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Martenies SE, Oloo A, Magzamen S, Ji N, Khalili R, Kaur S, Xu Y, Yang T, Bastain TM, Breton CV, Farzan SF, Habre R, Dabelea D. Independent and joint effects of neighborhood-level environmental and socioeconomic exposures on body mass index in early childhood: The environmental influences on child health outcomes (ECHO) cohort. ENVIRONMENTAL RESEARCH 2024; 253:119109. [PMID: 38751004 DOI: 10.1016/j.envres.2024.119109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 04/19/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024]
Abstract
Past studies support the hypothesis that the prenatal period influences childhood growth. However, few studies explore the joint effects of exposures that occur simultaneously during pregnancy. To explore the feasibility of using mixtures methods with neighborhood-level environmental exposures, we assessed the effects of multiple prenatal exposures on body mass index (BMI) from birth to age 24 months. We used data from two cohorts: Healthy Start (n = 977) and Maternal and Developmental Risks from Environmental and Social Stressors (MADRES; n = 303). BMI was measured at delivery and 6, 12, and 24 months and standardized as z-scores. We included variables for air pollutants, built and natural environments, food access, and neighborhood socioeconomic status (SES). We used two complementary statistical approaches: single-exposure linear regression and quantile-based g-computation. Models were fit separately for each cohort and time point and were adjusted for relevant covariates. Single-exposure models identified negative associations between NO2 and distance to parks and positive associations between low neighborhood SES and BMI z-scores for Healthy Start participants; for MADRES participants, we observed negative associations between O3 and distance to parks and BMI z-scores. G-computations models produced comparable results for each cohort: higher exposures were generally associated with lower BMI, although results were not significant. Results from the g-computation models, which do not require a priori knowledge of the direction of associations, indicated that the direction of associations between mixture components and BMI varied by cohort and time point. Our study highlights challenges in assessing mixtures effects at the neighborhood level and in harmonizing exposure data across cohorts. For example, geospatial data of neighborhood-level exposures may not fully capture the qualities that might influence health behavior. Studies aiming to harmonize geospatial data from different geographical regions should consider contextual factors when operationalizing exposure variables.
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Affiliation(s)
- Sheena E Martenies
- Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, IL, USA; Division of Nutritional Sciences, University of Illinois Urbana-Champaign, Urbana, IL, USA; Family Resiliency Center, University of Illinois Urbana-Champaign, Urbana, IL, USA.
| | - Alice Oloo
- Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Sheryl Magzamen
- Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA; Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Nan Ji
- Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Roxana Khalili
- Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Simrandeep Kaur
- Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Yan Xu
- Spatial Sciences Institute, University of Southern California, Los Angeles, CA, USA
| | - Tingyu Yang
- Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Theresa M Bastain
- Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Carrie V Breton
- Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Shohreh F Farzan
- Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rima Habre
- Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Spatial Sciences Institute, University of Southern California, Los Angeles, CA, USA
| | - Dana Dabelea
- Epidemiology, Colorado School of Public Health, Aurora, CO, USA; Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Rodrigues-Denize N, Zolnikov BTR, Furio F. A systematic review on the physical, mental, and occupational effects of exercise on pregnant women. DIALOGUES IN HEALTH 2024; 4:100181. [PMID: 38813580 PMCID: PMC11133494 DOI: 10.1016/j.dialog.2024.100181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/18/2024] [Accepted: 05/08/2024] [Indexed: 05/31/2024]
Abstract
Complications in pregnancy have been proven to be less frequent with exercise. The American College of Obstetrics and Gynecology suggests pregnant women should exercise an average of 20 to 30 min a day; however, only 13% of pregnant women exercise throughout their pregnancy. This amount could be improved if women are aware that exercise: 1. Can help avoid pregnancy complications or death and 2. Comes in various forms with different health outcomes associated with it. For this reason, this systematic literature review was conducted to review different types of exercise for pregnant women. Peer-reviewed articles were selected to discuss the benefits of the most researched exercises for pregnant women, which included yoga, resistance training, aquatic exercises, dance, and aerobic exercise such as running, walking, and cycling. Data from the review revealed that different types of exercises led to various benefits at different stages of pregnancy. Aquatic activities and yoga helped pregnant women toward the end of their pregnancies, whereas resistance training, dance, and aerobic exercises provided the most benefits during the first trimester. Other studies found that any form of exercise for 30 min a day or every other day for 60 min provided extensive beneficial results. Ultimately, this information could be used to create individualized exercise plans for pregnant women to adhere to throughout their pregnancy.
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Affiliation(s)
| | - By Tara Rava Zolnikov
- National University, Department of Community Health, San Diego, CA, USA
- California Southern University, School of Behavioral Sciences, Costa Mesa, CA, USA
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Garland M, Wilbur J, Schoeny M, Reed M, Semanik P, Halloway S, Waters T. Determinants of Physical Activity Among Black Women During Pregnancy. J Obstet Gynecol Neonatal Nurs 2024; 53:172-184. [PMID: 38072009 DOI: 10.1016/j.jogn.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVE To describe associations among background determinants of physical activity, modifiable theoretical determinants of physical activity, and measures of physical activity during the second and third trimesters of pregnancy among Black women. DESIGN Longitudinal cohort. SETTING Medical center obstetric clinic. PARTICIPANTS Pregnant Black women (n = 40 in second trimester, n = 38 in third trimester) METHODS: We measured background determinants (demographic and pregnancy characteristics, discrimination, and neighborhood walkability) during the second trimester. We measured modifiable theoretical determinants (self-efficacy and social support) and physical activity using self-report and device measures during the second and third trimesters. We used paired t tests to determine differences in the modifiable theoretical determinants from the second trimester to third trimester and used Pearson correlations among background and modifiable determinants and physical activity measures during the second trimester. RESULTS Participants' physical activity levels were low during the second and third trimesters (32% and 22% met recommendation, respectively). We found no changes in self-efficacy or social support between trimesters and found no associations between these modifiable determinants and actual physical activity. We found a positive correlation between previous pregnancies and physical activity measured by devices, r(36) = .33, p = .048. Pregnancy-specific stress, r(38) = -.40, p = .013, was negatively correlated, and age, r(38) = .38, p = .017, was positively correlated with self-reported physical activity. CONCLUSIONS Low levels of physical activity during pregnancy coupled with the absence of an association with modifiable factors affecting pregnancy physical activity indicate a need to further examine the social, cultural, and environmental determinants of physical activity.
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Yang X, Han R, Xiang Z, Li H, Zhao Q, Chen L, Gao L. Clinical practice guidelines on physical activity and exercise for pregnant women with gestational diabetes mellitus: A systematic review. Int J Nurs Pract 2023; 29:e13141. [PMID: 36929054 DOI: 10.1111/ijn.13141] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 01/11/2023] [Accepted: 01/27/2023] [Indexed: 03/18/2023]
Abstract
AIM This review aimed to appraise clinical guidelines about exercise for women with gestational diabetes mellitus and summarize consensus and inconsistent recommendations. BACKGROUND Exercise is an effective non-pharmacological therapeutic for gestational diabetes mellitus, but the variety of relevant clinical practice guidelines is confusing for healthcare professionals. DESIGN This is a systematic review of clinical practice guidelines. DATA SOURCES Websites of guideline development institutions, eight literature databases and organizations of obstetricians, gynaecologists, midwives, and medical sports associations were searched for guidelines published from January 2011 to October 2021. REVIEW METHODS Two reviewers independently extracted recommendations. Four reviewers assessed guideline quality using the AGREE II instrument independently. RESULTS Fifteen guidelines were included. All women with diabetes are recommended to exercise during pregnancy. The consistent recommendations were for pre-exercise screening, for 30 min per exercise session on 5 days of the week or every day after meals, exercise at moderate intensity, using aerobic and resistance exercise, and walking. The main non-consistent recommendations included warning signs for women on insulin during exercise, minimum duration per session, intensity assessment, duration and frequency of sessions for strengthening and flexibility exercise and detailed physical activity giving birth. CONCLUSIONS Guidelines strongly support pregnant women with diabetes to exercise regularly. Research is needed to make non-consistent recommendations clear.
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Affiliation(s)
- Xiao Yang
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Rongrong Han
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Zhixuan Xiang
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Hanbing Li
- School of Nursing, University of South China, Hengyang, China
| | - Qian Zhao
- Office of the Dean (Party Committee), Gem Flower Xi'an Changqing Staff Hospital, Xi'an, China
| | - Lu Chen
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Lingling Gao
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
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Er YT, Chan YM, Mohd Shariff Z, Abdul Hamid H, Mat Daud Z'A, Yong HY. Dietitian-led cluster randomised controlled trial on the effectiveness of mHealth education on health outcomes among pregnant women: a protocol paper. BMJ Open 2023; 13:e075937. [PMID: 37989361 PMCID: PMC10660825 DOI: 10.1136/bmjopen-2023-075937] [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] [Received: 05/23/2023] [Accepted: 10/13/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION Nutrition education is the cornerstone to maintain optimal pregnancy outcomes including gestational weight gain (GWG). Nevertheless, default for appointments is common and often lead to suboptimal achievement of GWG, accompanied with unfavourable maternal and child health outcomes. While mobile health (mHealth) usage is increasing and helps minimising barriers to clinic appointments among pregnant mothers, its effectiveness on health outcomes has been inconclusive. Therefore, this study aimed to address the gap between current knowledge and clinical care, by exploring the effectiveness of mHealth on GWG as the primary outcome, hoping to serve as a fundamental work to achieve optimal health outcomes with the improvement of secondary outcomes such as physical activity, psychosocial well-being, dietary intake, quality of life and sleep quality among pregnant mothers. METHODS AND ANALYSIS A total of 294 eligible participants will be recruited and allocated into 3 groups comprising of mHealth intervention alone, mHealth intervention integrated with personal medical nutrition therapy and a control group. Pretested structured questionnaires are used to obtain the respondents' personal information, anthropometry data, prenatal knowledge, physical activity, psychosocial well-being, dietary intake, quality of life, sleep quality and GWG. There will be at least three time points of data collection, with all participants recruited during their first or second trimester will be followed up prospectively (after 3 months or/and after 6 months) until delivery. Generalised linear mixed models will be used to compare the mean changes of outcome measures over the entire study period between the three groups. ETHICS AND DISSEMINATION Ethical approvals were obtained from the ethics committee of human subjects research of Universiti Putra Malaysia (JKEUPM-2022-072) and medical research & ethics committee, Ministry of Health Malaysia: NMRR ID-22-00622-EPU(IIR). The results will be disseminated through journals and conferences targeting stakeholders involved in nutrition research. TRIAL REGISTRATION NUMBER Clinicaltrial.gov ID: NCT05377151.
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Affiliation(s)
- Ying Ting Er
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Yoke Mun Chan
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
- Research Centre of Excellence Nutrition and Non-communicable Diseases, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Zalilah Mohd Shariff
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Habibah Abdul Hamid
- Department of Obstetrics & Gynaecology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Zulfitri 'Azuan Mat Daud
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
- Research Centre of Excellence Nutrition and Non-communicable Diseases, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Heng Yaw Yong
- Division of Nutrition and Dietetics, School of Health Sciences, International Medical University, Bukit Jalil, 57000 Kuala Lumpur, Wilayah Persekutuan, Malaysia
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Conway KS, Menclova AK. You'll never walk alone - The effects of walkability on pregnancy behaviors and outcomes. ECONOMICS AND HUMAN BIOLOGY 2023; 50:101269. [PMID: 37418829 DOI: 10.1016/j.ehb.2023.101269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 02/14/2023] [Accepted: 06/21/2023] [Indexed: 07/09/2023]
Abstract
This study investigates the relationship between local walkability and physical activity and subsequent health outcomes among pregnant women - for whom walking is the recommended, and by far most common, form of exercise. Using an EPA measure of walkability at the county level (as well as other county-level characteristics) combined with rich individual-level data on pregnant women yields evidence that higher walkability translates into improvements in maternal and infant health outcomes as well as physical activity. Using the 2011 Natality Detail Files with geographic identifiers and controlling for the overall health of women in the community as well as the individual mother's pre-pregnancy BMI, we show that women residing in more walkable counties are less likely to experience preterm birth, low birth weight, gestational diabetes and hypertension. While one potential mechanism is through improved gestational weight gain, the evidence points to more general improvements in health as walkability does not seem to prevent excessive weight gain or macrosomic babies. Evidence that these general improvements derive at least in part from greater physical activity comes from analyses using the 2011 Behavioral Risk Factor Surveillance System, in which higher walkability translates into more physical activity among pregnant women (and also relative to their non-pregnant counterparts). Our study suggests more broadly that pregnant women's physical activity responds to factors that facilitate it and that such activity makes a difference to birth outcomes.
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Affiliation(s)
- Karen S Conway
- Department of Economics, University of New Hampshire, 10 Garrison Avenue, Durham, NH 03824, USA
| | - Andrea K Menclova
- Department of Economics and Finance, University of Canterbury, Private Bag 4800, Christchurch, New Zealand.
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Boisseau N. Physical Activity During the Perinatal Period: Guidelines for Interventions During the Perinatal Period from the French National College of Midwives. J Midwifery Womens Health 2022; 67 Suppl 1:S158-S171. [PMID: 36480664 DOI: 10.1111/jmwh.13425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 12/12/1912] [Accepted: 05/10/2022] [Indexed: 12/13/2022]
Abstract
The aim of this review is to provide an update on the beneficial effects of regular physical activity and/or less sedentary behavior before, during, and after pregnancy, based on data from the scientific literature and the recommendations of expert committees. In the preconception period, it is recommended that women perform 30 minutes to 1 hour of moderate-to-high intensity physical activity per day, at least 5 days a week, and avoid the absence of any physical activity for 2 consecutive days. Pregnant women should: i) start or continue to perform moderate-intensity physical activity (up to 150 min/wk with at least 3 sessions longer than 30 min), ii) start or continue to do muscle strengthening activity involving the large muscle groups (once or twice a week). In the absence of medical contraindications, it is recommended that they continue physical activity (at least 30 min/d) during the postpartum period. Sedentary time must be limited, if possible, to less than 7 hours a day, regardless of the period.
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Affiliation(s)
- Nathalie Boisseau
- Laboratoire des Adaptations Métaboliques à l'Exercice en conditions Physiologiques et Pathologiques (AME2P), 3 rue de la Chebarde, Aubière Cedex, 63171, France
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Sadiya A, Jakapure V, Shaar G, Adnan R, Tesfa Y. Lifestyle intervention in early pregnancy can prevent gestational diabetes in high-risk pregnant women in the UAE: a randomized controlled trial. BMC Pregnancy Childbirth 2022; 22:668. [PMID: 36042401 PMCID: PMC9425994 DOI: 10.1186/s12884-022-04972-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose A prevalence of gestational diabetes mellitus (GDM) is approximately three times higher than the global rate in the UAE. However, it has not yet been studied whether a 12-week moderate-intensity lifestyle intervention can prevent gestational diabetes among pregnant women at high risk in this region. Patients and methods A pragmatic, open-label, randomized clinical trial was conducted. Sixty-three women aged 18 to 45 years, with ≤12 weeks of gestation, singleton pregnancy, and having ≥ two risk factors for GDM were randomly assigned to the Lifestyle Intervention (LI) group (n = 30) or Usual Care (UC) group (n = 33). The women in the LI group received a 12-week, moderate-intensity lifestyle intervention with individualized counseling on a diet, physical activity, and behavior change by a licensed dietitian. The women in the UC group received usual antenatal care. The primary outcome was the incidence of GDM based on the IADPSG criteria at 24-28 weeks of gestation. Results The incidence of GDM was 33.3% in LI group and 57.5% in UC group. The crude relative risk (RR) for GDM was 0.59 (95% CI, 0.32-1.04, p = 0.05). The multivariable logistic regression model without adjustment showed OR = 0.37 (95% CI, 0.13-1.02, p = 0.05) and after adjusting with Age, BMI and family history of diabetes reported OR = 0.26, 95%CI 0.07, 0.92, p = 0.04. in LI vs UC. The daily dietary intake of calories (− 120 kcal, p = < 0.01), carbohydrates (− 19 g, p < 0.01), and fat (− 5 g, p = 0.03) was reduced, and physical activity time (+ 52 min, p = 0.05) increased in the LI group after the intervention. However, the LI had no significant effect on maternal and neonatal outcomes. Conclusion A 12-week moderate intensity lifestyle intervention in early pregnancy could reduce the relative risk of GDM by 41% among high-risk pregnant women in the UAE. These findings could impact public health outcomes in the region. Trial registration Trial registration Retrospectively registered NCT04273412,18/02/2020.
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Affiliation(s)
- Amena Sadiya
- Rashid Centre for Diabetes and Research, Sheikh Khalifa Medical City, Ajman, PO Box-5166, UAE.
| | - Vidya Jakapure
- Education, Training and Research Department, Sheikh Khalifa Medical City, Ajman, UAE
| | - Ghida Shaar
- Rashid Centre for Diabetes and Research, Sheikh Khalifa Medical City, Ajman, PO Box-5166, UAE
| | - Rama Adnan
- Rashid Centre for Diabetes and Research, Sheikh Khalifa Medical City, Ajman, PO Box-5166, UAE
| | - Yohannes Tesfa
- Rashid Centre for Diabetes and Research, Sheikh Khalifa Medical City, Ajman, PO Box-5166, UAE
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The Influence of a Shoe's Heel-Toe Drop on Gait Parameters during the Third Trimester of Pregnancy. Bioengineering (Basel) 2022; 9:bioengineering9060241. [PMID: 35735484 PMCID: PMC9220068 DOI: 10.3390/bioengineering9060241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 05/28/2022] [Accepted: 05/29/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Changes in physical shape and body mass during pregnancy may increase the risk of walking falls. Shoes can protect and enhance the inherent function of the foot, helping to maintain dynamic and static stability. Methods: Sixteen women during the third trimester of pregnancy participated in this study to investigate the effect of negative heel shoes (NHS), positive heel shoes (PHS), and normal shoes (NS) on spatiotemporal parameters, ground reaction force (GRF), and stability. Differences in spatiotemporal parameter, GRF, and center of pressure (COP) between footwear conditions were examined using Statistical Parametric Mapping (SPM) and repeated measures analyses of variance (ANOVA). Results: The walking speed and step length increased with the increase in heel-toe drop. The anterior-posterior (AP)-COP in NHS decreased significantly (p < 0.001). When wearing NHS, peak posterior angles were significantly lower than NS and PHS (p < 0.05). Conclusions: The results show that changing the heel-toe drop can significantly affect the gait pattern of pregnant women. Understanding the gait patterns of pregnant women wearing shoes with different heel-toe drops is very important for reducing the risk of injury and equipment design.
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Okafor UB, Goon DT. Uncovering Barriers to Prenatal Physical Activity and Exercise Among South African Pregnant Women: A Cross-Sectional, Mixed-Method Analysis. Front Public Health 2022; 10:697386. [PMID: 35433615 PMCID: PMC9010665 DOI: 10.3389/fpubh.2022.697386] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe barriers to prenatal physical activity and exercise have been widely reported in the literature, highlighting context-specific challenges. However, generally, research on prenatal physical activity and exercise among pregnant women in South Africa is rare; and particularly concerning the barriers to their prenatal physical activity practice. This study assessed the barriers to physical activity participation among pregnant women in the Eastern Cape, South Africa.MethodsThis was a sequential explanatory mixed method, predominantly quantitative study involving 1,082 pregnant women. A structured self-administered questionnaire on perceived barriers to physical participation was applied to collect quantitative data; while a subset of 15 pregnant women participated in individual in-depth semi-structured interviews to augment quantitative data. Quantitative and qualitative data were analyzed using descriptive statistics and thematic analysis, respectively.ResultsThe results of the quantitative analysis presented major barriers: lack of advice on prenatal physical activity and inadequate or conflicting information about prenatal physical activity; tiredness; work commitments; discomfort; lack of time; low energy; non-accessibility to physical activity; lack of financial resources, and safety concerns for the mother and the baby. Qualitatively, the barriers identified relate to four main themes: individual, lack of information, lack of resources, and environmental barriers.ConclusionThe major barriers cited by the women were tiredness, lack of time, discomfort, and low energy. They also include lack of support, advice and information about prenatal physical activity. The multiple constraining factors responsible for low or non-prenatal physical activity of pregnant women in this setting highlight the need to tailor interventions to address their individual uniquely perceived barriers.
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Affiliation(s)
- Uchenna Benedine Okafor
- Department of Nursing Science, University of Fort Hare, Alice, South Africa
- *Correspondence: Uchenna Benedine Okafor
| | - Daniel Ter Goon
- Department of Public Health, University of Fort Hare, Alice, South Africa
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Adeoye IA. Pattern and correlates of physical activity and sedentary behaviours of pregnant women in Ibadan, Nigeria: Findings from Ibadan pregnancy cohort study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001153. [PMID: 36962637 PMCID: PMC10021993 DOI: 10.1371/journal.pgph.0001153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 09/14/2022] [Indexed: 11/07/2022]
Abstract
Globally, physical inactivity is the fourth leading risk factor for premature death. Pregnancy is associated with reduced physical activity because of physiological and anatomical changes and socio-cultural barriers. Even though physical activity provides many benefits, such as improved insulin sensitivity and reduced cardiometabolic risk, it is not emphasized among pregnant women in Nigeria. This study described the pattern of physical activity and sedentary behaviours of pregnant women from the Ibadan Pregnancy Cohort Study in Ibadan, Nigeria. The Ibadan Pregnancy Cohort Study (IbPCS) is a prospective cohort study investigating the associations between maternal obesity, lifestyle factors on glycaemia control, gestational weight gain, pregnancy and postpartum outcomes among pregnant women in Ibadan. The Pregnancy Physical Activity Questionnaire (PPAQ) was used to assess physical activity and sedentary behaviour. Sedentary time was estimated from the time spent watching television, sitting at work and the computer. Bivariate and multivariate logistic regression analyses were done to investigate associations at a 5% level of statistical significance. None of the pregnant women met the WHO recommendation of 150mins of moderate-intensity activity per week. The average time spent engaged in moderate-intensity activity was 26.3 ± 22.9 mins. The mean daily sedentary time was 6.5 ± 4.2 hours. High parity para ≥ 4: [AOR 0.57 95% CI: (0.36-0.89) p = 0.014] and being employed [AOR 0.23 95% CI: (0.15-0.33) p <0.001] reduced the odds of having inadequate physical activity. Correlates of sedentary behavior after adjusting for confounders were high parity: para 1-3 AOR 0.73, 95% CI: (0.58-0.91) p = 0.004], tertiary education: AOR 2.39 95% CI: (1.16-4.91) p = 0.018] and earning a higher income: AOR 1.40: 95% CI: (1.11-1.78) p = 0.005]. Pregnant women's physical activity and sedentary behaviours are emerging public health issues, especially in Nigeria. The level of physical activity was inadequate among pregnant women, while the sedentary time was high. There is a need to implement programmes that promote physical activity and discourage sedentary behaviour among pregnant women in Nigeria.
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Affiliation(s)
- Ikeola A Adeoye
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Consortium for Advanced Research in Africa (CARTA), Nairobi, Kenya
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Ruart S, Sinnapah S, Hue O, Janky E, Antoine-Jonville S. Association Between Maternal Body Mass and Physical Activity Counseling During Pregnancy. Front Psychol 2021; 12:612420. [PMID: 34899448 PMCID: PMC8656300 DOI: 10.3389/fpsyg.2021.612420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/19/2021] [Indexed: 11/13/2022] Open
Abstract
Aims: The antenatal period provides an important opportunity for giving advice on healthy lifestyle choices. However, the prevalence of maternal obesity is increasing, and women report that they do not receive counseling. We investigated the information given to pregnant women on gestational weight gain, physical activity, and nutrition during pregnancy in relation with their initial weight status, current gestational weight gain and diagnoses of either pre-pregnancy overweight/obesity or excessive gestational weight gain. Methods: Cross-sectional survey using a questionnaire. Pregnant participants (n = 141) were recruited from a midwife center. They completed a structured questionnaire on the information they received during their pregnancy and we assessed its relationship with their weight. Results: We found that many pregnant women did not receive advice about physical activity, gestational weight gain and nutrition (37.5, 53.2, and 66.2%, respectively). Women with weight problems (pre-pregnancy overweight/obesity and excessive gestational weight gain) were less targeted for counseling, although more than 80% of the women viewed receiving information on these topics as positive. Also, being informed of a weight problem was associated with a greater chance of receiving information about physical activity, gestational weight gain and nutrition (all p < 0.05). However, verbalization of the weight problems was low (14.0% of women with pre-pregnancy overweight were informed of their status). Conclusion: Health professionals should dispense more information, especially on PA and particularly for women with weight problems. Verbalization of the weight problem seems associated with more frequent transmission of information.
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Affiliation(s)
- Shelly Ruart
- Laboratoire Adaptations au Climat Tropical Exercices et Santé (ACTES) (EA 3596), Université des Antilles, Pointe-à-Pitre, France
| | - Stéphane Sinnapah
- Laboratoire Adaptations au Climat Tropical Exercices et Santé (ACTES) (EA 3596), Université des Antilles, Pointe-à-Pitre, France
| | - Olivier Hue
- Laboratoire Adaptations au Climat Tropical Exercices et Santé (ACTES) (EA 3596), Université des Antilles, Pointe-à-Pitre, France
| | - Eustase Janky
- Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire de la Guadeloupe, Pointe-à-Pitre, France
| | - Sophie Antoine-Jonville
- Laboratoire Adaptations au Climat Tropical Exercices et Santé (ACTES) (EA 3596), Université des Antilles, Pointe-à-Pitre, France
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Shojaei B, Loripoor M, Sheikhfathollahi M, Aminzadeh F. The effect of walking during late pregnancy on the outcomes of labor and delivery: A randomized clinical trial. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:277. [PMID: 34485574 PMCID: PMC8395880 DOI: 10.4103/jehp.jehp_1437_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/16/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND Exercising during pregnancy has various benefits for the mother and the fetus, but there are controversial results about its effect on labor and delivery. Therefore, the present study was conducted to evaluate the effect of walking during late pregnancy on the outcomes of labor and delivery. MATERIALS AND METHODS The present randomized clinical trial was conducted on 102 pregnant women who were referred to the comprehensive health service centers of Rafsanjan and were selected using convenient sampling method and randomly were allocated into two groups from August 2018 to February 2019. The intervention group performed walking from the 34th week of pregnancy until the time of delivery 4 times per week, each time for 40 min. The control group just received the routine prenatal care. Information about the outcomes of delivery were gathered from the participants' medical files in the hospital and were analyzed using SPSS software version 22 and Chi-square and independent t-tests. RESULTS The results indicated that the Bishop score of the intervention group was significantly higher than the control group (P < 0.05). Furthermore, regarding the duration of the third phase of delivery, spontaneous labor, induced labor, cesarean section , and instrumental delivery, a statistically significant difference was observed between the intervention and the control groups (P < 0.05). There was no statistically significant difference between both the groups regarding the duration of the first and the second stages of delivery and Apgar score at 1st and 5th min (P > 0.05). CONCLUSIONS Walking during late pregnancy could improve Bishop score, increase spontaneous onset of labor, and decrease induction, cesarean, and instrumental delivery without having any adverse effect on the neonate's Apgar score.
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Affiliation(s)
- Behnaz Shojaei
- Department of Midwifery, Student Research Committee, School of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Marzeyeh Loripoor
- Department of Midwifery, Geriatric Care Research Center, School of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Mahmoud Sheikhfathollahi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Fariba Aminzadeh
- Department of Obstetrics and Gynecology, Nik Nafs Educational and Medical Center, Faculty of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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Mohammad S, Hutchinson KA, da Silva DF, Bhattacharjee J, McInnis K, Burger D, Adamo KB. Circulating small extracellular vesicles increase after an acute bout of moderate-intensity exercise in pregnant compared to non-pregnant women. Sci Rep 2021; 11:12615. [PMID: 34135428 PMCID: PMC8209031 DOI: 10.1038/s41598-021-92180-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 06/07/2021] [Indexed: 12/12/2022] Open
Abstract
The physiological and molecular mechanisms linking prenatal physical activity and improvements in maternal–fetal health are unknown. It is hypothesized that small extracellular vesicles (EVs, ~ 10–120 nm) are involved in tissue cross-talk during exercise. We aimed to characterize the circulating small EV profile of pregnant versus non-pregnant women after an acute bout of moderate-intensity exercise. Pregnant (N = 10) and non-pregnant control (N = 9) women performed a single session of moderate-intensity treadmill walking for 30 min. Plasma was collected immediately pre- and post-exercise, and small EVs were isolated by differential ultracentrifugation. EV presence was confirmed by western blotting for the small EV proteins TSG-101 and flottilin-1. Small EVs were quantified by size and concentration using nanoparticle tracking analysis and transmission electron microscopy. All EV fractions were positive for TSG-101 and flotillin-1, and negative for calnexin. Mean vesicle size at baseline and percent change in size post-exercise were not different between groups. At baseline, pregnant women had higher levels of small EVs compared to controls (1.83E+10 ± 1.25E+10 particles/mL vs. 8.11E+09 ± 4.04E+09 particles/mL, respectively; p = 0.032). Post-exercise, small EVs increased significantly in the circulation of pregnant compared to non-pregnant women after correcting for baseline values (64.7 ± 24.6% vs. − 23.3 ± 26.1%, respectively; F = 5.305, p = 0.035). Further research is needed to assess the functional roles of exercise-induced small EVs in pregnancy.
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Affiliation(s)
- Shuhiba Mohammad
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - Kelly Ann Hutchinson
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | | | - Jayonta Bhattacharjee
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - Kurt McInnis
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - Dylan Burger
- Kidney Research Centre, Department of Cellular and Molecular Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Kristi B Adamo
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada. .,, 200 Lees Avenue, Building E, Room E250F, Ottawa, ON, K1N 6N5, Canada.
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15
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Ehrlich SF, Maples JM, Barroso CS, Brown KC, Bassett DR, Zite NB, Fortner KB. Using a consumer-based wearable activity tracker for physical activity goal setting and measuring steps in pregnant women with gestational diabetes mellitus: exploring acceptance and validity. BMC Pregnancy Childbirth 2021; 21:420. [PMID: 34103002 PMCID: PMC8188700 DOI: 10.1186/s12884-021-03900-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/19/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Activity monitoring devices may be used to facilitate goal-setting, self-monitoring, and feedback towards a step-based physical activity (PA) goal. This study examined the performance of the wrist-worn Fitbit Charge 3™ (FC3) and sought opinions on walking and stepping-in-place from women with gestational diabetes (GDM). METHODS Participants completed six 2-min metronome-assisted over ground bouts that varied by cadence (67, 84, or 100 steps per minute) and mode (walking or stepping-in-place; N = 15), with the sequence randomized. Steps were estimated by FC3 and measured, in duplicate, by direct observation (hand-tally device, criterion). Equivalence testing by the two one-sided tests (TOST) method assessed agreement within ± 15%. Mean absolute percent error (MAPE) of steps were compared to 10%, the accuracy standard of the Consumer Technology Association (CTA)™. A subset (n = 10) completed a timed, 200-m self-paced walk to assess natural walking pace and cadence. All participants completed semi-structured interviews, which were transcribed and analyzed using descriptive and interpretive coding. RESULTS Mean age was 27.0 years (SD 4.2), prepregnancy BMI 29.4 kg/m2 (8.3), and gestational age 32.8 weeks (SD 2.6). The FC3 was equivalent to hand-tally for bouts of metronome-assisted walking and stepping-in-place at 84 and 100 steps per minute (i.e., P < .05), although walking at 100 steps per minute (P = .01) was no longer equivalent upon adjustment for multiple comparisons (i.e., at P < .007). The FC3 was equivalent to hand-tally during the 200-m walk (i.e., P < .001), in which mean pace was 68.2 m per minute (SD 10.7), or 2.5 miles per hour, and mean cadence 108.5 steps per minute (SD 6.5). For walking at 84 and 100 steps per minute, stepping-in-place at 100 steps per minute, and the 200-m walk, MAPE was within 10%, the accuracy standard of the CTA™. Interviews revealed motivation for PA, that stepping-in-place was an acceptable alternative to walking, and competing responsibilities made it difficult to find time for PA. CONCLUSIONS The FC3 appears to be a valid step counter during the third trimester, particularly when walking or stepping-in-place at or close to women's preferred cadence.
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Affiliation(s)
- Samantha F Ehrlich
- Department of Public Health, The University of Tennessee, Knoxville, 390 HPER, 1914 Andy Holt Ave, Knoxville, TN, 37996, USA.
| | - Jill M Maples
- The University of Tennessee, Graduate School of Medicine, 1924 Alcoa Highway, Knoxville, TN, 37920, USA
| | - Cristina S Barroso
- College of Nursing, The University of Tennessee, Knoxville, 1200 Volunteer Blvd, Knoxville, TN, 37996, USA
| | - Kathleen C Brown
- Department of Public Health, The University of Tennessee, Knoxville, 390 HPER, 1914 Andy Holt Ave, Knoxville, TN, 37996, USA
| | - David R Bassett
- Department of Kinesiology, Recreation, and Sport Studies, The University of Tennessee, Knoxville, 1914 Andy Holt Ave, Knoxville, TN, 37996, USA
| | - Nikki B Zite
- The University of Tennessee, Graduate School of Medicine, 1924 Alcoa Highway, Knoxville, TN, 37920, USA
| | - Kimberly B Fortner
- The University of Tennessee, Graduate School of Medicine, 1924 Alcoa Highway, Knoxville, TN, 37920, USA
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16
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Benvenuti MB, Bø K, Draghi S, Tandoi E, Haakstad LA. The weight of motherhood: Identifying obesity, gestational weight gain and physical activity level of Italian pregnant women. ACTA ACUST UNITED AC 2021; 17:17455065211016136. [PMID: 34032172 PMCID: PMC8155776 DOI: 10.1177/17455065211016136] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Pre-pregnancy obesity and suboptimal gestational weight gain are on the rise
globally and are independently associated with several maternal and neonatal
complications. A healthy lifestyle, including regular physical activity, may
improve health and reduce these complications, but many women are less
active and willing to engage in physical activity with advancing gestation.
Therefore, the inclusion of a wider range of physical activity such as
domestic chore, occupational activity and active commuting may help pregnant
women to meet the physical activity recommendations of 150 min/week. Very
little is known about these issues in Italy, a country with strong
traditional roles regarding pregnancy and motherhood, including “la
famiglia” (the family). Primary objective describes health and lifestyle
behavior of pregnant Italian women. Secondary objective reports total
physical activity level, recreational exercise and context of these
activities from pre-pregnancy and throughout gestation in regard to
gestational weight gain management. Study design: Cross-sectional study performed in one public hospital and four antenatal
clinics in Italy. Participants (n = 513) completed a validated
self-administered questionnaire, the Physical Activity Pregnancy
Questionnaire, in gestation week 36.01 (standard deviation 2.0).
Pre-pregnancy body weight (kg) was self-reported, whereas maternal weight
(kg) was measured at gestation week 36. In line with current American
College of Obstetricians and Gynecologists guidelines (2020), participants
were categorized into regular physical activity (⩾150 min/week) or
non-regular physical activity (<150 min/week). Results: Mean pre-pregnancy body-mass index was 22.8 kg/m2 (standard
deviation 3.9), with 14.4% of women entering motherhood overweight and 5.3%
obese. Mean gestational weight gain was 11.9 kg (standard deviation 4.1).
Among those with a body-mass index ⩾25, 46.5% gained above the Institute of
Medicine recommendations. With respect to recreational exercise/sport, 4.7%
were active according to guidelines, whereas 82.7% accumulated ⩾150 min/week
when combining exercise/sport with daily-life physical activity (commuting
and occupational). Exercising ⩾150 min/week and working 100% in third
trimester were associated with gestational weight gain within Institute of
Medicine recommendations (p = 0.06 and p = 0.03). Conclusion: Italian pregnant women have a low exercise level, still over 80% achieved a
total physical activity level ⩾150 min/week when adding occupational and
commuting activities. Nearly 50% of overweight and obese women exceeded the
recommended gestational weight gain during pregnancy.
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Affiliation(s)
| | - Kari Bø
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | | | | | - Lene Ah Haakstad
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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17
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Onaade O, Maples JM, Rand B, Fortner KB, Zite NB, Ehrlich SF. Physical activity for blood glucose control in gestational diabetes mellitus: rationale and recommendations for translational behavioral interventions. Clin Diabetes Endocrinol 2021; 7:7. [PMID: 33896420 PMCID: PMC8074463 DOI: 10.1186/s40842-021-00120-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/15/2021] [Indexed: 12/12/2022] Open
Abstract
Gestational Diabetes Mellitus (GDM) is associated with adverse health outcomes during pregnancy and beyond. Previous randomized controlled trials of exercise interventions have demonstrated that exercise, conducted primarily during supervised sessions, improves maternal glycemic control in women with GDM. However, additional research is needed to develop physical activity interventions that are easily implemented in healthcare settings (e.g., recommendations and strategies to increase non-supervised physical activity). This narrative review presents: current physical activity recommendations for pregnancy and women with GDM; the scientific literature to date on physical activity, particularly walking, and blood glucose control in GDM; rationale for physical activity interventions targeting women with GDM that are appropriate for translation to the clinical setting (e.g., lifestyle interventions that include behavioral counseling with a health coach); and the strategies employed by previous, successful lifestyle interventions for pregnant and postpartum women that were based in clinical settings.Most previous exercise interventions for blood glucose control in women with GDM have included supervised exercise sessions, and will thus be difficult to translate to the health care system. However, lifestyle interventions for weight maintenance (i.e., healthy diet and physical activity) set in the health care system and delivered by health coaches have been successfully implemented in pregnant and postpartum populations. Therefore, we suggest that future trials examine lifestyle interventions that promote unsupervised walking with evidence-based behavioral strategies (e.g., goal setting, monitoring, and feedback) and consider incorporating the use of physical activity tracking devices to support these strategies.
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Affiliation(s)
- Oluwafemifola Onaade
- Department of Public Health, The University of Tennessee, 369 HPER, 1914 Andy Holt Ave., TN, 37996, Knoxville, USA.
| | - Jill M Maples
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tennessee, Knoxville, TN, USA
| | - Bethany Rand
- Department of Public Health, The University of Tennessee, 369 HPER, 1914 Andy Holt Ave., TN, 37996, Knoxville, USA
| | - Kimberly B Fortner
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tennessee, Knoxville, TN, USA
| | - Nikki B Zite
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tennessee, Knoxville, TN, USA
| | - Samantha F Ehrlich
- Department of Public Health, The University of Tennessee, 369 HPER, 1914 Andy Holt Ave., TN, 37996, Knoxville, USA
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18
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Majewska A, Stanirowski P, Wielgoś M, Bomba-Opoń D. Flash glucose monitoring in gestational diabetes mellitus: study protocol for a randomised controlled trial. BMJ Open 2021; 11:e041486. [PMID: 33653744 PMCID: PMC7929891 DOI: 10.1136/bmjopen-2020-041486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) is a glucose intolerance occurring in 3%-10% of pregnant women and being a risk factor for multiple maternal and fetal complications. The risk of perinatal complications is proportional to the level of maternal hyperglycaemia. Proper glycaemic control is therefore one of the key elements of GDM therapy. Until recently, determination of blood glucose concentration was performed using glucose meters, which involved multiple fingerpricks. Nowadays, due to the flash glucose monitoring (FGM) availability, it is possible to collect measurements at any time without routine puncturing. The aim of the presented study is to assess the impact of FGM on the efficacy of treatment in population of patients diagnosed with GDM. METHODS AND ANALYSIS This is a prospective, randomised study, that will recruit 100 women at 24-28 weeks of gestation at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland. Women diagnosed with GDM, who will meet the inclusion criteria, will be individually randomised to the FGM or self-monitoring of blood glucose groups. Further on, clinical and laboratory results of the mother and their newborns will be collected for analysis during the course of pregnancy. Primary outcome is mean glycaemia result in each group after 1 month analysis and percentage of results in the target glycaemic range. The secondary objectives will be to compare the two groups for maternal and neonatal outcomes in conjunction with long-term glycaemic control using blood glycated haemoglobin and fructosamine serum concentrations. ETHICS AND DISSEMINATION The study is exempt from regional ethics review due to its nature of quality improvement in patient care. The study has been approved by the Bioethics Committee at the Medical University of Warsaw and the patient privacy protection boards governing over the recruitment sites. Results of the study will be presented in peer-reviewed journals and at conferences. TRIAL REGISTRATION NUMBER NCT04422821.
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Affiliation(s)
- Agata Majewska
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Paweł Stanirowski
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Mirosław Wielgoś
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Dorota Bomba-Opoń
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
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Ehrlich SF, Ferrara A, Hedderson MM, Feng J, Neugebauer R. Exercise During the First Trimester of Pregnancy and the Risks of Abnormal Screening and Gestational Diabetes Mellitus. Diabetes Care 2021; 44:425-432. [PMID: 33355301 PMCID: PMC7818322 DOI: 10.2337/dc20-1475] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 11/18/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To estimate the effects of exercise during the first trimester on the risks of abnormal screening and gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS Data come from PETALS, a prospectively followed pregnancy cohort (n = 2,246, 79% minorities) receiving care at Kaiser Permanente Northern California. A Pregnancy Physical Activity Questionnaire was used to assess exercise. Glucose testing results for screening and diagnostic tests were obtained from electronic health records. Inverse probability of treatment weighting and targeted maximum likelihood with data-adaptive estimation (machine learning) of propensity scores and outcome regressions were used to obtain causal risk differences adjusted for potential confounders, including prepregnancy BMI, exercise before pregnancy, and gestational weight gain. Exercise was dichotomized at 1) the cohort's 75th percentile for moderate- to vigorous-intensity exercise (≥13.2 MET-h per week or ≥264 min per week of moderate exercise), 2) current recommendations (≥7.5 MET-h per week or ≥150 min per week of moderate exercise), and 3) any vigorous exercise. RESULTS Overall, 24.3% and 6.5% had abnormal screening and GDM, respectively. Exercise meeting or exceeding the 75th percentile decreased the risks of abnormal screening and GDM by 4.8 (95% CI 1.1, 8.5) and 2.1 (0.2, 4.1) fewer cases per 100, respectively, in adjusted analyses. CONCLUSIONS Exercise reduces the risks of abnormal screening and GDM, but the amount needed to achieve these risk reductions is likely higher than current recommendations. Future interventions may consider promoting ≥38 min per day of moderate-intensity exercise to prevent GDM.
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Affiliation(s)
- Samantha F Ehrlich
- Division of Research, Kaiser Permanente Northern California, Oakland, CA .,Department of Public Health, University of Tennessee, Knoxville, Knoxville, TN
| | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | | | - Juanran Feng
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Romain Neugebauer
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
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Okafor UB, Goon DT. Applying the Ecological Model to understand pregnant women's perspectives on the modifiable constraints to physical activity during pregnancy: A qualitative research study. Medicine (Baltimore) 2020; 99:e23431. [PMID: 33285736 PMCID: PMC7717830 DOI: 10.1097/md.0000000000023431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/19/2020] [Accepted: 10/26/2020] [Indexed: 11/26/2022] Open
Abstract
The benefits of physical activity (PA) during pregnancy are widely reported; however, PA practice is seemingly not a valued habit among pregnant women attending public antenatal health centres in the Eastern Cape of South Africa. Guided by the ecological model, we sought to explore modifiable barriers to PA among pregnant women.Semi-structured interviews involved a purposive sample of 15 pregnant women. Interview questions were guided by the ecological model constructs at intrapersonal, interpersonal, and environmental level. Thematic analysis was applied to summarise the modifiable barriers to PA during pregnancy.Three main themes emerged, based on the modifiable barriers to PA during pregnancy that belong to the varying Ecological Model constructs. On the intrapersonal level, 5 themes emerged, namely, time-constraint beliefs, feeling of tiredness, low energy, lack of motivation, and a lack of knowledge on benefits and types of PA. Two themes emerged for the interpersonal level, lack of PA advice and lack of information on PA recommendations and guidelines. Another theme defined the environmental level lacking resources. Most themes related to individual factors, which prevent PA-promoting behaviour.Overall, intrapersonal factors relating to tiredness and exhaustion, lack of time beliefs, work and household commitments, and lack of motivation were key modifiable barriers to PA by the women. The findings provide insights into possible interventional strategies to optimise PA during pregnancy among women in this setting. Appropriate knowledge, education and advice on the benefits, types, and intensity of PA in pregnancy are needed.
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Affiliation(s)
| | - Daniel Ter Goon
- Department of Public Health, University of Fort Hare, East London, South Africa
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21
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Diet and Healthy Lifestyle in the Management of Gestational Diabetes Mellitus. Nutrients 2020; 12:nu12103050. [PMID: 33036170 PMCID: PMC7599681 DOI: 10.3390/nu12103050] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/01/2020] [Accepted: 10/02/2020] [Indexed: 12/16/2022] Open
Abstract
Gestational diabetes mellitus (GDM) among pregnant women increases the risk of both short-term and long-term complications, such as birth complications, babies large for gestational age (LGA), and type 2 diabetes in both mother and offspring. Lifestyle changes are essential in the management of GDM. In this review, we seek to provide an overview of the lifestyle changes which can be recommended in the management of GDM. The diet recommended for women with GDM should contain sufficient macronutrients and micronutrients to support the growth of the foetus and, at the same time, limit postprandial glucose excursions and encourage appropriate maternal gestational weight gain. Blood glucose excursions and hyperglycaemic episodes depend on carbohydrate-intake. Therefore, nutritional counselling should focus on the type, amount, and distribution of carbohydrates in the diet. Further, physical activity has beneficial effects on glucose and insulin levels and it can contribute to a better glycaemic control.
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22
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Nagpal TS, Bhattacharjee J, da Silva DF, Souza SCS, Mohammad S, Puranda JL, Abu-Dieh A, Cook J, Adamo KB. Physical activity may be an adjuvant treatment option for substance use disorders during pregnancy: A scoping review. Birth Defects Res 2020; 113:265-275. [PMID: 32940021 DOI: 10.1002/bdr2.1803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Substance abuse in pregnancy increases the chance of physical and neurobehavioral disabilities as well as many other undesirable fetal outcomes. In nonpregnant populations, physical exercise has shown to be an effective adjunctive therapy option for substance use disorders. Given the known positive maternal and fetal physiological and mental health benefits associated with prenatal exercise, perhaps exercise during pregnancy may also be a viable adjuvant therapy option for women with substance use disorders. The purpose of this scoping review was to summarize the available literature that has assessed the relationship between prenatal exercise and substance use disorders. METHODS A search strategy was developed combining the terms pregnancy, exercise/physical activity, and substance use. A systematic search was completed in the following databases: Medline/PubMed, SPORTDiscus, and ProQuest. Substances eligible for inclusion included illicit drugs, alcohol, and cannabis. Retrieved data were categorized as animal or human model studies, and were summarized narratively. RESULTS Eight studies were included in this review (five human studies, three animal model studies). Studies in humans suggest that pregnant women with substance use disorders are interested in engaging in physical activity interventions; however, known acute metabolic and physiological responses to prenatal exercise may be impaired in this population. Rodent models show preliminary evidence for improved mental health outcomes following prenatal exercise for substance use disorders. CONCLUSION The findings from this review may inform the development of future clinical trials to test the effect of structured exercise programs as an adjunctive treatment option for pregnant women with substance use disorders.
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Affiliation(s)
- Taniya S Nagpal
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
- Society of Obstetricians and Gynaecologists of Canada, Ottawa, Canada
| | | | | | - Sara C S Souza
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Shuhiba Mohammad
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | | | - Anas Abu-Dieh
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Jocelynn Cook
- Society of Obstetricians and Gynaecologists of Canada, Ottawa, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada
| | - Kristi B Adamo
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
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Swindle T, Martinez A, Børsheim E, Andres A. Adaptation of an exercise intervention for pregnant women to community-based delivery: a study protocol. BMJ Open 2020; 10:e038582. [PMID: 32895286 PMCID: PMC7478046 DOI: 10.1136/bmjopen-2020-038582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Despite well-established guidelines and benefits to exercise, the majority of pregnant women in the USA fail to meet recommended activity levels. Studies need to determine feasible ways to translate clinical interventions to community settings by engaging pregnant women in widely accessible locations to ensure benefits to more women. The aim of this study is to adapt and determine feasibility, acceptability and fidelity of the research clinic-based Expecting intervention (NCT02125149) with pregnant women with obesity in community settings. METHODS AND ANALYSIS We will use the Replicating Effective Programs (REP) to guide the adaptation and implementation of the research clinic-based intervention into the community. REP provides a four-phase process for implementing evidence-based interventions including collection of feedback from community stakeholders, iterative piloting of the intervention in the community and a process for standardising the intervention across community settings. Following adaptation, the updated intervention will be piloted. The pilot study will include 60 expecting women. We will randomise half to receive the community-adapted Expecting intervention (intervention, N=30) and half to receive standard of care (control, N=30). Feasibility and Acceptability of Intervention Measures are primary outcomes as key indicators of feasibility. Secondary outcomes will include the number of intervention sessions completed, the change in the number of minutes of physical activity as measured by accelerometer, as well as change in health indicators from enrolment to time of delivery and 6 months post-delivery (ie, body mass index, blood pressure and total cholesterol). ETHICS AND DISSEMINATION This study has been approved by the Institutional Review Board (#260132). Findings will be shared with study participants and stakeholder advisors through written summaries and in-person presentations; results will also be shared through presentations at scientific conferences and publications in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04298125; Pre-results.
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Affiliation(s)
- Taren Swindle
- Family and Preventive Medicine, University of Arkansas For Medical Sciences, Little Rock, Arkansas, USA
| | - Audrey Martinez
- Arkansas Children's Nutrition Center, Little Rock, Arkansas, USA
| | - Elisabet Børsheim
- Arkansas Children's Nutrition Center, Little Rock, Arkansas, USA
- Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Aline Andres
- Arkansas Children's Nutrition Center, Little Rock, Arkansas, USA
- Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Xie Q, Li Z, Wang Y, Zaidi S, Baranova A, Zhang F, Cao H. Preeclampsia Drives Molecular Networks to Shift Toward Greater Vulnerability to the Development of Autism Spectrum Disorder. Front Neurol 2020; 11:590. [PMID: 32760337 PMCID: PMC7373751 DOI: 10.3389/fneur.2020.00590] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 05/22/2020] [Indexed: 02/05/2023] Open
Abstract
Preeclampsia (PE) confers a significant risk for subsequent diagnosis with autism spectrum disorder (ASD), with the mechanisms underlying this observation being largely unknown. To identify molecular networks affected by both PE and ASD, we conducted a large-scale literature data mining and a gene set enrichment analysis (GSEA), followed by an expression mega-analysis in 13 independently profiled ASD datasets. Sets of genes implicated in ASD and in PE significantly overlap (156 common genes; p = 3.14E−67), with many biological pathways shared (94 pathways; p < 1.00E−21). A set of PE-driven molecular triggers possibly contributing to worsening the risk of subsequent ASD was identified, possibly representing a regulatory shift toward greater vulnerability to the development of ASD. Mega-analysis of expression highlighted RPS4Y1, an inhibitor of STAT3 that is expressed in a sexually dimorphic manner, as a contributor to both PE and ASD, which should be evaluated as a possible contributor to male predominance in ASD. A set of PE-driven molecular triggers may shift the developing brain toward a greater risk of ASD. One of these triggers, chromosome Y encoded gene RPS4Y1, an inhibitor of STAT3 signaling, warrants evaluation as a possible contributor to male predominance in ASD.
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Affiliation(s)
- Qinglian Xie
- Department of Outpatient, West China Hospital of Sichuan University, Chengdu, China
| | - Zhe Li
- Mental Health Center and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Yan Wang
- Department of Outpatient, West China Hospital of Sichuan University, Chengdu, China
| | - Shan Zaidi
- School of Systems Biology, George Mason University, Fairfax, VA, United States
| | - Ancha Baranova
- School of Systems Biology, George Mason University, Fairfax, VA, United States.,Research Centre for Medical Genetics, Moscow, Russia
| | - Fuquan Zhang
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Hongbao Cao
- School of Systems Biology, George Mason University, Fairfax, VA, United States.,Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
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Tan S, Cao F, Yang J. The Study on Spatial Elements of Health-Supportive Environment in Residential Streets Promoting Residents' Walking Trips. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145198. [PMID: 32708465 PMCID: PMC7400223 DOI: 10.3390/ijerph17145198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 01/28/2023]
Abstract
Residents’ walking trips are a kind of natural motion that promotes health and wellbeing by modifying individual behavior. The purpose of this study was to evaluate the major influence of the spatial elements of a health-supportive environment on residents’ walking trips. This study analyzes residents’ walking trips’ elements based on the spatiotemporal characteristics of walking trips, as well as the spatial elements of a health-supportive environment in residential streets based on residential health needs. To obtain the spatial elements that promote residents’ walking trips and to build an ordered logistic regression model, two methods—a correlation analysis and a logistic regression analysis—were applied to analyze the elements of residents’ walking trips as well as the spatial elements of a health-supportive environment in residential streets by means of SPSS software, using on-site survey results of ten residential streets and 2738 pieces of research data. The research showed that the nine kinds of spatial elements that significantly affect residents’ walking trips are density of pedestrian access, density of bus routes, near-line rate of roadside buildings, average pedestrian access distance, square area within a 500 m walking distance, distance to the nearest garden, green shade ratio, density of street intersections, and the mixed proportion of differently aged residential buildings. In order to construct a spatial environment that promotes walking trips, it is necessary to improve the convenience of residents’ walking trips, to increase the safety of roadside buildings and pedestrian access, to expand the comfort of “getting out to the nature”, and to enrich the diversity of different architectural styles and street density.
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Bauer I, Hartkopf J, Kullmann S, Schleger F, Hallschmid M, Pauluschke-Fröhlich J, Fritsche A, Preissl H. Spotlight on the fetus: how physical activity during pregnancy influences fetal health: a narrative review. BMJ Open Sport Exerc Med 2020; 6:e000658. [PMID: 32206341 PMCID: PMC7078670 DOI: 10.1136/bmjsem-2019-000658] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2020] [Indexed: 12/16/2022] Open
Abstract
Before and during pregnancy, women often aim to improve their lifestyle so as to provide a healthier environment for their developing child. It remains unresolved, however, as to whether physical activity (PA) during pregnancy poses a possible risk or whether it might even have beneficial effects on the developing child. There is increasing evidence that PA during pregnancy is indeed beneficial to maternal physiological and psychological health and that it is generally not detrimental to the fetal cardiovascular system and neuronal function in the developing child. This also led to international recommendations for PAs during pregnancy. In the current review, we aimed to comprehensively assess the evidence of beneficial and harmful effects of maternal PA, including high-performance sports, on fetal development. The different mental and body-based relaxation techniques presented here are frequently performed during pregnancy. We found a considerable number of studies addressing these issues. In general, neither low key, moderate maternal PA nor relaxation techniques were observed to have a harmful effect on the developing child. However, we identified some forms of PA which could have at least a transient unfavourable effect. Notably, the literature currently available does not provide enough evidence to enable us to make a general conclusive statement on this subject. This is due to the lack of longitudinal studies on the metabolic and cognitive effects of regular PA during pregnancy and the wide diversity of methods used. In particular, the kind of PA investigated in each study differed from study to study.
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Affiliation(s)
- Ilena Bauer
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen/fMEG Center, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), University of Tübingen, Tübingen, Germany
| | - Julia Hartkopf
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen/fMEG Center, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), University of Tübingen, Tübingen, Germany
| | - Stephanie Kullmann
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen/fMEG Center, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), University of Tübingen, Tübingen, Germany
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology, and Nephrology, University Hospital Tübingen, Tübingen, Germany
| | - Franziska Schleger
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen/fMEG Center, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), University of Tübingen, Tübingen, Germany
| | - Manfred Hallschmid
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen/fMEG Center, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), University of Tübingen, Tübingen, Germany
- Institute of Medical Psychology and Behavioral Neurobiology, Eberhard Karls University Tübingen, Tübingen, Germany
| | | | - Andreas Fritsche
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen/fMEG Center, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), University of Tübingen, Tübingen, Germany
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology, and Nephrology, University Hospital Tübingen, Tübingen, Germany
| | - Hubert Preissl
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen/fMEG Center, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), University of Tübingen, Tübingen, Germany
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology, and Nephrology, University Hospital Tübingen, Tübingen, Germany
- Department of Pharmacy and Biochemistry, Institute of Pharmaceutical Sciences; Interfaculty Centre for Pharmacogenomics and Pharma Research, Eberhard Karls University Tübingen, Tübingen, Germany
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Walasik I, Kwiatkowska K, Kosińska Kaczyńska K, Szymusik I. Physical Activity Patterns among 9000 Pregnant Women in Poland: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051771. [PMID: 32182850 PMCID: PMC7084336 DOI: 10.3390/ijerph17051771] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 03/02/2020] [Accepted: 03/04/2020] [Indexed: 12/11/2022]
Abstract
The aim was to analyze the knowledge and experience of women regarding physical activity during their latest pregnancy. An anonymous questionnaire was completed electronically, in 2018, by 9345 women who gave birth at least once, with 52% of the women having performed exercises during pregnancy. Physically non-active respondents suffered from gestational hypertension (9.2% vs. 6.7%; p < 0.01) and gave birth prematurely (9% vs. 7%; p < 0.01) to newborns with a low birth weight significantly more often (6% vs. 3.6%; p < 0.001). Physically active women delivered vaginally more often (61% vs. 55%; p < 0.001) and were more likely to have a spontaneous onset of the delivery as compared with non-active women (73.8% vs. 70.7% p = 0.001). The women who were informed by gynaecologist about the beneficial influence of physical activity during pregnancy exercised significantly more often (67% vs. 44% p < 0.001). In addition, 13% of the women felt discrimination due to their physical activity during a pregnancy, 22% of respondents' physical activity was not accepted by their environment, and 39.1% of the women were told by others to stop physical exercise because it was bad for the baby's health. Physical activity during pregnancy is associated with improved fitness, decreased pregnancy ailments occurrence, and therefore influences the course of pregnancy and delivery in a positive way.
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Affiliation(s)
- Izabela Walasik
- Students Scientific Association at the 1st Department of Obstetrics and Gynecology, First Faculty of Medicine, Medical University of Warsaw, Plac Starynkiewicza 1/3, 02-015 Warsaw, Poland; (I.W.); (K.K.)
| | - Katarzyna Kwiatkowska
- Students Scientific Association at the 1st Department of Obstetrics and Gynecology, First Faculty of Medicine, Medical University of Warsaw, Plac Starynkiewicza 1/3, 02-015 Warsaw, Poland; (I.W.); (K.K.)
| | - Katarzyna Kosińska Kaczyńska
- 2nd Department of Obstetrics and Gynecology, The Center of Postgraduate Medical Education, Marymoncka st. 99/103, 01-813 Warsaw, Poland
- 1st Department of Obstetrics and Gynecology, First Faculty of Medicine, Medical University of Warsaw, Plac Starynkiewicza 1/3, 02-015 Warsaw, Poland;
- Correspondence: ; Tel.: +48-22-56-90-274
| | - Iwona Szymusik
- 1st Department of Obstetrics and Gynecology, First Faculty of Medicine, Medical University of Warsaw, Plac Starynkiewicza 1/3, 02-015 Warsaw, Poland;
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