Perceived barriers to physical activity among pregnant women

Safety and efficacy of motor imagery-based physical activity in high-risk pregnancy: A randomized controlled study

OBJECTIVE

This study aimed to investigate the acute effects of motor imagery-based physical activity on maternal well-being, maternal blood pressure, heart rate, oxygen saturation, fetal heart rate, and uterine contractions in women with high-risk pregnancies.

METHODS

This randomized controlled trial was conducted in Izmir Tepecik Education and Research Hospital from August 2023 to January 2024. Seventy-six women with high-risk pregnancies were randomized into two groups: a motor imagery group (n = 38, diaphragmatic-breathing exercise and motor imagery-based physical activity) and a control group (n = 38, diaphragmatic-breathing exercise). Maternal well-being was determined using the Numerical Rating Scale-11. Digital sphygmomanometry was used to measure maternal heart rate and blood pressure, pulse oximetry for oxygen saturation, and cardiotocography for fetal heart rate and uterine contractions. Assessments were performed pre-intervention, mid-intervention, and post-intervention.

RESULTS

There were no significant differences in baseline characteristics between groups (P > 0.05). There was a significant main effect of time in terms of maternal well-being and maternal heart rate (P = 0.001 and P = 0.015). In addition, there was a significant main effect of the group on oxygen saturation (P = 0.025). The overall group-by-time interaction was significant for maternal well-beingm with an effect size of 0.05 (P = 0.041).

CONCLUSION

The combination of diaphragmatic-breathing exercises and a motor imagery-based physical activity program in women with high-risk pregnancies was determined to have no adverse effects on the fetus, did not induce uterine contractions, and resulted in a significant improvement in maternal well-being and oxygen saturation. Thus, imagery-based physical activity can be used in high-risk pregnancies where physical activity and exercise are not recommended.

The association between first trimester physical activity levels and perinatal outcomes

OBJECTIVE

Physical activity in pregnancy decreases the risk of adverse maternal and neonatal outcomes. This study evaluates the association between first trimester physical activity, assessed by Kaiser Physical Activity Survey (KPAS) scores, and adverse perinatal outcomes.

STUDY DESIGN

This is a secondary analysis of a prospective cohort study in which patients were administered the KPAS in each trimester. The primary outcomes were birthweight, large for gestational age (LGA), and small for gestational age (SGA) neonates. Secondary outcomes were composite neonatal morbidity (neonatal acidemia with pH<7.1, hypoxic ischemic encephalopathy, mechanical ventilation, hypoglycemia, and suspected sepsis), gestational diabetes, gestational hypertension, preeclampsia, inadequate and excess gestational weight gain. Outcomes were compared between patients with and without high physical activity levels during early pregnancy, defined as 1st trimester KPAS scores ≥75th percentile and <75th percentile, respectively. Multivariable logistic regression was used to adjust for confounders.

RESULTS

1,045 patients with a complete 1st trimester KPAS were included in this analysis and 262 patients were in the top quartile of physical activity levels in early pregnancy. Higher physical activity levels in the 1st trimester were associated with numerically but not clinically significantly higher birthweights (3191.3 ± 696.1 vs 3076.3 ± 719.8 g, p=0.03) with no difference in rates of SGA (10.3% vs 13.3%, p=0.25, aRR 0.79; 95% CI 0.52, 1.16) or LGA neonates (8.0% vs 7.3%, p=0.80, aRR 1.14; 95% CI 0.68, 1.81). Higher physical activity levels were associated with decreased rates of composite neonatal morbidity (8.4% vs 15%, p<0.01, aRR 0.59; 95% CI 0.37, 0.89) and gestational hypertension (6.5% vs 12.9%, p<0.01, aRR 0.56; 95% CI 0.33, 0.89). Gestational weight gain and the incidence of gestational diabetes and preeclampsia were similar between groups.

CONCLUSION

Higher levels of physical activity in the first trimester are associated with higher birth weights and lower rates of composite neonatal morbidity and gestational hypertension.

"I have not been doing it because of my fear of something happening." Exploring perspectives on healthy dietary behaviors and physical activity in Mexican pregnant women and health care professionals: A qualitative study

OBJECTIVES

Mexico exhibits one of the highest prevalence rates of overweight and obesity globally, accompanied by a surge in non-communicable diseases, which in turn leads to elevated mortality rates. Existing efforts to address rising obesity rates have shown limited effectiveness. Maternal weight, diet, and physical activity (PA) during pregnancy affect the mother's and offspring's health. Despite the importance of establishing and engaging in healthy behaviors during pregnancy, little is known about which factors impact these behaviors among pregnant women in Mexico. This study explored perspectives on factors impacting healthy dietary behaviors and PA in pregnancy from pregnant women and health care professionals in Mexico.

METHODS

We conducted semistructured interviews with 11 pregnant women and 12 health care professionals working in prenatal care. Data were analyzed using qualitative content analysis in a stepwise inductive approach.

RESULTS

Classifying factors at the 1) individual level, 2) relational level, and 3) health care system level, three overall themes emerged. At the individual level, challenges with lack of time and competing priorities as well as knowledge of healthy dietary behaviors and PA were identified. At the relational level, influencing factors encompassed financial, social, and emotional support along with descriptive norms. At the health care system level, guidelines for PA during pregnancy and the quality of care were noted.

CONCLUSIONS

This study identified factors impacting healthy dietary behaviors and PA in pregnancy in Mexico. Important considerations for future interventions include addressing sociocultural norms around healthy dietary behaviors and PA in pregnancy and involving pregnant women's families, closest social networks, and health care professionals working at the prenatal care unit.

A smartphone coaching program ("Bouge Grossesse") improves daily physical activity in pregnant women

BACKGROUND

Physical activity has been shown to reduce obstetrical risks however pregnant women reduce their physical activity and sedentary behaviors increase.

OBJECTIVE

Our aim was to evaluate the impact of a smartphone application developed to increase daily physical activity in pregnant women.

METHODS

We enrolled 250 pregnant women in a prospective randomized controlled study. These women were instructed to download either an intervention application called «Bouge Grossesse» (coaching program and a pedometer; n=125) or a Placebo application (pedometer only; n=125). Primary outcome was defined as a daily increase of 2000 steps/day between day 1 and day 90 or 10 000 steps/week between week 1 and week 12. Data was analyzed with intention to treat. Secondary outcomes were the number of steps at week 12 and the evolution of quality of life measured by WHO score, EIFEL score and SPIEGEL scale, and on maternal and fetal outcomes.

RESULTS

Patients were enrolled between August 2017 and February 2019. They were retrospectively registered after September 2018. We found a significant difference in the primary outcome between the two groups in favor of the intervention group (22.4% success vs 3.2% in the control group, P<.001) but only 43 women in the intervention group (34.4%) and 16 women in the placebo group (12.8%) completed the 12-week coaching program. There were no significant differences in the SPIEGEL, EIFEL and WHO scores. The mean number of daily steps at week 12 was significantly higher in the intervention group (6900.0 vs 4371.9, P<.001).

CONCLUSION

The mobile health intervention « Bouge Grossesse » significantly increased physical activity in pregnant women but we observed a high percentage of withdrawals from the 12-week program.

TRIAL REGISTRATION

This clinical trial was registered under the number NCT03688087 ClinicalTrials.gov.

Smartphone GPS-Based Exposure to Greenspace and Walkability and Accelerometer-Assessed Physical Activity During Pregnancy and Early Postpartum-Evidence from the MADRES Cohort

A growing number of studies have associated walkability and greenspace exposure with greater physical activity (PA) in women during pregnancy. However, most studies have focused on examining women's residential environments and neglected exposure in locations outside the home neighborhood. Using 350 person-days (N = 55 participants) of smartphone global positioning system (GPS) location and accelerometer data collected during the first and third trimesters and 4-6 months postpartum from 55 Hispanic pregnant women from the Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) study, we examined the day-level effect of women's exposure to walkability and greenspace on their PA outcomes during pregnancy and in the early postpartum period. Moderate-to-vigorous physical activity [MVPA] minutes per day was assessed using accelerometers. Walkability and greenspace were measured using geographic information systems (GIS) within women's daily activity spaces (i.e., places visited and routes taken) recorded using a smartphone GPS and weighted by time spent. We used a generalized linear mixed-effects model to estimate the effects of daily GPS-derived environmental exposures on day-level MVPA minutes. Results showed that women engaged in 23% more MVPA minutes on days when they had some versus no exposure to parks and open spaces in activity spaces (b = 1.23; 95%CI: 1.02-1.48). In addition, protective effects of daily greenspace and walkability exposure on MVPA were stronger in the first and third trimesters, among first-time mothers, and among women who had high pre-pregnancy body mass index (BMI) and lived in least-safe neighborhoods. Our results suggest that daily greenspace and walkability exposure are important for women's PA and associated health outcomes during pregnancy and early postpartum.

How can the pain sensitivity to be affected by maximal progressive exercise test during pregnancy?

The multidimensional etiology of pain may explain the beneficial effects of regular physical activity, as evidenced by increased pain tolerance. Physically active people find it easier to exert themselves, which enables them to increase their physical activity, which in turn leads to a reduction in pain. However, no study investigated the physical activity and exercise tests as modulators of pain sensitivity in pregnant women. Therefore, this study aimed to investigate the changes in pain perception in pregnant women during pregnancy, with a particular interest in the effects of maximal progressive exercise test (CPET) and self-performed physical activity (PA). Thirty-one women with an uncomplicated singleton pregnancy (aged 23-41 years; M = 31.29, SD = 4.18) were invited to participate in pain sensitivity measurements before and after CPET twice during pregnancy (with an 8-week break). We found that pregnant women had a significantly lower pain threshold after a maximal exercise test than before, regardless of whether the test was performed in the second or third trimester of pregnancy. This effect was most pronounced in women with low levels of physical activity. Second, women with high physical activity had higher pain tolerance than women with moderate and low physical activity. In addition, physical activity levels predicted changes in pain tolerance over the course of pregnancy, with negative changes in women with low physical activity and positive changes in women with moderate physical activity. Finally, these associations were not reflected in differences in the subjective pain experience.

In search of the 'like-minded' people: pregnant women's sense-making of their physical activity-related social experiences

AIMS/BACKGROUND

Social factors are increasingly recognised as influential on antenatal physical activity. While pregnant women describe the people and support they require to remain physically active, little is known about how pregnant women select and make sense of their social experiences throughout pregnancy. This study followed pregnant women's sense-making of their physical activity-related social experiences as pregnancy progressed, and physical activity declined.

DESIGN/METHODS

This study used a qualitative design. Four pregnant women were recruited in their second trimester, participated in three individual semi-structured interviews and submitted diary entries throughout trimesters two and three. Data were analysed using longitudinal interpretative phenomenological analysis.

RESULTS

To facilitate physical activity, pregnant women were 'searching for the "like-minded" people who motivate, share and understand', namely pregnant women and prenatally trained exercise professionals. When making sense of social experiences, pregnant women were 'grading and critiquing the quality and paucity of "active pregnancy" information', and'cherry-picking social experiences necessary for "nesting", obtaining support and protecting self-esteem as physical activity declined'. This involved disengaging from social experiences, and consequently, some pregnant women found themselves 'lamenting interactions with the "like-minded" people, contending with grief and inner conflict'.

CONCLUSION

Pregnant women proactively seek and make sense of social experiences to facilitate physical activity. In an increasingly digitalised society, interventions should support pregnant women to utilise social media constructively and safely to access 'like-minded' people, provide in-person and virtual networks to meet individual support needs throughout pregnancy and encourage health professionals to demonstrate interest in the 'active pregnancy' to maximise influence.

The sedentary behavior reduction in pregnancy intervention (SPRING) pilot and feasibility randomized trial

Pregnant individuals rarely achieve moderate-to-vigorous intensity physical activity recommendations.Purpose The sedentary behavior reduction in pregnancy intervention (SPRING) pilot and feasibility randomized trial aimed to demonstrate feasibility, acceptability, and initial efficacy of a lower intensity intervention targeting reduced sedentary behavior and increased standing and steps.Methods First trimester pregnant individuals at risk for high sedentary behavior and adverse pregnancy outcomes (APO) were randomized 2:1 to a multi-component sedentary behavior reduction intervention or no-contact control. Intervention components included biweekly remote health coaching, wearable activity monitor, height-adjustable workstation, and a private Facebook group. Evidence-based behavioral targets included sedentary time < 9 h/day, increasing standing by 2-3 h/day, and ≥ 7500 steps/day. Participants completed all-remote assessments (baseline, second trimester, third trimester) of sedentary behavior and activity (thigh-worn activPAL) along with exploratory pregnancy health outcomes abstracted from medical records. Intervention effects vs. control were evaluated using generalized mixed models and an intention-to-treat approach. Intervention participants also provided feedback on perceived benefits and acceptability.Results Participants (34 intervention; 17 control) had mean age 32 years, were 83% White, with mean pre-pregnancy BMI 28 kg/m2. Retention was high (90% and 83% at second and third trimester follow-up visits). Intervention participants decreased sedentary time (-0.84 h/day, p = 0.019) and increased standing (+0.77 h/day, p = 0.003), but did not increase steps/day (+710, p = 0.257) compared to controls. Intervention participants reported many perceived benefits and identified the wearable, height-adjustable workstation, and behavioral lessons as most useful.Conclusion For pregnant individuals at risk for high sedentary behavior and APOs, a sedentary behavior reduction intervention is feasible, acceptable, and may offer a viable alternative to more intense physical activity recommendations during pregnancy. Further testing in a fully powered clinical trial is warranted.Trial registration NCT05093842 on clinicaltrials.gov.

Effects of physical activity on placental analytes in nulliparous persons

INTRODUCTION

Physical activity during pregnancy has long been investigated for its role in preeclampsia prevention. The mechanism of this relationship is unknown, although some studies suggest physical activity may affect placental analytes throughout pregnancy. The objective of this study was to determine the effect of physical activity on preeclampsia-associated placental analytes using a prospective cohort of pregnant nulliparous patients.

METHODS

This was a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be. Frequency and duration of up to three leisure activities was reported in the first and second trimesters and was analyzed, with participants either meeting or not meeting the recommended exercise of 150 min per week. Levels of the following placental analytes, placental growth factor, soluble endoglin, and soluble fms-like tyrosine kinase-1 (sFLT1), were analyzed stratified by the physical activity level.

RESULTS

A total of 1,956 participants were included in the analysis. The level of sFLT1 in the first trimester was lower in the group that had ≥ 150 min per week of physical activity, compared to the group that had < 150 min (846.3 [821.6, 871,8] versus 893.0 [864.5,922.5], p = 0.017). There were no significant sFLT1 changes in the second trimester based on physical activity. After controlling for maternal demographic and clinical factors, sFLT1 levels in the second trimester were significantly lower (p = 0.049) in participants that had ≥ 150 min of physical activity per week.

DISCUSSION

Our findings of decreased sFLT1 levels suggest this could be the mechanism explaining the association between PA in pregnancy and lower risk of preeclampsia.

Different experiences of weight management and physical activity during pregnancy - a qualitative study of women and healthcare professionals in Australia

OBJECTIVE

Pregnancy is often described as a pivotal life stage for women, where regular contact with health professionals may play an important role in lifestyle awareness. This study explored the knowledge, practices, and beliefs of health professionals and pregnant women regarding physical activity and weight management during the antenatal period.

METHODS

A qualitative study was undertaken in southeastern Australia using individual interviews. Recruitment sought women of gestation >12 weeks, experiencing an uncomplicated pregnancy (n = 6), and antenatal health professionals including midwives (n = 4) and an obstetrician (n = 1). Data were analysed using Interpretive Phenomenological Analysis.

RESULTS

Three major themes emerged: (1) women rely on multiple sources of pregnancy-related healthy lifestyle information; (2) discussions around healthy lifestyle behaviours are low priority and often inconsistent; and (3) lifestyle-related topics perceived as sensitive make some conversations and actions difficult.

CONCLUSIONS

Pregnant women expressed gaps in lifestyle-related knowledge and education being provided by health professionals. In turn, health professionals expressed difficulty discussing sensitive topics such as weight with pregnant women and had limited knowledge of pregnancy-specific physical activity guidelines. The themes generated by this study may form the foundation for further research to inform clinical policy and practice regarding advice in antenatal care.

Knowledge, attitude and practice of physical exercises among pregnant women attending prenatal care clinics of public health institutions in Hawassa city, Sidama, Ethiopia, in 2021: descriptive cross-sectional study

BACKGROUND

Participating in physical exercise enhances the physical and mental health of pregnant women. Preventing excessive weight gain, decreasing gestational hypertension, reducing back pain and labor complications are some of the main benefits of physical exercise during pregnancy and childbirth. Scrutinizing factors associated with sedentary life style among women during pregnancy could aid to design effective strategies to tackle the problem. Despite its benefit, little is explored about knowledge, attitude and practice of physical exercise among pregnant women in the study setting.

OBJECTIVE

To assess prevalence of knowledge, attitude and practice of physical exercise among pregnant women who visit antenatal care at public health facilities of Hawassa town, Ethiopia, in 2023.

METHODS

Facility based survey was conducted from November-December, in 2021. Data were collected using interview administered and structured questionnaire. Data were cleaned, coded and entered using Epi-data 4.6 and exported into SPSS 25 for analysis. Descriptive statistics was done using frequency count, percentage and mean values of variables. Finally, findings are presented using text, tables and charts.

RESULTS

All of the study subjects completed interview making a response rate of 100% in this study. The mean adequate knowledge score was 42.2%. Positive attitude towards physical exercise during pregnancy was accounted as 63.7% and proportion of good practice of physical exercise was as 35.8%. Regarding practice of exercise, most (95.9%) of the subjects walk, however; only 11(8.9%) women perform pelvic floor exercise were the highest and least practiced physical exercise. Concerning knowledge of exercise, prevent excess weight 72.1% and increasing energy 53.2% were the commonly known benefits of physical exercise. Breathing difficulty (41.3%), chest pain (39.8%) and premature labor (34.0%) were the predominant perceptions of contra-indication of physical exercise during pregnancy.

CONCLUSIONS

In conclusion, the proportion of knowledge, attitude and practice of antenatal exercise is found to be sub-optimum in the study area. Therefore, health education should be enhanced about the benefit of physical exercise during pregnancy.

A socio-ecological model of factors influencing physical activity in pregnant women: a systematic review

Physical activity (PA) is safe for most pregnant women, improving both maternal fitness and birth outcomes. Despite evidence of benefits, most pregnant women eliminate or reduce PA during pregnancy. This systematic review aimed to analyze the factors affecting maternal PA during pregnancy with reference to a socio-ecological model. A systematic search of relevant published studies between 2001 and 2022 was conducted through PubMed, Scopus, Web of Science, Academic Search Ultimate, Medline, and SPORTDiscus with full text via the EBSCO platform. A total of 32 studies that met the inclusion criteria were reviewed. The findings revealed that various study designs can lead to different outcomes in terms of what is identified as a PA facilitator or barrier. The factors that positively influenced PA in pregnant women were: higher levels of education, knowledge, and skills, as well as access to mass media. Conversely, lower levels of education, lack of knowledge and skills, low income, pregnancy discomforts, limited time, safety concerns, and societal perceptions of PA in pregnancy acted as barriers. Additionally, family, colleagues/friends, and partners could either support or hinder PA. Factors affecting overall maternal PA were somewhat different from those affecting the moderate-to-vigorous intensity of PA. Pregnant women receive little organizational and policy support. There is an urgent need to provide accessible information and resource systems for pregnant women. Since most pregnant women are motivated to engage in PA and susceptible to family advice, interventions should not be limited only to pregnant women, but should involve a family member, especially partners. There is a need to take global, systemic actions to promote an active lifestyle in pregnancy. Addressing safety concerns related to PA during pregnancy should be a significant part of these promotional activities.

Experiences of Physical Activity, Healthy Eating and Quality of Life During and Following Pregnancy in Overweight and Obese Postpartum Women

OBJECTIVES

This retrospective study explored the experiences of women with overweight or obesity regarding physical activity, diet and quality of life leading up to, during, and following pregnancy.

METHODS

A qualitative descriptive design was adopted, whereby data collected through semi-structured interviews were analysed using thematic analysis. Throughout the interviews, individuals were asked to describe their barriers to a healthy lifestyle during and following pregnancy.

RESULTS

Ten women (34.5 ± 5.2 years old, BMI 30.4 ± 3.5 kg·m- 2) who were between 12 and 52 weeks postpartum participated. A range of themes were identified when discussing barriers to physical activity and healthy eating during and following pregnancy. For example, tiredness, especially in the third trimester of pregnancy, and a lack of support at home, was often cited as preventing engagement in exercise and healthy eating practices. A lack of convenience when attending exercise classes, medical complications following the birth and the cost of attending pregnancy-specific classes were identified as barriers to exercise engagement. Cravings and nausea were identified as barriers to healthy eating during pregnancy. Quality of life was positively associated with exercise and healthy eating, whilst a lack of sleep, loneliness and a loss of freedom since the baby had arrived negatively influenced quality of life.

DISCUSSION

Postpartum women with overweight and obesity experience many barriers when attempting to engage in a healthy lifestyle during and following pregnancy. These findings can be used to inform the design and delivery of future lifestyle interventions in this population.

The Influence of Physical Activity during Pregnancy on Miscarriage-Systematic Review and Meta-Analysis

Miscarriage is an inability to complete the normal process of pregnancy and childbirth and represents a major concern for pregnant women that can be an emotionally devastating event. While it has been suggested that engaging in strenuous physical activity might be associated with an elevated risk of miscarriage, there is a recent systematic review that suggested that prenatal exercise is not associated with fetal mortality. The aim of this systematic review and meta-analysis (SR + MA) was to assess the effects of physical activity during pregnancy on the likelihood of experiencing a miscarriage (Registration No.: CRD42022370629). Thirteen randomized clinical trials (3728 pregnant women) were included. Meta-analyses were conducted with the dependent variable being the miscarriage ratio in each study. The total risk ratio (RR) sum was calculated using a random effects model. The I2 statistic was utilized to quantify the heterogeneity observed in the results. No significant association between exercise during pregnancy and the occurrence of miscarriage was found (RR = 0.83 95% CI = 0.83 (0.49-1.41); z = 0.69, p = 0.49; I2 = 0.00%, Heterogeneity p = 0.91). Results of the present SR + MA showed no increase in miscarriage risk in those who engaged in low- to moderate-intensity exercise compared to those who did not.

Rationale, Design, and Methods for the Sedentary Behavior Reduction in Pregnancy Intervention (SPRING): Protocol for a Pilot and Feasibility Randomized Controlled Trial

BACKGROUND

Adverse pregnancy outcomes (APOs) identify cardiovascular disease risk, but few effective interventions are available. High sedentary behavior (SED) has recently been associated with APOs, but very few randomized controlled trials (RCTs) have tested SED reduction in pregnancy.

OBJECTIVE

The Sedentary Behavior Reduction in Pregnancy Intervention (SPRING) pilot and feasibility RCT addresses this gap by testing the feasibility, acceptability, and preliminary pregnancy health effects of an intervention to reduce SED in pregnant women. The objective of this manuscript is to describe the rationale and design of SPRING.

METHODS

Pregnant participants (n=53) in their first trimester, who are at risk for high SED and APO and without contraindications, are randomized in a 2:1 ratio to an intervention or control group. SED (primary outcome) and standing durations, and steps per day, are measured objectively in each trimester for 1 week with a thigh-mounted activPAL3 accelerometer. SPRING also seeks to demonstrate feasibility and acceptability while estimating preliminary effects on maternal-fetal health outcomes assessed during study visits and abstracted from medical records. The pregnancy-customized intervention promotes daily behavioral targets of less than 9 hours of SED and at least 7500 steps, achieved via increased standing and incorporating light-intensity movement breaks each hour. The multicomponent intervention provides a height-adjustable workstation, a wearable activity monitor, behavioral counseling every 2 weeks (through videoconference), and membership in a private social media group. Herein, we review the rationale, describe recruitment and screening processes, and detail the intervention, assessment protocols, and planned statistical analyses.

RESULTS

This study was funded by the American Heart Association (20TPA3549099), with a funding period of January 1, 2021, and until December 31, 2023. Institutional review board approval was obtained on February 24, 2021. Participants were randomized between October 2021 and September 2022, with final data collection planned for May 2023. Analyses and submission of results are expected for winter of 2023.

CONCLUSIONS

The SPRING RCT will provide initial evidence on the feasibility and acceptability of an SED-reduction intervention to decrease SED in pregnant women. These data will inform the design of a large clinical trial testing SED reduction as a strategy to reduce APO risk.

TRIAL REGISTRATION

ClincialTrials.gov NCT05093842; https://clinicaltrials.gov/ct2/show/NCT05093842.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/48228.

The Effects of Exercise during Pregnancy on Gestational Diabetes Mellitus, Preeclampsia, and Spontaneous Abortion among Healthy Women-A Systematic Review and Meta-Analysis

The aim was to compare the effects of different exercise modalities (aerobic, resistance, aerobic and resistance combined, or mind-body exercise) on gestational diabetes mellitus (GDM), preeclampsia, spontaneous abortion, withdrawal from the study, and adverse events in healthy pregnant women. A systematic search was conducted in February 2022 using MEDLINE, EMBASE, Cochrane library, and SPORT Discus to identify eligible randomized trials. The meta-analysis of 18 studies that examined exercise compared to no exercise showed a reduced risk of GDM (RR: 0.66 (95% CI: 0.50 to 0.86)). No subgroup differences were found regarding modality, intensity, or supervision. Exercise did not reduce the risk of preeclampsia (nine studies, RR: 0.65 (95% CI: 0.42 to 1.03)); however, in subgroup analyses, mind-body exercise and low-intensity exercise seemed to be effective in reduction of preeclampsia. There was no effect of exercise on withdrawal or adverse events found. No studies reported on spontaneous abortion, therefore, exercise during pregnancy is beneficial and safe. In the prevention of GDM, any modality and intensity seem equally effective. Subgroup analyses support an association between mind-body exercise and physical activity with low intensity and reduced risk of preeclampsia, but more high-quality randomized studies are needed. PROSPERO: CRD42022307053.

Customizing Health Recommendations About Physical Activity During Pregnancy: A Qualitative Study Among Practitioners in France

While studies have long shown the beneficial health effects of physical activity during pregnancy, such recommendations have been rarely analyzed in terms of how practitioners adapt such health messages to patients' social profiles. The present study sought to apprehend the logics underlying practitioner (non)recommendations of physical activity and exercise during pregnancy, and how these were associated with social distinctions made between patients. Semi-directive interviews were conducted with 20 midwives and 17 gynaecologists and obstetricians in south-eastern France. Based on thematic analyses, the results show how recommendations draw from both medical and social knowledge, mobilizing social representations regarding physical activity, (non)normative bodies and othered social categories of class, ethnicity or obesity. The othering processes reiterate gendered social hierarchies as well as moral orders surrounding normative bodies and health-enhancing behaviours. The findings demonstrate how social hierarchies and beliefs intertwine with public health discourses about the body and health-enhancing practices, suggesting directions for reducing their impact in contexts of medicine and health.

[Fit for Two - A Study of Sedentary Behavior and Physical Activity During Pregnancy]

BACKGROUND

In the pilot study sedentary behavior and physical activity were measured in pregnant women using an accelerometer.

METHODS

A total of 32 pregnant women were enrolled in the study; eleven of them were included in the first trimester. The defined wearing periods for the accelerometer in the first, second and third trimester were weeks 9-12, 23-26, and 36-39, respectively. A self-administered survey was carried out after a 7-day measurement.

RESULTS

The pregnant women were on average 30 years old, 50% were nulliparous, and 68.8% had a high school diploma. The accelerometer was worn on average of 13 hours per day. Sedentary behavior was recorded more than half of the wearing time for all trimesters. The proportion of time spent in moderate-to-vigorous activity was highest at 4.7% in the second trimester, compared to 2.5% in the first and 3.8% in the third. A proportion of women, ranging from 32% in the first, 54% in the second, and 58% in the third trimester did reach the levels of PA recommended by the guidelines. Nulliparous women in the second and third trimester spent twice as much time in moderate-to-vigorous activities compared to multiparous women.

CONCLUSION

Pregnant women spent more than half of the monitored day in sedentary behaviors. Half of them did meet the recommendations for physical activity in the second and third trimester. The results show that sedentary behavior and physical activity should be considered more in clinical practice and research to motivate pregnant women to adopt a physically active lifestyle.

Self-compassion and body image in pregnancy and postpartum: A randomized pilot trial of a brief self-compassion meditation intervention

The current study evaluated the efficacy of a three-week self-compassion (SC) meditation intervention in improving body image and SC during pregnancy and postpartum. Participants (n = 71; age = 31.92 ± 3.98 years; white = 61, 85.9%; intervention = 35, 49.3%; pregnant = 33, 46.5%; postpartum = 38, 53.5%) were recruited from a health coaching program and 35 were randomly assigned into a three-week SC meditation intervention while 36 were randomly assigned to a waitlist control condition. Linear regressions using full-information maximum likelihood estimation examined the effect of intervention group on body image and SC outcomes controlling for baseline level of outcome, pregnancy or postpartum status, previous meditation experience, and physical activity. Results indicated women in the intervention group reported significantly reduced body shame and body dissatisfaction and improved body appreciation and self-compassion compared to women in the control group. Implementation of a brief SC meditation intervention during pregnancy and postpartum has potential to improve mental health outcomes related to body image. Future work should replicate this study with a larger, more diverse sample of women.

Physical Activity and Weight Gain Throughout Pregnancy Are Associated With Umbilical Cord Markers

OBJECTIVE

Maternal serum and umbilical cord (UC) lipid and glucose levels are influenced by a variety of maternal factors over the course of pregnancy, including maternal physical activity (PA) levels and gestational weight gain (GWG). However, previous research has not assessed the interaction of these 2 variables. This study investigated mid-gestation (24-28 weeks) and late gestation (34-38 weeks) maternal and UC serum lipid and glucose profiles in relation to maternal PA status and GWG, independently and in combination.

METHODS

This study had a longitudinal design. Pregnant participants (n = 40) were categorized as active or inactive based on the 2019 Canadian Guideline for Physical Activity throughout Pregnancy, and GWG was categorized as insufficient, appropriate, or excessive based on 2009 Institute of Medicine recommendations. Fasting maternal serum was taken in mid- and late gestation, and venous UC serum was taken at birth.

RESULTS

No relationship was found between maternal serum values and PA and/or GWG. Infants born to individuals who were physically active across pregnancy, or who were active in mid-pregnancy and had their activity status drop in late gestation, had lower UC total cholesterol levels than those who were inactive throughout pregnancy (P < 0.0001). Participants who had gained weight appropriately at mid-gestation had significantly lower UC glucose levels than those who gained weight insufficiently (P = 0.040) or excessively (P = 0.021).

CONCLUSION

In our study, PA, and GWG (independently and in combination) may not have affected maternal serum; however, meeting PA recommendations at mid-gestation may provide prophylactic effects on UC serum, potentially providing long-term health benefits to the newborn.

Process evaluation methods and results from the Health in Pregnancy and Postpartum (HIPP) randomized controlled trial

Background

Excessive gestational weight gain has increased over time and is resistant to intervention, especially in women living with overweight or obesity. This study described the process evaluation methods and findings from a behavioral lifestyle intervention for African American and white women living with overweight and obesity that spanned pregnancy (≤ 16 weeks gestation) through 6 months postpartum.

Methods

The Health in Pregnancy and Postpartum (HIPP) study tested a theory-based behavioral intervention (vs. standard care) to help women (N = 219; 44% African American, 29.1 ± 4.8 years) living with overweight or obesity meet weight gain guidelines in pregnancy and lose weight in postpartum. Participants completed process evaluation surveys at 32 weeks gestation (n = 183) and 6 months postpartum (n = 168) regarding their perceptions of most and least helpful aspects of the intervention. A database tracked delivery and receipt of intervention components (in-depth counseling session, telephone calls, podcasts). Descriptive statistics are used to report fidelity, dose, and participants’ perceptions. We also tested whether dose of behavioral intervention components was associated with gestational weight gain and 6-month postpartum weight retention with linear regression models controlling for baseline age and gestational weeks, receipt of Medicaid, race, parity, and marital status. A content analysis was used to code and analyze responses to open-ended survey questions.

Results

Over 90% of participants (both groups) would recommend the program to a friend. Implementation fidelity was moderately high and greater in pregnancy than postpartum for all intervention components. Dose received and participants’ ratings of the in-depth counseling session and telephone calls were more favorable than podcasts. The Facebook group was not perceived to be very helpful, likely because of low participant interaction. Although podcasts were created to reinforce call topics, this redundancy was viewed negatively by some. More calls completed and more podcasts downloaded related to lower gestational weight gain (p < .05).

Conclusion

Study findings underscore challenges in engaging this important but busy population, especially during the postpartum period.

Trial registration:

The study was registered at clinicaltrials.gov (NCT02260518) on 10/09/2014. https://clinicaltrials.gov/ct2/show/NCT02260518.

The association between physical activity and sleep during pregnancy: a systematic review

OBJECTIVES

Pregnant women frequently report experiencing poor sleep. Poor sleep during pregnancy is associated with negative health outcomes for both mother and baby. Physical activity (PA), including exercise may be an effective non-pharmacological strategy for improving sleep during pregnancy. The aim of this systematic review was to synthesize the current literature on the association between physical activity (including exercise) and sleep during pregnancy.

METHOD

A systematic online search was undertaken between 15-16 February 2022 in PsycINFO, CINAHL, Embase and PubMed. To meet the inclusion criteria articles had to; [1] be published in a peer reviewed journal; [2] consist of pregnant participants; and [3] be published in English. Studies were excluded if they were not published in English and did not investigate the association between a type of physical activity (including exercise) and a sleep variable during a trimester of pregnancy.

RESULTS

Ten studies were included in this review. Five of the ten studies used observational data collection measures and the remaining five used intervention based methods. Eight of the ten included studies found PA (including exercise) was positively associated with sleep during pregnancy.

CONCLUSION

In order to properly establish PA as a strategy to improve sleep during pregnancy, future research should aim to determine the PA characteristics most beneficial to sleep during pregnancy across each trimester.

"Conscious Nine Months": Exploring Regular Physical Activity amongst Pregnant Women-A Qualitative Study Protocol

Despite a clear and convincing evidence base and strong recommendations for pregnant women to maintain regular moderate physical activity throughout pregnancy, many of them reduce or discontinue exercise altogether. This is due to pregnancy-related difficulties and barriers. The aim of this protocol is to describe a qualitative research methodology for a study exploring the experiences of women who managed to achieve the recommended levels of physical activity throughout their pregnancy by regularly participating in a specially designed "Conscious nine months" exercise programme. A qualitative descriptive design will be used, including semi-structured in-depth literature-based interviews, together with thematic analysis. Consolidated criteria for reporting qualitative research (COREQ) guidelines will be used. In-depth individual interviews (60-90 min) with exercise programme participants, used together with a thematic analysis process, will allow for a better understanding and exploration of what enabled the participants to achieve such high adherence to the overall exercise programme. The chosen methodology offers a structured way for researchers to explore the experiences and factors that influence the ability of pregnant women to be physically active, enabling research into how pregnant women can be supported to remain active during this special, often challenging time in life.

Patterns, facilitators and barriers to physical activity among Nigerian pregnant women

Introduction

pregnancy is associated with sedentary behaviors and/or low levels of physical activity (PA). This study aimed to assess patterns, barriers, and facilitators of PA among pregnant women.

Methods

a convergent parallel mixed method design study involving a concurrent collection of quantitative (n=198) and qualitative (n=36) data was carried out. Respondents were drawn from five selected health care facilities in Ile-Ife, Osun state, South-West, Nigeria. Physical activity was assessed using the pregnancy physical activity questionnaire. Focus group discussions were used to qualitatively explore barriers and facilitators of PA. Quantitative data were analyzed using descriptive and inferential statistics, while qualitative data were analyzed using thematic content analysis.

Results

the mean total PA score for the population was 118.663±81.522 mets-min/wk. While it was 118.743±92.062 mets-min/wk, 113.861±72.854 mets-min/wk, and 25.429±87.766 mets-min/wk for the first, second, and third trimester respectively. The respondents engaged more in moderate (44.27±37.07) than vigorous (13.89±18.87) intensity PA. Respondents in the third trimester had the highest and the least scores for household-related PA (45.7±33.0) and vigorous-intensity PA (10.0±14.0) respectively. Major themes that emerged on enablers and barriers of PA engagement during pregnancy were related to intrapersonal, interpersonal, availability of specialized health personnel and policy for PA, good built environment/neighborhood factors, and pervading cultural beliefs and myths about pregnancy.

Conclusion

moderate intensity and household-related PA were most common among Nigerian pregnant women. Contextual facilitators and barriers to PA during pregnancy were largely related to intrapersonal, interpersonal, environmental or organizational, policy, and cultural factors.

Perceptions of Antenatal Exercise in Pregnant Females and the Impact of COVID-19

Exercise during pregnancy presents many benefits for the mother and baby. Yet, pregnancy is characterised by a decrease in exercise. Studies have reported barriers to antenatal exercise. The coronavirus (COVID-19) pandemic may have further exacerbated barriers to antenatal exercise as pregnant females faced many challenges. Rich, in-depth exploration into pregnant female's perceived barriers to antenatal exercise during COVID-19 is imperative. Questionnaires reporting physical activity levels were completed by all participants (n = 14). Semi-structured interviews were conducted between November 2020 and May 2021 in the UK. Interviews were analysed using thematic analysis and revealed four main themes: 'Perceptions of being an active person shaping activity levels in pregnancy', 'How do I know what is right? Uncertainty, seeking validation and feeling informed', 'Motivators to antenatal exercise' and 'A process of adaptations and adjustment'. Findings indicate that the COVID-19 pandemic exacerbated barriers to antenatal exercise and highlight the importance of direct psychosocial support and clear, trustworthy information. Findings also support the fundamental need for better education amongst healthcare professionals regarding antenatal exercise.

Physical fitness and maternal body composition indices during pregnancy and postpartum: the GESTAFIT project

We explored the association of physical fitness (PF) during pregnancy with maternal body composition indices along pregnancy and postpartum period. The study comprised 159 pregnant women (32.9 ± 4.7 years old). Assessments were carried out at the 16th and 34th gestational weeks (g.w.) and six weeks postpartum. Cardiorespiratory fitness (CRF), muscular strength (absolute and relative values) and flexibility were measured. Body composition indices were obtained by using dual-energy X-ray absorptiometry at postpartum. The results, after adjusting for potential covariates at the 16th g.w., indicated that greater CRF was associated with lower postpartum indices total fat mass, android and gynoid fat mass (all, p < 0.05). Greater absolute upper-body muscular strength was associated with greater pre-pregnancy body mass index (BMI), gestational weight gain (GWG); and postpartum indices body weight, BMI, lean mass, fat free mass, fat mass, gynoid fat mass, T-score and Z-score bone mineral density (BMD) (all, p < 0.05). Greater upper-body flexibility was associated with lower pre-pregnancy BMI; and postpartum indices body weight, BMI, lean mass, fat free mass, fat mass, android fat mass and gynoid fat mass, and with greater GWG (all, p < 0.05). At the 34th g.w., greater CRF was additionally associated with greater postpartum T-score and Z-score BMD (both, p < 0.05). In conclusion, this study reveals that greater PF levels, especially during early pregnancy, may promote a better body composition in the postpartum period. Therefore, clinicians and health promoters should encourage women to maintain or improve PF levels from early pregnancy.

Investigating psychological variables for technologies promoting physical activity

Background

Many technological interventions designed to promote physical activity (PA) have limited efficacy and appear to lack important factors that could increase engagement. This may be due to a discrepancy between research conducted in this space, and software designers' and developers' use of this research to inform new digital applications.

Objectives

This study aimed to identify (1) what are the variables that act as barriers and facilitators to PA and (2) which PA variables are currently considered in the design of technologies promoting PA including psychological, physical, and personal/contextual ones which are critical in promoting PA. We emphasize psychological variables in this work because of their sparse and often simplistic integration in digital applications for PA.

Methods

We conducted two systematized reviews on PA variables, using PsycInfo and Association for Computing Machinery Digital Libraries for objectives 1 and 2.

Results

We identified 38 PA variables (mostly psychological ones) including barriers/facilitators in the literature. 17 of those variables were considered when developing digital applications for PA. Only few studies evaluate PA levels in relation to these variables. The same barriers are reported for all weight groups, though some barriers are stronger in people with obesity.

Conclusions

We identify PA variables and illustrate the lack of consideration of these in the design of PA technologies. Digital applications to promote PA may have limited efficacy if they do not address variables acting as facilitators or barriers to participation in PA, and that are important to people representing a range of body weight characteristics.

Physical activity changes among non-Hispanic Black pregnant women

OBJECTIVE

To examine aerobic physical activity (PA) among non-Hispanic Black pregnant women.

DESIGN

Longitudinal prospective cohort study.

SAMPLE

A subset of 161 non-Hispanic Black pregnant women from the Midwestern US participating in a larger study completed questionnaires about aerobic physical activity (PA) before pregnancy (reported at 24.46±2.13 weeks gestation), mid-pregnancy (24.46±2.13 weeks gestation), and late pregnancy (31.78±1.95 weeks gestation).

MEASUREMENTS

Aerobic PA was measured using the Rapid Assessment of Physical Activity (RAPA).

RESULTS

Most participants reported being active prior to pregnancy (n = 101, 63%), with 60 (37%) underactive/sedentary. Aerobic RAPA scores were highest pre-pregnancy (3.29±1.11, median = 4, interquartile range [IQR] = 1) compared with mid-pregnancy (3.05±1.26, median = 4, IQR = 2) and late pregnancy (3.05±1.24, median = 4, IQR = 2). Pre-pregnancy scores were significantly higher than mid-pregnancy scores (Wilcoxon test = 1472, p = .008) and late pregnancy scores (Wilcoxon test = 1854, p = .01).

CONCLUSION

Most Black pregnant participants reported high levels of aerobic PA both before pregnancy and during pregnancy. However, many were underactive or sedentary. Aerobic PA decreased during pregnancy compared with pre-pregnancy, without the drop in third trimester PA found in other populations. Providers should assess PA across pregnancy and promote adequate PA for maternal and infant health, particularly among Black women.

Concurrent Agreement Between ActiGraph and activPAL for Measuring Physical Activity in Pregnant Women and Office Workers

INTRODUCTION

Current best practice for objective measurement of sedentary behavior and moderate-to-vigorous intensity physical activity (MVPA) requires two separate devices. This study assessed concurrent agreement between the ActiGraph GT3X and the activPAL3 micro for measuring MVPA to determine if activPAL can accurately measure MVPA in addition to its known capacity to measure sedentary behavior.

METHODS

Forty participants from two studies, including pregnant women (n = 20) and desk workers (n = 20), provided objective measurement of MVPA from waist-worn ActiGraph GT3X and thigh-worn activPAL micro3. MVPA from the GT3X was compared with MVPA from the activPAL using metabolic equivalents of task (MET)- and step-based data across three epochs. Intraclass correlation coefficient and Bland-Altman analyses, overall and by study sample, compared MVPA minutes per day across methods.

RESULTS

Mean estimates of activPAL MVPA ranged from 22.7 to 35.2 (MET based) and 19.7 to 25.8 (step based) minutes per day, compared with 31.4 min/day (GT3X). MET-based MVPA had high agreement with GT3X, intraclass correlation coefficient ranging from .831 to .875. Bland-Altman analyses revealed minimal bias between 15- and 30-s MET-based MVPA and GT3X MVPA (-3.77 to 8.63 min/day, p > .10) but with wide limits of agreement (greater than ±27 min). Step-based MVPA had moderate to high agreement (intraclass correlation coefficient: .681-.810), but consistently underestimated GT3X MVPA (bias: 5.62-11.74 min/day, p < .02). For all methods, activPAL appears to better estimate GT3X at lower quantities of MVPA. Results were similar when repeated separately by pregnant women and desk workers.

CONCLUSION

activPAL can measure MVPA in addition to sedentary behavior, providing an option for concurrent, single device monitoring. MET-based MVPA using 30-s activPAL epochs provided the best estimate of GT3X MVPA in pregnant women and desk workers.

Uncovering Barriers to Prenatal Physical Activity and Exercise Among South African Pregnant Women: A Cross-Sectional, Mixed-Method Analysis

Background

The barriers to prenatal physical activity and exercise have been widely reported in the literature, highlighting context-specific challenges. However, generally, research on prenatal physical activity and exercise among pregnant women in South Africa is rare; and particularly concerning the barriers to their prenatal physical activity practice. This study assessed the barriers to physical activity participation among pregnant women in the Eastern Cape, South Africa.

Methods

This was a sequential explanatory mixed method, predominantly quantitative study involving 1,082 pregnant women. A structured self-administered questionnaire on perceived barriers to physical participation was applied to collect quantitative data; while a subset of 15 pregnant women participated in individual in-depth semi-structured interviews to augment quantitative data. Quantitative and qualitative data were analyzed using descriptive statistics and thematic analysis, respectively.

Results

The results of the quantitative analysis presented major barriers: lack of advice on prenatal physical activity and inadequate or conflicting information about prenatal physical activity; tiredness; work commitments; discomfort; lack of time; low energy; non-accessibility to physical activity; lack of financial resources, and safety concerns for the mother and the baby. Qualitatively, the barriers identified relate to four main themes: individual, lack of information, lack of resources, and environmental barriers.

Conclusion

The major barriers cited by the women were tiredness, lack of time, discomfort, and low energy. They also include lack of support, advice and information about prenatal physical activity. The multiple constraining factors responsible for low or non-prenatal physical activity of pregnant women in this setting highlight the need to tailor interventions to address their individual uniquely perceived barriers.

The 'new normal' includes online prenatal exercise: exploring pregnant women's experiences during the pandemic and the role of virtual group fitness on maternal mental health

BACKGROUND

Prenatal anxiety and depressive symptoms have significantly increased since the onset of the coronavirus (COVID-19) pandemic In addition, home confinement regulations have caused a drastic increase in time spent sedentary. Online group fitness classes may be an effective strategy that can increase maternal physical activity levels and improve mental health outcomes by providing an opportunity for social connectedness. The present study explores the experiences of pregnant women who participated in an online group exercise program during the pandemic and identifies relationships with maternal mental health and well-being. In addition, we present person-informed recommendations on how to improve the delivery of future online prenatal exercise programs.

METHODS

Semi-structured interviews were conducted with pregnant women (8-39 weeks of pregnancy) who participated in an online group exercise program, from March to October 2020 in Spain. A phenomenological approach was taken, and open-ended questions were asked to understand women's experiences throughout the pandemic and the role the online exercise classes may have had on their physical activity levels, mental health, and other health behaviours such as diet. A thematic analysis was performed to evaluate data. In addition, women completed the State-Trait Anxiety Inventory and these data supplemented qualitative findings.

RESULTS

Twenty-four women were interviewed, and the anxiety scores were on average 32.23 ± 9.31, ranging from low to moderate levels. Thematic analysis revealed that women felt safe exercising from home, an increased availability of time to schedule a structured exercise class, and consequently an improvement in their adherence to the program and other behaviours (i.e., healthier diet). Women emphasized feeling connected to other pregnant women when they exercised online together, and overall, this had a positive effect on their mental well-being. Women suggested that future online exercise programs should include flexible options, detailed instructions and facilitation by a qualified exercise professional.

CONCLUSION

Pregnant women are receptive to online group exercise classes and expressed that they are an accessible option to accommodating physical activity during the pandemic. In addition, the online group environment provides an important sense of connectivity among pregnant women exercising together and this may mitigate the detrimental effect of COVID-19 on maternal mental health.

Exercise During Pregnancy: What Do OB/GYNs Believe and Practice? A Descriptive Analysis

Introduction: Although regular exercise is recommended during non-complicated pregnancies to promote maternal and fetal/infant health, estimates suggest that only 15% of expectant mothers achieve current exercise recommendations. Although lack of motivation and fear related to potential fetal injury are often cited as reasons for not engaging in regular physical activity/exercise during pregnancy, less is understood about individual attitudes and practice habits of obstetrician and gynecologists (OB/GYNs) regarding exercise recommendations that may influence patient engagement in exercise during pregnancy. Purpose: To describe the attitudes, knowledge, and clinical practice of OB/GYNs regarding exercise during pregnancy. Methods: Surveys were sent via U.S. mail to 950 practicing OB/GYNs identified via publicly available databases. The survey included 11 questions regarding demographic information, exercise physiology knowledge, as well as their attitudes and clinical practice recommendations regarding exercise during pregnancy. Results: One hundred thirty-nine completed surveys were returned (14.6% response rate). Ninety-four percent of physicians surveyed agreed that there are benefits of exercise during pregnancy and/or the benefits of exercise during pregnancy outweigh the risks. Ninety-eight percent of physicians surveyed reported that they (or their medical staff) routinely advise their patients to exercise during pregnancy and 46% reported discussing exercise guidelines related to time, intensity, and type of exercise. Only 13% of physicians surveyed reported taking a semester-long exercise physiology course, yet 27% of physicians surveyed reported developing personalized exercise prescriptions for all (6%) or some (21%) of their patients. Conclusions: Low exercise engagement among expectant mothers does not appear to be due to a lack of guidance or negative views of OB/GYNs regarding exercise during pregnancy.

Exercise for perinatal depressive symptoms: A systematic review and meta-analysis of randomized controlled trials in perinatal health services

BACKGROUND

Exercise improves perinatal depressive (PD) symptoms, but reports call for more robust evidence. This systematic review and meta-analysis aimed at synthesizing evidence exclusively from randomized controlled trials (RCTs) examining the effects of exercise on PD symptoms in women recruited through perinatal health services.

METHODS

Nine e-databases and fifteen systematic reviews were searched for relevant RCTs. Exercise-specific tools extracted/coded data. A meta-analysis using a random effects model (Standardized Mean Difference [SMD]) investigated the effects of exercise on PD scores post-intervention.

RESULTS

From 285 records, 14 RCTs (2.025 participants) were considered eligible including two RCTs with clinically diagnosed PD women. Exercise showed a statistically significant, small, overall antidepressant effect (SMD = -0.21, 95% CI = -0.31, -0.11, p = 0.0001) with low/non-significant heterogeneity (Q = 17.82, I ² = 16%, p = 0.27). Only the fail-safe criterion recorded marginally significant publication bias, but trim-fill analysis added no study. Sensitivity analyses increased the overall effect in RCTs showing lower risk of bias or delivering ≥150 min/week moderate intensity aerobic exercise. Subgroup analyses revealed significant antidepressant effects for exercise across various settings, delivery formats, depressive symptoms severities and outcome measures used. Heterogeneity was low/non-significant in all analyses (I ² ≤ 50%). Hedges' g corrections did not influence the results.

LIMITATIONS

Study limitations include the small number of available trials and clinically diagnosed PD samples and the variety of exercise modalities.

CONCLUSIONS

Exercise improved PD symptoms, especially in RCTs with lower risk of bias or with ≥150 min/day moderate intensity aerobic exercise interventions. Findings are clinically useful but more RCTs for clinically diagnosed PD women are needed for firmer conclusions.

Physical Activity in High-Risk Pregnancies

It is known that physical activity before and during pregnancy is associated with health benefits for both the mother and fetus. The WHO recommends a minimum of 150 min per week of moderate-intensity aerobic physical activity for pregnant women. However, the majority of pregnant woman seem not to be physically active in pregnancy as recommended. In addition, the WHO recommendations do not include information on physical activity (PA) for specific target groups. This might be particularly problematic in women with assisted reproduction technologies (ART) or those who have received the fetal diagnosis of congenital heart defects (CHD). The aim of our study was to elaborate on whether assisted reproduction technologies (ART) and/or the diagnosis of fetal congenital heart defects (CHD) influence the level of PA in pregnant women, and to determine if there is a difference between PA behavior before and during pregnancy. In addition, we will evaluate whether high-risk pregnant women also reach the WHO recommendations. A non-interventional, cross-sectional, monocentric study based on two standardized questionnaires on physical activity was conducted. In total, n = 158 pregnant women were included. All of the participants were recruited from the outpatient clinics of the German Heart Center, Munich, and the Klinikverbund Kempten-Oberallgäu, Germany. Pregnant women after ART (n = 18), with fetal CHD (n = 25) and with both ART and CHD (n = 8) could be included. A total of 107 pregnant women served as healthy controls. Women, after ART, showed a significantly reduced level of physical activity (p = 0.014) during pregnancy compared to women who became pregnant naturally. Additionally, less (p < 0.001) and lighter (p = 0.002) physical activity was observed in all groups during pregnancy compared to those before pregnancy. An increase in maternal age increases the likelihood of CHD (p < 0.001) and decreases the level of physical activity before pregnancy (p = 0.012). The overall level of physical activity decreased in healthy and high-risk pregnancies, and only a quarter (26.49%) of all pregnant women reached the WHO recommendations. Further research for the specific target groups is highly recommended in order to promote and increase physical activity in ART and CHD pregnancies.

Measurement of Barriers, Attitudes, and Expectations for Sitting Less in Pregnancy

OBJECTIVE

Our objective was to develop, validate, and describe findings from an instrument to measure barriers, attitudes, and outcome expectations of sitting less in pregnant women.

METHODS

This validation (sub-study 1) and descriptive study (sub-study 2) evaluated a new questionnaire measuring sedentary time in pregnant women (N=131) in each trimester.

RESULTS

In sub-study 1, construct validity was supported by associations between device-measured sedentary time and questionnaire scores. An optimized questionnaire removed infrequently reported and non-correlated items. The original and optimized questionnaires with scoring instructions are provided. In sub-study 2, physical symptoms and work were most commonly reported as major reasons for sitting in pregnancy, followed by leisure, family, and social activities. Some women reported limiting sitting due to boredom/restlessness, to improve energy or health, and to control weight. In the third trimester, some women reported sitting more/less due to pain and encouragement from family, friends, and co-workers. Few women reported household chores or pregnancy risks as reasons to sit, felt sitting was healthy or necessary during pregnancy, or were encouraged to sit by healthcare providers.

CONCLUSIONS

The developed questionnaire demonstrated validity and identified barriers to and expectations of sitting less during pregnancy. Prenatal interventions to reduce sitting should address general and pregnancy-specific barriers.

Exploring the intensity, barriers and correlates of physical activity In Iranian pregnant women: a cross-sectional study

Objectives

To determine the intensity, barriers and correlates of physical activity (PA) in Iranian pregnant women.

Methods

This cross-sectional study was carried out with 300 eligible pregnant women referred to the Ilam health centres and bases using stratified random sampling with proportional allocation. Data collection tools included a demographic and obstetrical history questionnaire, the Pregnancy Physical Activity Questionnaire and the Exercise Benefits/Barriers Scale. The association between demographic and obstetrical characteristics and PA intensity and barriers were studied using multiple linear regression models.

Results

The mean and SD of the total score of PA intensity were 47.15 and 26.25 metabolic equivalent of task (MET)-hour/week, respectively. The highest and the lowest barriers were related to the time expenditure (42.77±18.04) and family discouragement (50.72±24.99) constructs, respectively. The PA intensity was significantly associated with prepregnancy or early pregnancy body mass index (B=25.6), ethnicity (B=16.94), level of education (B=−8.77), number of children (B=5.95), gestational age (B=0.81), participation in childbirth preparation classes (B=−11.27), habitual exercise before pregnancy (B=6.09), income (B=−9.22). The PA barriers were significantly associated with ethnicity (B=−4.96), income (B=2.23) and habitual exercise before pregnancy (B =−1.35).

Conclusion

PA intensity may be enhanced by encouraging individuals to be more physically active before pregnancy. Additionally, strategies to enhance support from friends and family to engage in PA throughout pregnancy and PA interventions focused on women with lower levels of income and education are required.

Professional Exercise Recommendations for Healthy Women Who Are Pregnant: A Systematic Review

Background: Exercise in pregnancy favorably affects maternal and fetal outcomes, yet only 50% of women receive exercise guidance during prenatal care and 15% are told to stop exercising. Reasons for clinician reluctance to recommend exercise include safety concerns and ambiguity of recommendations. To better inform clinicians, this systematic review assembled a consensus exercise prescription (ExRx) for healthy pregnant women framed by the Frequency, Intensity, Time, and Type (FITT) principle. Methods: In April 2021, PubMed, Scopus, SPORTDiscus, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Cochrane databases were searched. Reports were eligible if: (1) targeted healthy pregnant women, (2) framed the ExRx by the FITT, and (3) published by a professional society from 2000 to 2021 in English. The Appraisal of Guidelines for Research and Evaluation II tool assessed risk of bias. Results: Twelve reports of poor to good quality were included. Nine societies conducted systematic reviews, but only three provided a detailed, transparent description of the review conducted. Although the FITT varied, the most common was most days of the week, moderate intensity, 30 minutes/session to accumulate 150 minutes/week, and aerobic, resistance, and flexibility exercise with three societies advising neuromotor exercise. All professional societies specified activities to avoid and eight societies included contraindications to exercise. Conclusions: This systematic review produced a consensus ExRx for healthy pregnant women to better inform clinicians about advising their patients to exercise during pregnancy. Future research is needed to determine the upper limits of exercise while pregnant and provide better informed guidance relating to safety concerns for women who are pregnant.

Development and psychometric testing of the 'barriers to physical activity during pregnancy scale' (BPAPS)

BACKGROUND

Pregnancy can affect the amount of physical activity that women engage in, so ensuring adequate physical activity in pregnant women can be a challenge. Therefore, there is a need to explore and identify barriers to physical activity in this population. Consequently, this study was conducted in order to develop and validate a scale to assess barriers to physical activity in pregnant populations.

METHODS

The study was conducted in two phases. During phase 1, a comprehensive review of the most relevant literature from electronic databases on barriers to physical activity was carried out and appropriate scale items were extracted using a deductive approach. During phase 2, the psychometric properties of the extracted scale items were determined using face, content and construct validity, internal consistency and stability. Qualitative and quantitative face validity was assessed via face-to-face interviews with 30 and 10 pregnant women, respectively. To confirm the qualitative and quantitative content validity, 10 experts in the field of research and instrument design were invited to complete the resulting scale. To assess construct validity, the scale items were further tested among 320 pregnant women attending perinatal clinics at health centers in Ilam, Iran, where data were collected via continuous sampling. The internal consistency and stability of the study were measured by Cronbach's alpha and intra-class correlation coefficient (ICC), respectively.

RESULTS

Following a review of the relevant literature, 48 items for the BPAPS were extracted. Subsequent to the assessment of face and content validity, the number of items was reduced to 38. Through a subsequent exploratory factor analysis, the number of items dropped further to 29. These items were then structured under four major factors. Finally, the internal consistency and stability of the scale was confirmed by a Cronbach alpha coefficient of 0.824 and a test-retest reliability score of 0.87.

CONCLUSION

Findings show that the 29-item scale to assess barriers to physical activity in pregnant populations is a valid and appropriate instrument.

Enablers and barriers to women's lifestyle behavior change during the preconception period: A systematic review

Healthy lifestyle behaviors during the preconception period are important to optimize maternal and child outcomes, including weight. However, the majority of women do not have optimal preconception lifestyle behaviors. This systematic review explored enablers and barriers to women's preconception lifestyle behaviors using the Capability, Opportunity, Motivation, Behaviour (COM-B) model and Theoretical Domains Framework (TDF). Preconception was defined as the time before conception, capturing planned and unplanned pregnancies. Medline Complete, EMBASE, PsycINFO, and CINAHL were searched for peer-reviewed, quantitative and qualitative primary studies (English, 2006-2020) that explored enablers and barriers to lifestyle behaviors (diet, physical activity, smoking, alcohol use, supplement intake). Forty-two studies (of 3406) were included, assessing supplement use (n = 37), diet (n = 10), smoking (n = 10), alcohol use (n = 8), and physical activity (n = 5). All three COM-B components were identified only for diet and supplement use. Of the 14 TDF domains, 7 were identified: knowledge, beliefs about capabilities, beliefs about consequences, goals, intentions, social support, and environmental context and resources. The presence/absence of knowledge on healthy behaviors was the most commonly assessed enabler/barrier. Future studies should explore a wider range of factors influencing preconception women's capability, opportunity, and motivation to modify their lifestyle behaviors.

Demographic, Socioeconomic, and Health-Related Predictors of Objectively Measured Sedentary Time and Physical Activity During Pregnancy

BACKGROUND

Sedentary behavior (SED) and moderate-to-vigorous intensity physical activity (MVPA) have important implications for health; however, little is known about predictors of these behaviors during pregnancy.

METHODS

This cohort study measured SED (activPAL) and MVPA (GT3X) in each trimester of pregnancy. Univariate associations of demographic, socioeconomic, and pregnancy health-related factors with SED or MVPA were calculated. Associations with P < .10 were included in stepwise linear regression models to determine independent predictors in each trimester.

RESULTS

Pregnant women (n = 127) were age 31.0 (4.9) years and 78% white. In regression models across trimesters, fewer children ≤ age 5 in the household (P < .04) and primarily sitting job activity (P < .008) were related to higher SED and use of assisted reproductive technology (P < .05) was associated with higher MVPA. In at least one trimester, younger age was related to higher SED (P = .014); no history of pregnancy loss (P < .04), being married (P = .003), employed (P < .004, full time or student), white race (P = .006), and higher education (P = .010) were associated with higher MVPA.

CONCLUSIONS

Predictors of SED in pregnancy were more consistent, and differed from predictors of MVPA. These findings may help identify women at risk of high SED or low MVPA, though future research in larger samples is needed.

Level of exercise and physical activity among pregnant women in Saudi Arabia: A systematic review

The current study aimed to clarify the health benefits of physical activity on the mother and fetus in the Saudi women population. Besides, it is intended to provide recommendation based on the literature and results of studies from Saudi Arabia for exercise in pregnancy to improve the general health of women in Saudi Arabia. Prenatal physical exercise enhances physical and mental health of pregnant women. It can also reduce the risk of multiple pregnancy-related complications such as; lower back pain, fluid retention and risk of gestational diabetes. All these factors can affect fetal development and life later. Multiple studies showed that prenatal exercise could reduce the risk of fetal macrosomia with no effect on other perinatal or postnatal complications. The study followed the systematic literature review approach where it included multiple medical search Databases using PICOS eligibility criteria up to January 2019. The review was based on the following keywords: pregnancy, gestational, or prenatal) and (physical exercise, exercise, or physical activity. There are only two studies that dealt with physical exercises among Saudi women. The results indicated a relation between prenatal physical exercise on improving or decreasing risks on the mother and child during pregnancy.

Exercise among pregnant females in maternity and children hospital in Jeddah, Saudi Arabia, 2019: Prevalence and barriers

OBJECTIVES

To estimate the prevalence and explore factors of adequate physical activity among pregnant women in maternal care.

MATERIALS AND METHODS

A cross-sectional study conducted in healthy pregnant women visiting the antenatal clinics of the Maternity & Children's Hospital, Jeddah, Saudi Arabia. A structured questionnaire was administered face to face to collect the following: 1) sociodemographic and obstetrical data; 2) the Arabic version of the Pregnancy Physical Activity Questionnaire (PPAQ) developed by Lisa Chasan-Taber; and 3) barriers to exercise. The PPAQ enabled calculating average weekly energy expenditures in various activities, in metabolic equivalent (MET-h/week) and determining two levels of physical activity (active versus inactive).

RESULTS

Two hundred and five pregnant women were included: 49.3% were multiparous (gravida >2) and 55.6% declared exercising before pregnancy. The median overall energy expenditure was 108.0 MET-h/week, and household/caregiving activities accounted for the most important share (median = 45.7 MET-h/week), followed by transportation (12.6 MET-h/week). Of the total, 45.9% met the WHO criteria of adequate physical activity. There was no statistically significant difference between physically active and inactive participants across demographic factors. The most common barriers to being active were lack of energy, fatigue, or drowsiness (70.2%), lack of education by doctors (68.3%), and inconvenient weather (62.0%).

CONCLUSION

Women in Saudi Arabia have decline in physical activity during pregnancy, and less than 50% maintain a level of exercise that enables beneficial effects on their overall health and pregnancy outcome. Health authorities and decision makers should consider implementing a national strategy and guidelines for the promotion of physical activity during pregnancy.

The weight of motherhood: Identifying obesity, gestational weight gain and physical activity level of Italian pregnant women

Objective:

Pre-pregnancy obesity and suboptimal gestational weight gain are on the rise globally and are independently associated with several maternal and neonatal complications. A healthy lifestyle, including regular physical activity, may improve health and reduce these complications, but many women are less active and willing to engage in physical activity with advancing gestation. Therefore, the inclusion of a wider range of physical activity such as domestic chore, occupational activity and active commuting may help pregnant women to meet the physical activity recommendations of 150 min/week. Very little is known about these issues in Italy, a country with strong traditional roles regarding pregnancy and motherhood, including “la famiglia” (the family). Primary objective describes health and lifestyle behavior of pregnant Italian women. Secondary objective reports total physical activity level, recreational exercise and context of these activities from pre-pregnancy and throughout gestation in regard to gestational weight gain management.

Study design:

Cross-sectional study performed in one public hospital and four antenatal clinics in Italy. Participants (n = 513) completed a validated self-administered questionnaire, the Physical Activity Pregnancy Questionnaire, in gestation week 36.01 (standard deviation 2.0). Pre-pregnancy body weight (kg) was self-reported, whereas maternal weight (kg) was measured at gestation week 36. In line with current American College of Obstetricians and Gynecologists guidelines (2020), participants were categorized into regular physical activity (⩾150 min/week) or non-regular physical activity (<150 min/week).

Results:

Mean pre-pregnancy body-mass index was 22.8 kg/m² (standard deviation 3.9), with 14.4% of women entering motherhood overweight and 5.3% obese. Mean gestational weight gain was 11.9 kg (standard deviation 4.1). Among those with a body-mass index ⩾25, 46.5% gained above the Institute of Medicine recommendations. With respect to recreational exercise/sport, 4.7% were active according to guidelines, whereas 82.7% accumulated ⩾150 min/week when combining exercise/sport with daily-life physical activity (commuting and occupational). Exercising ⩾150 min/week and working 100% in third trimester were associated with gestational weight gain within Institute of Medicine recommendations (p = 0.06 and p = 0.03).

Conclusion:

Italian pregnant women have a low exercise level, still over 80% achieved a total physical activity level ⩾150 min/week when adding occupational and commuting activities. Nearly 50% of overweight and obese women exceeded the recommended gestational weight gain during pregnancy.

Effectiveness of an intervention focusing on diet and walking during pregnancy in the primary health care service

Interventions during prenatal care can mitigate negative outcomes of a sedentary lifestyle and unhealthy diet during pregnancy. We aimed to evaluate the effectiveness of an intervention that promoted healthy diet and leisure-time walking during antenatal care in a pragmatic, controlled, non-randomized intervention study. Physicians and nurses from all health care units of the Family Health Strategy model of health assistance participated in educational training to promote leisure-time walking and healthy diet during antenatal care visits. Pregnant women who received health care from these professionals constituted the intervention group (n = 181). The control group (n = 172) included pregnant women who received routine antenatal care, in health care units of the traditional model of health assistance. Data were collected in each trimester of pregnancy. Diet was investigated using a food frequency questionnaire adapted from Risk and Protective Factors Surveillance System for Chronic Non-Comunicable Diseases Through Telephone Interview (Vigitel). Leisure-time walking in a typical week was assessed using questions from the Physical Activity in Pregnancy Questionnaire. There were positive effects on leisure-time walking during the second trimester and the third trimester of pregnancy and on the women who achieved 150 minutes per week of walking during the third trimester. The intervention reduced the risk of pregnant women consuming soft drinks and/or commercially prepared cookies in the third trimester. This lifestyle intervention was partially effective, tripling the proportion of pregnant women who achieved the recommended walking time and reducing by half the proportion of women who had a high weekly consumption of soft drinks and industrially processed cookies.

A qualitative investigation of a prenatal yoga intervention to prevent excessive gestational weight gain: A thematic analysis of interviews

PURPOSE

To describe pregnant women's experiences and perceived facilitators/barriers of a prenatal yoga intervention to prevent excessive gestational weight gain (EGWG).

METHODS

Pregnant women (N = 13) were interviewed after participation in a 12-week prenatal yoga intervention to prevent EGWG. Interviews were summarized using thematic analysis.

RESULTS

Twelve themes were identified and organized into four categories: 1) experiences of prenatal yoga (positive experience/enjoyment, pain relief, connecting to body), 2) prenatal yoga and weight (increased mindfulness/self-awareness, increased physical activity, weight management), 3) barriers to prenatal yoga (physical body, commute/traffic, schedule), and 4) facilitators of prenatal yoga (healthy pregnancy, support from other pregnant women, the feeling from prenatal yoga).

CONCLUSION

Prenatal yoga may relieve pain and help women be more connected to their bodies. Prenatal yoga may also help women become more aware of their health behaviors and increases their physical activity which may have important implications for reducing EGWG.

Obstetric Patients and Healthcare Providers Perspectives to Inform Mobile App Design for Physical Activity and Weight Control During Pregnancy and Postpartum in a Rural Setting

Background

Mobile health technology offers the opportunity for women to engage with physical activity promotion programs without many of the barriers commonly associated with exercise during and after pregnancy (eg, childcare concerns, rigid schedules, fear of doing harm to fetus or self, access to fitness facilities, uncomfortable with body in front of others) which may be particularly useful in under-resourced rural environments. We conducted the first known study on perspectives of pregnant women, postpartum women, and obstetric healthcare providers in a rural setting on needs related to the development of a mobile app designed to increase physical activity during pregnancy and postpartum.

Methods

Focus groups and in-depth face-to-face personal interviews were conducted with 14 pregnant women, 13 postpartum women, and 11 healthcare providers in a rural community. Semi-structured questions utilizing constructs of the Health Belief Model were used to identify barriers, facilitators, and other influences on physical activity during pregnancy and postpartum. Recordings of all in-depth interviews and focus groups were transcribed and standard content analyses for qualitative data were conducted.

Results

Rural women and healthcare providers expressed several key perspectives about and recommendations to promote physical activity during and after pregnancy. Broadly, these perspectives encapsulated two main themes: 1) physical activity as critical for weight control and 2) the need for evidence-based exercise information. Key desired features of this app identified include goal setting/progress tracking, evidence-based exercise guidance tailored to specific time points of pregnancy and postpartum, social support via community-based forum, symptom tracking, time-efficient workouts, and push notifications.

Conclusion

The perspectives identified by participants should be utilized when designing mobile health physical activity mobile apps for pregnant and postpartum women in rural areas.

Physical activity for blood glucose control in gestational diabetes mellitus: rationale and recommendations for translational behavioral interventions

Gestational Diabetes Mellitus (GDM) is associated with adverse health outcomes during pregnancy and beyond. Previous randomized controlled trials of exercise interventions have demonstrated that exercise, conducted primarily during supervised sessions, improves maternal glycemic control in women with GDM. However, additional research is needed to develop physical activity interventions that are easily implemented in healthcare settings (e.g., recommendations and strategies to increase non-supervised physical activity). This narrative review presents: current physical activity recommendations for pregnancy and women with GDM; the scientific literature to date on physical activity, particularly walking, and blood glucose control in GDM; rationale for physical activity interventions targeting women with GDM that are appropriate for translation to the clinical setting (e.g., lifestyle interventions that include behavioral counseling with a health coach); and the strategies employed by previous, successful lifestyle interventions for pregnant and postpartum women that were based in clinical settings.Most previous exercise interventions for blood glucose control in women with GDM have included supervised exercise sessions, and will thus be difficult to translate to the health care system. However, lifestyle interventions for weight maintenance (i.e., healthy diet and physical activity) set in the health care system and delivered by health coaches have been successfully implemented in pregnant and postpartum populations. Therefore, we suggest that future trials examine lifestyle interventions that promote unsupervised walking with evidence-based behavioral strategies (e.g., goal setting, monitoring, and feedback) and consider incorporating the use of physical activity tracking devices to support these strategies.

An Assessment of Mobile Applications Designed to Address Physical Activity During Pregnancy and Postpartum

Only 15% of women meet physical activity guidelines during and after pregnancy despite the well-established positive impacts on both the mother and the neonate. There is a clear lack of guidance on this topic, and mobile health interventions are a promising direction for future interventions to facilitate a necessary increase in physical activity during pregnancy and postpartum. The purpose of the study was to objectively assess the quality and perceived impact of existing free mobile apps that are designed to cover physical activity during and after pregnancy. The Mobile Application Rating Scale (MARS) was used by two independent reviewers to determine overall quality of mobile apps freely available in the U.S. iTunes store. The initial search for pregnancy and postpartum physical activity apps yielded 732 results. After careful screening, 567 apps were excluded, leaving 165 that went under further screening procedures. Upon further screening, 54 apps were downloaded and scored using the MARS system. Of the 54 apps included in the analyses, 20 apps contained physical activity information for pregnant women (37.0%), 11 apps contained information for postpartum women (20.4%), and 23 apps contained information pertaining to both pregnant and postpartum women (42.6%). Of note, 33 (61.1%) of the apps required hidden costs in the form of in-app purchases. The mean overall MARS score was 3.06 ± 0.94 out of 5 (1-inadequate and 5-excellent). Overall, the quality of existing apps appears low, and none of the existing apps had specific goal setting based on current recommendations for pregnant women. Due to low quality and perceived impact, existing mobile apps are insufficient to enable women to achieve recommended levels of physical activity during pregnancy and postpartum.

Association of Self-Reported Physical Fitness with Pregnancy Related Symptoms the GESTAFIT Project

We explored the association of physical fitness (PF) with pregnancy-related symptoms, at the 16th and 34th gestational weeks (g.w.). The International Fitness Scale and the Pregnancy Symptoms Inventory were employed to assess self-reported PF and pregnancy-related symptoms, respectively. At the 16th g.w. greater self-reported overall PF was associated with lower incidence of urinary frequency (p = 0.020); greater overall PF, cardiorespiratory fitness (CRF), muscular strength and speed-agility were associated with lower incidence of tiredness-fatigue (all, p < 0.05); greater overall PF and speed-agility were associated with lower incidence of poor sleep (both, p < 0.05); greater CRF and flexibility were associated with lower limitations by tiredness-fatigue (both, p < 0.05); and greater flexibility was associated with lower limitations by poor sleep (p = 0.021). At the 34th g.w. greater self-reported overall PF, CRF and muscular strength were associated with lower incidence of tiredness-fatigue (all, p < 0.05); greater CRF was associated with lower incidence of poor sleep (p = 0.019); and, greater flexibility was associated with lower incidence of increased vaginal discharge (p = 0.023). Adequate levels of PF, especially CRF, may help women to cope with the most endorsed pregnancy-related symptoms and its limitations, especially tiredness-fatigue and poor sleep.

Objectively Measured Sedentary Behavior and Physical Activity Across 3 Trimesters of Pregnancy: The Monitoring Movement and Health Study

BACKGROUND

Though moderate- to vigorous-intensity physical activity is recommended, limited research exists on sedentary behavior (SED) during pregnancy.

METHODS

The authors conducted a prospective cohort study to describe objectively measured patterns of SED and activity during each trimester of pregnancy. Women wore thigh- (activPAL3) and waist-mounted (ActiGraph GT3X) activity monitors. SED and activity were compared across trimesters using likelihood ratio tests and described using group-based trajectories. Exploratory analyses associated SED and activity trajectories with adverse pregnancy outcomes and excessive gestational weight gain.

RESULTS

Pregnant women (n = 105; mean [SD] age = 31 [5] y; prepregnancy body mass index = 26.2 [6.6] kg/m2) had mean SED of 9.7, 9.5, and 9.5 hours per day (P = .062) across trimesters, respectively. Some activities differed across trimesters: standing (increased, P = .01), stepping (highest in second trimester, P = .04), steps per day (highest in second trimester, P = .008), and moderate- to vigorous-intensity physical activity (decreased, P < .001). Prolonged SED (bouts ≥ 30 min) and bouted moderate- to vigorous-intensity physical activity (≥10 min) were stable (P > .05). In exploratory analyses, higher SED and lower standing, stepping, and steps per day trajectories were associated with increased odds of adverse pregnancy outcomes (P < .05). No trajectories were associated with excessive gestational weight gain.

CONCLUSIONS

Pregnant women exhibited stable SED of nearly 10 hours per day across pregnancy. Future research evaluating SED across pregnancy and adverse pregnancy outcome risk is warranted.