Development and validation of a Pregnancy Physical Activity Questionnaire

Impact of a Lifestyle Intervention Among Latina Women on Infant Birth and Anthropometric Measures: Pooled Analyses of 2 Randomized Controlled Trials

BACKGROUND

To assess the impact of a pregnancy and postpartum culturally modified, motivationally targeted, individually tailored intervention on infant outcomes among Latinas.

METHODS

We conducted a pooled analysis of 2 randomized controlled trials in Western Massachusetts: Estudio Parto (collected 2013-2017, analyzed 2018-2020, n = 203) and Proyecto Mamá (data collected 2014-2020, analyzed 2021-2022, n = 141) focused on pregnant Latinas (predominantly Puerto Rican) with abnormal glucose tolerance and prepregnancy body mass index in the overweight/obese range, respectively. Women were randomized in pregnancy to a Lifestyle Intervention (n = 167) focusing on healthy exercise and diet or to a comparison Health and Wellness Intervention (n = 177) with no mention of exercise or diet. The primary outcomes in both studies were birth weight, gestational age, birth weight-for-gestational-age z score, low birth weight, preterm birth, small-for-gestational-age, large for gestational age, macrosomia). Proyecto Mamá also assessed infant anthropometrics (ie, weight, length, sum and ratio of skin fold thickness, ponderal index) at 6 weeks of age. We used linear regression for continuous outcomes and logistic regression for dichotomous outcomes.

RESULTS

In modified intent-to-treat analyses, we observed no statistically significant impact of the Lifestyle Intervention on infant outcomes or anthropometric measures. For example, there was no difference in odds of small-for-gestational-age between intervention arms (odds ratio = 1.29; 95% confidence interval, 0.60-2.76).

CONCLUSIONS

In these randomized trials among pregnant Latina women, we found that a culturally modified, individually tailored Lifestyle Intervention did not lead to a significant difference in infant birth weight outcomes or anthropometric measures when compared to the Health and Wellness control arm.

The physical activity and sedentary behavior of pregnant women with gestational diabetes mellitus: A cross-sectional study

BACKGROUND

Although physical activity is recommended as a measure for treatment and management of gestational diabetes mellitus (GDM), little is known about the status of sedentary behavior, barriers and enablers to exercise, and the needs for exercise guidance in pregnant women with GDM.

AIM

The objectives of this study were to investigate the status of physical activity, sedentary behaviors and needs for exercise guidance in pregnant women with GDM, and explore its barriers, enablers and determinants.

METHOD

A cross-sectional study was conducted. A self-designed questionnaire was used to collect the data of exercise, sedentary behavior and barriers/enablers to exercise. Pregnancy Physical Activity Questionnaire was used to evaluate the physical activity. A stepwise multivariate logistic regression was conducted to analyze the determinants of exercise among pregnant women with GDM.

FINDINGS

A total of 371 questionnaires were collected. The exercise compliance rate was only 27.42%. 41% of pregnant women with GDM had sedentary time more than 6h per day. 50.9% of participants had sedentary lifestyle. The most common barriers and enablers to physical activity were pregnancy symptoms or discomfort (32.1%) and easier glycemic control (88.9%), respectively. Advanced age (≥35 years old), low capita monthly family income, and the number of sedentary-lifestyle days (OR=1.227, 95%CI 1.090-1.382, P=0.001) were the independent risk factors for failing to meet exercise standard among pregnant women.

DISCUSSION/CONCLUSION

Health care providers should provide interventions based on reducing sedentary behavior and increasing moderate physical activity to minimize the potential health problems in pregnant women with GDM.

Associations of Prepregnancy Weight Change with Fetal Growth and Adverse Birth Outcomes: A Prospective Cohort Study in China

BACKGROUNDS

Evidence regarding prepregnancy weight change (from age 18 to conception) and fetal outcomes remains limited in Asian populations.

OBJECTIVES

To explore associations of prepregnancy weight change with fetal growth and adverse birth outcomes, and joint effects between prepregnancy weight change and gestational weight gain (GWG) among Chinese women.

METHODS

We included 6330 pregnant women from Tongji-Huaxi-Shuangliu Birth Cohort. Prepregnancy weight change was defined as the difference between the recalled weight at age 18 and recalled weight just before pregnancy. Ultrasound-assessed fetal growth parameters at three gestational intervals (≤24, 25-32, and 33-42 weeks) were standardized to Z scores. Adverse birth outcomes were obtained from medical records. Associations were assessed using linear mixed and logistic regression models.

RESULTS

Compared to women with low prepregnancy weight gain (0.0-4.9 kg), those with high prepregnancy weight gain (≥ 10.0 kg) had significantly higher Z scores for all fetal growth parameters. Positive associations with femur length and estimated fetal weight were observed across all gestational periods, whereas head circumference, abdominal circumference, and biparietal diameter showed significant associations only after 25 weeks. Prepregnancy weight gain exhibited a dose-response association with higher macrosomia and large for gestational age (LGA) risks (all P < 0.001). Conversely, prepregnancy weight loss was linked to a higher small for gestational age (SGA) risk in female newborns. Furthermore, women with high prepregnancy weight gain and excessive GWG had the highest risks of macrosomia (odds ratio [OR]: 5.55; 95% confidence interval [CI]: 3.34, 9.22) and LGA (OR: 3.19; 95% CI: 2.37, 4.28).

CONCLUSIONS

Excessive prepregnancy weight gain was associated with accelerated fetal growth and increased macrosomia and LGA risks, whereas prepregnancy weight loss showed a sex-specific impact on SGA. The combination of high prepregnancy weight gain and excessive GWG was associated with the highest risks of macrosomia and LGA.

Predicting pregnancy-related pelvic girdle pain using machine learning

BACKGROUND

Pregnancy-related pelvic girdle pain (PPGP) is a common complication during gestation which negatively influences pregnant women's quality of life. There are numerous risk factors associated with PPGP, however, there is limited information about being able to predict the diagnosis of PPGP.

OBJECTIVE

To compare machine learning (ML) and traditional predictive modelling to predict the clinical diagnosis of PPGP.

METHODS

This study reanalysed data from 780 pregnant women attending a tertiary hospital. ML algorithms, including Logistic Regression (LR), Random Forest, Xtreme Gradient Boost (XGBoost), and K-Nearest Neighbors, were used to predict the clinical diagnosis of PPGP. Feature selection methods and cross-validation were employed to optimize model performance, with the Area Under the Receiver Operating Characteristic Curve (AUROC) as the primary outcome measure.

RESULTS

The ML models, particularly XGBoost and LR, demonstrated high levels of predictive accuracy (AUROC = 0.70). Key predictive factors were a history of low back pain/pelvic girdle pain (LBP/PGP) in previous pregnancies, family history, gestational age, and a longer duration of standing during the day. The history of LBP/PGP in previous pregnancies emerged as the most significant predictor.

CONCLUSIONS

This study highlighted the potential of ML models to enhance the ability to predict PPGP and offers a more accurate and comprehensive approach to identifying women at risk of PPGP. The integration of ML techniques into clinical practice could improve early identification and inform preventative and intervention strategies, potentially reducing the impact of PPGP on pregnant women.

Effect of a Tailored eHealth Physical Activity Intervention on Physical Activity and Depression During Postpartum: Randomized Controlled Trial (The Postpartum Wellness Study)

Background

Strong evidence suggests physical activity (PA) can ameliorate postpartum depression (PPD) symptoms; however, many postpartum individuals do not meet PA guidelines. Electronic health (eHealth) interventions are a promising approach to address common barriers to PA during postpartum.

Objective

To test the effectiveness of a tailored eHealth PA intervention for increasing PA and decreasing depressive symptoms in individuals at high risk for PPD.

Methods

We conducted a randomized controlled trial within the Kaiser Permanente Northern California integrated health care delivery system. From November 2020 to September 2022, individuals 2-6 months postpartum at high risk for PPD were randomized to an eHealth PA intervention (n=50) or usual care (n=49). The eHealth PA intervention group received access to an online library of 98 ten-minute workout videos developed for postpartum individuals, including interaction with their infants. At baseline, 3 months, and 6 months postrandomization, surveys were used to assess depressive symptoms, PA, sleep quality, anxiety symptoms, perceived stress, and mother-infant bonding. PA was also measured using a wrist-worn accelerometer for 7 days at each timepoint. Primary outcomes were depressive symptoms and device-measured moderate-to-vigorous intensity PA (dm-MVPA) at 3 months postrandomization. Secondary outcomes were self-reported MVPA (sr-MVPA) at 3 and 6 months postrandomization and depressive symptoms and dm-MVPA at 6 months postrandomization. Intent-to-treat and modified intent-to-treat (excluding participants in the intervention group who did not watch at least 1 video) analyses were conducted using linear regression adjusted for variables used in the randomization procedure and using multiple imputation to account for missing data.

Results

Participants were 4 months postpartum at baseline with moderately severe depressive symptoms (mean PHQ-8 [Patient Health Questionnaire-8] score=12.6), on average. Intent-to-treat analyses indicated no association between the intervention and change in depressive symptoms (mean difference=-0.9; 95% CI -3.3 to 1.5), dm-MVPA per day (mean difference=-4.5 minutes; 95% CI -23.5 to 14.5), or sr-MVPA per week (mean difference=3.8; 95% CI -1.9 to 9.5) at 3 months postrandomization or 6 months postrandomization (depressive symptoms: mean difference=-1.3; 95% CI -3.7 to 1.1; dm-MVPA: mean difference=1.3 minutes; 95% CI -18.9 to 21.5; sr-MVPA: mean difference=-1.8 MET-hours; 95% CI -7.7 to 4.2). Engagement with the intervention was suboptimal; although 52% (n=26) of participants allocated to the intervention group logged on to the intervention website and watched at least 1 video, the median minutes watched per week peaked at 10 minutes 2 weeks postrandomization, then fell to zero for the rest of the follow-up period. Results from modified intent-to-treat analyses were similar to those from intent-to-treat analyses.

Conclusions

An eHealth PA intervention tailored to postpartum individuals did not affect depressive symptoms or PA among those at high risk for PPD. Additional research to develop effective and engaging PA interventions is needed to help alleviate PPD symptoms and decrease PPD risk.

Association Between Plant-Based Diet and Continuous Glucose Monitoring-Derived Glycemic Dynamics Among Pregnant Women With Gestational Diabetes

We aim to investigate the association of plant-based diets with the continuous glucose monitoring (CGM)-derived glycemic metrics among gestational diabetes mellitus (GDM) patients. We included 1756 GDM patients in the present analyses and assessed plant-based dietary patterns through constructing a plant-based diet index (PDI), healthy PDI (hPDI), and unhealthy PDI (uPDI). CGM-glycemic metrics, such as time in range (TIR), mean blood glucose (MBG), time below range (TBR), low blood glucose index (LBGI), mean of daily differences (MODD), and glycemic risk assessment in diabetes equation (GRADE), were constructed. We found that individuals in the highest quartile of PDI were more likely to have greater TIR (β: 0.28, 95% CI: 0.14 to 0.41) and MBG (β: 0.23, 95% CI: 0.09 to 0.36), while lower TBR (β: -0.26, 95% CI: -0.39 to -0.12), LBGI (β: -0.18, 95% CI: -0.32 to -0.05), and GRADE (β: -0.25, 95% CI: -0.39 to -0.11), compared to those in the lowest quartile. Moreover, most of these associations demonstrated a dose-response relationship, and hPDI and uPDI showed distinct associations with MODD, with higher hPDI favoring a healthier MODD pattern (FDR < 0.05). This study suggests potential benefits of increasing intake of plant-based food for glycemic management among GDM patients.

Racial/ethnic-derived maternal diets predict birth outcomes better than a diet derived from a combined sample among Hispanic/Latina and non-Hispanic White pregnant individuals in the ECHO Cohort

Little is known about diet based on maternal fasting blood glucose (FBG) and birth outcomes in diverse populations. We hypothesized that racial/ethnic-derived FBG-based diets would predict birth outcomes better than a diet derived from the overall sample. Pregnant Hispanic/Latina (n = 420) and non-Hispanic White (n = 564) individuals (combined, n=984) from two Environmental influences on Child Health Outcomes (ECHO) cohorts provided ≥ 1 24-h diet recalls. We evaluated primary (birthweight [BW]-for-age, macrosomia, large-for-gestational age, and preterm birth) and secondary (BW, gestational age [GA] at birth, low birthweight (LBW), and small-for-gestational age) birth outcomes. Reduced-rank regression with maternal FBG was used to derive dietary patterns in the combined and racial/ethnic samples. We used multivariable linear and logistic regression to estimate diet associations with birth outcomes. In each racial/ethnic group, seemingly unrelated estimation with clustering was used to test differences in diet coefficients between combined and racial/ethnic-specific models. The overall sample diet was characterized by higher intakes of refined grains and lower intakes of whole grains, solid fats, and nuts and seeds; racial/ethnic-derived diets were similar, with some exceptions. A one-standard deviation increase in the combined pattern was significantly associated with lower BW-for-age (β = -0.08, 95% confidence interval [CI]: -0.16, -0.004), BW (β = -57.5, 95% CI: -94.8, -20.2), and GA at birth (β = -0.13, 95% CI: -0.24, -0.01) and greater odds of preterm birth (OR = 1.41, 95% CI: 1.03, 1.94) and LBW (OR = 1.62, 95% CI: 1.07, 2.46), with pronounced coefficients in racial/ethnic-derived diets. Overall, racial/ethnic-derived FBG diets predicted adverse birth outcomes better than the diet derived from the overall sample in each racial/ethnic group.

Sleep Quality and Its Predictors Among Pregnant Women in Jordan: A Cross-Sectional Study

Introduction

Pregnant women often report poor sleep quality and increased sleep disturbances, especially in the second and third trimesters. Studies showed inconsistent prevalence of poor sleep quality among pregnant women, with unclear predictive factors. Furthermore, physical, psychological, and socioeconomic factors may negatively affect sleep in pregnant women.

Purpose

The study aims to explore sleep quality and to identify possible physical, psychological, and socioeconomic predictors of poor sleep quality among pregnant women.

Patients and Methods

The cross-sectional study was conducted from July 2021 to January 2022. Pregnant women in their second and third trimesters were recruited during their regular visits to the gynecology and obstetrics clinics and hospitals in northern Jordan. Using convenience sampling, two hundred six participants completed questions about sociodemographics, pregnancy, and women's health history using the interviewer-administered method. Additionally, participants completed the Pittsburgh Sleep Quality Index (PSQI), Pregnant Physical Activity Questionnaire (PPAQ), and Hospital Anxiety and Depression Scale (HADS). Descriptive statistics were used to analyze sleep quality, and a multivariable linear regression model was used to identify significant predictors of the PSQI total score.

Results

206 pregnant women participated: 23.3% in the second trimester and 73.3% in the third, with a mean age of 30.6 years. 76.6% of pregnant women reported poor sleep quality (PSQI total score >5). The results showed that increased age (B= 0.125, 95% CI [0.042 - 0.208], p< 0.003), Low educational level (high school or lower vs higher education) (B= 1.097, 95% CI= [0.033-2.161], p= 0.043), having leg cramps (B= 1.578, 95% CI [0.627-2.529], p< 0.001), anemia during pregnancy (B= 1.311, 95% CI [0.131-2.492], p= 0.030), and increased anxiety (B= 0.355, 95% CI [0.258 - 0.452], p< 0.001) are significant predictors poor sleep quality.

Conclusion

Poor sleep is highly prevalent among pregnant women due to factors such as age, education, anxiety, and medical conditions. Clinicians should consider this high prevalence and the possible associated factors in assessing and managing sleep quality to improve pregnant women's health and quality of life.

Association between the physical activity level in the third trimester of pregnancy and the gestational age at birth

OBJECTIVE

The aim of this study was to evaluate the association between the physical activity level in the third trimester and the time of labor onset.

METHODS

Two hundred and sixty women with low-risk pregnancies, who gave birth at 37 weeks of gestation or beyond, and completed the Pregnancy Physical Activity Questionnaire were included in this prospective, cross-sectional study. According to the gestational age at delivery, the study population was divided into case (≥41 weeks) and control (37-406/7 weeks) groups. The clinical characteristics and the physical activity levels of the two groups were compared. The physical activity levels of the participants were also compared according to the delivery route.

RESULTS

The nulliparity rate (54.3 vs. 21.7%), the median gestational weight gain (10.5 [2-30] vs. 10 [2-25] kg), and the cesarean delivery rate (27.7 vs. 6.6%) were higher in the case group than the control group (p<0.05). While the median level of sedentary activity was higher, the median moderate-intensity activity level and the median household/caregiving activity level were lower in the case group than the control group (p<0.05). The level of sedentary activity was also higher in women who gave birth by a cesarean section than vaginally (p<0.05).

CONCLUSION

Physical activity in the third trimester was associated with the time of labor onset. Decreased moderate-intensity and household/caregiving activity levels and an increased level of sedentary activity in the last trimester of pregnancy were found in women who gave birth at ≥41 weeks of gestation. A decreased level of sedentary activity was observed in women who gave birth vaginally.

Circulating linoleic acid and its interplay with gut microbiota during pregnancy for gestational diabetes mellitus

BACKGROUND

Circulating linoleic acid (LA) levels have been reported to be associated with various metabolic outcomes. However, the role of LA and its interplay with gut microbiota in gestational diabetes mellitus (GDM) remains unclear. This study aimed to investigate the longitudinal association between circulating LA levels during pregnancy and the risk of GDM, and the potential role of gut microbiota.

METHODS

A nested case-control study was conducted within the ongoing Tongji-Huaxi-Shuangliu Birth Cohort in Chengdu, China. Blood and fecal samples were collected during early and middle pregnancy from 807 participants. GDM was diagnosed in middle pregnancy using the International Association of Diabetes and Pregnancy Study Groups criteria. Plasma LA levels were measured using gas chromatography-mass spectrometry, and gut microbiota was analyzed through 16S rRNA gene sequencing and shotgun metagenomic sequencing. A two-sample Mendelian randomization study was conducted using data from the IEU OpenGWAS database and the FinnGen consortium.

RESULTS

Elevated plasma LA levels were associated with a lower risk of GDM in both early (P for trend = 0.002) and middle pregnancy (P for trend = 0.02). Consistently, Mendelian randomization analysis revealed that each unit increase in LA was associated with a 16% reduction in GDM risk (odds ratio: 0.84, 95% confidence interval: 0.72, 0.95). In early pregnancy, higher plasma LA levels were correlated with higher adiponectin levels (P < 0.001) and lower levels of triglycerides (P < 0.001), HbA1c (P = 0.04), and C-peptide (P = 0.04). The LA-accociated microbiota mediated the relationship between LA and C-peptide (P = 0.01). Additionally, the inverse association between LA and GDM was modified by Bilophila (P for interaction = 0.03), with a stronger association observed in participants with lower Bilophila levels in early pregnancy. Metagenomic analyses further showed that the LA-associated pathway (D-galacturonate degradation I) and its key enzyme (EC 4.2.1.7) were associated with metabolic traits.

CONCLUSIONS

Our study provides evidence for an inverse causal association between plasma LA levels during pregnancy and GDM risk, which is both mediated and modified by gut microbiota.

Preventive health risks in pregnancy: Cross-sectional prevalence survey in three regions of New South Wales, South Australia and Tasmania

OBJECTIVE

To examine the proportion of pregnant people meeting preventive health guideline recommendations in three regions of New South Wales, South Australia and Tasmania.

METHODS

Cross-sectional surveys of pregnant people attending public maternity services were conducted between November 2021 and April 2022. Participants were asked about their preventive health risks during pregnancy, including tobacco smoking, e-cigarette use, alcohol consumption, gestational weight gain, dietary intake and physical activity.

RESULTS

In total, 1064 surveys were completed. Smoking during pregnancy was reported by 10.5% of participants in New South Wales, 7.8% in South Australia and 18.0% in Tasmania. Most participants (95.2%-96.1%) reported that they did not currently consume alcohol. In each region, the majority of participants were currently gaining gestational weight outside recommended ranges (65.0%-70.2%) and not meeting minimum recommendations regarding intake of core food groups (except for fruit) and physical activity (65.2%-75.6%).

CONCLUSIONS

This study demonstrates a need for greater access to evidence-based interventions to support people reduce their preventive health risks in pregnancy and in turn achieve positive outcomes for themselves and their babies.

IMPLICATIONS FOR PUBLIC HEALTH

The findings can inform region-based needs and prioritisation of support for addressing preventive health risks in pregnancy.

Physical activity (PA) during pregnancy in Greece

OBJECTIVE

To evaluate the amount and types of physical activity (PA) performed by Greek women during pregnancy and assess the validity and reliability of the Greek version of the Pregnancy Physical Activity Questionnaire (PPAQ).

STUDY DESIGN

This prospective study comprised two stages. The first stage was the completion of the PPAQ Greek version twice, with a one-week interval between the two rounds, to assess internal consistency and reproductivity. The validity was evaluated by comparing the PPAQ results with data from smartwatches that recorded step counts and metabolic equivalent tasks (METs). The second stage included pregnant women from various regions of Greece that completed the PPAQ once during their pregnancy. The level of PA during pregnancy and consistency with the international PA recommendations was evaluated with the use of METs.

RESULTS

A total of 1058 pregnant women filled the PPAQ Greek version, while eighteen women randomly participated in the reliability and validity analyses of the PPAQ. Results from the PPAQ completed one week apart showed strong agreement (Intraclass Correlation Coefficient [ICC]: 0.82-0.96). A comparison between the PPAQ results and smartwatch data revealed no significant differences in PA levels (correlation coefficient: 0.542; p = 0.022). The median total PA for all the participants was 142.1 MET-hours/week (interquartile range: 106.04 MET-hours/week). PA levels increased with advancing gestation in sports/exercise (1st vs. 2nd trimester, p = 0.048; 2nd vs. 3rd trimester, p < 0.001), occupational activities (1st vs. 3rd trimester, p < 0.001; 2nd vs. 3rd trimester, p = 0.024), and transportation activities (1st vs. 3rd trimester, p < 0.001; 2nd vs. 3rd trimester, p < 0.001). Moderate-to-vigorous intensity activities also increased with gestational age (p = 0.023, 95 % confidence interval [CI]: 0.1-1.4; p = 0.045, 95 % CI: 0-0.08, respectively). Women were more active in household/caregiving activities across all trimesters (p = 0.017; 95 % CI: 0.09-0.95). Women with higher educational levels were more likely to engage in sports/exercise (p = 0.039, 95 % CI: -3.3 to -0.08) and had higher overall PA levels (p = 0.029, 95 % CI: 0.37-6.3). However, only 14.8 % of the participants met the international PA recommendations for pregnancy.

CONCLUSION

The Greek version of the PPAQ is a reliable tool for assessing PA in pregnant Greek women. Higher educational levels and advanced gestational age were found to be associated with increased PA levels. However, only a small proportion of pregnant Greek women met the international PA recommendations, highlighting the need for targeted interventions.

Maternal obesity, lifestyle factors and associated pregnancy outcomes in Ibadan, Nigeria: a Nigerian cohort study

Maternal obesity is a neglected but modifiable maternal health threat in Nigeria associated with adverse pregnancy outcomes. We investigated maternal obesity, lifestyle factors, and pregnancy outcomes in Ibadan, Nigeria. We used the Ibadan Pregnancy Studtudy (IbPCS) data. Maternal obesity (BMI ≥ 30.0 kg/m2) was the primary outcome variable, and pregnancy outcomes were secondary. Information on lifestyle characteristics, i.e. diet and physical activity in pregnancy, were obtained using standardised instruments. We constructed bivariate, multivariate logistic and Poisson models at < 0.05 significance. The prevalence of maternal obesity was 19.3%: 95% CI (17.5 - 21.3). Maternal age, parity and income were associated (p < 0.05) with maternal obesity. Regular physical activity was associated with decreased odds of maternal obesity. Maternal obesity was directly related to experiencing any adverse pregnancy outcome by twofold [Adjusted Odds Ratio: 1.87, 95% CI (1.36 - 2.57). The relative risk (RR) of macrosomia: RR 1.83, 95% CI (1.08 - 3.08)], caesarean section: [RR: 1.41, 95% CI (1.09 - 1.81)], and birth asphyxia at 1 min [RR: 1.50, 95% CI (1.01 - 2.37)], GDM [RR 1.74 (95% CI): (1.15 - 2.62). Maternal obesity is prevalent in Ibadan and increases the risk of adverse perinatal events. Maternal services should emphasise physical activity and a healthy diet to reduce maternal obesity.

Physical Inactivity Among Pregnant Women at High Risk for Gestational Diabetes Mellitus: A Cross-Sectional Study

AIM

To examine the prevalence and predictors of physical inactivity among pregnant women at high risk for gestational diabetes mellitus (GDM) in mainland China.

METHODS

A cross-sectional study was implemented in Zhengzhou, China from October 2021 to February 2022. Two hundred fifty-two pregnant women at high risk for GDM were recruited. Physical inactivity was assessed by the Pregnancy Physical Activity Questionnaire. The Pregnancy Physical Activity Self-Efficacy Scale, Knowledge of Physical Activity Questionnaire, Social Support for Physical Activity Scale, 7-item Generalized Anxiety Disorder Scale, Edinburgh Postnatal Depression Scale and sociodemographic and antenatal characteristics questionnaire were collected and used to predict physical inactivity. Binary logistic regression was applied. Adjusted odds ratios and 95% confidence intervals (CIs) were calculated.

RESULTS

The prevalence of physical inactivity was 53.2%. The risk factors for physical inactivity included low level of physical activity self-efficacy (aOR: 6.05, 95% CI: 1.13-32.31), middle levels of physical activity self-efficacy (aOR: 5.13, 95% CI: 1.45-18.20), no pregnancy physical activity goals (aOR: 3.06, 95% CI: 1.18-8.0), low pregnancy physical activity goals (aOR: 2.64, 95% CI: 1.02-6.8), nulliparity (aOR: 7.17, 95% CI: 3.74-13.75), having a junior college degree or below (aOR: 2.03, 95% CI: 1.10-3.74) and husbands having no habits of regular physical activity (aOR: 2.07, 95% CI: 1.06-4.04).

CONCLUSION

This study revealed that physical inactivity among pregnant women at high risk for GDM was a public health concern in mainland China. Physical activity self-efficacy and pregnancy physical activity goals may be used to develop interventions to enhance physical activity.

Anemia in pregnant women: findings from Kuwait birth cohort study

BACKGROUND

Anemia is the most common hematologic disorder in pregnancy, affecting over one-third of pregnant women globally. This study aimed to assess the prevalence of anemia in pregnant women and its associated factors in the Kuwait Birth Cohort study.

METHODS

The Kuwait birth cohort (n = 1,108) was a prospective study in which pregnant women were recruited during their second or third trimester. Data were collected through personal interviews during antenatal care visits, including data on sociodemographic and lifestyle factors. Blood samples were analyzed under strict quality control to measure various laboratory indicators. Anemia was defined as hemoglobin (Hb) < 110 g/L. Predictors of anemia were categorized as underlying or direct factors, and logistic regression models were used to investigate their association with anemia.

RESULTS

The prevalence of anemia was 28.16% (95% CI:25.53-30.91%), with 8.75% of women experiencing moderate anemia and 19.40% mild anemia. No cases of severe anemia were observed. Multivariable analysis identified current iron supplement use, (Adjusted Odds Ratio [AOR] 0.52, 95%CI:0.28-0.99; p = 0.049), vitamin D status (sufficient vs. insufficient/deficient), (AOR 0.63, 95%CI:0.43-0.92; p = 0.018), iron levels (p < 0.001), and ferritin levels (p < 0.001) as factors significantly associated with anemia.

CONCLUSION

Anemia in pregnant women in Kuwait represents a mild to moderate public health concern, primarily driven by iron deficiency. The estimated prevalence of anemia is influenced by the Hb threshold used to define anemia, a topic currently subject to vigorous debate. Our findings suggest that improved screening for iron deficiency during pregnancy may further reduce anemia in pregnant women in Kuwait.

Physical activity during pregnancy and pregnancy related complication

Even though motherhood is a positive and enjoyable experience, it is also a vulnerable period that can be accompanied by various complications. Hypertensive disorders of pregnancy and gestational diabetes mellitus are the most significant contributors to these complications. Therefore, the main objective of this study was to assess if the degree of physical activity during pregnancy has an impact on the development of hypertensive disorder of pregnancy and gestational diabetes mellitus. In this cross-sectional study, 150 women were involved. Among the total study participants, 65(43.3%) and 85(56.7%) of them were engaged in vigorous physical activities and light physical activities during pregnancy, respectively. Of these study participants, 62 (41.3%) of them had pregnancy-related complications. It was found that women who engaged in vigorous physical activity had a lower proportion of complications (17.74%) compared to those who engaged in light physical activity (82.26%). This difference was statistically significant (p = 0.001). The finding of this study showed that pregnancy-related complications, specifically HDP and GDM, were low in women who had vigorous physical activities during pregnancy as compared to those who had a sedentary lifestyle or engaged in light physical activities.

Assessment of Maternal Dietary Intake, Physical Activity Status, and Body Composition During Pregnancy: A Cross-Sectional Study

Objective: This study aimed to estimate the Greek population's maternal dietary intake, physical activity status, and body composition during pregnancy. Research method: Forty-nine women during pregnancy, with a mean age of 31.08 ± 4.90 years old, were asked to fill in the Pregnancy Physical Activity Questionnaire (PPAQ) to assess their physical activity levels, the Food Frequency Questionnaire (FFQ) to assess the maternal dietary intake, and a Bioelectrical Impedance Analysis (BIA) to evaluate different body composition indices. Results: Variance analysis showed that the pregnancy trimester's effect on various indices of BIA was statistically significant. Moreover, the results showed that pregnant women consume a median of 2135 kcal and 2012.10 mL of water per day, regardless of their trimester. The Pearson correlation analysis unveiled a significant positive correlation between energy (r = 0.795, p < 0.001), water (r = 0.759, p < 0.001), fat (r = 0.535, p = 0.029), and dietary fibers (r = 0.310, p < 0.001) with pregnancy trimester. According to the PPAQ in women, categorized based on their pregnancy trimester, the results showed that women in the third trimester were statistically more sedentary than those in the second and first trimesters, respectively. Lastly, multiple regression analysis showed that pregnancy trimester (p = 0.005), employment status (p = 0.040), economic status (p = 0.037), and higher BMI (p = 0.013), BFMI (p = 0.017), and FFMI (p = 0.024) values had a significant contribution to the model. Conclusions: Pregnancy trimester has a significant impact on different indices of BIA and nutrients based on the FFQ, while physical activity levels decrease dramatically during pregnancy.

Association between oxidative balance score and risk of postpartum depression in Iranian women: a prospective cohort study

The oxidative balance score (OBS) serves as a comprehensive measure of exposures related to oxidative stress, considering both dietary antioxidants and lifestyle exposures. There is no evidence regarding the relation between OBS and postpartum depression (PPD). In this study, we aimed to determine the relationship between OBS during pregnancy and PPD. In this cohort study, 243 Iranian pregnant women were recruited using a convenience sampling method from 2022 to 2023. Dietary intakes were obtained using a validated food frequency questionnaire. OBS was separately constructed based on nutrients/lifestyle (NLOBS) and food groups/lifestyle (FLOBS) according to the previously proposed methods. PPD was diagnosed 4 to 6 weeks after delivery using the Edinburgh Postpartum Depression Scale. Cox proportional hazards regression was utilized to examine the relationship between OBS and PPD. Participants had a mean (SD) age of 30.9 ± 6.12 years. In total, 43 females were diagnosed with PPD. Findings revealed that, after controlling all confounders, subjects with the highest level of NLOBS, compared to the lowest, had a 69% lower risk of PPD (HR: 0.31; 95% CI: 0.12-0.83). Although a significant inverse relation was found between FLOBS and PPD in the crude model (HR: 0.43; 95% CI: 0.19-0.96); this association was not significant in fully adjusted model (HR: 0.53; 95% CI: 0.22-1.27). Considering subtypes of each score, inverse relations were significant for NOBS and LOBS, but not for FOBS. This study suggests that a higher OBS, particularly nutrient-based OBS, during pregnancy may be associated with a reduced risk of PPD. Further research is necessary to validate these findings.

A physical activity counseling intervention to promote health among pregnant women: a study protocol of randomized clinical trial

BACKGROUND

Pregnancy may result in gestational diabetes mellitus (GDM), discomfort, pregnancy-related musculoskeletal pain, sleep disturbances, and decreased quality of life in pregnant women. Physical activity during pregnancy can lower the odds ratio of developing GDM and offer numerous health benefits for mothers and infants. However, the prevalence of physical inactivity among pregnant women worldwide is high. The Behavior Change Wheel (BCW) can be used to develop interventions to enhance physical activity. However, no research has been conducted to evaluate the effectiveness of physical activity interventions among Chinese pregnant women using the BCW framework.

METHODS/DESIGN

We will conduct a single-center, parallel, randomized controlled trial at a maternal-child health care center. A total of 244 pregnant women at high risk for GDM will be randomly allocated to either a study group receiving a physical activity counseling intervention or a control group receiving standard care. The intervention will comprise one face-to-face individual counseling session combined with three weekly online group counseling sessions based on Motivational Interviewing, supplemented by four biweekly counseling before 24 gestation weeks, and WeChat group support (Tencent, Shenzhen, China). Educational materials will also be available on the WeChat Official Account. The program will begin before 12+6 gestational weeks, the counseling sessions will end before 24 gestation weeks and WeChat group support will end before delivery. The primary outcomes will include physical activity, the incidence of GDM and glucose level. The secondary outcomes will include gestational weight gain, sleep quality, quality of life, low back pain, pelvic girdle pain, physical activity-related variables, and maternal and newborns health outcomes.

DISCUSSION

This research will contribute to understanding the effects of a physical activity counseling intervention, including physical activity, incidence of GDM, glucose levels, gestational weight gain, sleep quality, quality of life, low back and pelvic girdle pain, and maternal and newborn health outcomes.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (CHiCTR) ChiCTR2400081364, on February 29, 2024.

Effect of extended parallel process model training on enhancing physical activity of overweight pregnant women: A randomized controlled trial

BACKGROUND

The present study determined the effect of extended parallel process model (EPPM) based training on enhancing the physical activity of overweight pregnant women.

MATERIALS AND METHODS

This randomized controlled clinical trial examined 100 overweight pregnant women referred to prenatal care clinics in Mahdiye and Shohadaye Tajrish Hospital, in August 2022. The participants were assigned into two intervention and control groups through random allocation. The intervention group underwent EPPM-based training three times (18-20, 26-30, and 37-38 weeks of gestation), while the control group received regular prenatal care. The training content and approach were designed and presented based on the four constructs of EPPM, that is, perceived susceptibility, perceived severity, perceived efficacy, and perceived self-efficacy. The 32-item Pregnancy Physical Activity Questionnaire (PPAQ) was used to measure and compare the participants' four activity types at three rounds (18-20, 26-30, and 37-38 weeks of gestation) and their physical activity calendar in two periods. The data were analyzed by the Statistical Package for the Social Sciences (SPSS) version 16 software at a significance level of < 0.05.

RESULTS

After the educational intervention, the mean physical activity scores of the intervention and control groups were1462.2 ± 477.67and 861 ± 381.29 (P < 0.001; CI = 95%) in the first round, 1278.15 ± 480.31 and 675 ± 375.03 (P < 0.001; CI: 95%) in the second round, respectively. The mean weight gain value in the second trimester equaled 4.09 ± 0.76 and 4.52 ± 0.71for the intervention and the control group, orderly. This difference was significant in the second trimester (P = 0.002) but not in the third. Likewise, a comparative analysis of the neonates' anthropometric indices and prenatal complications revealed no significant differences.

CONCLUSION

The EPPM-based educational intervention effectively contributes to motivating pregnant women and changing their behavior toward improving their physical activity and can be employed to encourage them to enhance their physical activity during pregnancy.

Protocol for a randomised controlled trial of a weight maintenance intervention to promote fat loss in pregnant individuals with obesity

INTRODUCTION

In pregnancy, people with obesity or excess adiposity are prone to excess gestational weight gain (GWG) and have the highest risks for multiple maternal morbidities. Epidemiological studies suggest that the lowest incidence of adverse maternal and infant outcomes occurs with GWG lower than current recommendations (<5 kg) and with gestational weight maintenance, resulting in fat mass loss, in those with obesity. Data from randomised clinical trials are needed to evaluate the efficacy of a fat mass loss intervention on pregnancy outcomes. The objective of this proof-of-principle randomised controlled trial is to test the effect of a gestational fat mass loss intervention in pregnant individuals with obesity on changes in weight, fat mass and cardiometabolic disease risk factors.

METHODS AND ANALYSIS

In this two-site randomised parallel group, 100 women (30% black; 30% Hispanic) with pre-existing obesity (31.0≤body mass index≤55.0 kg/m2) are randomised to usual care (Provider Directed Group) or usual care plus a fat mass loss intervention with food provision (Weight Maintenance Group). The primary outcomes of the trial (Healthy Mamas/Mamis Saludables) are weight, fat mass (via three-compartment model) and cardiometabolic disease risk factors (ie, blood pressure, lipids, glucose, insulin) from baseline (~13 weeks gestation) to ~35 weeks gestation and at 2 weeks postpartum. Secondary aims evaluate the safety of the fat mass loss intervention during pregnancy and test the hypotheses that compared with usual care, the intervention will have no significant adverse effect on fetal growth, neonatal size, infant body composition and other adverse events. Mediators (eg, eating, activity) and moderators (eg, parity, obesity grade, race/ethnicity) of intervention effects are also examined. Finally, the study will explore the effect of prenatal fat mass loss on reducing the incidence of adverse obstetrical outcomes, including non-elective caesarean delivery, gestational diabetes, hypertension and pre-eclampsia.

ETHICS AND DISSEMINATION

The trial has been approved by the Pennington Biomedical Research Center Institutional Review Board, is monitored by an independent data and safety monitoring board and will be conducted in agreement with the Declaration of Helsinki. All results, positive, negative and inconclusive, will be disseminated at national and/or international scientific meetings and in peer-reviewed scientific journals.

TRIAL REGISTRATION NUMBER

NCT04731688.

Swedish version of the Pregnancy Physical Activity Questionnaire (PPAQ-SWE), translation and cultural adaptation

OBJECTIVE

Physical activity has well-known health benefits in all stages of life and may also reduce the risk for pregnancy-related complications, but many pregnant women do not reach the recommended activity levels. Tailored advice is often provided by healthcare professionals to promote physical activity during pregnancy. To provide such advice, assessment of the actual level of physical activity is necessary, but there are currently no standardized methods for this. The Pregnancy Physical Activity Questionnaire (PPAQ) is a self-administered instrument, designed to determine physical activity during pregnancy but a Swedish version of the questionnaire is not yet available.

RESULT

The PPAQ was translated and culturally adapted into a Swedish version, i.e., PPAQ-SWE according to the process described by Beaton et al. Several minor linguistic adjustments were needed, that mainly concerned semantic and cultural adaptations, such as adding, removing, or replacing words to match Swedish cultural aspects. For instance, "gestational week" was used instead of "trimester," and "older person" replaced "older adult." The reference to a "1-gallon milk jug" was replaced with "3-4 liters of milk" to fit the metric system used in Sweden. Two questions regarding bicycling, a common form of transportation in Sweden, and one free-text comment option was added.

Association between sleep during pregnancy and birth outcomes: a prospective cohort study

OBJECTIVE

A prospective cohort study was conducted to investigate sleep status during the early and second trimester of pregnancy in pregnant women on adverse birth outcome, such as preterm birth, low birth weight and small for gestational age.

METHODS

Multivariable logistic regression models were used to analyze the association of sleep status during the early and second trimester of pregnancy with adverse birth outcomes and generated the odds ratio and 95% confidence interval.

RESULTS

5,418 pregnant women were included in the analysis. In the multivariable model, compared with 7.1-8 h/night, sleep ≤ 7 h/night during second trimester increases the risk of preterm birth (OR: 1.43, 95% CI: 1.12,1.85), and the risk of preterm birth was decreased in pregnant women who slept > 9 h/night (OR: 0.79, 95% CI: 0.53,0.93). Sleep quality, and sleep changes in the early and second trimesters, and sleep duration in the early pregnancy were not statistically associated with preterm birth, low birth weight and small for gestational age.

CONCLUSIONS

Short sleep duration during pregnancy is associated with a higher risk of preterm birth and longer sleep duration at night is associated with a lower risk of preterm birth, but the latter needs further verification. Sleep status during pregnancy was not associated with low birth weight and small for gestational age. In order to reduce risk of adverse birth outcomes, sleep problems in pregnant women should be strengthened during pregnancy care.

CLINICAL TRIAL NUMBER

Not applicable.

Associations of physical activity and mental health in pregnant women: A cross-sectional isotemporal substitution analysis

BACKGROUND

Prenatal mental health is an increasing public concern. At present, it has been shown that increasing physical activity (PA) is effective in promoting mental health of pregnant women. However, mental health may depend not only on the amount of time spent on a specific activity, but also on the intensity and type of the activity that it replaces. This study is aimed to explore the impact of replacing 60 min of one health behavior with another on the mental health of pregnant women.

METHODS

The cross-sectional study recruited 983 pregnant women from Chongqing, China between June and December 2021. The pregnant women self-reported their movement behaviors using the Pregnancy Physical Activity Questionnaire-Chinese version (PPAQ-C). Participants also completed three measures of mental health: Childbirth Attitudes Questionnaire (CAQ), 9-item Patient Health Questionnaire (PHQ-9) and the Positive affect sub-scale. An Isotemporal Substitution Model was used to evaluate mental health after replacing one movement behavior.

RESULTS

The analysis showed that replacing 60 min of sedentary behavior (SB) with moderate-to-vigorous intensity PA (MVPA) promoted positive emotions, and replacing SB with light intensity PA (LPA) reduced childbirth fear. Regarding PA types, replacing inactivity with household, occupational, or transport PA could reduce fear, and replacing inactivity, occupational, household or transport PA with sport PA could improve positive emotions and alleviate depression.

CONCLUSION

An active pregnancy lifestyle with higher levels of moderate-to-vigorous physical activity and light physical activity and less sedentary behavior time and other inactive states may improve mental health. Future health promotion for pregnant women should consider the flexibility of physical activity types and intensities.

Protocol of an adaptive mobile health intervention for the management of gestational weight gain: The LEAP cluster randomized controlled trial

BACKGROUND

More than half of pregnant patients with overweight or obesity exceed national gestational weight gain (GWG) guidelines, increasing their risk of adverse outcomes. There is an urgent need to develop effective and scalable interventions to improve GWG.

OBJECTIVE

To describe the protocol of Lifestyle, Eating, and Activity in Pregnancy (LEAP), a cluster randomized controlled trial evaluating a mobile health (mHealth) intervention promoting appropriate GWG in an integrated healthcare system.

METHODS

LEAP is a cluster randomized trial with randomization at the clinician level. Patient eligibility includes a pre-pregnancy BMI of 25.0-40.0 kg/m2 and singleton pregnancy. Consented patients receive standard care or standard care plus mHealth intervention per their clinician's randomization. The patient adaptive intervention provides personalized, automated feedback on GWG and physical activity using 1) a smartphone application, 2) a Wi-Fi scale and activity tracker; 3) weekly educational topics; and 4) step-wise support (added when GWG is >75th percentile of the GWG guidelines). Intervention clinicians receive newsletters with motivational interviewing tips to facilitate discussing GWG. Primary outcomes are total GWG (last measured weight - pre-pregnancy weight) and weekly rate of GWG (total GWG/gestational weeks at delivery) as continuous variables and categorized per the IOM GWG guidelines. Secondary outcomes include trimester-specific rate of GWG, GWG trajectory, diet and physical activity, postpartum weight retention, birthweight, infant size for gestational age, and infant growth to 12 months.

CONCLUSIONS

LEAP addresses gaps in the implementation of GWG interventions in healthcare settings. The adaptive and mHealth nature of the intervention may enhance scalability.

TRIAL REGISTRATION

ClinicalTrials.govNCT03880461.

Maternal pre- and postnatal stress and maternal and infant gut microbiota features

BACKGROUND

Maternal stress can have short and long term adverse (mental) health effects for the mother and her child. Previous evidence suggests that the gut microbiota may be a potential mediator and moderator for the effects of stress via various pathways. This study explored the maternal microbiota trajectory during pregnancy as well as the association between pre- and postnatal maternal stress and features of the maternal and infant gut microbiota during and after pregnancy. In line with previous research, we hypothesized that maternal stress would be positively related to maternal and infant microbiota volatility and that infants of highly stressed mothers would show a relative increase in Proteobacteria and a relative decrease in Bifidobacterium.

METHODS

We collected maternal stool samples at 18 and 32 weeks of pregnancy and 8 months postpartum. Infant stools samples were obtained at 2, 6 and 12 weeks and 8 months postpartum. All samples were analyzed using shotgun metagenome sequencing. We also collected several measures of maternal stress (self-reported depression, anxiety, and stress, and hair cortisol and cortisone), most at the same time points as the microbiota samples.

RESULTS

Our data indicated that the maternal microbiota does not undergo drastic changes from the second to the third trimester of pregnancy but that the postpartum microbiota differs significantly from the prenatal microbiota. Furthermore, we identified associations between several stress measures and maternal and infant gut microbiota features at different time points including positive and negative associations with alpha diversity, beta diversity and individual microbial phyla and species relative abundances. Also, the maternal stress composite score, the perceived stress score and the log-ratio of hair cortisol and cortisone were all positively associated with infant microbiota volatility.

CONCLUSION

Our study provides evidence that maternal prenatal and postnatal stress is related to both the maternal and the infant microbiota. Collectively, this and previous studies indicate that maternal stress does not uniformly associate with most gut microbial features. Instead, the associations are highly time point specific. Regarding infant microbiota volatility, we have consistently found a positive association between stress and infant microbiota volatility. This warrants future research investigating this link in more depth.

The physical activity and sedentary behavior among pregnant women in Macao: A cross-sectional study

OBJECTIVE

The current investigation sought to elucidate the prevalence and contributing factors of sedentary behavior among pregnant women in Macao, a densely populated region characterized by a distinctive fusion of Eastern and Western cultures and a thriving global economy.

METHODS

Through a cross-sectional study design, a total of 306 expectant mothers were recruited via various social media platforms and completed a sociodemographic questionnaire alongside the Chinese version of the Pregnancy Physical Activity Questionnaire.

RESULTS

The findings revealed that sedentary activities accounted for a relatively small proportion (7.8%) of the participants' total activity energy expenditure. Interestingly, employment status emerged as a significant determinant, with employed pregnant women exhibiting a 57.9% lower risk of being sedentary compared to their unemployed counterparts. Moreover, multiparous women (those with two or more children) were approximately 9 times more likely to meet moderate-intensity activity standards than nulliparous women.

CONCLUSION

These insights highlight the importance of tailoring physical activity interventions to address the specific needs and challenges faced by primiparous women and those who are unemployed during pregnancy, with a view to enhancing education on the potential hazards associated with sedentary habits and promoting active lifestyles within this unique sociocultural context.

Enhancing physical activity during pregnancy using a multi-theory model: a study protocol for a randomised controlled trial in China

BACKGROUND

Physical inactivity is a global concern and poses serious health risks. Physical inactivity is exacerbated and affects the health of both generations during the special period of pregnancy. Appropriate physical activity (PA) intervention programmes based on health behaviour change theory are lacking. This study aims to evaluate the effectiveness of a PA intervention based on the multi-theory model (MTM) by assessing changes in PA levels, MTM constructs, exercise self-efficacy, quality of life, prenatal depressive symptoms, gestational weight gain and pregnancy and delivery outcomes.

METHODS AND ANALYSIS

This single-centre, parallel, randomised, controlled trial will be conducted at a tertiary care institution in Hangzhou, China. A total of 72 pregnant women without contraindications to exercise at 14-27 weeks+6 days of gestation will be included. Participants will be randomly assigned to either the intervention or control group. The intervention group will engage in a 12 week PA intervention programme based on the MTM and delivered through WeChat, while the control group will receive standard antenatal care. Data will be collected at baseline, 6 weeks of the intervention, 12 weeks of the intervention and within 1 week of delivery. The primary outcomes will include PA levels measured by accelerometers and the PA in Pregnancy Questionnaire, along with the constructs of the MTM. Secondary outcomes will comprise exercise self-efficacy during pregnancy, quality of life, prenatal depressive symptoms, gestation weight gain and pregnancy and delivery outcomes. Data analysis will adhere to the Consolidated Standards of Reporting Trials 2010 statement and follow the intention-to-treat principle.

ETHICS AND DISSEMINATION

The study followed the ethical guidelines approved by the ethics committee of Women's Hospital School of Medicine Zhejiang University (IRB-20230254-R, Approval Date: 27 July 2023). The results of the study will be submitted for publication and dissemination in a peer-reviewed journal. Participants will receive clarification regarding the study objectives, procedures and will be asked to sign informed consent in written form before the start of the study.

TRIAL REGISTRATION NUMBER

ChiCTR2400080843. Prospectively registered on 8 February 2024.

Prenatal exposure to phthalates and phthalate replacements in relation to chorionic plate surface vasculature at delivery

Pregnant people are ubiquitously exposed to endocrine-disrupting phthalates through consumer products and food. The placenta may be particularly vulnerable to the adverse effects of phthalates, with evidence from animal models suggesting impacts on placental development and vascularization. We translate this research to humans, examining gestational exposure to phthalates and phthalate replacements in relation to novel markers of chorionic plate surface vascularization. Phthalate and phthalate replacement metabolites were measured in first trimester urine from pregnant participants in the Understanding Pregnancy Signals and Infant Development (UPSIDE) cohort (n = 154). At delivery, placentae underwent specialized 2D and 3D digital imaging to quantify chorionic plate surface vasculature. Using weighted quantile g-computation mixtures methods as well as multivariable linear regression models examining individual metabolites, we evaluated associations with overall chorionic plate surface area and five chorionic plate surface vascular measures, adjusting for covariates. We additionally examined interactions with placental sex. Exposure to a phthalate mixture was associated with longer total arterial arc length (β = 9.64 cm; 95%CI: 1.68, 17.59), shorter mean arterial arc length (β = -0.07 cm; 95%CI: -0.14, -0.01), and more arterial branch points (β = 5.77; 95%CI: 1.56, 9.98), but not chorionic plate surface area. In models considering individual metabolites and their molar sums, results were strongest for the metabolites of Di-isobutyl phthalate (DiBP), Di-isononyl phthalate (DiNP), and Di(2-ethylhexyl) phthalate (DEHP). Associations with metabolites of phthalate replacements tended to be in the same direction but weaker. Few sex differences were observed. Gestational phthalate exposure may be associated with alterations in placental chorionic plate surface vasculature characterized by more branching and shorter segments. These alterations may have implications for placental perfusion and suggest a placental mechanism by which phthalates may impact fetal development.

Factors associated with sleep quality in adolescent pregnant women

OBJECTIVE

To verify the association of sociodemographic, anthropometric, obstetric, lifestyle factors, and depressive symptoms with sleep quality in pregnant adolescents.

METHOD

This cross-sectional study involved pregnant adolescents aged 10 to 19 who received prenatal care in Recife, Pernambuco, Brazil. Data collection included an individual evaluation form and the administration of the Pregnancy Physical Activity Questionnaire (PPAQ), the Pittsburgh Sleep Quality Index (PSQI), and the Beck Depression Inventory (BDI). Prevalence and associations were calculated using Pearson's chi-square test or Fisher's exact test, followed by logistic regression analysis.

RESULTS

The study included 386 pregnant adolescents with a mean age of 17 ± 2 years. The prevalence of poor sleep quality was 67.5%. Poor sleep quality was associated with moderate to severe depressive symptoms (OR = 2.21; 95%CI 1.27-3.85), higher education levels (OR = 2.26; 95%CI 1.43-3.57), and the presence of gestational physical symptoms (OR = 1.18; 95%CI 1.10-1.27).

CONCLUSION

Pregnant adolescents exhibit a high prevalence of poor sleep quality, which is linked to depressive symptoms, higher education levels, and gestational physical symptoms. These findings highlight the importance of screening for sleep disorders in this population and emphasize the need for guidelines addressing physical symptoms and their impact on sleep, as well as the presence of depression.

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.

The Interplay of Persistent Organic Pollutants and Mediterranean Diet in Association With the Risk of Gestational Diabetes Mellitus

OBJECTIVE

Certain foods characterizing the alternate Mediterranean diet (aMED) are high in persistent organic pollutants (POPs), which are related to greater gestational diabetes mellitus (GDM) risk. We examined the associations of combined aMED and POP exposure with GDM.

RESEARCH DESIGN AND METHODS

aMED score of 1,572 pregnant women was derived from food frequency questionnaires at early pregnancy within the U.S. Fetal Growth Study and plasma concentrations of 76 POPs, including organochlorine pesticides, polybrominated diphenyl ethers, polychlorinated biphenyls (PCBs), and per- and polyfluoroalkyl substances, were measured. Associations of combined aMED score and exposure to POPs with GDM risk were examined by multivariable logistic regression models.

RESULTS

In 61 of 1,572 (3.88%) women with GDM, 25 of 53 included POPs had a detection rate >50%. Higher POP levels appeared to diminish potential beneficial associations of aMED score with GDM risk, with the lowest GDM risk observed among women with both high aMED score and low POP concentrations. Specifically, adjusted log-odds ratios of GDM risk comparing women with low PCB and high aMED score with those with low aMED score and high PCB concentrations was -0.74 (95% CI -1.41, -0.07). Inverse associations were also observed among women with low aMED score and high TransNo_chlor, PCB182_187, PCB196_203, PCB199, and PCB206. These associations were more pronounced among women with overweight or obesity.

CONCLUSIONS

Pregnant women who consumed a healthy Mediterranean diet but had a low exposure to POP concentrations had the lowest GDM risk. Future endeavors to promote a healthy diet to prevent GDM may consider concurrent POP exposure.

The effect of sedentary behavior during pregnancy on premature rupture of membrane in women above 35 years old

Background

Sedentary life is now considered among the main health risks globally among general population and pregnant women. Premature rupture of membranes is a serious pregnancy condition that is a main cause of newborn morbidity and death globally. There is very limited data about the effect of sedentary behavior during pregnancy on premature rupture of membranes.

Aim and objectives

The current study set out to evaluate the impact of sedentary behavior during pregnancy on premature rupture of the membranes in women older than 35.

Setting and methods

A cohort prospective study was done on 90 pregnant women at Kasr Al-Ainy Hospitals. Participants were met three times (once per trimester). Routine labs and examinations were done and physical activities and sedentary behavior were assessed using prenatal physical activity questionnaire at each visit then pregnant women were followed up till rupture of membranes happened.

Results

A statistically significant difference was observed in the kind and intensity of physical activity among pregnant individuals at the first, second, and third trimesters. Women who experienced premature rupture of membranes demonstrated significantly lower levels of physical activity (household or caregiving, occupational, and low physical activities) and they also showed signs of a more sedentary lifestyle.

Conclusion

Sedentary behavior during pregnancy had great effect on premature rupture of membranes in women above 35 years old. Sedentary participants were twice as likely to develop premature rupture of membranes in contrast to individuals who don't engage in sedentary behavior.

Voice, Speech, and Clinical Aspects During Pregnancy: A Longitudinal Study

BACKGROUND

Pregnancy involves anatomical, physiological, and metabolic changes in a woman's body. However, the effects of these changes on the voice remains unclear, particularly regarding the clinical characteristics.

OBJECTIVES

We aimed to evaluate changes in vocal and speech acoustic measures and the relationship between them and clinical aspects in women during pregnancy.

METHOD

A prospective, longitudinal study was carried out with 41 low risk, adult, pregnant women, followed for prenatal care. Demographic and anthropometric data as well as lifestyle habits and health conditions were collected. Voice recordings of sustained vowels, and automatic and spontaneous speech were held over each trimester and analyzed by PRAAT®to evaluate acoustic, aerodynamic, and articulatory measures.

RESULTS

There were no changes in fundamental frequency, jitter, shimmer, and harmony to noise ratio during pregnancy. Maximum phonation time (MPT), pause rate, and pause duration reduced at the end of pregnancy. MPT was lower in sedentary pregnant women. The fundamental frequency peak rate was higher in eutrophic participants and lower in the third trimester in women with BMI ≥25 kg/m2. Pause rate was higher in pregnant women with BMI ≥25 kg/m2. There was no relationship between sleep quality, reflux, and vocal symptoms and acoustic and aerodynamic measures.

CONCLUSIONS

Differences were shown in MPT and temporal pause measurements during pregnancy. Acoustic measurements did not change. There was a relationship between acoustic and aerodynamic measures and clinical variables (BMI, physical activity, and body mass gain).

[Gestational diabetes, interculturality and precariousness: support and challenges]

Managing gestational diabetes (GDM) is a particular challenge for women in precarious situations. Precariousness can hamper access to healthy food and medical care. The management of GDM requires careful multidisciplinary medical follow-up. Health professionals need to adopt a holistic approach, taking into account the socio-economic and cultural realities of each patient.

Dietary patterns during pregnancy and maternal and birth outcomes in women with type 1 diabetes: the Environmental Determinants of Islet Autoimmunity (ENDIA) study

AIMS/HYPOTHESIS

Dietary patterns characterised by high intakes of vegetables may lower the risk of pre-eclampsia and premature birth in the general population. The effect of dietary patterns in women with type 1 diabetes, who have an increased risk of complications in pregnancy, is not known. The aim of this study was to investigate the relationship between dietary patterns and physical activity during pregnancy and maternal complications and birth outcomes in women with type 1 diabetes. We also compared dietary patterns in women with and without type 1 diabetes.

METHODS

Diet was assessed in the third trimester using a validated food frequency questionnaire in participants followed prospectively in the multi-centre Environmental Determinants of Islet Autoimmunity (ENDIA) study. Dietary patterns were characterised by principal component analysis. The Pregnancy Physical Activity Questionnaire was completed in each trimester. Data for maternal and birth outcomes were collected prospectively.

RESULTS

Questionnaires were completed by 973 participants during 1124 pregnancies. Women with type 1 diabetes (n=615 pregnancies with dietary data) were more likely to have a 'fresh food' dietary pattern than women without type 1 diabetes (OR 1.19, 95% CI 1.07, 1.31; p=0.001). In women with type 1 diabetes, an increase equivalent to a change from quartile 1 to 3 in 'fresh food' dietary pattern score was associated with a lower risk of pre-eclampsia (OR 0.37, 95% CI 0.17, 0.78; p=0.01) and premature birth (OR 0.35, 95% CI 0.20, 0.62, p<0.001). These associations were mediated in part by BMI and HbA1c. The 'processed food' dietary pattern was associated with an increased birthweight (β coefficient 56.8 g, 95% CI 2.8, 110.8; p=0.04). Physical activity did not relate to outcomes.

CONCLUSIONS/INTERPRETATION

A dietary pattern higher in fresh foods during pregnancy was associated with sizeable reductions in risk of pre-eclampsia and premature birth in women with type 1 diabetes.

A Tailored Postpartum eHealth Physical Activity Intervention for Individuals at High Risk of Postpartum Depression-the POstpartum Wellness Study (POW): Protocol and Data Overview for a Randomized Controlled Trial

BACKGROUND

Postpartum depression (PPD) is associated with significant health consequences for the parent and child. Current recommendations for PPD prevention require intense health care system resources. Evidence-based interventions for PPD prevention that do not further burden the health care system are needed. Evidence suggests that physical activity (PA) can generally reduce depressive symptoms. Technology-based interventions may help decrease common barriers to PA.

OBJECTIVE

This study aims to report the protocol and provide a data overview of the POstpartum Wellness study (POW)-an effectiveness trial evaluating whether an eHealth PA intervention tailored for postpartum individuals increased PA and decreased depressive symptoms among individuals at high PPD risk.

METHODS

This remote parallel-group randomized controlled trial included postpartum individuals with a history of depression or at least moderate current depressive symptoms not meeting the PPD diagnostic threshold and with low PA levels from an integrated health care delivery system. Participants were randomized to an eHealth PA intervention or usual care. The intervention group received access to a library of web-based workout videos designed for postpartum individuals, which included interaction with their infants. At baseline and follow-up (3 and 6 months), PA was measured using questionnaires and a wrist-worn accelerometer. Depressive symptoms were measured using the Patient Health Questionnaire-8 (PHQ-8). Data were collected to assess exploratory outcomes of sleep, perceived stress, anxiety, parent-infant bonding, and infant development.

RESULTS

The study was funded in January 2020. Participants were enrolled via REDCap (Research Electronic Data Capture) or telephonically between November 2020 and September 2022; data collection ended in April 2023. Randomized participants (N=99) were 4 months post partum at baseline with moderately severe depressive symptoms (mean PHQ-8 score 12.6, SD 2.2). Intervention (n=50) and usual care (n=49) groups had similar sociodemographic characteristics, months post partum, baseline depressive symptoms, number of children at home, and prepregnancy PA levels. Retention in assessments was ≥66% for questionnaires and ≥48% for accelerometry, with modest differences by group. At 3-month follow-up, 73 of 99 (74%) participants (intervention: 35/50, 70%; usual care: 38/49, 78%) completed questionnaires; 53 of 99 (54%) wore the accelerometer for 7 days (27 of 50 (54%) intervention, 26 of 49 (53%) usual care). At 6-month follow-up, 66 of 99 (67%) participants (30 of 50 (60%) intervention, 36 of 49 (73%) usual care) completed questionnaires and 43 of 99 (43%) wore the accelerometer for 7 days (21 of 50 (42%) intervention, 22 of 49 (45%) usual care). Data analysis is completed, and a manuscript with these findings is currently under review for publication.

CONCLUSIONS

The POW trial evaluates the effectiveness of an eHealth PA intervention for improving depressive symptoms and increasing PA among postpartum individuals at high PPD risk. Results have implications for the design and delivery of behavioral interventions among vulnerable patients.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04414696; https://clinicaltrials.gov/ct2/show/NCT04414696.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/56882.

A Call for the Implementation of Physical Activity as a Vital Sign (PAVS) During Pregnancy

Despite decades of research and clinical insights on the importance of physical activity during pregnancy for maternal and infant health, over 75% of pregnant individuals do not meet general physical activity guidelines of 150 minutes of moderate-intensity physical each week. This may be due to several barriers that restrict engagement in physical activity during pregnancy. Without providing individualized facilitators to overcome these respective barriers, physical activity engagement during pregnancy may be severely limited and/or reduced. This literary review presents the challenges specific populations face and strategies to facilitate the inclusion of physical activity as a vital sign (PAVS) during pregnancy to assist individuals to engage in and maintain physical activity throughout pregnancy. Additionally, the Exercise is Medicine's global initiative's ability to assist in implementing PAVS during pregnancy is discussed. We conclude by defining recommendations for routine prenatal care to consider PAVS to aid pregnant individuals in meeting physical activity guidelines.

Continuous Glucose Monitor Metrics That Predict Neonatal Adiposity in Early and Later Pregnancy Are Higher in Obesity Despite Macronutrient-Controlled Eucaloric Diets

BACKGROUND

Fasting glucose is higher in pregnancies with obesity (OB); less is known about postprandial (PP) and nocturnal patterns when the diet is eucaloric and fixed or about the continuous-glucose-monitor (CGM) metrics that predict neonatal adiposity (NB%fat). We hypothesized that continuous glucose monitors (CGMs) would reveal higher glycemia in OB vs. normal weight (NW) during Early (14-16 weeks) and Later (26-28 weeks) gestation despite macronutrient-controlled eucaloric diets and elucidate unique predictors of NB%fat.

METHODS

In a prospective, parallel-group comparative study, a eucaloric diet (NW: 25 kcal/kg; OB: 30 kcal/kg) was provided (50% carbohydrate [20% simple/30% complex; of total calories], 35% fat, 15% protein) to Early and Later gestation groups wearing a blinded CGM for three days. CGM metrics (mean fasting; 1 h and 2 h PP; daytime and nocturnal glucose; percent time-in-range (%TIR: 63-140 mg/dL); PP excursions; and area-under-the-curve [AUC]) were interrogated between groups and as predictors of NB%fat by dual X-ray absorptiometry(DXA).

RESULTS

Fifty-four women with NW (BMI: 23 kg/m2; n = 27) and OB (BMI: 32; n = 27) provided their informed consent to participate. Early, the daytime glucose was higher in OB vs. NW (mean ± SEM) (91 ± 2 vs. 85 ± 2 mg/dL, p = 0.017), driven by 2 h PP glucose (95 ± 2 vs. 88 ± 2, p = 0.004). Later, those with OB exhibited higher nocturnal (89 ± 2 vs. 81 ± 2), daytime (95 ± 2 vs. 87 ± 2), 1 h (109 ± 3 vs. 98 ± 2), and 2 h PP (101 ± 3 vs. 92 ± 2) glucose (all p < 0.05) but no difference in %TIR (95-99%). Postprandial peak excursions for all meals were markedly blunted in both the Early (9-19 mg/dL) and Later (15-26 mg/dL). In OB, the Later group's 24 h AUC was correlated with NB%fat (r = 0.534, p = 0.02). Despite similar weight gain, infants of OB had higher birthweight (3528 ± 107 vs. 3258 ± 74 g, p = 0.037); differences in NB%fat did not reach statistical significance (11.0 vs. 8.9%; p > 0.05).

CONCLUSIONS

Despite macronutrient-controlled eucaloric diets, pregnancies with OB had higher glycemia Early and Later in gestation; the Later 24 h glucose AUC correlated with NB%fat. However, glycemic patterns were strikingly lower than current management targets.

Physical activity level among pregnant women attending maternal healthcare services in rural Karnataka; findings of a cross-sectional study

Background Regular exercise during pregnancy improves fetal and mother outcomes unless contraindicated. Despite being generally safe and beneficial, non-participation in prenatal activity is relatively common among most of the Asian countries due to multiple reasons. In India, findings related to maternal physical activity and its determinant are scant. Objective The objective of this study is to assess the physical activity level and associated factors among pregnant women attending maternal healthcare services in Dakshina Kannada District in India. Method A multi-center community-based cross-sectional study was conducted recruiting 424 pregnant women attending the maternal healthcare facilities at four taluks of Dakshina Kannada district in Karnataka state, India. A structured questionnaire that collected information on socio-demographic, and maternal characteristics was used and the Pregnancy Physical Activity Questionnaire tool was used to determine the physical activity during pregnancy. Logistic regression model was used to determine the predictor variables. Results The prevalence of physical inactivity was 40.33%. Physical activity is favorable among pregnant women aged between 25 to 29 years, residing in an urban locality, diploma or graduation and being housewife. Determinants of physical inactivity during pregnancy were sedentary occupation (AOR 7.22, 95% CI 2.2, 23.4), low family income (AOR 3.16, 95% CI 1.414, 7.054), having one child (AOR 5.4, 95% CI 1.3, 22.2), during 2nd trimester (AOR 2.513, 95% CI 1.5, 4.23) and self-reported lack of time (AOR 2.884, 95% CI 1.410, 5.901). Conclusion and recommendation A moderate proportion of pregnant women reported physical inactivity during pregnancy in the Dakshina Kannada district, Karnataka. Physical inactivity was associated with sedentary employment, low income, number of children, trimester, and time constraints. Measures should be undertaken to promote the importance of recommended levels of physical activity, enhance access, and support system targeting pregnant women.

Type of delivery lacks the association with dietary patterns followed by pregnant women in their third trimester

Background: Maternal nutrition plays a crucial role in fetal development, women's health, and reproductive capacity. Dietary pattern (DP) is a measure of overall diet and has become widespread in nutrition research as an alternative method to studying individual components of the diet. Aim: this study aims to determine the adopted DPs by Jordanian pregnant women and evaluate their potential associations with the mode of delivery. Methods: A cross-sectional study included 249 healthy Jordanian pregnant women in their third trimester of pregnancy who attended antenatal clinics at Jordan University. Personal information was gathered using a pre-tested structured questionnaire. To investigate dietary patterns, a valid and reliable food frequency questionnaire was employed, and a pregnant physical activity questionnaire was used to estimate physical activity levels. The mode of delivery data was collected from the medical records after delivery. Results: The majority of pregnant women (82.3%) fell within the age range of 20 to 35 years. Notably, 34.5% of the mothers were classified as overweight or obese. Additionally, around one in five deliveries involved emergency cesarean sections. Four distinct DPs were identified and labelled as "fruit and vegetables", "healthy", "traditional", and 'fat and sugar" dietary patterns. However, no significant association was found between these identified dietary patterns and the occurrence of Caesarean section (CS) across all tertiles. Conclusion: The analysis revealed no substantial protective effect of the DPs against the occurrence of CS across all tertiles of dietary patterns. However, further studies are needed to either confirm or challenge our findings.

Validity and reliability of the Polish version of the Pregnancy Mobility Index (PMI-PL)

Introduction

Mobility, defined as active, controlled, multi-joint flexibility used in movement, is limited in pregnant women due to problems with low back pain (LBP) and pelvic girdle pain (PGP). The Pregnancy Mobility Index (PMI) is a tool for assessing mobility in relation to LBP/PGP. The lack of a Polish version of the PMI test prompted a transcultural adaptation to the Polish conditions. The aim of the study was to evaluate the measurement properties of the Polish adaptation of the Pregnancy Mobility Index.

Methods

The study involved 121 pregnant women aged 18-44. The translation process was in accordance with the transcultural adaptation design. Reliability was assessed by intraclass correlation coefficient (ICC). Construct validity between the Polish version of the PMI (PMI-PL) and the Physical Activity Pregnancy Questionnaire (PPAQ-PL) was assessed by Spearman's rank correlation coefficient.

Results

The transcultural adaptation of the PMI test into Polish was satisfactory, with high internal consistency (Cronbach's alpha = 0.97-0.98, ICC = 0.989). Statistically significant inverse proportional correlations were found for total PA, total PA (light and above), light PA, moderate PA, and vigorous PA in the construct validity analysis between PMI-PL and PPAQ-PL.

Discussion

The Polish version of the PMI is a reliable instrument. The introduction of a questionnaire with a classification system will make it easier for health professionals to monitor the health status of pregnant women and encourage them to engage in physical activity appropriate for their current level of mobility.

Non-Pharmacological Management of Gestational Diabetes Mellitus with a High Fasting Glycemic Parameter: A Hospital-Based Study in Vietnam

Background/Objectives: The prevalence of gestational diabetes mellitus (GDM) is increasing at an alarming rate worldwide. Delayed management can lead to adverse composite outcomes for both mother and her offspring. To our knowledge, the clinical association between glycemic parameters and the results of the non-pharmacological GDM approach remains limited; thus, this study aimed to address this important clinical issue in the literature. Methods: This was a retrospective cross-sectional study of 174 Vietnamese pregnant women with the positive oral glucose tolerance test (OGTT) for a high fasting glycemic parameter at Hung Vuong Hospital from 04/2022 to 07/2022. This study aimed to evaluate the success rate of GDM with an elevated index of fasting glycemic concentration which was managed after 2 weeks of a dietary regimen combined with adequate physical activities and to reveal its related factors. Results: Out of 174 singleton pregnancies that met the inclusion criteria, 103 GDM pregnant women were successfully managed after 2 weeks of monitoring (59.2%; 95% confidence intervals (CI): 51.9-66.5). The study revealed a fair correlation between the corresponding test of blood glucose at OGTT and after 2 weeks of GDM management (r = 0.270-0.290, p < 0.0001). The GDM pregnant women with an elevated fasting glycemic parameter and with any of elevated 1 h or 2 h blood glucose levels and in cases of three elevated glycemic parameters (fasting, 1 h, and 2 h blood glucose at the initial results of OGTT) reduced the success rate of glycemic control to 56.5%, 49.2%, respectively, compared to the group with solely a high fasting index of blood glucose (69.6%). The pregnant women who participated in high-intensity sports activities related to a two-fold increase in success rate compared with the group engaging in light and moderate-intensity physical activity. Conclusions: The success rate of glycemic control in GDM women was highest in the group with solitary fasting hyperglycemia and lower in the contributory groups with two and three high parameters. The application of diet therapy plus physical activities among GDM pregnant women is potentially necessary to improve the effectiveness of treatment, minimize adverse pregnancy outcomes, and reduce substantially the hospitalization rate.

Adherence to physical activity among pregnant women in Southern Italy: results of a cross-sectional survey

PROBLEM

Knowledge about physical activity in pregnancy is limited compared to general population and several approaches have been used to evaluate duration and intensity of physical activity during pregnancy.

BACKGROUND

Although physical activity can contribute to maternal and fetal well-being, more than half of women stopped their physical activity because of pregnancy.

AIM

To evaluate the adherence to physical activity of low-risk pregnant women by adapting an Italian version of the PPAQ.

METHODS

PPAQ was administered to women with singleton uneventful pregnancies between May and December 2022. The intensity of physical activity was calculated using activity's metabolic equivalent (MET).

FINDINGS

Respondents spent 8.5 hours/week during the third trimester in all the types of activities included in the questionnaire, and the majority of METs were spent in household/caregiving activities (91.7 METs-h/week). Only 2,6 % of women reported they spent at least 150 minutes per week in moderate-intensity sport/exercise activity. One-hundred-forty-one women (37.2 %) reported they have been counselled by a midwife or an obstetrician regarding the importance of physical activity in pregnancy and 164 participants (43.3 %) declared that have been advised in favour of bed rest at least once in the current pregnancy.

DISCUSSION

Our results showed that a very small percentage was regularly involved in sport/exercise activities.

CONCLUSION

The engagement in physical activity of pregnant women during the third trimester is still very low and specific policies to improve exercise in pregnancy should be warrantied.

Sexual Function of Women with and without Pregnancy-Related Pelvic Girdle Pain and its Relationship with Physical Activity, Kinesiophobia and Body Image: A Cross-Sectional Comparative Study

The aim of this study was to compare the sexual function of women with and without pregnancy-related PGP, and to investigate its relationship with physical activity (PA), kinesiophobia, and body image (BI). Demographic characteristics, sexual function (Pregnancy Sexual Response Inventory), PA (Pregnancy Physical Activity Questionnaire), kinesiophobia (Tampa Kinesiophobia Scale), and BI (Body Image in Pregnancy Scale) of 125 pregnant women were recorded. In the PGP group (n = 46), visual analogue scales were used to assess the pain intensity during resting and sexual activity, and Pelvic Girdle Questionnaire was used to evaluate the activity limitation. Although total sexual function and BI scores of the groups were similar (p > 0.05), dyspareunia during pregnancy and level of kinesiophobia were higher, and energy expenditure during moderate-intensity PA was lower in pregnant women with PGP (p < 0.05). The PGP group had moderate activity limitation and reported increased PGP intensity during sexual activities (p < 0.001). PA level was significantly correlated with sexual desire (r = 0.180), and overall sexual function was correlated with kinesiophobia (r = -0.344) and BI (r = -0.199) during pregnancy (p < 0.05). These findings suggest that pregnant women with PGP are more vulnerable to sexual dysfunctions, and there is a need to develop biopsychosocial framework-oriented management strategies which aim to improve PA level and to eliminate psychological factors such as kinesiophobia and negative BI.Clinical Trial Registration: NCT05990361.

Association of trajectories and cumulative exposure of antenatal depression with high birth weight

BACKGROUND

Inconsistent associations between antenatal depression and fetal birth weight were reported previously, and little is known about the dynamic changes and long-term cumulative effect of antenatal depression during pregnancy.

METHODS

Participants were from the Tongji-Huaxi-Shuangliu Birth Cohort. Depressive symptoms were measured using the Edinburgh Postnatal Depression Scale in early, middle, and late pregnancy respectively. Trajectories of antenatal depression were assessed using the latent class mixed model. The percentage of days with depression (PDD) and frequency of antenatal depression were measured to assess the cumulative exposure. Multivariable logistic regression models were used to evaluate the associations of antenatal depression with macrosomia and large for gestational age (LGA).

RESULTS

We identified four distinct trajectories, including the low stable group (n = 1,327, 27.99 %), the moderate stable group (n = 2,610, 55.05 %), the peak group (n = 407, 8.58 %), and the valley group (n = 397, 8.37 %). Compared with the low stable group, the valley group showed a higher risk of macrosomia (OR, 1.98; 95 % CI, 1.17, 3.38) and LGA (OR, 1.44; 95 % CI, 1.002, 2.09); the peak group showed a higher risk of LGA (OR, 1.52; 95 % CI, 1.07, 2.16), but the association was not significant for macrosomia (OR, 1.47; 95 % CI, 0.85, 2.55). Consistently, cumulative antenatal depression was also positively associated with the risks of macrosomia and LGA.

LIMITATION

The antenatal depression was self-reported using a screening scale and information bias could not be ruled out.

CONCLUSION

Certain trajectories and cumulative exposure of antenatal depression were associated with higher risks of high birth weight.

The Impact of a Lifestyle Intervention on Cardiometabolic Risk Factors among Postpartum Hispanic Women with Overweight and Obesity in a Randomized Controlled Trial (Proyecto Mamá)

INTRODUCTION

Maternal overweight or obesity has been associated with metabolic syndrome through 1 year postpartum, but it remains unknown whether a culturally-modified, motivationally-targeted, and individually-tailored Lifestyle Intervention could improve postpartum cardiometabolic health among Hispanic women with overweight or obesity.

METHODS

Proyecto Mamá was a randomized controlled trial conducted in Western Massachusetts from 2014 to 2020 in which Hispanic women with overweight/obesity were randomized to a Lifestyle Intervention (LI) involving diet and exercise or to a comparison Health and Wellness Intervention (HW). Biomarkers of cardiovascular risk (i.e., lipids, C-reactive protein) and insulin resistance (fasting insulin, glucose, HbA1c, homeostasis model assessment [HOMA-IR], leptin, adiponectin) were measured at baseline (early pregnancy), mid-pregnancy, and 6 weeks, 6 months, and 12 months postpartum. Generalized linear mixed effect models were used to evaluate differences in the change in biomarkers over the course of postpartum follow-up time.

RESULTS

In intent-to-treat analyses among eligible women (LI; n=51, HW; n=58) there were no significant differences in changes in biomarkers of CVD risk or insulin resistance over the postpartum year; for example, the intervention effect for total cholesterol was 6.98 (SE: 6.36, p=0.27) and for HbA1c was -0.01 (SE: 0.4, p=0.85). In pooled analyses, regardless of intervention arm, women who participated in any vigorous activity had less of an increase in HbA1c (intervention effect = -0.17, SE: 0.05, p=0.002) compared to those with no vigorous activity, and similarly beneficial associations with other cardiovascular risk biomarkers (p<0.05).

DISCUSSION

Women who participated in vigorous activity, regardless of their assigned intervention arm, had more favorable changes in biomarkers of insulin resistance.

Physical activity levels and influencing factors among pregnant women in China: A systematic review and meta-analysis

BACKGROUND

Physical activity during pregnancy has been recommended as an effective measure to prevent various pregnancy complications. However, global physical activity participation during pregnancy is not optimal, and the factors influencing physical activity participation during pregnancy need to be further investigated. In China, where there are no localized guidelines for physical activity during pregnancy, the prevalence of meeting recommended physical activity levels among Chinese pregnant women is still unclear.

OBJECTIVES

This study aimed to comprehensively review the prevalence of meeting recommended physical activity levels among pregnant women in China and to further explore the factors influencing physical activity participation during pregnancy.

DESIGN

This was a systematic review and meta-analysis.

METHODS

A systematic review was conducted in both English and Chinese databases from inception until August 1, 2023. Two reviewers independently screened literature, assessed study eligibility and extracted data. The Agency for Healthcare Research and Quality was used to evaluate methodological quality of included studies. The pooled prevalence was calculated using a random-effects model. Subgroup analyses were conducted to explore sources of heterogeneity.

RESULTS

A total of 12 cross-sectional studies, including 11,323 Chinese pregnant women with a mean age ranging from 27.0 to 33.0 years, met the inclusion criteria. The prevalence of meeting recommended physical activity levels among pregnant women in China was 21.0 % (95 % confidence interval (CI):12.5 %-29.5 %). A higher prevalence of meeting recommended physical activity levels was observed among pregnant women who were in their second trimester, who were living in the southern region, who were assessed by validated questionnaires, and who used 150 min physical activity per week as a criterion for meeting recommendation.

CONCLUSIONS

The findings suggested a low prevalence of meeting recommended physical activity levels among Chinese pregnant women, which was affected by a variety of factors. It is recommended that further research be conducted in the future to explore physical activity intervention strategies for women of childbearing age before and during pregnancy based on the factors affecting physical activity to improve physical activity compliance, maternal and child health and population quality.

REGISTRATION NUMBER

CRD42022372722 (PROSPERO).

The German version of the Pregnancy Physical Activity Questionnaire: a translation, cross-cultural adaptation, reliability and validity assessment

BACKGROUND

Validated and internationally standardised measurement instruments are a prerequisite for ensuring that physical activity during pregnancy is comparable and for deriving physical activity recommendations. In Germany, there has been no adapted version of the internationally used Pregnancy Physical Activity Questionnaire (PPAQ) until now. This study's aim centred around translating the original English version into German (PPAQ-G) and determining its reliability as well as validity in a German population.

METHODS

The PPAQ was translated into German using the forward-backwards technique. Its reliability and validity were tested. Thirty-four correctly completed questionnaires were analysed. The test-retest reliability was presented using the intraclass correlation coefficient (ICC) and Spearman correlation coefficient. Validity was tested by using accelerometer (n = 23) and determined by Spearman correlation coefficient.

RESULTS

In the transcultural adjustment, two questions were amended to describe intensity more precisely, and two other questions were adapted to reflect the units of measurement used in Germany. The ICC indicated a reliability of r = 0.79 for total activity (without sitting), and the intensity subcategories ranged from r = 0.70 (moderate-intensity activities) to r = 0.90 (sitting). Although, validity assessment showed no significant correlation for sedentary, moderate or vigorous intensity, there were significant correlations for total activity (light and above; r = 0.49; p < 0.05) and for light activity (r = 0.65; p < 0.01).

CONCLUSIONS

The PPAQ-G showed good reliability for use on pregnant German women and a moderately accurate measurement of physical activity. It can be used nationally for epidemiological studies, and it also enables international comparisons of physical activity during pregnancy.

TRIAL REGISTRATION

DRKS00023426; Registration date 20 May 2021.

Antenatal Depression and its Associated Factors: Findings from Kuwait Birth Cohort Study

BACKGROUND

Pregnant and postpartum women are at high risk of depression due to hormonal and biological changes. Antenatal depression is understudied compared to postpartum depression and its predictors remain highly controversial.

AIM

To estimate the prevalence of depressive symptoms during pregnancy and investigate factors associated with this condition including vitamin D, folate and Vitamin B12 among participants in the Kuwait Birth Study.

METHODS

Data collection occurred as part of the Kuwait Birth Cohort Study in which pregnant women were recruited in the second and third trimester during antenatal care visits. Data on antenatal depression were collected using the Edinburgh Postnatal Depression Scale (EPDS), considering a score of ≥ 13 as an indicator of depression. Logistic regression was used to investigate factors associated with depressive symptoms in pregnant women.

RESULTS

Of 1108 participants in the Kuwait Birth Cohort study, 1070(96.6%) completed the EPDS. The prevalence of depressive symptoms was 21.03%(95%CI:18.62-23.59%) and 17.85%(95%CI:15.60-20.28%) as indicated by an EPDS ≥ 13 and EPDS ≥ 14 respectively. In the multivariable analysis, passive smoking at home, experiencing stressful life events during pregnancy, and a lower level of vitamin B12 were identified as predisposing factors. Conversely, having desire for the pregnancy and consumption of fruits and vegetables were inversely associated with depressive symptoms.

CONCLUSION

Approximately, one fifth of pregnant women had depressive symptoms indicating the need to implement screening program for depression in pregnant women, a measure not systematically implemented in Kuwait. Specifically, screening efforts should focus on pregnant women with unintended pregnancies, exposure to passive smoking at home, and recent stressful live events.