Influence of physical activity before and during pregnancy on infant's sleep and neurodevelopment at 1-year-old

Physically active pregnancies: Insights from the placenta

Physical activity (PA) positively influences pregnancy, a critical period for health promotion, and affects placental structure and function in ways previously overlooked. Here, we summarize the current body of literature examining the association between PA, placenta biology, and physiology while also highlighting areas where gaps in knowledge exist. PA during pregnancy induces metabolic changes, influencing nutrient availability and transporter expression in the placenta. Hormones and cytokines secreted during PA contribute to health benefits, with intricate interactions in pro- and anti-inflammatory markers. Extracellular vesicles and placental "-omics" data suggest that gestational PA can shape placental biology, affecting gene expression, DNA methylation, metabolite profiles, and protein regulation. However, whether cytokines that respond to PA alter placental proteomic profiles during pregnancy remains to be elucidated. The limited research on placenta mitochondria of physically active gestational parents (gesP), has shown improvements in mitochondrial DNA and antioxidant capacity, but the relationship between PA, placental mitochondrial dynamics, and lipid metabolism remains unexplored. Additionally, PA influences the placenta-immune microenvironment, angiogenesis, and may confer positive effects on neurodevelopment and mental health through placental changes, vascularization, and modulation of brain-derived neurotrophic factor. Ongoing exploration is crucial for unraveling the multifaceted impact of PA on the intricate placental environment.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

REGISTRATION

PROSPERO: CRD42023440886.

TWEETABLE ABSTRACT

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

Maternal Exercise during Pregnancy Impacts Motor Performance in 9-Year-Old Children: A Pilot Study

The benefits of maternal physical activity during pregnancy are well documented, but long-term effects on the child have been less studied. Therefore, we conducted a pilot follow-up study of a lifestyle intervention during pregnancy that aimed to investigate whether exercise (endurance and strength training) during pregnancy affects motor performance and body composition of children up to 9 years of age, as well as possible influencing factors like brain-derived neurotrophic factor (BDNF) and lifestyle. Eleven mother-child pairs from the intervention and eight mother-child pairs from the control group were included. From birth up to 9 years of age, no differences in body mass index (BMI) or body mass index standard deviation scores (BMI-SDS) were found between the groups. Lifestyle intervention was one of the influencing factors for children's cardiorespiratory endurance capacity and coordination. Moreover, maternal BDNF in the last trimester was significantly associated with running performance, which may be due to better neuronal development. This is the first study evaluating the effects of a lifestyle intervention during pregnancy on the motor performance 9 years after birth. Children's participation in exercise programs over the past 9 years was not continuously recorded and therefore not included in the analysis. Even a cautious interpretation of these results indicates that a healthy lifestyle during pregnancy is essential in promoting child health. Larger studies and randomized control trials are necessary to confirm our results, especially those pertaining to the role of BDNF.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Mother’s physical activity during pregnancy and newborn’s brain cortical development

Background

Physical activity is known to improve mental health, and is regarded as safe and desirable for uncomplicated pregnancy. In this novel study, we aim to evaluate whether there are associations between maternal physical activity during pregnancy and neonatal brain cortical development.

Methods

Forty-four mother/newborn dyads were included in this longitudinal study. Healthy pregnant women were recruited and their physical activity throughout pregnancy were documented using accelerometers worn for 3–7 days for each of the 6 time points at 4–10, ∼12, ∼18, ∼24, ∼30, and ∼36 weeks of pregnancy. Average daily total steps and daily total activity count as well as daily minutes spent in sedentary/light/moderate/vigorous activity modes were extracted from the accelerometers for each time point. At ∼2 weeks of postnatal age, their newborns underwent an MRI examination of the brain without sedation, and 3D T1-weighted brain structural images were post-processed by the iBEAT2.0 software utilizing advanced deep learning approaches. Cortical surface maps were reconstructed from the segmented brain images and parcellated to 34 regions in each brain hemisphere, and mean cortical thickness for each region was computed for partial correlation analyses with physical activity measures, with appropriate multiple comparison corrections and potential confounders controlled.

Results

At 4–10 weeks of pregnancy, mother’s daily total activity count positively correlated (FDR corrected P ≤ 0.05) with newborn’s cortical thickness in the left caudal middle frontal gyrus (rho = 0.48, P = 0.04), right medial orbital frontal gyrus (rho = 0.48, P = 0.04), and right transverse temporal gyrus (rho = 0.48, P = 0.04); mother’s daily time in moderate activity mode positively correlated with newborn’s cortical thickness in the right transverse temporal gyrus (rho = 0.53, P = 0.03). At ∼24 weeks of pregnancy, mother’s daily total activity count positively correlated (FDR corrected P ≤ 0.05) with newborn’s cortical thickness in the left (rho = 0.56, P = 0.02) and right isthmus cingulate gyrus (rho = 0.50, P = 0.05).

Conclusion

We identified significant relationships between physical activity in healthy pregnant women during the 1st and 2nd trimester and brain cortical development in newborns. Higher maternal physical activity level is associated with greater neonatal brain cortical thickness, presumably indicating better cortical development.

Prospective Associations Between Maternal Depression and Infant Sleep in Women With Gestational Diabetes Mellitus

Background

Women with gestational diabetes mellitus have higher rates of perinatal depressive symptoms, compared to healthy pregnant women. In the general population, maternal depressive symptoms have been associated with infant sleep difficulties during the first year postpartum. However, there is lack of data on infants of mothers with gestational diabetes mellitus.

Methods

This study assessed the prospective associations between maternal perinatal depressive symptoms and infant sleep outcomes. The study population consisted of 95 Swiss women with gestational diabetes mellitus and their infants, enrolled in the control group of the MySweetheart trial (NCT02890693). Perinatal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale at the first gestational diabetes mellitus visit during pregnancy, at 6–8 weeks postpartum, and 1 year postpartum. The Brief Infant Sleep Questionnaire was used to assess infant sleep (i.e., nocturnal sleep duration, number of night waking, and maternal perception of infant sleep) at 1 year postpartum. Relevant maternal and infant measurements (e.g., infant sex or maternal age or social support) were collected or extracted from medical records as covariates.

Results

Antenatal maternal depressive symptoms at the first gestational diabetes mellitus visit were inversely associated with infant nocturnal sleep duration at 1 year postpartum (β = –5.9, p = 0.046). This association became marginally significant when covariates were added (β = –5.3, p = 0.057). Maternal depressive symptoms at 6–8 weeks postpartum were negatively and prospectively associated with infant nocturnal sleep duration (β = –9.35, p = 0.016), even when controlling for covariates (β = –7.32, p = 0.042). The association between maternal depressive symptoms and maternal perception of infant sleep as not a problem at all was significant at 1 year postpartum (β = –0.05, p = 0.006), although it became non-significant when controlling for appropriate covariates. No other significant associations were found.

Limitations

This study solely included measures derived from self-report validated questionnaires.

Conclusion

Our findings suggest it is of utmost importance to support women with gestational diabetes mellitus as a means to reduce the detrimental impact of maternal perinatal depressive symptoms on infant sleep, given its predictive role on infant metabolic health.

Neurological development in 36‐month‐old children conceived via assisted reproductive technology: The Japan Environment and Children's Study

Purpose

This study aimed to investigate neurodevelopment in children conceived via in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) with several types of embryo transfers.

Methods

We analyzed data for 77 928 children and their mothers included in a Japanese birth cohort study. Among the included children, 4071 were conceived via IVF, while 1542 were conceived via ICSI. Neurodevelopmental delay at the age of 3 years was assessed using the Japanese version of the Ages and Stages Questionnaires, 3rd edition.

Results

In the crude model, the odds ratios for developmental delay in 1–4 domains were higher among children conceived via IVF, ICSI, and non‐ART (ovulatory induction or intrauterine insemination) than in spontaneously conceived children. After adjusting for parental background factors and the child's sex, there were no differences in the risk of developmental delay when comparing singletons conceived by IVF, ICSI, or non‐ART and those conceived spontaneously. Higher odds ratios for developmental delay in one domain were observed in singleton girls conceived via IVF when compared with those who were spontaneously conceived.

Conclusion

Most cases of developmental delay may be associated with multiple pregnancies and factors related to infertility, such as parental age, irrespective of the use of ART.

Relationship between Physical Activity and Physical and Mental Health Status in Pregnant Women: A Prospective Cohort Study of the Japan Environment and Children's Study

To discuss appropriate physical activity (PA) levels during pregnancy, this prospective cohort study examined the relationships between PA levels before and during pregnancy and physical and mental health status. Fixed data for 104,102 pregnant women were used from the Japan Environment and Children’s Study, of which data for 82,919 women were analyzed after excluding women with multiple birth and pregnancy complications. PA levels were measured using the International Physical Activity Questionnaire-Short Form. The 8-Item Short Form Health Survey was used to measure outcomes. Logistic regression with multiple imputations showed that moderate PA for over 720 min/wk and vigorous PA before pregnancy were associated with poorer mental health in the first trimester (adjusted odds ratio (AOR): 1.087–1.376. Walking in the second and third trimesters was associated with better physical and mental health (AOR: 0.855–0.932). Moderate PA over 1080 min/wk and vigorous PA in the second and third trimesters were associated with poorer mental health (AOR: 1.223–1.873). Increases over 4135.4 MET–min/wk and decreases in PA levels were associated with poorer mental and physical health (AOR: 1.070–1.333). Namely, pregnant women receiving health benefits prefer continuous walking in addition to avoiding vigorous PA and excessive changes in PA levels during pregnancy.