Obstetrician Practice Patterns and Recommendations for Physical Activity During Pregnancy

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.

Is Health Education among the Decisive Factors for the Diet Quality of Pregnant Women in Poland?

Health education (HE), an educational process that leads to increased nutritional awareness and improved health, is one of the factors influencing diet quality (DQ) during pregnancy. The aim was to evaluate the DQ of pregnant women and its determinants considering their HE. The study included 122 pregnant women aged 20-40 years. DQ was assessed using the Kom-PAN^® questionnaire and the Pro-Healthy Diet Index (pHDI). Data collected included dietary habits, socio-demographic data, education level, place of residence, and maternal lifestyle-related characteristics, namely, pre-pregnancy weight, trimester of pregnancy, and pre-pregnancy and pregnancy physical activity (PA). Weekly energy expenditure was determined using the Polish version of the PPAQ questionnaire. HE at school more than tripled the odds of a higher DQ. Women in their second trimester were 54% more likely to have a higher DQ than women in their third trimester of pregnancy. Undertaking pre-pregnancy PA increased the odds of a higher DQ 2.5 times. Comparative analyses performed in a group of women with HE (HEG, n = 33) and without HE (nHEG, n = 89) showed better DQ in the former, but this was still unsatisfactory in health-promoting properties. The results obtained showed that the HE and trimester of pregnancy and pre-pregnancy Pa influenced DQ in pregnant women.

Case Studies in Physiology: Adaptation of Loading-Bearing Tendons during Pregnancy

Pregnancy is characterized by hormone changes that could alter musculoskeletal (MSK) properties and temporarily increase soft tissue injury risk. Whilst the prevalence of MSK injuries in pregnancy has not yet proven itself to be a widespread problem, indirect evidence indicates an uptake in the prevalence of strength training and vigorous-intensity activity during pregnancy, which may result in increased MSK injury incidence. Combining this evidence with the association between sex hormones and MSK injury risk, we recognize the potential importance of this research area and believe the (prospective) examination of connective tissue properties in relation to hormonal changes in pregnancy are appropriate. Given the dearth of information on MSK adaptations to pregnancy, we present a variety of morphological, mechanical and functional tendon data from two consecutive pregnancies in one woman as a means of highlighting this under-researched topic. This data may be representative of the general pregnant population, or it may be highly individualized - more research is required for a better understanding of MSK adaptation and injury risk during and after pregnancy.

Monitoring Physical Activity Intensity During Pregnancy

For apparently healthy pregnant women, regular physical activity is recommended. The American College of Obstetricians and Gynecologists (ACOG) created recommendations for physical activity and exercise during pregnancy in 1985. At that time, pregnant women were advised to not exceed a heart rate of 140 beats per minute with physical activity. The heart rate recommendation was subsequently removed with the recommendations published in 1994, 2002, and 2015. In 2020, the ACOG updated its recommendations on physical activity for pregnant and postpartum women. The recommendation included exercising at a "fairly light to somewhat hard" perceived intensity and at less than 60-80% of age-predicted maximum heart rate, usually not exceeding a heart rate of 140 beats per minute. Women often seek advice from healthcare providers on physical activity during pregnancy, yet providers report concern about giving appropriate physical activity guidance. This paper summarizes the key scientific literature on monitoring absolute and relative exercise intensity in relation to the current ACOG recommendations, providing background on intensity-related concepts used in the recommendation. This paper also provides practical guidance to assist healthcare providers in relaying this information to pregnant women.

Maternal Obesity: A Focus on Maternal Interventions to Improve Health of Offspring

Maternal obesity has many implications for offspring health that persist throughout their lifespan that include obesity and cardiovascular complications. Several different factors contribute to obesity and they encompass interplay between genetics and environment. In the prenatal period, untreated obesity establishes a foundation for a myriad of symptoms and negative delivery experiences, including gestational hypertensive disorders, gestational diabetes, macrosomia, and labor complications. However, data across human and animal studies show promise that nutritional interventions and physical activity may rescue much of the adverse effects of obesity on offspring metabolic health. Further, these maternal interventions improve the health of the offspring by reducing weight gain, cardiovascular disorders, and improving glucose tolerance. Mechanisms from animal studies have also been proposed to elucidate the signaling pathways that regulate inflammation, lipid metabolism, and oxidative capacity of the tissue, ultimately providing potential specific courses of treatment. This review aims to pinpoint the risks of maternal obesity and provide plausible intervention strategies. We delve into recent research involving both animal and human studies with maternal interventions. With the increasing concerning of obesity rates witnessed in the United States, it is imperative to acknowledge the long-term effects posed on future generations and specifically modify maternal nutrition and care to mitigate these adverse outcomes.

Baby Steps: Using Intervention Mapping to Develop a Sustainable Perinatal Physical Activity Healthcare Intervention

While the benefits of physical activity (PA) during and after pregnancy have been established, many women do not reach the recommended PA levels during this time. A major barrier found in the literature is a lack of counselling by healthcare providers (HCPs), which is partly caused by the limited knowledge on the topic. The aim of this study was to develop an intervention to improve the promotion of PA by HCPs. We used Intervention Mapping (IM), a theory-based framework to develop an intervention, called "Baby steps", in a high-income (Austria) and a low-to-middle-income country (South Africa). We applied the following IM steps: (1) A needs assessment to determine the barriers and enablers of PA promotion by HCPs, including a scoping literature review and community needs assessments (qualitative interviews, questionnaires, and focus groups with midwives, obstetricians, and community health workers) to determine the desired outcomes of the intervention. (2) Performance and change objectives were formulated, describing the behaviors that need to change for the intervention to succeed. (3) Based on these objectives, theory-based behavior change techniques were selected, and practical applications were developed. (4) The applications were combined into two evidence-based interventions tailored to each country's needs. Step (5) and (6) consist of an implementation and evaluation plan, respectively. The intervention is aimed at HCPs, such as midwives and community health workers, consisting of a two-day training course, including practical resources. Combining didactic and interactive education, it addresses both PA knowledge and the skills needed to transfer knowledge and facilitate behavior change. In the future, the intervention's effect on women's activity levels during and after pregnancy needs to be studied.

What exercise advice are women receiving from their healthcare practitioners during pregnancy?

BACKGROUND

Exercise during pregnancy is associated with a variety of health benefits for both mother and child. Despite these benefits, few Australian pregnant women are sufficiently active to meet current exercise during pregnancy guidelines. Healthcare practitioners can play an instrumental role in encouraging women to be active during their pregnancy through the provision of clear and accurate exercise advice. However, little is known about the exercise advice that pregnant women receive from Healthcare practitioners.

METHODS

Regionally-based Australian women were asked to self-report the exercise advice they received from their Healthcare practitioners during their pregnancy via a survey during one of their clinic visits.

RESULTS

Of the 131 participants, 53% (n=70) reported receiving some form of exercise advice from their Healthcare practitioner. Specifically, frequency of exercise was discussed among 34% of the participants (n=23) while exercise intensity 57% was discussed among 57% of the participants (n=38). Exercise duration was discussed among 39% of participants (n=26) and types of exercise was discussed among 84% of the participants (n=56). In most instances, participants report receiving advice not in accordance with current exercise during pregnancy guidelines.

CONCLUSIONS

Healthcare practitioners may not be actively providing advice to pregnant women about their exercise behaviours. Of the advice that is provided, it may not in accordance with current evidence-based exercise during pregnancy guidelines. Whilst healthcare practitioners may be uniquely positioned to provide exercise advice to pregnant women, they may not have the necessary knowledge, training or support to provide specific exercise advice.

Assessment of physical activity status among pregnant women in southwestern China

Objective

To assess the patterns and intensities of physical activity among pregnant women in southwestern China, which help us create a fitness regimen based on the 2002 American College of Obstetricians and Gynecologists (ACOG) guidelines for exercise during pregnancy.

Methods

A cross-sectional study was performed to recruit pregnant women at a prenatal checking visit clinic with the self-administered Chinese version of Pregnancy Physical Activity Questionnaire (PPAQ).

Results

A total of 1179 Chinese pregnant women were enrolled, of whom 92.60% were classified as not meeting the ACOG guidelines. By intensity, 47.36% of the score was attributed to light-intensity activities (1.5 to <3.0 metabolic equivalent [MET]) in the first trimester; the other 2 trimesters were similar. By patterns, about 45.15% of the score was attributed to inactivity. More than 82.35% of enrolled pregnant women regarded slowly walking as the most common type of exercise during pregnancy.

Conclusions

This study represents a group of Chinese women who maintained an inactive lifestyle, including low-intensity activities and unitary type of exercises during their pregnancy. Health-care providers are advised to provide appropriate physical activity guidelines to pregnant women. Development of MET-hours/week recommendations is warranted to promote greater physical activity during pregnancy.

Midwives understanding of physical activity guidelines during pregnancy

OBJECTIVE

to examine the current level of understanding held by midwives regarding the NICE physical activity guidelines in the UK, and to investigate the physical activity guidance given to women during pregnancy.

DESIGN

an 11 question online survey comprising of a mixture of closed and open ended questions.

SETTING

data reflects participants sampled across the United Kingdom.

PARTICIPANTS

fifty-nine midwives completed the online survey MEASUREMENTS AND FINDINGS: an electronic survey was used to explore the midwives understanding of physical activity guidelines during pregnancy, and the advice they offered to women in their care. Qualitative content analysis was used to gain a more in-depth understanding of midwife knowledge. Two per cent of midwives correctly identified the physical activity guidelines, with 44% giving partially correct responses, 25% giving incorrect responses and 29% unsure of what the guidelines are. Despite the low level of correct responses, 59% of respondents reported they were confident or very confident in answering questions regarding physical activity. Only 4% of respondents reported having access to continual professional development (CPD) in the area of PA guidance.

KEY CONCLUSIONS

there appears to be a misplaced confidence amongst midwives in their knowledge of the NICE PA guidelines for pregnancy.

IMPLICATIONS FOR PRACTICE

as physical inactivity can be detrimental for the health of both mother and baby, there is a clear need for better dissemination of the current and future NICE physical activity guidelines in primary health care settings. The current study determined a substantial lack of CPD in the area of PA guidance, which may be a contributing factor to the lack of knowledge of the guidelines. As such, increasing CPD may in turn improve the accuracy of the advice given to pregnant women and consequently benefit the health of both mother and baby.

Physical activity during pregnancy and the role of theory in promoting positive behavior change: A systematic review

BACKGROUND

Physical activity (PA) during pregnancy provides physical and psychological benefits for mother and child. U.S. guidelines recommend ≥30 min of moderate exercise for healthy pregnant women most days of the week; however, most women do not meet these recommendations. Theory assists in identifying salient determinants of health behavior to guide health promotion interventions; however, the application of theory to examine PA among pregnant women has not been examined cohesively among multiple levels of influence (e.g., intrapersonal, interpersonal, neighborhood/environmental, and organizational/political). Subsequently, this systematic review aims to identify and evaluate the use of health behavior theory in studies that examine PA during pregnancy.

METHODS

Articles published before July 2014 were obtained from PubMed and Web of Science. Inclusion criteria applied were: (1) empirically-based; (2) peer-reviewed; (3) measured factors related to PA; (4) comprised a pregnant sample; and (5) applied theory. Fourteen studies were included. Each study's application of theory and theoretical constructs were evaluated.

RESULTS

Various theories were utilized to explain and predict PA during pregnancy; yet, the majority of these studies only focused on intrapersonal level determinants. Five theoretical frameworks were applied across the studies-all but one at the intrapersonal level. Few determinants identified were from the interpersonal, neighborhood/environmental, or organizational/political levels.

CONCLUSION

This systematic review synthesized the literature on theoretical constructs related to PA during pregnancy. Interpersonal, community, and societal levels remain understudied. Future research should employ theory-driven multi-level determinants of PA to reflect the interacting factors influencing PA during this critical period in the life course.

Educational intervention regarding diet and physical activity for pregnant women: changes in knowledge and practices among health professionals

BACKGROUND

The knowledge and practices of health professionals have a recognized role in behaviors related to the health of their patients. During pregnancy, this influence can be even stronger because there is frequent contact between women and doctors/nurses at periodic antenatal visits. When trained, supported and motivated, these professionals can act as health promoters. This study aimed to evaluate the effect of a focused educational intervention on improving the knowledge and practices of health professionals concerning diet and physical activity during pregnancy.

METHODS

A controlled, non-randomized study was performed to assess the effects of an educational intervention on the knowledge and practices of nurses and doctors who provide primary care to pregnant women. The intervention group, doctors and nurses (n = 22) from the family health units in a medium-sized city of São Paulo State, Brazil, received 16 h of training comprising an introductory course and three workshops, whereas the control group, doctors and nurses (n = 20) from traditional basic health units in Botucatu, did not. The professionals' knowledge was assessed at two time points, 1 month prior to and 1 year after the beginning of the intervention, using an ad hoc self-report questionnaire. The increases in the knowledge scores for walking and healthy eating of the intervention and control groups were calculated and compared using Student's t-test. To analyze the professionals' practice, women in the second trimester of pregnancy were asked whether they received guidance on healthy eating and leisure-time walking; 140 of these women were cared for by professionals in the intervention group, and 141 were cared for by professionals in the control group. The percentage of pregnant women in each group that received guidance was compared using the chi-square test and the Prevalence Ratio (PR), and the corresponding 95 % confidence intervals (CI) were calculated.

RESULTS

The intervention improved the professionals' knowledge regarding leisure-time walking (92 % increase in the score, p < 0.001). The women who were cared for by the intervention group were more likely to receive guidance regarding leisure-time walking (PR = 2.65; 95 % CI = 1.82-3.83) and healthy eating (PR = 1.76; 95 % CI = 1.34-2.31) when compared to the control group.

CONCLUSION

It is possible to improve the knowledge and practices of health professionals through the proposed intervention aimed at primary health care teams providing antenatal care.

Cardiac Physiology of Pregnancy

Although the physiology of the heart and vascular system has not changed, there are many things we have learned and are still learning today. Research related to heart adaptations during pregnancy has been performed since the 1930s. Since the mid-1950s, researchers began to look at changes in the maternal cardiovascular system during exercise while pregnant. Research related to exercise during pregnancy and offspring heart development began and has continued since the 1970s. We will review the normal female cardiovascular system adaptations to pregnancy in general. Additionally, topics related to maternal cardiac adaptations to pregnancy during acute exercise, as well as the chronic conditioning response from exercise training will be explored. Since physical activity during pregnancy influences fetal development, the fetal cardiac development will be discussed in regards to acute and chronic maternal exercise. Similarly, the influence of various types of maternal exercise on acute and chronic fetal heart responses will be described. Briefly, the topics related to how and if there is maternal-fetal synchrony will be explained. Lastly, the developmental changes of the fetal cardiovascular system that persist after birth will be explored. Overall, the article will discuss maternal cardiac physiology related to changes with normal pregnancy, and exercise during pregnancy, as well as fetal cardiac physiology related to changes with normal development, and exercise during pregnancy as well as developmental changes in offspring after birth.

Exercise during pregnancy: knowledge and beliefs of medical practitioners in South Africa: a survey study

Background

There is compelling evidence for the benefits of regular exercise during pregnancy, and medical practitioners (MPs) can play an important role in changing antenatal health behaviours. The purpose of this study was to assess the knowledge, attitudes and beliefs of South African MPs towards exercise during pregnancy.

Methods

A convenience sample of ninety-six MPs working in the private health care sector, including General Practitioners (n = 58), Obstetricians/Gynaecologists (n = 33) and other Specialists (n = 5), participated in this cross sectional, descriptive survey study. A 33-item questionnaire was distributed manually at medical practices and via email to an on-line survey tool. Descriptive statistics and frequency tables were calculated for all questions. Chi-squared and Fisher’s exact statistical tests were used to determine the differences in response by age, speciality and years of practice (p < 0.05).

Results

The majority of practitioners (98 %) believe that exercise during pregnancy is beneficial, and were knowledgeable on most of the expected benefits. Seventy-eight percent believed that providing exercise advice is an important part of prenatal care, however only 19 % provided informational pamphlets and few (24 %) referred to exercise specialists. A large majority (83 %) were unaware of the recommended exercise guidelines. Although age and years of practice played no role in this awareness, practitioners who focussed on obstetrics and gynaecology were more likely to be aware of the current guidelines, than those in general practice (p < 0.001).

Conclusion

Although the MPs were largely positive towards exercise during pregnancy, their advice did not always align with the current guidelines. Therefore, better dissemination of available research is warranted, to bridge the gap between clinical knowledge and current recommendations for physical activity promotion.

Electronic supplementary material

The online version of this article (doi:10.1186/s12884-015-0690-1) contains supplementary material, which is available to authorized users.

Exercise and yoga during pregnancy: a survey

The primary objective of this survey was to ascertain the opinions, practices and knowledge about exercise, including yoga, during pregnancy; the secondary objective to compare the responses among women with body mass index (BMI) <30 kg/m(2) versus ≥30 kg/m(2). Survey consisted of 20 multiple choice questions assessing demographics and exercise practices, and five questions testing their knowledge about it during pregnancy (ACOG Committee Opinion # 267). Of the 500 surveys distributed, 84% (422) responses were analyzed. While 86% of women responded that exercise during pregnancy is beneficial, 83% felt it was beneficial to start prior to pregnancy, and walking was considered the most beneficial (62%). The majority (64%) of respondents were currently exercising during pregnancy and 51% exercised 2-3 times/week. Among the five questions testing knowledge about prenatal exercise, majority (range 60 to 92%) were aware of ACOG recommendations. About half had a BMI ≥30. Knowledge about benefits of exercise during pregnancy did not differ significantly between obese and non-obese. Yoga was tried significantly more among non-obese, 65% believed it is beneficial, and 40% had attempted yoga before pregnancy. In our population, the majority believes that exercise, including yoga, is beneficial and they are active.

Exercise during pregnancy: the role of obstetric providers

CONTEXT

Obstetric providers are logical choices for conveying information about physical activity to their pregnant patients. However, research regarding obstetric providers counseling pregnant patients about physical activity is sparse.

OBJECTIVES

To investigate the association between obstetric providers discussing exercise with their pregnant patients and patients' exercise behaviors and to explore factors related to obstetric providers discussing exercise and other health behaviors (tobacco use, alcohol use, and nutrition) with their patients.

METHODS

We received completed surveys from 238 pregnant women and 31 obstetric providers at 12 obstetrician offices. The offices were located throughout the United States and were heterogeneous in regards to patient insurance coverage, number of patients treated per month, and percentage of patients with complications.

RESULTS

Women who were "more careful about eating healthy" (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.2-8.0) and who discussed exercise with their obstetric provider (OR, 2.2; 95% CI, 1.1-4.3) were more likely to "maintain or increase exercise" during pregnancy than those who were not conscientious about their diets and those who did not discuss exercise with their obstetric provider, respectively. The odds of obstetric providers discussing exercise with pregnant patients increased 7-fold (OR, 7.1; 95% CI, 1.4-37.3) for each health behavior the obstetric provider discussed with the patient.

CONCLUSION

Patient discussions with obstetric providers about exercise and patient attention to eating habits are associated with exercising during pregnancy. A more multibehavioral approach by obstetric providers may improve the likelihood that patients exercise during pregnancy.

Sex differences among obstetrician-gynecologists: a review of survey studies

Whether practice differences exist between the sexes is a question of clinical and educational significance. The obstetrician-gynecologist (ob-gyn) workforce has been shifting to majority women. An examination of sex differences in ob-gyn practice contributes to the discussion about how the changing workforce may impact women's healthcare. We sought to review survey studies to assess whether there are specific topics in which differences in attitudes, opinions, and practice patterns between male and female ob-gyns are apparent. We conducted a systematic review to identify all survey studies of ob-gyns from the years 2002-2012. A total of 93 studies were reviewed to identify statements of sex differences and categorized by conceptual theme. Sex differences were identified in a number of areas. In general, women report more supportive attitudes toward abortion. A number of differences were identified with regard to workforce issues, such as women earning 23% less than their male counterparts as reported in 1 study and working an average of 4.1 fewer hours per week than men in another study. Men typically provide higher selfratings than women in a number of areas. Other noted findings include men tending toward more pharmaceutical therapies and women making more referrals for medical conditions. Although a number of areas of difference were identified, the impact of such differences is yet to be determined. Additional research may help to clarify the reasons for such differences and their potential impact on patients.

TARGET AUDIENCE

Obstetricians and gynecologists, family physicians Learning Objectives: After completing this CME activity, physicians should be better able to determine how the relevance of studying sex differences among physicians, specifically ob-gyns, can help improve patient care, assess whether there are topical areas in which male and female ob-gyns have reported different beliefs, practices, attitudes, and opinions, and examine how the limitations of survey studies and systematic reviews can affect the findings of these studies and reviews.

Walking patterns in pregnancy

Women are encouraged to be active before, during and after pregnancy. However, most pregnant women do not engage in sufficient levels of physical activity. For women who experience gestational diabetes mellitus (GDM), physical activity recommendations are part of the standard management. Walking is the most common activity undertaken by women across the lifespan and often recommended by health professionals. Little research specifically exploring the patterns of walking before, during and after pregnancy has been undertaken. This study investigated patterns of walking undertaken by pregnant women, including those who experienced GDM. A sample of convenience was used to recruit pregnant or postpartum women in regional New South Wales, Australia. Women completed a self-report physical activity survey. The survey also included demographic questions, GDM diagnosis and physical activity advice received from health professionals. The respondents were divided into two groups; those with GDM (GDM) and those without GDM (NoGDM). In both groups, walking declined during pregnancy and returned to prepregnancy levels in the postpartum. This decline was similar to the decline observed in leisure-time physical activity. The GDM group walked more than the NoGDM group and a higher percentage of GDM reported being advised to engage in physical activity by health professionals. Even though walking is the most common activity undertaken for women across the lifespan, prepregnancy walking levels do not necessarily continue during pregnancy. Advice from health professionals may assist in maintaining walking levels during pregnancy. Encouraging pregnant women to continue their prepregnancy walking level may be a relatively simple strategy to increase participation in physical activity.

Diet and pregnancy: health-care providers and patient behaviors

In this study, associations between health-care providers (HCPs) discussing diet with their pregnant patients and patient dietary behavior were assessed in addition to factors related to HCPs discussing diet with their patients. Questionnaires were completed by 237 pregnant women and 31 HCPs at 12 obstetrics-gynecology clinics across the United States. Patients provided versus those not provided dietary counseling by their HCP were more likely (OR = 2.17, 95%; CI = 0.75-6.25) to engage in healthy dietary practices. HCPs that discussed multiple health behaviors were nearly four times more likely to discuss diet with their pregnant patients compared with HCP who did not discuss other health behaviors (OR = 3.67, 95%; CI = 1.10-12.28). This study indicates that HCP education can positively impact dietary behaviors of their pregnant patients.

Changes in leisure time physical activity during pregnancy compared to the prior year

To quantify changes in leisure time physical activity (LTPA) type, frequency, duration and intensity during the first half of pregnancy as compared with the year prior to pregnancy. A cross sectional study was conducted at the Maternal University Hospital in Granada, Spain. A total of 1,175 healthy pregnant women attending a scheduled visit during the 20-22nd gestational week were enrolled in the study. Information about socio-demographic, obstetric and life-style variables during the previous year and the first half of pregnancy were collected. LTPA was quantified by assigning metabolic equivalents to each activity according to frequency, intensity and duration. The prevalence of women who met the optimal physical activity recommendations before and during pregnancy was calculated, and the McNemar-Bowker symmetry test was used to assess changes in type, frequency, intensity and duration of activities between the two periods. Some sort of LTPA was performed before and during pregnancy by 68.6% of the pregnant women. Respectively, just 27.5% and 19.4% of women fulfilled LTPA recommendations prior to pregnancy and during pregnancy; 12.6% of the women meeting recommendations prior to pregnancy later did not meet those recommendations during gestation, and 4.5% showed the reverse trend. A light increase in walking as a LTPA, and a decrease in the rest of the LTPA type activities, were seen during pregnancy. Some 13.4% of women changed from moderate--the year before- to light LTPA- during pregnancy. Pregnancy involved a decrease in LTPA, not only regarding frequency, but also duration and intensity.

Association of prenatal physical activity and gestational weight gain: results from the first baby study

BACKGROUND

In response to increasing rates of excessive gestational weight gain (GWG) and evidence of postpartum weight retention and long-term overweight and obesity, the Institute of Medicine (IOM) revised their guidelines for GWG in 2009. Prenatal physical activity is recommended, although its role in preventing excessive GWG is unclear. We sought to understand the association between prenatal physical activity and GWG in a longitudinal cohort.

METHODS

During a baseline survey at 34 weeks, women (n = 3,006) reported their height, prepregnancy weight, and physical activity during pregnancy. GWG was self-reported at 1-month postpartum. Multivariable logistic regression adjusting for age, race/ethnicity, education, poverty status, marital status, gestational age at the time of delivery, and smoking was used to model the association between adequate physical activity during pregnancy and exceeding the IOM recommendations for GWG.

FINDINGS

Overweight women were most likely to exceed the IOM recommendations for GWG (78.7%), followed by obese women and normal weight women (65.0% and 42.4%, respectively). The majority of women participated in some physical activity during pregnancy, with 41.2% engaging in 60 to 149 minutes and 32.1% engaging in at least 150 minutes of physical activity per week. In adjusted analysis, meeting the physical activity guidelines was associated with a 29% (confidence interval, 0.57-0.88) lower odds of exceeding the IOM recommendations for GWG compared with inactive women.

CONCLUSIONS

Findings of high rates of excessive GWG, especially among women with overweight and obesity, are concerning given the associated health burdens. The association of guideline-concordant physical activity with appropriate GWG suggests this is an important target for future interventions.

Is intensive counseling in maternity care feasible and effective in promoting physical activity among women at risk for gestational diabetes? Secondary analysis of a cluster randomized NELLI study in Finland

BACKGROUND

Women who are physically active during early pregnancy have notably lower odds of developing gestational diabetes than do inactive women. The purpose of the intervention was to examine whether intensified physical activity (PA) counseling in Finnish maternity care is feasible and effective in promoting leisure-time PA (LTPA) among pregnant women at risk of gestational diabetes.

METHODS

Fourteen municipalities were randomized to intervention (INT) and usual care group (UC). Nurses in INT integrated five PA counseling sessions into routine maternity visits and offered monthly group meetings on PA instructed by physiotherapists. In UC conventional practices were continued. Feasibility evaluation included safety (incidence of PA-related adverse events; questionnaire), realization (timing and duration of sessions, number of sessions missed, attendance at group meetings; systematic record-keeping of the nurses and physiotherapists) and applicability (nurses' views; telephone interview). Effectiveness outcomes were weekly frequency and duration of total and intensity-specific LTPA and meeting PA recommendation for health self-reported at 8-12 (baseline), 26-28 and 36-37 weeks' gestation. Multilevel analysis with adjustments was used in testing for between-group differences in PA changes.

RESULTS

The decrease in the weekly days of total and moderate-to-vigorous-intensity LTPA was smaller in INT (N = 219) than in UC (N = 180) from baseline to the first follow-up (0.1 vs. -1.2, p = 0.040 and -0.2 vs. -1.3, p = 0.016). A similar trend was seen in meeting the PA recommendation (-11%-points vs. -28%-points, p = 0.06). INT did not experience more adverse events classified as warning signs to terminate exercise than UC, counseling was implemented as planned and viewed positively by the nurses.

CONCLUSIONS

Intensified counseling had no effects on the duration of total or intensity-specific weekly LTPA. However, it was able to reduce the decrease in the weekly frequency of total and moderate-to-vigorous-intensity LTPA from baseline to the end of second trimester and was feasibly embedded into routine practices. TR

Gestational Diabetes

Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy and is strongly related to subsequent risk of type 2 diabetes. The epidemics of obesity and diabetes and the increasing incidence of GDM in recent years highlight the importance of preventing GDM among women at high risk to avoid the associated short- and long-term adverse health outcomes for both mothers and their offspring. Indeed, women may be more likely to adopt healthy lifestyle habits during pregnancy and maintain these habits into the postpartum period. Although there is substantial evidence that targeting at-risk groups for type 2 diabetes prevention is effective if lifestyle changes are made, relatively little attention has been paid to the prevention of GDM. Therefore, the objective of this article is to review the scientific evidence regarding the association between modifiable risk factors and GDM; discuss how lifestyle interventions, including weight management through diet and exercise could be successful in reducing the risk for GDM; and provide recommendations for future lifestyle intervention programs with a focus on translation and dissemination of research findings.

Eminence-based medicine versus evidence-based medicine: level V evidence in sports medicine

Through extensive survey analysis, we investigated expert opinion in sports medicine. The study had 3 purposes: to provide clinical guidance for cases in which the correct action is not necessarily apparent, to examine expert opinion itself, and to delineate areas of future study. A total of 500 members of the American Medical Society for Sports Medicine and the American Orthopaedic Society for Sports Medicine evaluated a set of 25 statements on unresolved issues in sports medicine. The following 10 statements were deemed false: "It's okay for 12-year-old pitchers to throw curve balls; it's the pitch count that matters"; "Resistance training ('weight lifting') should be avoided until physeal closure"; "Jogging during pregnancy is to be avoided"; "At an athletic event, if sideline coverage is offered by an emergency medical technician and athletic trainer, there is little additional benefit from having a physician present"; "Contact sport athletes who sustain a second concussion should be excluded from contact sports permanently"; "The utility of pre-season medical screening is derived from the history; as such, student-athletes should complete a questionnaire, with physical examination reserved for only those with a positive relevant history"; "Femoroacetabular impingement is a myth-the designation of anatomic variation as disease"; "An AC (acromioclavicular) separation in a contact athlete should not be treated surgically if the athlete won't give up the sport; it will fail"; "Ankle taping induces weakness and atrophy of the dynamic stabilizers of the ankle"; "Only autografts should be used in ACL (anterior cruciate ligament) surgery, as allografts have an unnecessary high failure rate in clinical practice." One statement was accepted as true: "Surgery to treat anterior (patello-femoral) knee pain in a patient with normal patellar mechanics and stability is contraindicated." In short, expert opinion may be a helpful adjunct to clinical practice. Expert opinion cannot replace individual judgment and certainly does not trump the primary medical literature. Yet when better evidence is lacking, expert opinion is valuable for even the staunchest practitioner of evidence-based medicine.