N° 367-2019 Lignes Directrices Canadiennes Sur L'activité Physique Durant La Grossesse

Strategies used by midwives to support prenatal physical activity: A scoping review

CONTEXT

Despite the well-known benefits of prenatal physical activity for the health of both the mother and her future child, and the existence of international Guidelines for prenatal physical activity, few pregnant women are sufficiently active. Prenatal health care providers, notably midwives, play an important role in promoting prenatal physical activity. Unfortunately, they face several challenges that hinder strategies used to support prenatal physical activity to their clients. The mode of communication used when giving advice and counselling is part of these strategies, as is the content of the information provided. However, little is known about how midwives communicate with their clients when it comes to recommendations about prenatal physical activity, whether it is general or specific recommendations, and about personal factors that may influence their recommendations.

OBJECTIVE

To present a comprehensive analysis of the existing literature on strategies used by midwives to support prenatal physical activity to their clients, focusing on the mode of communication used, the content of the recommendation provided, as well as personal factors that can influence their recommendations.

METHOD

A scoping review was conducted to retrieve original research articles on strategies used by midwives to support prenatal physical activity, published up to May 2023 and available in English and French. The search databases included CINAHL, MEDLINE, Cochrane, Scopus, PubMed, Psychology and behavioural Sciences Collection, and APA PsycINFO. Studies that fulfilled the eligibility criteria were selected for data extraction. The main findings were organized by the mode of communication used (unidirectional and bidirectional) and the type of recommendation provided (general versus specific). Midwives' knowledge, beliefs and attitudes towards prenatal physical activity were also extracted.

RESULTS

A total of 1 307 articles were retrieved and 19 were included. The use of unidirectional mode of communication was identified in 64 %, 64 % and 14 % of the studies when it comes to provide general recommendations, specific recommendations and information on safety, respectively. The use of bidirectional mode of communication was identified in 43 %, 21 % and 7 % of the studies when it comes to provide general recommendations, specific recommendations and information on safety, respectively. Midwives had knowledge gaps about prenatal physical activity, their beliefs were not always aligned with the most recent recommendations, and they sometimes feel vulnerable in the way they support physical activity. However, they expressed the desire to improve the support they are providing.

CONCLUSION

Results of this study highlight that when it comes to support prenatal physical activity, the unidirectional mode of communication is the most often used by midwives. Unfortunately, it is not considered effective as it does not allow discussing and explaining the information provided. Moreover, midwives exhibited some knowledge gaps about prenatal physical activity. Future work will be needed to better understand their challenges and needs in order to improve their initial training and clinical practice.

Association between physical activity education and prescription during prenatal care and maternal and fetal health outcomes: a quasi-experimental study

BACKGROUND

Physical activity (PA) during pregnancy is associated with healthy gestational weight gain (GWG) and a reduced risk of developing gestational diabetes (GD), gestational hypertension (GHT) and fetal macrosomia. However, in Canada, less than 20% of pregnant women meet PA recommendations. This study assessed associations between an intervention including PA education by prenatal nurses and a PA prescription delivered by physicians and fetal and maternal outcomes.

METHODS

This is a quasi-experimental study. Two groups of women who received their prenatal care at the obstetrics clinic of a university hospital were created. In the first group, 394 pregnant women followed at the clinic received standard care. In the second group, 422 women followed at the clinic received standard care supplemented with education on the relevance of PA during pregnancy and a prescription for PA. Data for both study groups were obtained from the medical records of the mothers and their newborns. Logistic regressions were used to compare the odds of developing excessive GWG, GD, GHT, and fetal macrosomia between the two study groups.

RESULTS

The addition of PA education and PA prescription to prenatal care was associated with 29% lower odds of developing excessive GWG (adjusted odds ratios (OR) 0.71, 95% confidence intervals (CI) 0.51-0.99), 73% lower odds of developing GHT (0.27, 0.14-0.53), 44% lower odds of fetal macrosomia (> 4 kg) (0.56, 0.34-0.93), and 40% lower odds of being large for gestational age (0.60, 0.36-0.99). The intervention was not associated with a difference in odds of developing GD (0.48, 0.12-1.94).

CONCLUSIONS

The inclusion of education and prescription of PA as part of routine prenatal care was associated with improvements in maternal and fetal health outcomes, including significantly lower odds of GWG, GHT and macrosomia.

Effects of a motor control exercise program on lumbopelvic pain recurrences and intensity in pregnant women with a history of lumbopelvic pain: a study protocol for a randomized controlled feasibility trial

Background

About 50% of women experience lumbopelvic pain (LBPP) during their pregnancy. LBPP has negative repercussions on sleep, social and sexual life, physical and work capacity, and psychological health and contributes to physical inactivity. The benefits of LBPP prevention or treatment in pregnant women through specific exercises should therefore be further investigated. This study protocol has been designed to establish the feasibility of implementing motor control exercise program with pregnant women presenting with a history of LBPP.

Methods/design

Forty pregnant women with a history of LBPP will be recruited and randomly allocated to a control (20 participants) or intervention (20 participants) group. The control group will receive standard prenatal care, including basic information on what to do when suffering from LBPP. The intervention group will participate in three 40-min exercise sessions per week from < 20 weeks until 34–36 weeks of gestation: one supervised group session via the Zoom platform (once a month, this session will take place at the Université du Québec à Trois-Rivières) and two unsupervised sessions at home. A motor control exercise program will be developed to target strengthening of the lumbo-pelvic-hip core muscles and improve spinal and pelvic stabilization. Participants of this group will also receive standard prenatal care. Women of the control group will receive after 6 weeks postpartum an exercise program designed to reduce LBPP they may have developed during pregnancy and that may persist after delivery. Primary outcomes will be participants’ recruitment, retention and adherence rates, safety, and acceptability of the intervention. Secondary outcomes will include LBPP incidence, frequency, and intensity, as well as self-reported functional disability, physical activity levels, fear avoidance behavior, anxiety, and depression.

Discussion

This study will inform the feasibility of conducting a full-scale randomized controlled study to test the effectiveness of a motor control exercise program on the prevention and treatment of LBPP in women with a history of LBPP. Adequate prevention and treatment of pregnant women with a history of LBPP should help limit the recurrences of LBPP or the aggravation of its intensity during pregnancy.

Trial registration

US National Institutes of Health Clinical Trials registry NCT04253717 April 27, 2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-022-01024-0.

Healthy for My Baby Research Protocol- a Randomized Controlled Trial Assessing a Preconception Intervention to Improve the Lifestyle of Overweight Women and Their Partners

Background: Preconception lifestyle interventions appear promising to reduce pregnancy complications, prevent adult cardiometabolic diseases, and prevent childhood obesity. These interventions have almost exclusively been studied in populations of obese infertile women. The development of preconception lifestyle interventions targeting a broader population of overweight and obese women without a history infertility and their partners is needed.

Methods: This study is a multicenter open label parallel group randomized controlled trial. Sixty-eight non-infertile women with overweight or obesity in the preconception period and their partners will be recruited from the Sherbrooke and Quebec City regions. The couples will be randomized in a 1:1 ratio to receive the Healthy for my Baby intervention or standard care in the preconception period and pregnancy. Women and their partners will be invited to take part in this lifestyle intervention which includes motivational interviews and daily self-monitoring of lifestyle goals through a mobile phone application. The primary endpoint of this study is the diet quality of women during the preconception period, which will be evaluated using the C-HEI 2007 score at baseline, 2, 4- and 6-months following study enrolment. Women's dietary quality will also be evaluated through the measure of urinary biomarkers of habitual dietary intake at baseline and 2 months in preconception, and 24–26 weeks in pregnancy. Additional indicators of women's lifestyle as well as anthropometric measures will be documented in preconception and pregnancy. For the pregnancy period, the main secondary endpoint is the pattern of gestational weight gain. Pregnancy and neonatal complications will also be evaluated. For partners, diet quality, other lifestyle habits, and anthropometric measures will be documented in the preconception and pregnancy periods.

Discussion: This study will evaluate the effectiveness of a low-cost intervention designed to improve diet and other lifestyle characteristics of women in the preconception period who are overweight or obese. If the Healthy for my Baby intervention is efficacious regarding dietary measures, larger trials will be needed to evaluate the impact of this intervention on the rates of pregnancy complications, childhood obesity, and adult cardiometabolic disease.

Clinical Trial Registration:clinicaltrials.gov (NCT04242069).

Prenatal exercise and cardiovascular health (PEACH) study: The remote effect of aerobic exercise training on conduit artery and resistance vessel function

We assessed the impact of a structured lower-limb aerobic exercise training intervention during pregnancy on brachial artery endothelial function, shear rate and patterns, and forearm blood flow and reactive hyperemia. Twenty-seven pregnant women were recruited and randomized into either a control group (n=11; 31.0 ± 0.7 years), or an exercise intervention group (n=16; 32.6 ± 0.9 years; NCT02948439). The exercise group completed 40 minutes of aerobic exercise (50-70% heart rate reserve) 3-4 times per week, between the second and third trimester of pregnancy. Endothelial function was assessed using flow-mediated dilation (FMD, normalized for shear stress) pre- (16-20 weeks) and post-intervention (34-36 weeks). The exercise training group experienced an attenuated increase in mean arterial pressure (MAP) relative to the control group (∆MAP exercise: +2± 2 mmHg vs. control: +7±3 mmHg; p=0.044) from pre- to post-intervention. % FMD change corrected for shear stress was not different between groups (p=0.460); however, the post occlusion mean flow rate (exercise: 437±32 mL/min vs. control: 364±35 mL/min; p=0.001) and post occlusion anterograde flow rate (exercise: 438±32 mL/min vs. control: 364±46 mL/min;p=0.001) were larger for the exercise training group compared to controls, post-intervention. Although endothelial function was not different between groups, we observed an increase in microcirculatory dilatory capacity, as suggested by the augmented reactive hyperemia in the exercise training group. Novelty: • Endothelial function was not altered with exercise training during pregnancy. • Exercise training did contribute to improved cardiovascular outcomes, which may have been associated with augmented reactive hyperaemia, indicative of increased microcirculatory dilatory capacity.

Cardiac Responses to Prenatal Resistance Exercise with and without the Valsalva Maneuver

PURPOSE

Exercise guidelines recommend incorporating resistance exercise (RE) into a regular aerobic training program during pregnancy. However, few women do so because of uncertainties about the safety of prenatal RE, particularly regarding the Valsalva maneuver (VM). The aim of this study was to determine the acute cardiovascular responses to prenatal RE at different intensities, with and without VM.

METHODS

Healthy pregnant (n = 15; 22.9 ± 5.9 wk of gestation) and nonpregnant women (n = 15) were recruited. Maximal strength over 10 repetitions (10RM) for semireclined leg press was determined. Women underwent standardized assessments of cardiac structure, function and mechanics (echocardiography), heart rate (ECG), and blood pressure (photoplethysmography) at baseline, during RE at 20%, 40%, and 60% 10RM while free-breathing, and at 40% 10RM with VM. Significant differences were identified between subjects at baseline (independent t-tests), between and within subjects during free-breathing RE (general linear model, baseline as a covariate), and between and within subjects for 40% 10RM free-breathing versus VM (mixed-effects model).

RESULTS

Resting cardiac output, heart rate, and stroke volume were greater in pregnant women, without differences in blood pressure, ejection fraction, or cardiac mechanics. During free-breathing RE, pregnant women had a greater ejection fraction compared with nonpregnant women; however, all other hemodynamic variables were not different between groups. Cardiac mechanics during free-breathing RE across all intensities were not different between groups, with the exception that pregnant women had a lower apical circumferential strain that did not affect global cardiac function. No differences were observed between groups during 40% 10RM RE with and without VM.

CONCLUSIONS

Pregnant women have proportionate cardiac responses to light-moderate RE, both with and without the VM. These findings reinforce the safety of RE in healthy pregnancy.

Physical Activity Behaviors and Barriers in Multifetal Pregnancy: What to Expect When You're Expecting More

The health benefits of prenatal physical activity (PA) are established for singleton pregnancies. In contrast, individuals with multifetal pregnancies (twins, triplets or more) are recommended to restrict or cease PA. The objectives of the current study were to determine behaviors and barriers to PA in multifetal pregnancies. Between 29 May and 24 July 2020, individuals with multifetal pregnancies participated in an online survey. Of the 415 respondents, there were 366 (88%) twin, 45 (11%) triplet and 4 (1%) quadruplet pregnancies. Twenty-seven percent (n = 104/388) of respondents completed no PA at all during pregnancy, 57% (n = 220/388) completed PA below current recommendations, and 16% (n = 64/388) achieved current recommendations (150-min per week of moderate-intensity activity). Most respondents (n = 314/363 [87%]) perceived barriers to PA during multifetal pregnancy. The most prominent were physical symptoms (n = 204/363 [56%]) and concerns about risks to fetal wellbeing (n = 128/363 [35%]). Sixty percent (n = 92/153) felt that these barriers could be overcome but expressed the need for evidence-based information regarding PA in multifetal pregnancy. Individuals with multifetal pregnancies have low engagement with current PA recommendations but remain physically active in some capacity. There are physical and psychosocial barriers to PA in multifetal pregnancy and future research should focus on how these can be removed.

Knowledge translation and social media: Twitter data analysis of the 2019 Canadian Guideline for Physical Activity throughout Pregnancy

OBJECTIVES

Despite extensive evidence demonstrating the benefits of prenatal physical activity (PA), inefficient knowledge translation may contribute to low rates of PA during pregnancy. This study aimed to examine the impact of the 2019 Canadian Guideline for Physical Activity throughout Pregnancy (hereafter Guideline) on knowledge transmission via Twitter.

METHODS

Tweets containing keywords regarding prenatal PA were mined using the Twitter Application Programming Interface 1 month prior to (PRE), and 2 months following (POST-Month1 and Month2) Guideline release (October 18, 2018). The volume, user and location of Tweets relevant to prenatal PA were analyzed.

RESULTS

In this 3-month period, 19,944 Tweets were collected. After randomization to select 10% of the sample, 1995 Tweets were analyzed. Tweets related to prenatal PA increased following Guideline release (PRE = 318/674 [45%]; POST-Month1 = 377/755 [50%]); however, this was not sustained into POST-Month2 (202/566 [36%]). The main users Tweeting about prenatal PA were categorized as 'General Population' (33%), whereas top users Tweeting about the Guideline were 'Academics' (25%), 'Exercise Specialists' (27%) and 'Medical Professionals' (20%). POST-Guideline, Tweets originated from users in 42 countries (PRE = 28).

CONCLUSIONS

Twitter can be an effective tool for knowledge transmission of PA guidelines to a variety of end-users around the globe.

Why can't I exercise during pregnancy? Time to revisit medical 'absolute' and 'relative' contraindications: systematic review of evidence of harm and a call to action

BACKGROUND

Clinical guidelines recommend pregnant women without contraindication engage in regular physical activity. This is based on extensive evidence demonstrating the safety and benefits of prenatal exercise. However, certain medical conditions or contraindications warrant a reduction, modification or cessation of activity due to potential health risks.

AIM

To review and evaluate the evidence related to medical disorders which may warrant contraindication to prenatal exercise.

METHODS

Online databases were searched up to 5 April 2019. Forty-four unique studies that reported data on our Population (pregnant women with contraindication to exercise), Intervention (subjective/objective measures of acute or chronic exercise), Comparator (not essential) and Outcomes (adverse maternal or fetal outcomes) were included in the review.

KEY FINDINGS

We found that the majority of medical conditions listed as contraindications were based on expert opinion; there is minimal empirical evidence to demonstrate harm of exercise and benefit of activity restriction. We identified 11 complications (eg, gestational hypertension, twin pregnancy) previously classified as contraindications where women may in fact benefit from regular prenatal physical activity with or without modifications. However, the evidence suggests that severe cardiorespiratory disease, placental abruption, vasa previa, uncontrolled type 1 diabetes, intrauterine growth restriction, active preterm labour, severe pre-eclampsia and cervical insufficiency are associated with strong potential for maternal/fetal harm and warrant classification as absolute contraindications.

CONCLUSION

Based on empirical evidence, we provide a call to re-evaluate clinical guidelines related to medical disorders that have previously been considered contraindications to prenatal exercise. Removing barriers to physical activity during pregnancy for women with certain medical conditions may in fact be beneficial for maternal-fetal health outcomes.

Reproductive history, maternal anxiety and past physical activity practice predict physical activity levels throughout pregnancy

We compared physical activity (PA) levels between pregnant women who conceived naturally (NC) or after fertility treatments (FT) and determined factors predicting prenatal moderate-to-vigorous intensity physical activity (MVPA).

The study was conducted in Trois-Rivières (Canada) between October 2015 and July 2018. MVPA and anxiety levels were assessed at each trimester of pregnancy (TR1, TR2 and TR3) using an accelerometer and the State-Trait Anxiety Inventory, respectively. Sociodemographic and reproductive history data were self-reported or collected from medical files. Repeated measures analysis of variance and regression analyses were conducted.

Ninety-six women were included in the analyses (58 NC and 38 FT). MVPA levels and daily step counts decreased significantly throughout pregnancy (time effect: F = 28.68, p < 0.0001 and F = 39.18, p < 0.0001, respectively), but NC and FT women presented similar MVPA and daily step counts (no group effect). The decline in PA practice throughout pregnancy was similar in both groups (no interaction effect). At TR1, State (β = −0.272, p = 0.012) and Trait (β = −0.349, p = 0.001) anxiety and past PA (β = 0.483, p < 0.0001) were correlated with MVPA. Past MVPA was also correlated with MVPA at TR2 (β = 0.595, p < 0.0001) and TR3 (β = 0.654, p < 0.0001). Past PA was the strongest predictors of MVPA levels at TR1, TR2, and TR3, predicting 17% (p = 0.0002), 34% (p < 0.0001) and 42% (p < 0.0001), respectively. Overall, our findings suggest that MVPA practice throughout pregnancy is built on past PA practice. Therefore, to be effective at promoting PA throughout pregnancy, obstetric health care providers and fitness professionals should reinforce the importance of being active as early as possible during pregnancy.