBP is more common and can lead to limitations to women's daily activity. Knowledge about preventing postpartum LBP is limited, and the relationship between prenatal physical activity (PA) and LBP remains inconclusive. We conducted a prospective cohort study of 1807 singleton pregnant Vietnamese women to investigate the association between prenatal PA and postpartum LBP using logistic regression analyses. The prevalence of postpartum LBP was 12.3% (n = 222). Women reporting LBP spent more hours sitting per week. Relative to the lowest level of total PA, the highest level was associated with reduced odds of postpartum LBP (odds ratio = 0.55; 95% confidence interval = 0.38-0.80). Inverse associations with LBP were also observed for light intensity, moderate-to-vigorous intensity, household/caregiving, occupational, and transportation activities. Overall, prenatal PA was inversely associated with postpartum LBP in Vietnamese women.

Effects of a lifestyle intervention in routine care on prenatal physical activity - findings from the cluster-randomised GeliS trial

BACKGROUND

Excessive gestational weight gain (GWG) is associated with an increased risk of pregnancy and obstetric complications. The "healthy living in pregnancy" (GeliS) study was performed in a routine care setting with the aim of limiting excessive GWG. The purpose of this secondary analysis is to evaluate the effect of the intervention on physical activity (PA) behaviour and to assess the impact of PA intensities on GWG.

METHODS

The cluster-randomised, multicentre GeliS trial was performed in a routine care setting alongside scheduled prenatal visits. Pregnant women with a pre-pregnancy BMI between 18.5 and 40.0 kg/m2 were either assigned to the control group receiving usual care or to the intervention group. Participants in the intervention group attended three antenatal counselling sessions on diet and PA and one additional postpartum session. Data on PA behaviour were collected twice, before the end of the 12th (baseline) and after the 29th week of gestation using the Pregnancy Physical Activity Questionnaire.

RESULTS

PA data were available for 1061 (93%) participants in the intervention and 1040 (93%) in the control group. Women in the intervention group reported significant improvements in the levels of total PA (p < 0.001), total PA of light intensity and above (p < 0.001), moderate-intensity (p = 0.024) and vigorous-intensity activities (p = 0.002) as well as sport activities (p < 0.001) in late pregnancy compared to the control group. The proportion of women meeting the international PA recommendations in late pregnancy was significantly higher in the intervention (64%) versus the control group (49%, p < 0.001). Activities of light-intensity and above (p = 0.006), light-intensity (p = 0.002) and vigorous-intensity (p = 0.014) in late pregnancy were inversely associated with total GWG.

CONCLUSION

We found significant evidence of improvements in the PA pattern of pregnant women receiving lifestyle counselling within the framework of routine care. Most PA intensities were inversely associated with total GWG which indicates that PA across different intensities should be promoted.

TRIAL REGISTRATION

NCT01958307, ClinicalTrials.gov, retrospectively registered 9 October, 2013.

Associations between Prenatal Physical Activity and Neonatal and Obstetric Outcomes-A Secondary Analysis of the Cluster-Randomized GeliS Trial

Prenatal physical activity (PA) was discussed to decrease the incidence of obstetric and neonatal complications. In this secondary cohort analysis of the cluster-randomized GeliS ("healthy living in pregnancy") trial, associations between prenatal PA and such outcomes were investigated. PA behavior was assessed twice, before or during the 12th week (baseline, T0) and after the 29th week of gestation (T1), using the self-reported Pregnancy Physical Activity Questionnaire. Obstetric and neonatal data were collected in the routine care setting. Data were available for 87.2% (n = 1994/2286) of participants. Significant differences between the offspring of women who adhered to PA recommendations at T1 and offspring of inactive women were found in birth weight (p = 0.030) but not in other anthropometric parameters. Sedentary behavior was inversely associated with birth weight at T1 (p = 0.026) and, at both time points, with an increase in the odds of low birth weight (T0: p = 0.004, T1: p = 0.005). Light-intensity PA at T0 marginally increased the odds of caesarean section (p = 0.032), but neither moderate-intensity nor vigorous-intensity activity modified the risk for caesarean delivery at any time point. The present analyses demonstrated associations between prenatal PA and some neonatal and obstetric outcomes.

Physical activity pattern in early pregnancy and gestational diabetes mellitus risk among low-income women: A prospective cross-sectional study

Objective:

Gestational diabetes mellitus is increasing worldwide, mainly in developing countries, and physical activity has not been studied in gestational diabetes mellitus prevention among low-income population. This prospective cross-sectional study assessed the gestational diabetes mellitus risk related to physical activity in early pregnancy among low-income women.

Methods:

A prospective cross-sectional study with 544 low-income pregnant women was conducted at the Instituto de Medicina Integral Prof. Fernando Figueira, Brazil. Gestational diabetes mellitus was diagnosed using the International Association of Diabetes and Pregnancy Study Groups criteria. Physical activity was assessed during early pregnancy using the Pregnancy Physical Activity Questionnaire and categorized as sedentary, light, moderate, or vigorous intensity.

Results:

Gestational diabetes mellitus occurred in 95 of 544 women (17.4%). Body mass index was higher in the gestational diabetes mellitus group. Nearly half of all pregnant women studied were physically inactive, and none of them were classified as vigorous physical active. Sedentary physical activity pattern was associated with a higher odds of gestational diabetes mellitus (odds ratio = 1.8, 95% confidence interval = 1.1–2.9), which did not change after adjusting for several covariates (odds ratio = 1.9, 95% confidence interval = 1.2–3.1).

Conclusion:

Physical inactivity in early pregnancy is associated with a higher risk of gestational diabetes mellitus among low-income women.

Prevalence of gestational diabetes mellitus and associated factors among women attending antenatal care at Gondar town public health facilities, Northwest Ethiopia

Background

Globally, Gestational Diabetes Mellitus (GDM) is rising, but it is a neglected health threat to mothers and their children in low resource countries. Although, GDM is known in Ethiopia, information regarding it remains scarce by recent diagnostic criteria. Therefore, this study aimed to determine the prevalence of GDM and associated factors among women attending antenatal care at Gondar town public health facilities, Northwest Ethiopia.

Methods

A cross-sectional study was conducted among 1027 pregnant women selected by the systematic random sampling technique. The universal one-step screening and diagnostic strategy was done using a two-hour 75 g oral glucose tolerance test. GDM was diagnosed using updated diagnostic criteria (2017 American Diabetes Association (ADA) or 2013 World Health Organization (WHO) or modified International Association of the Diabetes and Pregnancy Study Groups diagnostic criteria (IADPSG)). Binary logistic regression model was used to identify factors associated with GDM.

Results

Of the total 1027 pregnant women, 12.8% (95% CI: 10.8–14.8) were diagnosed with GDM. Overweight and/or obesity (MUAC ≥28 cm) (AOR = 2.25, 95% CI: 1.18–4.26), previous history of GDM (AOR = 5.82, 95% CI: 2.57–13.18), family history of diabetes (AOR = 4.03, 95% CI: 1.57–10.35), low physical activity (AOR = 3.36, 95% CI: 1.60–7.04), inadequate dietary diversity (AOR = 1.9, 95% CI: 1.02–3.53), and antenatal depression (AOR = 4.12, 95% CI: 1.85–9.20) were significantly associated with GDM.

Conclusions

The prevalence of GDM among women attending antenatal care at Gondar town public health facilities was high. Previous history of GDM, antenatal depression, family history of diabetes, low physical activity, overweight and/or obesity and inadequate dietary diversity were significantly associated with GDM. Routine screening of pregnant women and healthy lifestyle are strongly recommended.

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.