Linking nontraditional physical activity and preterm delivery in urban African-American women

Benefits and barriers to physical activity among African women: A systematic review

Black women have always been likened to being a less physically active group compared to women of other races/ethnicity, with reports of a high prevalence of obesity and other cardiometabolic diseases among them. The purpose of this study is to examine the health benefits of physical activity on women of color, as well as barriers that inhibit their participation. We searched PubMed and Web of Science databases for relevant research articles. Included articles were: Published in the English Language from 2011 to February 2022; conducted predominantly on black women, African women, or African American women. Articles were identified, screened, and data extracted following the Preferred Reporting Item for Systematic Review and Meta-Analysis (PRISMA) guidelines. The electronic search produced 2 043 articles, and 33 articles were reviewed after meeting the inclusion criteria. 13 articles focused on the benefits of physical activity while 20 articles addressed the barriers to physical activity. It was found that physical activity has various benefits for black women participants but they are being hindered from participation by some factors. These factors were grouped into four themes, namely Individual/Intrapersonal barriers, Socio-economic barriers, Social barriers, and Environmental barriers. Various studies have examined the benefits and barriers of physical activity among women of different racial and ethnic backgrounds, but there have been very few studies of African women, with the majority focusing on one geographical area. In addition to exploring these benefits and barriers, this review offers recommendations on the areas researchers should focus on to promote physical activity in this population.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Physical activity 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.

Physical Activity and Its Relationship with Preterm Birth in the Presence of Depressive Symptomology

OBJECTIVE

To examine the relationship between physical activity (PA) and preterm birth (PTB) within the context of depressive symptoms (DS).

METHODS

Data are from the Life-course Influences of Fetal Environments (LIFE) Study, a cohort comprised of 1410 Black women, age 18-45 years who delivered a singleton in Metropolitan Detroit, MI. DS were measured with the Center for Epidemiologic Studies Depression Scale (CES-D); a score > 23 indicates severe DS. Traditional leisure time PA (LTPA) and non-LTPA during pregnancy (walking for a purpose, climbing stairs) were both measured. Modified Poisson regression models were used to estimate the association between PTB and PA. Effect modification by severe DS was assessed via stratification.

RESULTS

Approximately 16% of women had a PTB; 20% had CES-D scores > 23. Walking for a purpose was the most frequently reported type of PA (79%), followed by any LTPA (37.7%) and climbing stairs (13.5%). Compared with women who reported no PA, women who reported walking for a purpose (PR = 0.70, 95% CI 0.61, 1.10), partaking in LTPA (PR = 0.67, 95% CI 0.50, 0.90), or climbing stairs (PR = 0.61, 95% CI 0.45, 0.81) were less likely to have PTB. Results stratified by severe DS show the association between LTPA and PTB was more pronounced in women with severe DS, while the non-LTPA relationship with PTB was more heterogeneous.

CONCLUSIONS

Women who participated in traditional LTPA (any or walking only) and non-LTPA experienced improved birth outcomes. LTPA may buffer against PTB among pregnant Black women with severe DS as well as none or mild DS.

Views on Exercise Among Black Women During Pregnancy

OBJECTIVE

To describe and understand exercise practices, beliefs about exercise, support for exercise, barriers to exercise, and preferences for a group exercise program in the context of individual and environmental factors among Black women during pregnancy.

DESIGN

Mixed-methods design.

SETTING

Large university-affiliated urban midwifery practice.

PARTICIPANTS

Fourteen Black women who were pregnant.

METHODS

We conducted semistructured interviews to determine participants' exercise practices, beliefs about exercise while pregnant, exercise support and barriers, and preferences for a group pregnancy exercise program. Participants also completed self-report measures for exercise, neighborhood environment, symptoms of depression, and sociodemographic characteristics. We used matrices to facilitate integrated analysis of the interview and self-report data to determine areas of concordance and discordance among the data sources and to note patterns in the data.

RESULTS

We identified and described themes that represented concepts in our data: Exercise Misinformation and Folklore, Supportfor Exercise While Pregnant, Barriers to Exercise While Pregnant, Perceived Health Benefits, and Exercise Program Preferences. Data diverged for some participants on neighborhood as a barrier to exercise. Except for the two participants with high levels of symptoms of depression, data converged regarding symptoms of depression as a barrier to exercise.

CONCLUSION

Health care providers can successfully promote exercise if they provide education about exercise during pregnancy, help pregnant women overcome barriers to exercise, prompt women to exercise with partners for tangible and social support while pregnant, and refer women to exercise programs for pregnant women if available.

Walking for health during pregnancy: A literature review and considerations for future research

Walking is the most commonly chosen type of physical activity (PA) during pregnancy and provides several health benefits to both mother and child. National initiatives have promoted the importance of walking in general, but little emphasis is directed toward pregnant women, the majority of whom are insufficiently active. Pregnant women face a variety of dynamic barriers to a physically active lifestyle, some of which are more commonly experienced during specific times throughout the pregnancy experience. Walking is unique in that it appears resistant to a number of these barriers that limit other types of PA participation, and it can be meaningfully integrated into some transportation and occupational activities when leisure-time options are unavailable. Preliminary intervention work suggests that walking programs can be effectively adopted into a typical pregnancy lifestyle. However, a great deal of work remains to administer successful pregnancy walking interventions, including developing and using validated methods of PA and walking assessment. This narrative review discusses the unique advantages of walking during pregnancy, provides recommendations for future intervention work, and outlines the need for pregnancy-focused community walking initiatives. Standard search procedures were followed to determine sources from the literature specific to walking during pregnancy for use in each section of this review.

Physical Activity and Risk of Preterm Birth in a Cohort of African American Women

BACKGROUND

Few studies have identified modifiable risk factors that are associated with the prevention of preterm delivery (PTD). This study examined the relationship between PTD and physical activity during pregnancy.

METHODS

Data were obtained by medical record review and postpartum questionnaires from a cohort of African American women (N = 1,410) delivering singleton infants. Physical activity was self-reported and analyses compared any and none. Additional analyses classified leisure time physical activity (LTPA) and walking for a purpose as 0, 1 to 19, 20 to 39, and 40 minutes per day or more and stair climbing as 0, 1 to 5, 6 to 9, and 10 or more times per day. Log-Poisson models adjusted for previous PTD, pregnancy complications, and income were used to examine the association between PTD and physical activity during pregnancy across body mass index categories.

RESULTS

Overall, 16.4% of deliveries were preterm. LTPA was associated with a decreased prevalence of PTD (prevalence ratio [PR], 0.73; 95% confidence interval [CI], 0.55-0.96), but stratification by maternal prepregnancy body mass index suggested that LTPA was only protective against PTD among women with normal weight (PR, 0.43; 95% CI, 0.23-0.79). Stair climbing 10 or more times per day was associated with a decreased prevalence of PTD among women with normal weight (PR, 0.32; 95% CI, 0.11-0.94) and women with overweight (PR, 0.24; 95% CI, 0.07-0.80) only. Walking for a purpose (e.g., to the store, the bus stop, or to work) was not associated with PTD.

CONCLUSIONS

African American women who participate in either LTPA or stair climbing during pregnancy have a decreased prevalence of PTD, but the protective effect varied by maternal body mass index.

Leisure-Time Physical Activity in Pregnancy and Maternal-Child Health: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Cohort Studies

BACKGROUND

Evidence suggests that leisure-time physical activity (LTPA) during pregnancy is associated with a reduced risk of preeclampsia, gestational diabetes mellitus (GDM), and preterm birth. However, these results are inconsistent when comparing cohort studies and randomized controlled trials (RCTs).

OBJECTIVE

The purpose of our study was to compare the associations between LTPA in pregnancy and maternal (GDM, preeclampsia, and weight gain during pregnancy) and child health outcomes (preterm birth, birthweight, and fetal growth) between RCTs and cohort studies.

METHODS

We performed a systematic search in PubMed, Web of Science, and EBSCO up to 31 August 2015. Inclusion criteria for experimental studies required randomized trials with a control group and exposure to a physical activity structured program. The inclusion criteria for cohort studies required information on LTPA during pregnancy as an exposure and at least one maternal-child health outcome. We assessed the methodological quality of all studies and performed a meta-analysis to produce summary estimates of the effects using random models.

RESULTS

We included 30 RCTs and 51 cohort studies. The meta-analysis of RCTs indicated that participation in LTPA was associated with lower weight gain during pregnancy, lower likelihood of GDM, and lower likelihood of delivering a large-for-gestational-age infant. Cohort studies indicated that participation in LTPA was associated with lower weight gain during pregnancy, lower likelihood of GDM, and lower risk of preterm delivery.

CONCLUSIONS

Our findings support the promotion of LTPA in pregnancy as a strategy to improve maternal and child health.

Physical activity and the risk of preterm birth: a systematic review and meta-analysis of epidemiological studies

BACKGROUND

Physical activity has been inconsistently associated with risk of preterm birth, and the strength of the association and the shape of the dose-response relationship needs clarification.

OBJECTIVES

To conduct a systematic review and dose-response meta-analysis to clarify the association between physical activity and risk of preterm birth.

SEARCH STRATEGY

PubMed, Embase and Ovid databases were searched for relevant studies up to 9 February 2017.

SELECTION CRITERIA

Studies with a prospective cohort, case-cohort, nested case-control or randomized study design were included.

DATA COLLECTION AND ANALYSIS

Data were extracted by one reviewer and checked for accuracy by a second reviewer. Summary relative risks (RRs) were estimated using a random effects model.

MAIN RESULTS

Forty-one studies (43 publications) including 20 randomized trials and 21 cohort studies were included. The summary RR for high versus low activity was 0.87 [95% confidence interval (CI): 0.70-1.06, I² = 17%, n = 5] for physical activity before pregnancy, and it was 0.86 (95% CI: 0.78-0.95, I² = 0%, n = 30) for early pregnancy physical activity. The summary RR for a 3 hours per week increment in leisure-time activity was 0.90 (95% CI: 0.85-0.95, I² = 0%, n = 5). There was evidence of a nonlinear association between physical activity and preterm birth, P_nonlinearity < 0.0001, with the lowest risk observed at 2-4 hours per week of activity.

CONCLUSION

This meta-analysis suggests that higher leisure-time activity is associated with reduced risk of preterm birth. Further randomized controlled trials with sufficient frequency and duration of activity to reduce the risk and with larger sample sizes are needed to conclusively demonstrate an association.

TWEETABLE ABSTRACT

Physically active compared with inactive women have an 10-14% reduction in the risk of preterm birth.

Non-occupational physical activity during pregnancy and the risk of preterm birth: a meta-analysis of observational and interventional studies

A meta-analysis was conducted to evaluate the association between non-occupational physical activity (PA) during pregnancy and the risk of preterm birth (PTB). By searching PubMed and EMBASE from inception to August 20, 2016, 25 observational studies (18 cohorts and 7 case-controls) and 12 interventional studies were identified. Comparing the highest to the lowest category of leisure-time PA during pregnancy, the pooled relative risk (RR) of PTB was 0.83 [95% confidence interval (CI) = 0.74-0.93] for cohort studies and 0.60 (95% CI = 0.43-0.84) for case-control studies. No overall significant association was found between domestic or commuting PA and the risk of PTB. In addition, PA intervention did not indicate significant beneficial effect on the risk of PTB. Evidence from the observational studies suggested that leisure-time, but not domestic or commuting, PA during pregnancy was inversely associated with the risk of PTB. The findings were not supported by small-scale and short-term interventional studies. Further research with objective measurement on leisure-time PA is warranted.

The Impact of Symptoms of Depression and Walking on Gestational Age at Birth in African American Women

BACKGROUND

Symptoms of depression have been related to lower gestational age and preterm birth (<37 completed weeks gestation). Leisure time physical activity may have protective effects on preterm birth; however, less has been published with regard to other domains of physical activity such as walking for a purpose (e.g., for transportation) or the pathways by which symptoms of depression impact gestational age at birth.

METHODS

This was a secondary analysis of available data of African American women. Women were interviewed within 3 days after birth. We proposed a model in which walking for a purpose during pregnancy mediated the effects of symptoms of depression (measured by the 20-item Center for Epidemiologic Studies-Depression [CES-D] scale) on gestational age at birth in a sample of 1,382 African American women.

RESULTS

Using structural equation modeling, we found that the direct effect of CES-D scores of 23 or greater, which have been correlated with major depression diagnosis, on gestational age at birth was -4.23 (p < .001). These results indicate that symptoms of depression were associated with a decrease in gestational age at birth of 4.23 days. Walking for a purpose mediated the effect of CES-D scores of 23 or greater on gestational age at birth.

CONCLUSIONS

Compared with African American women without symptoms of depression, African American women who had symptoms of depression walked less for a purpose during their pregnancy and delivered infants with lower gestational age at birth. If not medically contraindicated, clinicians should incorporate walking as part of prenatal care recommendations and reassure women about safety of walking during pregnancy.

The Influence of Prenatal Exercise on Offspring Health: A Review

Research has continued to demonstrate that exercise during pregnancy is safe. Growing evidence supports that exercise during pregnancy is beneficial for mother and fetus during gestation, with benefits persisting for the child into adulthood. Regardless of income or socioeconomic status, exercise during pregnancy is associated with increased incidence of full-term delivery. Additionally, normalization of birth measures, such as birth weight, occurs when women perform regular exercise throughout gestation. Measures of growth and development further indicate that exercise during pregnancy does not harm and may stimulate healthy growth throughout childhood. Measures of cognition and intelligence demonstrate that exercise during pregnancy causes no harm and may be beneficial. Overall, the benefits of exercise during pregnancy decrease the risk of chronic disease for both mother and child.

Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 2-the effect of exercise on the fetus, labour and birth

This is Part 2 of 5 in the series of evidence statements from the IOC expert committee on exercise and pregnancy in recreational and elite athletes. Part 1 focused on the effects of training during pregnancy and on the management of common pregnancy-related symptoms experienced by athletes. In Part 2, we focus on maternal and fetal perinatal outcomes.