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Kember AJ, Anderson JL, House SC, Reuter DG, Goergen CJ, Hobson SR. Impact of maternal posture on fetal physiology in human pregnancy: a narrative review. Front Physiol 2024; 15:1394707. [PMID: 38827993 PMCID: PMC11140392 DOI: 10.3389/fphys.2024.1394707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/24/2024] [Indexed: 06/05/2024] Open
Abstract
In numerous medical conditions, including pregnancy, gravity and posture interact to impact physiology and pathophysiology. Recent investigations, for example, pertaining to maternal sleeping posture during the third trimester and possible impact on fetal growth and stillbirth risk highlight the importance and potential clinical implications of the subject. In this review, we provide an extensive discussion of the impact of maternal posture on fetal physiology from conception to the postpartum period in human pregnancy. We conducted a systematic literature search of the MEDLINE database and identified 242 studies from 1991 through 2021, inclusive, that met our inclusion criteria. Herein, we provide a synthesis of the resulting literature. In the first section of the review, we group the results by the impact of maternal posture at rest on the cervix, uterus, placenta, umbilical cord, amniotic fluid, and fetus. In the second section of the review, we address the impact on fetal-related outcomes of maternal posture during various maternal activities (e.g., sleep, work, exercise), medical procedures (e.g., fertility, imaging, surgery), and labor and birth. We present the published literature, highlight gaps and discrepancies, and suggest future research opportunities and clinical practice changes. In sum, we anticipate that this review will shed light on the impact of maternal posture on fetal physiology in a manner that lends utility to researchers and clinicians who are working to improve maternal, fetal, and child health.
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Affiliation(s)
- Allan J. Kember
- Temerty Faculty of Medicine, Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
- Shiphrah Biomedical Inc., Toronto, ON, Canada
| | - Jennifer L. Anderson
- Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Sarah C. House
- Temerty Faculty of Medicine, Medical Education, University of Toronto, Toronto, ON, Canada
| | - David G. Reuter
- Cardiac Innovations, Seattle Children’s Hospital, Seattle, WA, United States
| | - Craig J. Goergen
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
| | - Sebastian R. Hobson
- Temerty Faculty of Medicine, Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Maternal-Fetal Medicine Division, Mount Sinai Hospital, Toronto, ON, Canada
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Dong J, Xu Q, Qian C, Wang L, DiSciullo A, Lei J, Lei H, Yan S, Wang J, Jin N, Xiong Y, Zhang J, Burd I, Wang X. Fetal growth restriction exhibits various mTOR signaling in different regions of mouse placentas with altered lipid metabolism. Cell Biol Toxicol 2024; 40:15. [PMID: 38451382 PMCID: PMC10920423 DOI: 10.1007/s10565-024-09855-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/27/2024] [Indexed: 03/08/2024]
Abstract
Fetal growth restriction (FGR) is a common complication of pregnancy and can have significant impact on obstetric and neonatal outcomes. Increasing evidence has shown that the inhibited mechanistic target of rapamycin (mTOR) signaling in placenta is associated with FGR. However, interpretation of existing research is limited due to inconsistent methodologies and varying understanding of the mechanism by which mTOR activity contributes to FGR. Hereby, we have demonstrated that different anatomic regions of human and mouse placentas exhibited different levels of mTOR activity in normal compared to FGR pregnancies. When using the rapamycin-induced FGR mouse model, we found that placentas of FGR pregnancies exhibited abnormal morphological changes and reduced mTOR activity in the decidual-junctional layer. Using transcriptomics and lipidomics, we revealed that lipid and energy metabolism was significantly disrupted in the placentas of FGR mice. Finally, we demonstrated that maternal physical exercise during gestation in our FGR mouse model was associated with increased fetal and placental weight as well as increased placental mTOR activity and lipid metabolism. Collectively, our data indicate that the inhibited placental mTOR signaling contributes to FGR with altered lipid metabolism in mouse placentas, and maternal exercise could be an effective method to reduce the occurrence of FGR or alleviate the adverse outcomes associated with FGR.
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Affiliation(s)
- Jie Dong
- Department of Obstetrics and Gynecology, Tangdu Hospital, Air Force Medical University, NO. 569, Xinsi Road, Baqiao District, Xi'an, 710038, Shaanxi Province, China.
| | - Qian Xu
- Department of Obstetrics and Gynecology, Tangdu Hospital, Air Force Medical University, NO. 569, Xinsi Road, Baqiao District, Xi'an, 710038, Shaanxi Province, China
| | - Chenxi Qian
- Department of Obstetrics and Gynecology, Tangdu Hospital, Air Force Medical University, NO. 569, Xinsi Road, Baqiao District, Xi'an, 710038, Shaanxi Province, China
| | - Lu Wang
- Department of Obstetrics and Gynecology, Tangdu Hospital, Air Force Medical University, NO. 569, Xinsi Road, Baqiao District, Xi'an, 710038, Shaanxi Province, China
| | - Alison DiSciullo
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland, 22 S. Greene Street, Suite P6H302, Baltimore, MD, 21201, USA
| | - Jun Lei
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland, 22 S. Greene Street, Suite P6H302, Baltimore, MD, 21201, USA
| | - Hui Lei
- Department of Obstetrics and Gynecology, Tangdu Hospital, Air Force Medical University, NO. 569, Xinsi Road, Baqiao District, Xi'an, 710038, Shaanxi Province, China
| | - Song Yan
- Department of Obstetrics and Gynecology, Tangdu Hospital, Air Force Medical University, NO. 569, Xinsi Road, Baqiao District, Xi'an, 710038, Shaanxi Province, China
| | - Jingjing Wang
- Department of Obstetrics and Gynecology, Tangdu Hospital, Air Force Medical University, NO. 569, Xinsi Road, Baqiao District, Xi'an, 710038, Shaanxi Province, China
| | - Ni Jin
- Department of Obstetrics and Gynecology, Tangdu Hospital, Air Force Medical University, NO. 569, Xinsi Road, Baqiao District, Xi'an, 710038, Shaanxi Province, China
| | - Yujing Xiong
- Department of Obstetrics and Gynecology, Tangdu Hospital, Air Force Medical University, NO. 569, Xinsi Road, Baqiao District, Xi'an, 710038, Shaanxi Province, China
| | - Jianhua Zhang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Xi'an Medical University, Xi'an, 710038, Shaanxi Province, China
| | - Irina Burd
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland, 22 S. Greene Street, Suite P6H302, Baltimore, MD, 21201, USA.
| | - Xiaohong Wang
- Department of Obstetrics and Gynecology, Tangdu Hospital, Air Force Medical University, NO. 569, Xinsi Road, Baqiao District, Xi'an, 710038, Shaanxi Province, China.
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Kasahun AW, Shitu S, Mekonnen BA, Hawlet M, Zewdie A. Knowledge, attitude and practice towards antenatal physical exercise among pregnant women in Ethiopia: A systematic review and meta-analysis. PLoS One 2023; 18:e0295275. [PMID: 38096224 PMCID: PMC10721098 DOI: 10.1371/journal.pone.0295275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/20/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Physical activity and exercise during pregnancy have paramount importance for both the mother and fetus. Regardless of the benefits of exercise during pregnancy, significant proportion of women usually opt sedentary lifestyle during pregnancy. The aim of this systematic review and meta-analysis is to synthesis evidences on knowledge, attitude, and practice towards antenatal physical exercise among pregnant women in Ethiopia. METHODS The systematic review and meta-analysis was conducted on knowledge, attitude, practice, and associated factors towards antenatal physical exercise among pregnant women in Ethiopia. The systematic review and meta-analysis protocol was registered on PROSPERO website with registration number CRD42023444723. Articles were searched on international databases using medical subject heading and keywords. After ensuring eligibility, data were extracted using Microsoft excel and imported to STATA 17 for analysis. Cochran Q test and I2 statistics were used to check presence of heterogeneity. Weighted Inverse variance random effect model was used to estimate the pooled level of knowledge, attitude, and practice on antenatal physical exercise among pregnant women in Ethiopia. Funnel plot and egger's test were used to check presence of publication bias. RESULTS A total of 11 studies were included in this systematic review and meta-analysis. The pooled prevalence of adequate knowledge, favorable attitude and good practice towards antenatal physical exercise were 46.04% with 95% CI (44.45%-47.63%), 43.71%, 95% CI (41.95%-45.46%) and 34.06, 95% CI (20.04%-48.08%) respectively. Good knowledge AOR 2.38 95% CI(1.80-3.14), unfavorable attitude AOR 0.43 95% CI (0.32-0.58), having no pre-pregnancy habit of physical exercise AOR 0.44 95 CI (0.24-0.79) and having diploma or above education status AOR 3.39 95% CI (1.92-5.98) were significantly associated with practice of antenatal physical exercise. CONCLUSION The level of knowledge, attitude and practice towards antenatal physical exercise among pregnant women was far below the recommended level in Ethiopia. Knowledge, attitude, education status and pre-pregnancy habit of physical exercise were significantly associated factors with antenatal physical exercise practice. It is highly essential to disseminate health information on the benefits of antenatal physical exercise for all pregnant women during antenatal care contacts.
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Affiliation(s)
- Abebaw Wasie Kasahun
- Department of Public Health, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Solomon Shitu
- Department of Midwifery, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Berhanu Abebaw Mekonnen
- Department of Nutrition and Dietetics, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Michael Hawlet
- School of Medicine, College of Medicine and Health sciences, Wolkite University, Wolkite, Ethiopia
| | - Amare Zewdie
- Department of Public Health, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
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Tekalegn Y, Solomon D, Sahiledengle B, Beressa G, Desta F, Tolcha F, Rogers HL, Petrucka PP, Mwanri L. Level of physical activity and its associated factors among adults in southeast Ethiopia: a community-based cross-sectional study. BMJ Open 2022; 12:e063333. [PMID: 36385036 PMCID: PMC9670934 DOI: 10.1136/bmjopen-2022-063333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Insufficient levels of physical activity are a well-known modifiable risk factor for a number of chronic conditions including obesity, type 2 diabetes, cardiovascular diseases and certain malignancies. Little is known about the status of physical activity and its associated factors among adults in low-income countries, including Ethiopia. Therefore, this study aimed to assess the level of physical activity and its associated factors among adults in southeast Ethiopia. DESIGN Analytical cross-sectional study. SETTING Community setting in southeast Ethiopia. PARTICIPANTS 641 adults aged 18-64 years. PRIMARY OUTCOME Level of physical activity assessed via the Global Physical Activity Questionnaire (GPAQ). RESULTS The overall prevalence of insufficient physical activity in this study was 29.48% (95% CI: 25.78 to 33.18). Women were more likely to report insufficient physical activity compared with men (39.0% for women and 12.3% for men, p<0.001). Being: a women (adjusted OR (AOR)=3.99, 95% CI: 2.15 to 7.40)), overweight/obese (AOR=1.95, 95% CI: 1.23 to 3.09), ever-married (AOR=2.13, 95% CI: 1.01 to 4.47), a person with no formal education (AOR=1.94, 95% CI: 1.05 to 3.56), a housewife (AOR=3.04, 95% CI: 1.75 to 5.29) and unemployed (AOR=3.30, 95% CI: 1.55 to 7.02) were significantly associated with insufficient physical activity. CONCLUSION The study revealed that three in 10 adults did not achieve the recommended level of physical activity. For chronic disease prevention in Ethiopia, the Ethiopian Ministry of Health and other stakeholders should pay special attention to strategies to improve the population's physical activity especially among women, housewives, people with no formal education, and married, unemployed and overweight/obese adults.
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Affiliation(s)
| | - Damtew Solomon
- Biomedical Department, Madda Walabu University, Robe, Ethiopia
| | | | - Girma Beressa
- Public Health, Madda Walabu University, Addis Ababa, Oromia, Ethiopia
- Public Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Fikreab Desta
- Public Health, Madda Walabu University, Robe, Oromia Region, Ethiopia
| | | | - Heather L Rogers
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Ikerbasque, Bilbao, Bizkaia, Spain
| | - Pammla P Petrucka
- Nursing Education, University of Saskatchewan College of Nursing, Saskatoon, Saskatchewan, Canada
| | - Lillian Mwanri
- Torrens University Australia, Adelaide, South Australia, Australia
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Factors associated with meeting the WHO physical activity recommendations in pregnant Colombian women. Sci Rep 2022; 12:19500. [PMID: 36376351 PMCID: PMC9663497 DOI: 10.1038/s41598-022-23947-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022] Open
Abstract
In the absence of medical contraindications, physical activity (PA) can offer health maternal and fetal health outcomes during pregnancy. However, most pregnant women may not consider PA to be feasible, suitable and safe. Hence, it is essential to determine the prevalence of pregnant women who meet the PA recommendations and the possible factors associated with that meeting, since it might be important from the perspective of pregnant women's health. The aim of the present study was to establish the prevalence of meeting the World Health Organization PA recommendations for Colombian pregnant women, as well as possible factors that may be associated with meeting that recommendations. A cross-sectional study including representative data from the National Nutritional Situation Survey (2015) in Colombia was performed. Data were collected in 2015-2016. From an initial sample of 1140 Colombian pregnant women, 702 participants with complete data were included in the final analysis. PA was assessed by self-reported information through the long version of the International Physical Activity Questionnaire. Several potential factors were analysed according to four levels of the socioecological model: the individual, interpersonal, organizational and community levels. The prevalence of Colombian pregnant women who met with the PA recommendations was 7.5%. Indigenous and Mestizo pregnant women showed lower probabilities of meeting the PA recommendations [Indigenous: OR 0.05, 95% CI (0.01-0.18); Mestizo: OR 0.12, 95% CI (0.06-0.22)] than Afro-Colombian participants. Additionally, participants who lived near green and safe spaces for PA were more likely to meet the PA recommendations [OR 2.30, 95% CI (1.06-4.79)] than those who did not live near green areas. In conclusion, a low percentage of Colombian pregnant women met the new PA recommendations. The associations found according to race/ethnicity and living near green and safe areas underline the presence of fundamental disparities associated with meeting PA recommendations.
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Okafor UB, Goon DT. Physical activity and exercise during pregnancy in Africa: a review of the literature. BMC Pregnancy Childbirth 2020; 20:732. [PMID: 33238920 PMCID: PMC7691114 DOI: 10.1186/s12884-020-03439-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 11/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pregnancy is an important phase in a woman's life, with health status at this stage affecting both the woman and her child's life. Global evidence suggests that many women engage in low levels of physical activity (PA) and exercise during pregnancy despite its beneficial effects. This is particularly the case in Africa. METHODS This article reviews the literature on levels of PA and exercise among pregnant women in Africa, highlighting the level of PA or exercise participation during pregnancy in Africa, including types of PA, factors affecting PA, beliefs about and benefits of prenatal activity, advice or counselling on PA during pregnancy in Africa, and PA interventions proposed to promote the uptake of prenatal PA. Electronic search databases used were Google Scholar, Science Direct, Scopus, EMBASE, ERIC, Medline, Web of Science, EBSCOhost, PubMed, BIOMED Central, and African Journal Online. The basic search terms were: 'Physical activity', 'Exercise', 'Pregnancy', 'Pregnant women' and 'Africa'. A total of 40 references were found. On the basis of an analysis of titles, abstracts and the language of publication (other than English), 11 articles were rejected, and 29 articles were fully read, although two had to be rejected due to a lack of access to the full version. Finally, 27 references were included in the review. RESULTS Few studies exist on PA during pregnancy in Africa. The limited data available suggests that, compared to the Western world, pregnant women in Africa do not adhere to the recommendations for PA during pregnancy. Levels of participation in PA during pregnancy are low and decline as the pregnancy progresses. The majority of the studies used direct, objective measures to assess PA during pregnancy. Personal and environmental factors such as lack of time, lack of knowledge, inadequate information from healthcare providers, feelings of tiredness and an absence of social support constituted the main barriers to PA during pregnancy. The types of PA participation among pregnant women varied across studies and geographical settings. CONCLUSIONS While published data is limited, it seems clear that the participation of pregnant women in PA during pregnancy in Africa is low and declines with advancing pregnancy. There is a need for more studies to examine the dynamics of PA during pregnancy in Africa to guide contextual interventions to improve and promote maternal health on the continent.
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Affiliation(s)
- Uchenna Benedine Okafor
- Department of Nursing Science, University of Fort Hare, 50 Church Street, 5201, East London, South Africa.
| | - Daniel Ter Goon
- Department of Public Health, University of Fort Hare, 05 Oxford Street, East London, South Africa
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