Factors affecting perceived change in physical activity in pregnancy

Physical activity changes and influencing factors among Chinese pregnant women: a longitudinal study

OBJECTIVE

Participating in physical activity during pregnancy has benefited a lot from maternal and child health. However, there are few longitudinal studies describing activity patterns and related factors during pregnancy. The aim of this study is to investigate longitudinal physical activity changes and the influencing factors of Chinese pregnant women.

METHODS

From January to August 2020, 240 pregnant women were recruited in Hangzhou, China. Physical activity during pregnancy was assessed in the first, second, and third trimesters of pregnancy by using the Pregnancy Physical Activity Questionnaire.

RESULTS

The daily energy consumption during first, second, and third trimesters was 20.55, 20.76, 17.19 METs-h/d. The results of repeated-measure analysis of variance and pairwise comparison showed that the total daily energy consumption of physical activity in the third trimester was significantly lower than that in the first and second trimesters, with statistical significance (p < 0.001). The generalized estimation equation showed that education level, pre-pregnancy BMI, gravidity, unnaturally conceived and pre-pregnancy exercise habits were the influencing factors of physical activity during pregnancy (p < 0.05).

CONCLUSION

Physical activity levels of pregnant women during different trimester were not optimistic. In order to improve physical activity during pregnancy and promote the health status of both mother and the developing baby, more attention should be paid on pregnant women with low education level, high BMI before pregnancy, primipara, unnaturally conceived and no good exercise habits before pregnancy.

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.

Why are pregnant women physically inactive? A qualitative study on the beliefs and perceptions about physical activity during pregnancy

This study aimed to describe the beliefs and perceptions of pregnant women and healthcare providers about physical activity during pregnancy. Using a qualitative approach, 30 pregnant women and the 14 healthcare providers caring for them were interviewed in the second trimester of pregnancy. We included women who maintained, decreased, or stopped physical activity since becoming pregnant. They were divided into low (≤ 8 years) and high schooling (> 8 years). Semi-structured, in-depth interviews were conducted and guided by three key questions: (1) When does physical activity during pregnancy start to be considered a wrong behavior?; (2) What are the main barriers (biological or others) to physical activity?; and (3) Do the actions of healthcare providers and people close to pregnant women reinforce barriers? Interviews were audio recorded, transcribed, and analyzed based on recurring themes. All women changed their physical activity behavior (decreased or stopped) when they discovered their pregnancy. Fear of miscarriage, contractions, bleeding, and of causing malformations in the baby were the most reported reasons for decreasing or stopping physical activity. Participants also lacked access to consistent information and healthcare providers' support on the benefits of physical activity. Despite the current international recommendations to regular physical activity during pregnancy, uncertainty regarding its benefits remains. Interventions to promote physical activity during this period should include the training of healthcare providers so they can advise and discard ideas contrary to mother-child health benefits.

Knowledge, attitude and practice towards antenatal physical exercise among pregnant women in Ethiopia: A systematic review and meta-analysis

INTRODUCTION

Physical activity and exercise during pregnancy have paramount importance for both the mother and fetus. Regardless of the benefits of exercise during pregnancy, significant proportion of women usually opt sedentary lifestyle during pregnancy. The aim of this systematic review and meta-analysis is to synthesis evidences on knowledge, attitude, and practice towards antenatal physical exercise among pregnant women in Ethiopia.

METHODS

The systematic review and meta-analysis was conducted on knowledge, attitude, practice, and associated factors towards antenatal physical exercise among pregnant women in Ethiopia. The systematic review and meta-analysis protocol was registered on PROSPERO website with registration number CRD42023444723. Articles were searched on international databases using medical subject heading and keywords. After ensuring eligibility, data were extracted using Microsoft excel and imported to STATA 17 for analysis. Cochran Q test and I2 statistics were used to check presence of heterogeneity. Weighted Inverse variance random effect model was used to estimate the pooled level of knowledge, attitude, and practice on antenatal physical exercise among pregnant women in Ethiopia. Funnel plot and egger's test were used to check presence of publication bias.

RESULTS

A total of 11 studies were included in this systematic review and meta-analysis. The pooled prevalence of adequate knowledge, favorable attitude and good practice towards antenatal physical exercise were 46.04% with 95% CI (44.45%-47.63%), 43.71%, 95% CI (41.95%-45.46%) and 34.06, 95% CI (20.04%-48.08%) respectively. Good knowledge AOR 2.38 95% CI(1.80-3.14), unfavorable attitude AOR 0.43 95% CI (0.32-0.58), having no pre-pregnancy habit of physical exercise AOR 0.44 95 CI (0.24-0.79) and having diploma or above education status AOR 3.39 95% CI (1.92-5.98) were significantly associated with practice of antenatal physical exercise.

CONCLUSION

The level of knowledge, attitude and practice towards antenatal physical exercise among pregnant women was far below the recommended level in Ethiopia. Knowledge, attitude, education status and pre-pregnancy habit of physical exercise were significantly associated factors with antenatal physical exercise practice. It is highly essential to disseminate health information on the benefits of antenatal physical exercise for all pregnant women during antenatal care contacts.

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.

Self-reported exercise or physical activity level: what matters to a better quality of life in the third trimester of pregnancy?

This study evaluated the relationship of self-reported exercise, physical activity (PA) level, and Quality of Life (QoL) among women in their third trimester of pregnancy and verified which factors are associated with physical exercise (PE) and QoL. A cross-sectional study was performed with women who have been pregnant for at least 28 weeks and who can engage in PE. Data on self-reported exercise, sociodemographic characteristics, PA level, and QoL were collected through the International Physical Activity Questionnaire (IPAQ) and the World Health Organization Quality of Life Questionnaire BREF version (WHOQOL-BREF). Frequencies, bivariate analyses, and logistic and linear regression were performed. Among 405 pregnant women, 103 (25.43 percent) reported practicing PE. The self-reported PE was associated with better scores in the physical and environmental domains of the WHOQOL-BREF. Several IPAQ variables and the WHOQOL-BREF environmental score were associated with self-reported exercise. The majority classified as "active" by the IPAQ was due to employment and not the PE practice. A correct conceptual approach to PA and PE during antenatal care has a different impact on health and QoL during pregnancy.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Physical Activity and Sitting Time From 16 to 24 Weeks of Pregnancy to 12, 24, and 48 Months Postpartum: Findings From the 2015 Pelotas (Brazil) Birth Cohort Study

BACKGROUND

Physical activity levels decrease during pregnancy, and the time course of return to prepregnancy levels is unclear. This study aimed to describe changes in leisure-time physical activity (LTPA) and sitting time from 16 to 24 weeks of pregnancy to 12, 24, and 48 months postpartum in women with different education levels in Brazil.

METHODS

Data from 4000 mothers of children enrolled in the 2015 Pelotas (Brazil) Birth Cohort were analyzed. The women were interviewed between 16 and 24 weeks of pregnancy and when their children were aged 12, 24, and 48 months. The LTPA and sitting time were self-reported.

RESULTS

Only 15.7% of the women reported any LTPA during pregnancy; this declined to 7.9% at 12 months postpartum; it was 16.8% at 24 months and 23.2% at 48 months. On average, participants spent a mean (SD) of 6.4 (3.9), 4.2 (3.2), 4.3 (3.3), and 4.4 (3.3) hours per day sitting during pregnancy, and at 12, 24, and 48 months after the birth, respectively. Both any LTPA and high sitting (8+ h/d) were consistently higher among women with higher education.

CONCLUSION

After 24 months postpartum, LTPA levels had returned to or exceeded pregnancy levels, but sitting time remained lower than during pregnancy.

Diabetes risk status and physical activity in pregnancy: U.S. BRFSS 2011, 2013, 2015, 2017

BACKGROUND

Pregnant women without complications are advised to engage in physical activity (PA) to mitigate adverse outcomes. Differences may exist among pregnant women of diverging diabetes status in meeting national PA recommendations. We sought to examine differences in aerobic activity (AA) and muscle strengthening activity (MSA) by diabetes risk status (DRS) among pregnant women in the United States.

METHODS

The sample (n = 9,597) included pregnant women, age 18-44 years, who participated in the 2011, 2013, 2015, and 2017 Behavioral Risk Factor Surveillance System. Levels of DRS include: no diabetes (ND), high risk for diabetes (HRD) due to self-reported gestational diabetes or pre-diabetes, and overt diabetes due to self-reported, clinically diagnosed diabetes (DM). Odds ratios (ORs) and 95% confidence intervals (CI) for meeting PA recommendations were obtained. Covariates included age, race, education, household child count, alcohol consumption, and smoking status.

RESULTS

Findings revealed that on average, DM had 46.5 fewer minutes of weekly AA compared to ND. Furthermore, a significantly lower OR (0.39; CI 0.19-0.82) for meeting both recommendations was observed in DM as compared to ND after adjustment.

CONCLUSIONS

We observed that pregnant women with overt diabetes had a lower odds of engaging in PA, while those at high risk were similar in their PA engagement to ND. Future studies aimed at assessing determinants of PA behavior may help guide efforts to promote exercise in pregnant women with diabetes.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Physical Activity Level during Pregnancy in South Africa: A Facility-Based Cross-Sectional Study

Physical activity participation during pregnancy confers many maternal and foetal health benefits to the woman and her infant and is recommended by various health bodies and institutions. However, in South Africa, scant information exists about the physical activity status and its determinants among pregnant women. The aim of this study was to assess the physical activity level and associated factors among pregnant women. This cross-sectional study enrolled 1082 pregnant women attending public health facilities in Buffalo City Municipality, Eastern Cape, South Africa. Information on socio-demographic and maternal characteristics were obtained, and the Pregnancy Physical Activity Questionnaire was used to assess physical activity during pregnancy. Multiple logistic regression analyses were used to assess associations between physical activity and the predictor variables during pregnancy. Adjusted odds ratios with 95% confidence interval were applied to estimate factors associated with physical activity levels. Statistical significance was set at p < 0.05. Only 278 of the women (25.7%) met recommendations for prenatal activity (≥150 min moderate intensity exercise per week). The average time spent in moderate-vigorous physical activity was 151.6 min (95% CI: 147.2-156.0). Most of the women participated in light exercises with a mean of 65.9% (95% CI: 64.8-67.0), and 47.6% (95% CI: 46.3-48.9) participated in household activities. The majority of the women did not receive physical activity advice during prenatal care sessions (64.7%). Factors negatively associated with prenatal physical activity were lower age (<19 years) (adjusted odd ratio (AOR) = 0.3; CI: 0.16-0.76), semi-urban residence (AOR = 0.8; CI: 0.55-1.03), lower educational level (AOR = 0.5; CI: 0.20-0.71), unemployment (AOR = 0.5; CI: 0.29-0.77) and nulliparity (AOR = 0.6; CI: 0.28-1.31). However, prenatal physical activity was positively associated with starting physical activity in the first trimester (AOR = 1.9; CI: 1.06-3.31) compared to other trimesters. The findings of this study demonstrated low levels of physical activity during pregnancy in South Africa. The majority of women did not meet the recommendation of 150 min of moderate intensity activity per week. Light intensity and household activities were the most preferred form of activity. The factors affecting physical activity of women in this present study include lower age, semi-urban setting, low educational level, unemployment and nulliparity. In order to increase activity levels, future work should seek to improve knowledge, access and support for physical activity in pregnant women in South Africa. This should include education and advocacy regarding physical activity for professionals involved in maternal health provision.

Development of Mother's Postnatal Sense of Security

Introduction:

Although sense of security in mothers is not clearly specified in literature, most important factors that make it up in women that do not have issues in pregnancy are social support, prenatal health care and partner’s support. Psychological factors play a key role in recognizing fear of childbirth, distinguishing anxiety from clinical depression. Recognizing risk factors and adequate intervention support would significantly reduce fear.

Aim:

to analyze development of mother’s sense of security during the postnatal period and establish the differences between two study groups.

Methods:

The Cross section study was conducted in 2017 in the Public Institute for Health care Protection of Women and Maternity in Canton Sarajevo. Using random method in the study were included 395 mothers. The research instrument was PPSS-instrument and modified questionnaire.

Results:

Postnatal sense of security in n=395 of the mothers on average was 49, 61±7, 6. Mothers’ sense of security during the first week after their child’s birth differed significantly (p=0.004) between mothers whose husband actively participated in psychophysical preparation for childbirth. Development of parents sense of security is in direct connection with psycho-physical preparations of pregnant women for labor only when both partners took active part in preparations for labor.

Conclusion:

Postnatal sense of security in parents is a term that has not been researched enough and it requires further studies. Bachelor degree in health care/graduated nurse/midwife, especially in primary health care field, according to her competencies would be able to independently create and work on promoting prevention programs through holistic approach with individuals and families.

Physical activity and associated factors among pregnant women in Ethiopia: facility-based cross-sectional study

BACKGROUND

Regular physical activity (PA) has health benefits, including reducing the risk of complications during pregnancy. In Ethiopia, little is known about PA status and its determinants among pregnant women. The purpose of this study was to assess PA status and associated factors among pregnant women attending antenatal care at public and private health facilities in Mekelle, Ethiopia.

METHODS

A facility-based cross-sectional study was conducted. Data was collected from 299 pregnant women using a structured questionnaire. Study participants were selected using a simple random sampling technique. A binary logistic regression was modeled to investigate the statistical significance of independent variables with PA status during pregnancy. Factors associated with PA status were estimated using adjusted odds ratios with 95% confidence intervals and statistical significance was declared at p-value < 0.05.

RESULTS

79.3% of the study participants were classified as sedentary. The age group of 26-35 years (AOR: 2.69, 95% CI: 1.07-6.78), attending non-formal education (AOR: 13.50, 95% CI: 2.65-68.91), and women who did not work outside the home (AOR: 5.23, 95% CI: 1.34-20.38) were significantly associated with a higher risk of sedentary activity status. Pregnant women who were married (AOR: 0.26, 95% CI: 0.09-0.73), had two children (AOR: 0.13, 95% CI: 0.03-0.59), traveled an hour or more to health facilities (AOR: 0.31, 95% CI: 0.11-0.89) were protected from being sedentary.

CONCLUSION

Sedentary PA status was highly prevalent during pregnancy. Pregnant women in the age group of 26-35 years, with a non-formal education, and women who did not work outside the home had a greater risk of reporting being sedentary. Those who were married, had two children, and traveled an hour or more to health facilities were less likely to be sedentary. Stakeholders (Tigrai regional health bureau, Mekelle University, local NGOs working with pregnant women and societies at large) should give higher emphasis on designing appropriate strategies including educational interventions to overcome barriers to PA during pregnancy.

Physical activity during pregnancy and postpartum depression: Systematic review and meta-analysis

BACKGROUND

It is still largely unknown whether physical activity (PA) during pregnancy may be useful to avert subsequent postpartum depression (PPD). We conducted a systematic review and meta-analysis to determine the preventive effects of PA during pregnancy on PPD.

METHODS

A systematic review of English and non-English articles was conducted using CINAHL, Cochrane Controlled Trials Register, PsycINFO, MEDLINE, SportDiscuss and Web of Science databases. Studies which tested the effect of any type of PA measured during pregnancy on depression or depressive symptoms in the first year postpartum were included. Relevant articles were extracted independently by 2 authors using predefined data fields, including study quality indicators. The protocol was registered on PROSPERO (CRD42018087086).

RESULTS

Twenty one studies, fit our selection criteria. Among them, seventeen studies were included in the meta-analysis, representing 93 676 women. Robust Variance Estimation random-effects meta-analysis indicated a significant reduction in postpartum depression scores (Overall SMD = -0.22 [95% CI -0.42 to -0.01], p = 0.04; I² = 86.4%) for women physically active during pregnancy relative to those who were not active. This association was reinforced in intervention studies (SMD = -0.58 [9% CI -1.09 to -0.08]).

LIMITATIONS

Overall meta-analysis showed important heterogeneity in PA assessment, suggesting the existence of potential moderators such as intensity, frequency, trimester of pregnancy or type of physical activity practiced.

CONCLUSIONS

PA during pregnancy appears to reduce the risk of PPD symptoms. High quality studies addressing the role of PA in the perinatal period and its impact on new mother's mental health remain necessary.

Comparison of psychometric properties between recall methods of interview-based physical activity questionnaires: a systematic review

BACKGROUND

This systematic review examined the methodological quality of studies and assessed the psychometric qualities of interview-administered Past-week and Usual-week Physical Activity Questionnaires (PAQs). Pubmed and Embase were used to retrieve data sources.

METHODS

The studies were selected using the following eligibility criteria: 1) psychometric properties of PAQs were assessed in adults; 2) the PAQs either consisted of recall periods of usual 7-days (Usual-week PAQs) within the past 12 months or during the past 7-days (Past-week PAQs); and 3) PAQs were interview-administered. The COSMIN taxonomy was utilised to critically appraise study quality and a previously established psychometric criteria employed to evaluate the overall psychometric qualities.

RESULTS

Following screening, 42 studies were examined to determine the psychometric properties of 20 PAQs, with the majority of studies demonstrating good to excellent ratings for methodological quality. For convergent validity (i.e., the relationship between PAQs and other measures), similar overall associations were found between Past-week PAQs and Usual-week PAQs. However, PAQs were more strongly associated with direct measures of physical activity (e.g., accelerometer) than indirect measures of physical activity (i.e., physical fitness), irrespective of recall methods. Very few psychometric properties were examined for each PAQ, with the majority exhibiting poor ratings in psychometric quality. Only a few interview-administered PAQs exhibited positive ratings for a single psychometric property, although the other properties were either rated as poor or questionable, demonstrating the limitations of current PAQs.

CONCLUSION

Accordingly, further research is necessary to explore a greater number of psychometric properties, or to develop new PAQs by addressing the psychometric limitations identified in the current review.