Self-report Pregnancy Physical Activity Questionnaire overestimates physical activity

Sex-specific associations between feto-placental growth and maternal physical activity volume and sitting time: Findings from the Queensland Family Cohort study

INTRODUCTION

Antenatal physical activity (PA) is associated with beneficial changes in placental growth and function; however, the effect of excessive sitting time is less clear. The aim of this study was to investigate whether feto-placental growth changes with maternal activity, and whether these associations differ in a sex-specific manner.

METHODS

This study included women enrolled in the Queensland Family Cohort study who self-reported PA and sitting time at 24 or 36 weeks of gestation. Placental growth factors and feto-placental growth parameters at delivery were analysed by PA volume and sitting time, as well as by fetal sex.

RESULTS

Women who reported excessive sitting time during mid-pregnancy and had a female fetus showed higher placental PlGF (p = 0.031) and FLT1 (p = 0.032) mRNA expression with no difference in placental size at delivery. For the male, excessive sitting time during mid-pregnancy was associated with a lower placental weight (p = 0.001) and placental surface area (p = 0.012) and a higher birthweight to placental weight (BWPW) ratio (p = 0.042), with no change in placental growth factors. Moderate volume PA during mid-pregnancy was associated with lower VEGFA mRNA expression in the male placenta (p = 0.005) and a higher abdominal circumference in the female neonate (p = 0.042), with no overall difference in placental weight or birthweight for either sex.

CONCLUSIONS

The results of this study suggest that mid-pregnancy may be an important timepoint for programming of feto-placental growth in relation to maternal activity. Our findings highlight the independent benefits of reducing sitting time during pregnancy, particularly for women carrying male fetuses.

Maternal physical activity and sitting time and its association with placental morphology and blood flow during gestation: Findings from the Queensland Family Cohort study

OBJECTIVES

Antenatal exercise is associated with placental morphological alterations, however research in this area is limited. Given the emphasis on the beneficial effects of antenatal exercise, it is important to understand its effect on placental function and the relationship to foetal development. The aim of this study was to investigate the association between physical activity, sitting time, and placental outcomes measured during gestation.

DESIGN

Prospective cohort study.

METHODS

Pregnant women in the Queensland Family Cohort study self-reported physical activity at 24 and 36 weeks of gestation (n = 203) and were categorised into physical activity volume groups of nil-low (0-<500 metabolic equivalent of task·minutes/week), moderate (500-<1000 metabolic equivalent of task·minutes/week), or high-volume activity (≥1000 metabolic equivalent of task·minutes/week). Participants reported average daily sitting time, whereby excessive sitting time was considered as ≥8h/day. Placental stiffness, thickness, and uteroplacental blood flow resistance were measured by ultrasound imaging at each timepoint.

RESULTS

Physical activity volume was not associated with changes to placental morphometrics or uteroplacental blood flow resistance at 24 or 36 weeks of gestation. Excessive sitting time at 36 weeks was associated with greater placental stiffness (p = 0.046), and a lower umbilical artery pulsatility index (p = 0.001).

CONCLUSIONS

Placental tissue stiffness and umbilical artery resistance were altered in late gestation with higher maternal sitting time but not with physical activity volume. Overall, excessive sitting time may be a risk for suboptimal placental function and could be an important focus for antenatal care.

The Fit After Baby randomized controlled trial: An mHealth postpartum lifestyle intervention for women with elevated cardiometabolic risk

BACKGROUND

Postpartum women with overweight/obesity and a history of adverse pregnancy outcomes are at elevated risk for cardiometabolic disease. Postpartum weight loss and lifestyle changes can decrease these risks, yet traditional face-to-face interventions often fail. We adapted the Diabetes Prevention Program into a theory-based mobile health (mHealth) program called Fit After Baby (FAB) and tested FAB in a randomized controlled trial.

METHODS

The FAB program provided 12 weeks of daily evidence-based content, facilitated tracking of weight, diet, and activity, and included weekly coaching and gamification with points and rewards. We randomized women at 6 weeks postpartum 2:1 to FAB or to the publicly available Text4baby (T4B) app (active control). We measured weight and administered behavioral questionnaires at 6 weeks, and 6 and 12 months postpartum, and collected app user data.

RESULTS

81 eligible women participated (77% White, 2% Asian, 15% Black, with 23% Hispanic), mean baseline BMI 32±5 kg/m2 and age 31±5 years. FAB participants logged into the app a median of 51/84 (IQR 25,71) days, wore activity trackers 66/84 (IQR 43,84) days, logged weight 17 times (IQR 11,24), and did coach check-ins 5.5/12 (IQR 4,9) weeks. The COVID-19 pandemic interrupted data collection for the primary 12-month endpoint, and impacted diet, physical activity, and body weight for many participants. At 12 months postpartum women in the FAB group lost 2.8 kg [95% CI -4.2,-1.4] from baseline compared to a loss of 1.8 kg [95% CI -3.8,+0.3] in the T4B group (p = 0.42 for the difference between groups). In 60 women who reached 12 months postpartum before the onset of the COVID-19 pandemic, women randomized to FAB lost 4.3 kg [95% CI -6.0,-2.6] compared to loss in the control group of 1.3 kg [95% CI -3.7,+1.1] (p = 0.0451 for the difference between groups).

CONCLUSIONS

There were no significant differences between groups for postpartum weight loss for the entire study population. Among those unaffected by the COVID pandemic, women randomized to the FAB program lost significantly more weight than those randomized to the T4B program. The mHealth FAB program demonstrated a substantial level of engagement. Given the scalability and potential public health impact of the FAB program, the efficacy for decreasing cardiometabolic risk by increasing postpartum weight loss should be tested in a larger trial.

Physical activity and mental health: the connection between step count and depression, anxiety and quality of sleep

While there are studies connecting everyday physical activity (PA) to mental health, they mostly use self-report measures for PA which are biased in multiple ways. Nevertheless, a realistic assessment of everyday PA is important for the development and implementation of low-threshold public health interventions. Therefore, we want to analyze the relationship between objectively measured daily steps and mental health. We included 1451 subjects from a subsample of the population-based LIFE-Adult-Study (2011-2014) with an average age of 55.0 years, 52.1% were female. We analyzed the effects of PA (step count measured via SenseWear Pro 3) on depression (CES-D), anxiety (GAD-7), and quality of sleep (PSQI). The regression analysis showed a significant negative association between low to moderate PA [Incidence rate ratio: 0.87 (0.77; 0.98)] as well as high to very high PA [0.84 (0.74; 0.95)] and depression and no significant associations between PA and anxiety [l-m: 0.98 (0.81; 1.18)/h-vh: 1.00 (0.82; 1.21)] or quality of sleep [l-m: 0.94 (0.84, 1.06)/h-vh: 0.92 (0.82, 1.03)], controlling for sociodemographic variables and personality. Low-threshold interventions that increase daily step count could be a useful approach for the prevention of depression. The use of objective PA measurement for research is highly encouraged.

Changes in self-reported and accelerometer-measured physical activity among pregnant TRICARE Beneficiaries

Background

Physical activity is recommended for all pregnant individuals and can prevent excessive gestational weight gain. However, physical activity has not been assessed among military personnel and other TRICARE beneficiaries, who experience unique military lifestyles. The current study assessed physical activity among pregnant TRICARE beneficiaries, both active duty and non-active duty, as measured by accelerometry and self-report data to examine potential predictors of physical activity engagement in the third trimester, and if self-report data was consistent with accelerometry data. We expected having a lower BMI, being active-duty, and having higher baseline physical activity engagement to be associated with higher physical activity at 32-weeks. We also hypothesized that accelerometry data would show lower physical activity levels than the self-reported measure.

Methods

Participants were 430 TRICARE adult beneficiaries (204 Active Duty; 226 non-Active Duty) in San Antonio, TX who were part of a randomized controlled parent study that implemented a stepped-care behavioral intervention. Participants were recruited if they were less than 12-weeks gestation and did not have health conditions precluding dietary or physical activity changes (e.g., uncontrolled cardiovascular conditions) or would contribute to weight changes. Participants completed self-report measures and wore an Actical Activity Monitor accelerometer on their wrist to collect physical activity data at baseline and 32-weeks gestation.

Results

Based on the accelerometer data, 99% of participants were meeting moderate physical activity guidelines recommending 150 min of moderate activity per week at baseline, and 96% were meeting this recommendation at 32-weeks. Based on self-report data, 88% of participants at baseline and 92% at 32-weeks met moderate physical activity recommendations. Linear regression and zero-inflated negative binomial models indicated that baseline physical activity engagement predicted moderate physical activity later in pregnancy above and beyond BMI and military status. Surprisingly, self-reported data, but not accelerometer data, showed that higher baseline activity was associated with decreased vigorous activity at 32-weeks gestation. Additionally, self-report and accelerometry data had small correlations at baseline, but not at 32-weeks.

Conclusions

Future intervention efforts may benefit from intervening with individuals with lower pre-pregnancy activity levels, as those who are active seem to continue this habit.

Trial Registration

The trial is registered on clinicaltrials.gov (NCT 03057808).

Impact of Physical Activity of Pregnant Women on Obstetric Outcomes

Regular and well-planned physical activity (PA) has a positive impact on pregnancy outcomes. In this study, we determine the impact of the PA of pregnant women on the occurrence of certain pregnancy outcomes, such as type of labor, duration of pregnancy, and birthweight. The study is based on the results of a Polish national survey performed between 2011 and 2017 on a group of 9170 women. The Pregnancy Physical Activity Questionnaire (PPAQ) was used to estimate the PA of pregnant women. Light intensity PA accounts for the largest proportion of women's total energy expenditure. Increase in women's total energy expenditure was associated with an increase in the birthweight of a child. A similar relationship was observed in the case of light and moderate PA. Vaginal birth was more common among women with higher total energy expenditure. Mothers of preterm children showed lower energy expenditure for each type of PA compared to term pregnancies. There was also a correlation between moderate and vigorous PA and low birthweight. Our study indicates that PA undertaken by pregnant women has a positive impact on pregnancy outcomes.

Physical Activity during Pregnancy and Newborn Body Composition: A Systematic Review

The current literature demonstrates that not only is exercise during pregnancy safe, but it has substantial maternal and infant benefits and appears to influence infant growth/size throughout pregnancy and at birth. However, many existing studies have investigated only the effects of prenatal exercise on birth weight. The purpose of this review was to determine the impact or association of maternal physical activity during pregnancy on neonatal body composition assessed between birth and two weeks of age. Electronic database searches were conducted on 29 July 2019 for randomized control trials and cohort studies, with an updated search completed on 8 January 2021. A total of 32 articles that met eligibility criteria were selected for review. Overall, prenatal exercise was not associated with infant body composition at birth. Yet, five of the studies identified suggest that infant body composition could be influenced by higher volumes of mid-to-late term prenatal physical activity. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in PROSPERO (Registration No. CRD42020160138).

Exercise and Stress in At-Risk Women during Pregnancy and Postpartum

PURPOSE

We aimed to understand the relationship between exercise and stress among socioeconomically at-risk women who participated in a home visitation service during pregnancy and postpartum.

METHODS

A mixed-methods design was used to support and supplement quantitative data using qualitative data. Convenience sampling was used to collect data from at-risk women via questionnaires and follow-up interviews. The Perceived Stress Scale was used to assess stress. Frequency and duration of exercise were assessed based on the American College of Obstetricians and Gynecologists exercise guidelines. Regression analyses examined the association between stress and exercise controlling for covariates. Content analysis was used to understand women's stress management experiences.

RESULTS

N = 114 women completed the questionnaire and a subgroup of 11 received follow-up interviews. Greater frequency of exercise was significantly associated with lower levels of stress. Approximately one-third of women reported experiencing significant stress. Talking to their husband or partner was the most used and exercise was the least used coping strategy. Many women recognized the importance of managing stress and benefits of exercise, but were hindered by barriers such as feeling tired, preventing them from exercising.

CLINICAL IMPLICATIONS

A personalized and safe exercise program has the potential to be a low-cost stress management strategy for women during pregnancy and postpartum.

Misreporting of Physical Activity and Sedentary Behavior in Parents-to-Be: A Validation Study across Sex

This study validated the International Physical Activity Questionnaire (IPAQ) and the Context-specific Sedentary Behavior Questionnaire (CSBQ) against accelerometry among parents-to-be. Sex-differences in potential misreporting of physical activity (PA) and sedentary behavior (SB) were also investigated. Self-reported total PA (TPA), light-intensity PA (LPA), moderate-intensity PA (MPA), vigorous-intensity PA (VPA), moderate-to-vigorous-intensity PA (MVPA), and SB of 91 parents-to-be (41 men and 50 women) were compared with Actigraph data according to sex. Furthermore, the extent of misreporting was compared between sexes. Strong correlations for TPA and weak-to-moderate correlations for LPA, MPA, VPA, MVPA, and SB were observed. Participants underestimated TPA by 1068 min/week (=17.8 h/week; −50%), LPA by 1593 min/week (=26.6 h/week; −83%), and SB by 428 min/week (=7.1 h/week; −11%) and overestimated MPA by 384 min/week (=6.4 h/week; +176%) and MVPA by 525 min/week (=8.8 h/week; +224%). Males overreported VPA more than females in absolute minutes per week (238 min/week, i.e., 4.0 h/week vs. 62 min/week, i.e., 1.0 h/week), whereas, in relative terms, the opposite (+850% vs. +1033%) was true. The IPAQ and CSBQ can be used with caution to estimate TPA and SB among parents-to-be considering a strong correlation but low agreement for TPA and a weak-to-moderate correlation but acceptable agreement for SB. We disadvise using these self-reports to estimate PA on the distinct intensity levels.

How Many Valid Days Are Necessary to Assess Physical Activity Data From Accelerometry During Pregnancy?

BACKGROUND

The authors examined whether or not ≤3 days wearing Actical® accelerometers provided acceptable results in comparison with the recommendation of ≥4 days in women across gestation.

METHODS

A total of 26, 76, and 57 participants at early, mid, and late pregnancy, respectively, were assessed. Participants were instructed to wear the device for 7 days and women who wore it for ≥4 days were included. For each participant, 3, 2, and 1 day(s) were randomly selected. Paired comparisons, intraclass correlations coefficients, and kappa statistics were performed for ≥4 days (criterion) versus 3, 2, and 1 day(s). Averages (in minutes per day) of sedentary time, light, moderate, vigorous, moderate to vigorous physical activity (PA) and steps per day were examined.

RESULTS

When 3 valid days were compared with the criterion, no significant differences were found for any gestational period. The intraclass correlations coefficients were "high" for all PA-related variables. The k values varied from .819 to .838 across pregnancy ("strong"). Two and 1 valid day(s) versus the criterion showed significant differences in some PA intensities, reduced intraclass correlations coefficients, "moderate" k values for 2 valid days (.638-.788) and "minimal-to-moderate" k values for 1 valid day (.367-.755).

CONCLUSION

In pregnant women during early, mid, and late pregnancy, PA data obtained from 3 valid days of wear was equivalent and agreed with ≥4 valid days.

Maternal and Cord Blood Metabolite Associations with Gestational Weight Gain and Pregnancy Health Outcomes

Pre-pregnancy obesity and excessive gestational weight gain (GWG) are risk factors for future maternal and childhood obesity. Maternal obesity is potentially communicated to the fetus in part by the metabolome, altering the child's metabolic program in early development. Fasting maternal blood samples from 37 singleton pregnancies at 25-28 weeks of gestation were obtained from mothers with pre-pregnancy body mass indexes (BMIs) between 18 and 40 kg/m². Various health measures including GWG, diet, and physical activity were also assessed. At term (37-42 weeks), a venous umbilical cord sample was obtained. Serum metabolomic profiles were measured using nuclear magnetic resonance spectroscopy as well as a gut and metabolic hormone panel. Maternal and cord serum metabolites were tested for associations with pre-pregnancy BMI, GWG, health outcomes, and gut and metabolic hormones. While cord blood metabolites showed no significant correlation to maternal obesity status or other measured health outcomes, maternal serum metabolites showed distinct profiles for lean, overweight, and obese women. Additionally, four serum metabolites, namely, glutamate, lysine, pyruvate, and valine, allowed prediction of excessive GWG when pre-pregnancy BMI was controlled. Metabolic biomarkers predictive of GWG are reported and, if validated, could aid in the guidance of prenatal weight management plans as the majority of pregnancy weight gain occurs in the third trimester.

Physical activity differentially regulates VEGF, PlGF, and their receptors in the human placenta

Physical activity (PA) has beneficial effects on the function of many organs by modulating their vascular development. Regular PA during pregnancy is associated with favorable short‐ and long‐term outcomes for both mother and fetus. During pregnancy, appropriate vascularization of the placenta is crucial for adequate maternal–fetal nutrient and gas exchange. How PA modulates angiogenic factors, VEGF, and its receptors in the human placenta, is as of yet, unknown. We objectively measured the PA of women at 24–28 and 34–38 weeks of gestation. Participants were considered “active” if they had met or exceeded 150 min of moderate‐intensity PA per week during their 2nd trimester. Term placenta tissues were collected from active (n = 23) or inactive (n = 22) women immediately after delivery. We examined the expression of the angiogenic factors VEGF, PlGF, VEGFR‐1, and VEGFR‐2 in the placenta. Western blot analysis showed VEGF and its receptor, VEGFR‐1 was significantly (p < 0.05) higher both at the protein and mRNA levels in placenta from physically active compared to inactive women. No difference in VEGFR‐2 was observed. Furthermore, immunohistochemistry showed differential staining patterns of VEGF and its receptors in placental endothelial, stromal, and trophoblast cells and in the syncytial brush border. In comparison, PlGF expression did not differ either at the protein or mRNA level in the placenta from physically active or inactive women. The expression and localization pattern of VEGF and its receptors suggest that PA during pregnancy may support a pro‐angiogenic milieu to the placental vascular network.

Cross-Validation of Ratings of Perceived Exertion Derived from Heart Rate Target Ranges Recommended for Pregnant Women

Currently, there are no established evidence-based rating of perceived exertion (RPE) targets for physical activity (PA) in pregnant women. Yet, a set of target heart rate (HR) ranges have been recommended. Using the Borg Scale, we aimed to determine and validate the RPE target ranges for different PA intensities derived from the recommended HR ranges in the 2019 Canadian Guideline for PA throughout pregnancy. We assessed 13 pregnant women (age: 31.2 ± 3.5 years; gestational age: 20.5 ± 5.0 weeks) using the following three phases: 1) the incremental submaximal walking test to develop the linear regression equation; 2) establishment of the RPE targets for light- and moderate-intensity PA; 3) moderate-intensity exercise session aiming to cross-validate RPE targets in women whose HR ranges were within (Step 1; six participants; 36 RPE values) or outside (Step 2; seven participants; 42 RPE values) the guideline. Study Phase 1 showed a strong linear relationship between RPE x HR (RPE = -7.370 + 0.155*HR; R2 = 0.863). RPE targets for pregnant women aged ≤ 29 years are 8-12 (light-intensity) and 12-15 (moderate-intensity), respectively. For women aged ≥ 30 years, RPE targets are 8-11 (light-intensity) and 11-14 (moderate-intensity), respectively. The cross-validation suggested no differences between predicted (13.4 ± 0.7) vs. observed RPE (13.3 ± 1.4; p = 0.703) and a strong % agreement (Step 1 = 80.6%; Step 2 = 73.8%) between observed RPE and its predicted range. Thus, we have determined pregnancy-specific, evidence-based RPE targets. These RPE targets will help exercise professionals, other health care providers, and pregnant women to easily monitor exercise intensity during pregnancy to meet recommended Canadian PA Guideline.

Physical Activity During Pregnancy Is Associated with Increased Placental FATP4 Protein Expression

Placental function is of utmost importance to ensure proper fetal development in utero. Among the placenta's many roles includes the passage of sufficient macronutrients, such as glucose, amino acids, and fatty acids, to the fetus. Macronutrients are carried from maternal circulation to the fetus across transporters within the placenta. The objective of this study was to examine the impact of (i) an acute bout of exercise and (ii) chronic exercise participation on placenta nutrient transporter expression and localization. To investigate the effect of acute exercise, pre- and post-exercise serum was collected from pregnant (n = 5) and non-pregnant (n = 5) women who underwent a moderate-intensity exercise session and used to treat BeWo cells. To assess chronic physical activity, we analyzed term placenta from women categorized as active (n = 10) versus non-active (n = 10). Protein expression and localization for the transporters GLUT1, SNAT1, and FATP4 were examined for both groups. GLUT1 expression in BeWo cells treated with serum from pregnant women was higher compared with that from non-pregnant, independent of exercise. FATP4 protein expression was elevated in the term placenta of active women. Immunohistochemistry analysis of term placenta illustrated increased staining of FATP4 in placental tissue from active women and differential staining pattern of GLUT1 depending on physical activity status. Chronic exercise during pregnancy increases the expression of placental FATP4 in vivo, suggesting greater metabolism and usage of fatty acids. Additionally, serum from pregnant women could contain factors that increase GLUT1 protein expression in vitro. BeWo cells treated with pre- and post-exercise serum from pregnant women resulted in greater GLUT1 expression compared with those treated with pre- and post-exercise serum from non-pregnant women. Physical activity appears to differentially impact key placental transporters involved in the transfer and availability of nutrients from mother to fetus. Future research ought to examine the mechanisms involved in regulating these changes and their impact on fetal growth and health.

Determination of minimal recording period to assess resting heart rate variability during pregnancy

Traditionally, resting heart rate variability (rHRV) is measured for 10 min using the last 5 min for analyses (e.g., criterion period). It is unknown whether the measurement period can be shortened in pregnant women as there are currently no established standards. We aimed to compare shorter time segments (e.g., from the 1st to 10th minutes) of the parasympathetic index natural logarithm transformation of root mean square of successive R–R differences (Ln rMSSD) with the criterion period in pregnant and nonpregnant women. Twelve pregnant (age: 30.8 ± 3.4 years; gestational age: 20.1 ± 5.0 weeks) and 15 nonpregnant women (age: 29.8 ± 4.0 years) were included. rHRV was measured using a portable heart rate monitor for 10 min while sitting. Ln rMSSD difference/agreement between shorter time segments and criterion period was analyzed. The result observed between the 4th–5th minutes was the shortest time segment not different from/highly agreed with the criterion period in pregnant women (difference [95% confidence interval (CI)]: −0.10 [−0.22 to 0.02]/bias ± 1.96 × SD: −0.06 [−0.38 to 0.25]). In nonpregnant women, the 2nd–3rd-minute segment was the shortest with similar results (difference [95% CI]: −0.04 [−0.15 to 0.07]/bias ± 1.96 × SD: −0.03 [−0.39 to 0.32]). The Ln rMSSD was found to be stable from the 5th–10th minutes and the 3rd–10th minutes in pregnant and nonpregnant women, respectively. A shortened rHRV assessment can increase its applicability in clinical/exercise-training settings.

Novelty Ln rMSSD can be measured for 5 min in pregnant women, with the last 1-min segment analyzed. The last 1-min segment from 3 min can be used for rHRV measurement in nonpregnant women. The shortened rHRV assessment can facilitate its applicability in clinical/exercise-training settings.

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

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

Energy Intake Requirements in Pregnancy

Energy intake requirements in pregnancy match the demands of resting metabolism, physical activity, and tissue growth. Energy balance in pregnancy is, therefore, defined as energy intake equal to energy expenditure plus energy storage. A detailed understanding of these components and their changes throughout gestation can inform energy intake recommendations for minimizing the risk of poor pregnancy outcomes. Energy expenditure is the sum of resting and physical activity-related expenditure. Resting metabolic rate increases during pregnancy as a result of increased body mass, pregnancy-associated physiological changes, i.e., cardiac output, and the growing fetus. Physical activity is extremely variable between women and may change over the course of pregnancy. The requirement for energy storage depends on maternal pregravid body size. For optimal pregnancy outcomes, women with low body weight require more fat mass accumulation than women with obesity, who do not require to accumulate fat mass at all. Given the high energy density of fat mass, these differences affect energy intake requirements for a healthy pregnancy greatly. In contrast, the energy stored in fetal and placental tissues is comparable between all women and have small impact on energy requirements. Different prediction equations have been developed to quantify energy intake requirements and we provide a brief review of the strengths and weaknesses and discuss their application for healthy management of weight gain in pregnant women.

The Need to Objectively Measure Physical Activity During Pregnancy: Considerations for Clinical Research and Public Health Impact

Engaging in recommended levels of physical activity during pregnancy can provide a host of physical and mental health benefits for the expecting mother and her child. However, methodological issues related to physical activity measurement have plagued many studies examining the effects of physical activity during this important life stage. Burgeoning support exists for the more widespread use of objective methods, and accelerometers specifically, for an accurate appraisal of maternal physical activity. In this commentary, we highlight discrepancies between activity estimates obtained via self-report and objective measures and describe the implications of erroneous measurement when making clinical recommendations and in conducting future physical activity and pregnancy research. Most importantly, we aim to foster academic discussion and propose a call to action requiring a paradigm shift where we acknowledge the shortcomings of self-report and move toward an empirically driven approach for physical activity measurement. Results from more high-quality research studies will help support public health messaging and facilitate trust among health care providers, clinical researchers, and expecting mothers regarding the health benefits of physical activity recommendations.

Physical Activity Questionnaires for Pregnancy: A Systematic Review of Measurement Properties

Background

In order to assess physical activity (PA) during pregnancy, it is important to choose the instrument with the best measurement properties.

Objectives

To systematically summarize, appraise, and compare the measurement properties of all self-administered questionnaires assessing PA in pregnancy.

Methods

We searched PubMed, Embase, and SPORTDiscus with the following inclusion criteria: (i) the study reported at least one measurement property (reliability, criterion validity, construct validity, responsiveness) of a self-administered questionnaire; (ii) the questionnaire intended to measure PA; (iii) the questionnaire was evaluated in healthy pregnant women; and (iv) the study was published in English. We evaluated results, quality of individual studies, and quality of evidence using a standardized checklist (Quality Assessment of Physical Activity Questionnaires [QAPAQ]) and the GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) approach.

Results

Seventeen articles, reporting 18 studies of 11 different PA questionnaires (17 versions), were included. Most questionnaire versions showed insufficient measurement properties. Only the French and Turkish versions of the Pregnancy Physical Activity Questionnaire (PPAQ) showed both sufficient reliability and construct validity. However, all versions of the PPAQ pooled together showed insufficient construct validity. The quality of individual studies was usually high for reliability but varied considerably for construct validity. Overall, the quality of evidence was very low to moderate.

Conclusions

We recommend the PPAQ to assess PA in pregnancy, although the pooled results revealed insufficient construct validity. The lack of appropriate standards in data collection and processing criteria for objective devices in measuring PA during pregnancy attenuates the quality of evidence. Therefore, research on the validity of comparison instruments in pregnancy followed by consensus on validation reference criteria and standards of PA measurement is needed.

Electronic supplementary material

The online version of this article (10.1007/s40279-018-0961-x) contains supplementary material, which is available to authorized users.

Sensor Measures of Symmetry Quantify Upper Limb Movement in the Natural Environment Across the Lifespan

Knowledge of upper limb activity in the natural environment is critical for evaluating the effectiveness of rehabilitation services. Wearable sensors allow efficient collection of these data and have the potential to be less burdensome than self-report measures of activity. Sensors can capture many different variables of activity and daily performance, many of which could be useful in identifying deviation from typical movement behavior or measuring outcomes from rehabilitation interventions. Although it has potential, sensor measurement is just emerging, and there is a lack of consensus regarding which variables of daily performance are valid, sensitive, specific, and useful. We propose that symmetry of full-day upper limb movement is a key variable. We describe here that symmetry is valid, robustly observed within a narrow range across the lifespan in typical development, and shows evidence of being different in populations with neuromotor impairment. Key next steps include the determination of sensitivity, specificity, minimal detectable change, and minimal clinically important change/difference. This information is needed to determine whether an individual belongs to the typical or atypical group, whether change has occurred, and whether that change is beneficial.

Trimester-Specific Dietary Intakes in a Sample of French-Canadian Pregnant Women in Comparison with National Nutritional Guidelines

Diet during pregnancy greatly impacts health outcomes. This study aims to measure changes in dietary intakes throughout trimesters and to assess pregnant women’s dietary intakes in comparison with current Canadian nutritional recommendations. Seventy-nine pregnant women were recruited and completed, within each trimester, three Web-based 24-h dietary recalls and one Web questionnaire on supplement use. Dietary intakes from food, with and without supplements, were compared to nutritional recommendations throughout pregnancy. Energy and macronutrient intakes remained stable throughout pregnancy. A majority of women exceeded their energy and protein requirements in the first trimester, and fat intakes as a percentage of energy intakes were above recommendations for more than half of the women in all trimesters. Supplement use increased dietary intakes of most vitamins and minerals, but 20% of women still had inadequate total vitamin D intakes and most women had excessive folic acid intakes. This study showed that pregnant women did not increase their energy intakes throughout pregnancy as recommended. Furthermore, although prenatal supplementation reduces the risk of inadequate intake for most micronutrients, there is still a risk of excessive folic acid and insufficient vitamin D intake, which needs further investigation.

Antenatal risk factors associated with neonatal morbidity in large-for-gestational-age infants: an international prospective cohort study

INTRODUCTION

Large-for-gestational-age infants are associated with increased risk of neonatal morbidity and mortality. However, most of them will not have adverse outcomes. Our aim was to identify antenatal clinical factors associated with neonatal morbidity in large-for-gestational-age infants.

MATERIAL AND METHODS

Nulliparous women from the Screening for Pregnancy Endpoints (SCOPE) study were included. We compared maternal and fetal factors between large-for-gestational-age infants (birthweight >90th customized centile) with and without neonatal morbidity, defined as admission to a neonatal intensive care unit or severe neonatal morbidity. Factors were selected based on a priori hypotheses of association and included maternal demography, anthropometric measures and self-reported physical activity (15 and 20 weeks), fetal biometry (20 weeks), and clinical information. Multivariable logistic regression was used to identify risk factors. Stratified analyses were performed by maternal obesity and physical activity.

RESULTS

Among term pregnancies, prevalence of large-for-gestational-age infants was 9.3% (491/5255), with 11.8% (58/491) prevalence of neonatal morbidity. Random glucose at 20 weeks (odds ratio 1.52; 95% confidence interval 1.17-1.97, per 1 mmol/L increase) and no regular physical activity at 20 weeks (odds ratio 3.93; 95% confidence interval 1.75-8.83) were associated with increased risk of neonatal morbidity after adjustment for birthweight, gestational age at delivery and gestational diabetes. The increased risk associated with higher glucose levels was not evident in women with regular physical activity or without obesity.

CONCLUSIONS

Regular physical activity in mid-pregnancy is associated with lower risk for neonatal morbidity in large-for-gestational-age infants and seems to offer protection against the increased risk associated with higher maternal glucose levels.

The introduction of simple cardiorespiratory fitness testing in overweight/obese type 2 diabetics: a pilot study

BACKGROUND

Low level of cardiorespiratory fitness has been recognized as an important independent and modifiable risk factor of increased morbidity and mortality. However, in standard outpatient settings, patients are not routinely screened for fitness and advantages of such testing for the management of type 2 diabetes have not been defined.AimTo describe the toleration of a fast, simple and practicable fitness test (2-min step-in-place test) by overweight/obese type 2 diabetics and their performance indicated by 2-min step-in-place test score (STS). To study short-term anthropometric, functional and metabolic changes following the implementation of the test in the selected population.

METHODS

A total of 33 overweight/obese type 2 diabetics underwent, besides routine examination at the outpatient clinic, the fitness test (group A). Patients were asked to increase their regular physical activity with focus on walking without change in diet and chronic medication. Three to four months later, the subjects were tested again. An identical number of age- and sex-matched obese diabetics followed in our outpatient clinic (without fitness testing), was randomly selected from the Hospital Information System (control group B).FindingsAll patients subjected to fitness testing completed the protocol successfully. STS score was found to have a considerable range with differences between males and females at the borderline of statistical significance. The data are compliant with lower aerobic endurance of obese diabetics compared with healthy population. Within study period, the tested group presented with improvements in STS (referring especially to the males) as well as in several laboratory parameters of glucose and lipid homeostasis, glomerular function and subclinical inflammation with no reflection in anthropometry. Group B demonstrated no significant change. In conclusion, 2-min step-in-place test is fast, undemanding and well-tolerated by patients and personnel. Following its validation based on cardiopulmonary exercise testing, the test may prove recommendable for screening or self-monitoring purposes.

Physical activity during pregnancy and infant's birth weight: results from the 3D Birth Cohort

Aim

To evaluate the association between maternal physical activity and infant’s birth weight or risk of inappropriate weight for gestational age (GA), and whether this association differs by infant’s sex, maternal body mass index (BMI) or pregnancy complications in a prospective cohort study.

Methods

1913 pregnant women from the 3D Birth Cohort (Québec, Canada) completed the Pregnancy Physical Activity Questionnaire at each trimester. Energy expenditure (metabolic equivalent of task (MET)*hours/week) for total activity, sports and exercise and vigorous intensity activities was calculated. The associations with birth weight and risk of inappropriate weight for GA were evaluated by regression modelling. Interactions were tested with infant’s sex, maternal prepregnancy BMI, gestational diabetes, hypertensive disorders and prematurity.

Results

Each 1 MET/hours/week increase in sports and exercise in the first trimester was associated with a 2.5 g reduction in infant’s birth weight (95% CI −4.8 to −0.3) but was not associated with the risk of small weight for GA. In contrast, although not significant, a 17% reduction in the risk of large weight for GA was observed with increasing sports and exercise. Furthermore, in women with subsequent pre-eclampsia (but not normotensive or hypertensive women), each 1 MET/hours/week increment spent in any vigorous exercise in the first trimester reduced the infant’s birth weight by 19.8 g (95% CI −35.2 to −4.3).

Conclusions

Pregnant women with higher sports and exercise levels in the first trimester delivered infants with a lower birth weight. The risk of reducing infant’s birth weight with vigorous exercise in women who develop pre-eclampsia later in pregnancy requires evaluation.

Reliability and concurrent validity of the International Physical Activity Questionnaire short form among pregnant women

ABSTRACT

Sanda B, Vistad I, Haakstad LAH, Berntsen S, Sagedal LR, Lohne-Seiler H, Torstveit MK. Reliability and concurrent validity of the International Physical Activity Questionnaire short form among pregnant women.

BACKGROUND

The International Physical Activity Questionnaire short-form (IPAQ-SF) is frequently used to assess physical activity (PA) level in the general adult population including pregnant women. However, the reliability and validity of the questionnaire in pregnancy is unknown. Therefore, the aims of the present study were to investigate test-retest reliability and concurrent validity of IPAQ-SF among pregnant women, and whether PA is reported differently among those who fulfill (active) vs. do not fulfill (inactive) recommendations of ≥150 min of weekly moderate intensity PA in pregnancy.

METHOD

Test-retest reliability was examined by answering IPAQ-SF twice, two weeks apart (n = 88). To assess validity, IPAQ-SF was compared to the physical activity monitor SenseWear Armband® (SWA) (n = 64). The participants wore SWA for 8 consecutive days before answering IPAQ-SF. PA level was reported as time spent in moderate-, vigorous- and moderate-to-vigorous intensity PA (MPA, VPA and MVPA) corresponding to the cut-off points 3-6, >6 and >3 Metabolic Equivalents (METs), respectively.

RESULTS

Test-retest intraclass-correlation of MPA, VPA and MVPA ranged from 0.81-0.84 (95% Confidence Intervals: 0.69,0.90). Comparing time spent performing PA at various intensities; the mean differences and limits of agreement (±1.96 Standard Deviation) from Bland-Altman plots were-84 ± 402 min/week for MPA,-85 ± 452 min/week for MVPA and 26 ± 78 min/week for VPA, illustrating that the total group under-reported MPA by 72% and MVPA by 52%, while VPA was over-reported by 1400%. For the inactive group corresponding numbers were 44 ± 327 min/week for MPA, 52 ± 355 min/week for MVPA and 16 ± 33 min/week for VPA, illustrating that the inactive group over-reported MPA by 13% and MVPA by 49%, while VPA was not detected by SWA, but participants reported 16 min of VPA/week. In contrast, corresponding numbers for the active group were-197 ± 326 min/week for MPA,-205 ± 396 min/week for MVPA and 35 ± 85 min/week for VPA, illustrating that the active group under-reported MPA by 81% and MVPA by 60%, while they over-reported VPA by 975%.

CONCLUSION

IPAQ-SF had good test-retest reliability, but low to fair concurrent validity for MPA, VPA and MVPA compared to an objective criterion measure among pregnant women. Further, women fulfilling PA guidelines in pregnancy under-reported, while inactive women over-reported PA level.

The influence of physical activity during pregnancy on maternal, fetal or infant heart rate variability: a systematic review

Background

Physical activity (PA) during pregnancy has been shown to be associated with several positive effects for mother, fetus, and offspring. Heart rate variability (HRV) is a noninvasive and surrogate marker to determine fetal overall health and the development of fetal autonomic nervous system. In addition, it has been shown to be significantly influenced by maternal behavior. However, the influence of maternal PA on HRV has not yet been systematically reviewed. Therefore, the aim of this systematic review was to assess the influence of regular maternal PA on maternal, fetal or infant HRV.

Methods

A systematic literature search following a priori formulated criteria of studies that examined the influence of regular maternal PA (assessed for a minimum period of 6 weeks) on maternal, fetal or infant HRV was performed in the databases Pubmed and SPORTDiscus. Quality of each study was assessed using the standardized Quality Assessment Tool for Quantitative Studies (QATQS).

Results

Nine articles were included into the present systematic review: two intervention studies, one prospective longitudinal study, and six post-hoc analysis of subsets of the longitudinal study. Of these articles four referred to maternal HRV, five to fetal HRV, and one to infant HRV. The overall global rating for the standardized quality assessment of the articles was moderate to weak. The articles regarding the influence of maternal PA on maternal HRV indicated contrary results. Five of five articles regarding the influence of maternal PA on fetal HRV showed increases of fetal HRV on most parameters depending on maternal PA. The article referring to infant HRV (measured one month postnatal) showed an increased HRV.

Conclusions

Based on the current evidence available, our overall conclusion is that the hypothesis that maternal PA influences maternal HRV cannot be supported, but there is a trend that maternal PA might increase fetal and infant HRV (clinical conclusion). Therefore, we recommend that further, high quality studies addressing the influence of maternal PA on HRV should be performed (methodological conclusion).

Predicting who fails to meet the physical activity guideline in pregnancy: a prospective study of objectively recorded physical activity in a population-based multi-ethnic cohort

BACKGROUND

A low physical activity (PA) level in pregnancy is associated with several adverse health outcomes. Early identification of pregnant women at risk of physical inactivity could inform strategies to promote PA, but no studies so far have presented attempts to develop prognostic models for low PA in pregnancy. Based on moderate-to-vigorous intensity PA (MVPA) objectively recorded in mid/late pregnancy, our objectives were to describe MVPA levels and compliance with the PA guideline (≥150 MVPA minutes/week), and to develop a prognostic model for non-compliance with the PA guideline.

METHODS

From a multi-ethnic population-based cohort, we analysed data from 555 women with MVPA recorded in gestational week (GW) 28 with the monitor SenseWear™ Pro3 Armband. Predictor variables were collected in early pregnancy (GW 15). We organized the predictors within the domains health, culture, socioeconomic position, pregnancy, lifestyle, psychosocial factors, perceived preventive effect of PA and physical neighbourhood. The development of the prognostic model followed several steps, including univariate and multiple logistic regression analyses.

RESULTS

Overall, 25 % complied with the PA guideline, but the proportion was lower in South Asians (14 %) and Middle Easterners (16 %) compared with Westerners (35 %). Among South Asians and Middle Easterners, 35 and 28 %, respectively, did not accumulate any MVPA minutes/week compared with 18 % among Westerners. The predictors retained in the prognostic model for PA guideline non-compliance were ethnic minority background, multiparity, high body fat percentage, and perception of few physically active friends. The prognostic model provided fair discrimination between women who did vs. did not comply with the PA guideline.

CONCLUSION

Overall, the proportion who complied with the PA guideline in GW 28 was low, and women with ethnic minority background, multiparity, high body fat percentage and few physically active friends had increased probability of non-compliance. The prognostic model showed fair performance in discriminating between women who did comply and those who did not comply with the PA guideline.