Validity and reliability of the Danish version of the pregnancy physical activity questionnaire to assess levels of physical activity during pregnancy

Danish Diabetes Birth Registry 2: a study protocol of a national prospective cohort study to monitor outcomes of pregnancies of women with pre-existing diabetes

INTRODUCTION

Despite technological developments and intensified care, pregnancies in women with pre-existing diabetes are still considered high-risk pregnancies. The rate of adverse outcomes in pregnancies affected by diabetes in Denmark is currently unknown, and there is a limited understanding of mechanisms contributing to this elevated risk. To address these gaps, the Danish Diabetes Birth Registry 2 (DDBR2) was established. The aims of this registry are to evaluate maternal and fetal-neonatal outcomes based on 5 years cohort data, and to identify pathophysiology and risk factors associated with short-term and long-term outcomes of pregnancies in women with pre-existing diabetes.

METHODS AND ANALYSIS

The DDBR2 registry is a nationwide 5-year prospective cohort with an inclusion period from February 2023 to February 2028 of pregnancies in women with all types of pre-existing diabetes and includes registry, clinical and questionnaire data and biological samples of mother-partner-child trios. Eligible families (parents age ≥18 years and sufficient proficiency in Danish or English) can participate by either (1) basic level data obtained from medical records (mother and child) and questionnaires (partner) or (2) basic level data and additional data which includes questionnaires (mother and partner) and blood samples (all). The primary maternal outcome is Hemoglobin A1c (HbA1c) levels at the end of pregnancy and the primary offspring endpoint is the birth weight SD score. The DDBR2 registry will be complemented by genetic, epigenetic and metabolomic data as well as a biobank for future research, and the cohort will be followed through data from national databases to illuminate possible mechanisms that link maternal diabetes and other parental factors to a possible increased risk of adverse long-term child outcomes.

ETHICS AND DISSEMINATION

Approval from the Ethical Committee is obtained (S-20220039). Findings will be sought published in international scientific journals and shared among the participating hospitals and policymakers.

TRIAL REGISTRATION NUMBER

NCT05678543.

Effects of Two Physical Activity Interventions on Sleep and Sedentary Time in Pregnant Women

Pregnancy is often associated with poor sleep and high sedentary time (SED). We investigated the effect of physical activity (PA) interventions on sleep and SED in pregnant women. A secondary analysis of a randomized controlled trial (n = 219) explored the effect of structured supervised exercise training (EXE) or motivational counseling on PA (MOT) compared to standard prenatal care (CON) on sleep and SED during pregnancy. Three times during pregnancy, sleep was determined by the Pittsburgh Sleep Quality Index (PSQI) and SED by the Pregnancy Physical Activity Questionnaire (PPAQ). Also, a wrist-worn consumer activity tracker measured sleep and SED continuously. Data from the activity tracker confirmed that sleep time decreases, and SED increases by approx. 30 and 24 min/day, respectively, from baseline (maximum gestational age (GA) week 15) to delivery. Compared to CON, the global PSQI score was better for EXE in GA week 28 (-0.8 [-1.5; -0.1], p = 0.031) and for both EXE and MOT in GA week 34 (-1 [-2; -0.5], p = 0.002; -1 [-2; -0.1], p = 0.026). In GA week 28, SED (h/day) from PPAQ was lower in EXE compared to both CON and MOT (-0.69 [-1; -0.0], p = 0.049; -0.6 [-1.0; -0.02], p = 0.042). In conclusion, PA interventions during pregnancy improved sleep quality and reduced SED.

Impact of Physical Activity of Pregnant Women on Obstetric Outcomes

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

The Translation and Cross-Cultural Adaptation of the Pregnancy Physical Activity Questionnaire: Validity and Reliability of a Serbian Version (PPAQ-SRB)

Exercise during pregnancy has a positive effect on the health of both pregnant women and their fetuses. This study aimed to translate the Pregnancy Physical Activity Questionnaire (PPAQ) into the Serbian language and assess its validity and reliability among Serbian pregnant women. The study was conducted between October 2020 and March 2021 at the Obstetrics and Gynecology Clinic (Narodni Front), in Belgrade, Serbia. The PPAQ was translated according to a standardized methodology, and its internal consistency and construct and concurrent validity were assessed. The mean PPAQ score for the total amount of physical activity was 37.72 MET-h/week⁻¹. Exploratory factor analysis of the Serbian PPAQ identified six factors similar to the original questionnaire that explained 70.26% of the data variance. The Cronbach’s alpha coefficient of the Serbian version of the PPAQ was 0.69. The two-week intraclass correlation coefficient (ICC) scores ranged from 0.768 to 0.930. We tested the evidence to assess the concurrent validity of the Serbian version of PPAQ (PPAQ-SRB) correlations with the International Physical Activity Questionnaire-long form (IPAQ-LF), and all domains of the PPAQ were significantly correlated with domains of the IPAQ-LF. The findings of our reliability and validity evaluation are consistent with those of prior studies, indicating that the PPAQ was successfully translated and implemented in the Serbian population and that its reliability was acceptable.

Effects of Structured Supervised Exercise Training or Motivational Counseling on Pregnant Women's Physical Activity Level: FitMum - Randomized Controlled Trial

Background

Physical activity (PA) during pregnancy is an effective and safe way to improve maternal health in uncomplicated pregnancies. However, compliance with PA recommendations remains low among pregnant women.

Objective

The purpose of this study was to evaluate the effects of offering structured supervised exercise training (EXE) or motivational counseling on PA (MOT) during pregnancy on moderate-to-vigorous intensity physical activity (MVPA) level. Additionally, complementary measures of PA using the Pregnancy Physical Activity Questionnaire (PPAQ) and gold standard doubly labeled water (DLW) technique were investigated. The hypotheses were that both EXE and MOT would increase MVPA in pregnancy compared with standard care (CON) and that EXE would be more effective than MOT. In addition, the association between MVPA and the number of sessions attended was explored.

Methods

A randomized controlled trial included 220 healthy, inactive pregnant women with a median gestational age of 12.9 (IQR 9.4-13.9) weeks. A total of 219 women were randomized to CON (45/219), EXE (87/219), or MOT (87/219). The primary outcome was MVPA (minutes per week) from randomization to the 29th gestational week obtained by a wrist-worn commercial activity tracker (Vivosport, Garmin International). PA was measured by the activity tracker throughout pregnancy, PPAQ, and DLW. The primary outcome analysis was performed as an analysis of covariance model adjusting for baseline PA.

Results

The average MVPA (minutes per week) from randomization to the 29th gestational week was 33 (95% CI 18 to 47) in CON, 50 (95% CI 39 to 60) in EXE, and 40 (95% CI 30 to 51) in MOT. When adjusted for baseline MVPA, participants in EXE performed 20 (95% CI 4 to 36) minutes per week more MVPA than participants in CON (P=.02). MOT was not more effective than CON; EXE and MOT also did not differ. MVPA was positively associated with the number of exercise sessions attended in EXE from randomization to delivery (P=.04). Attendance was higher for online (due to COVID-19 restrictions) compared with physical exercise training (P=.03). Adverse events and serious adverse events did not differ between groups.

Conclusions

Offering EXE was more effective than CON to increase MVPA among pregnant women, whereas offering MOT was not. MVPA in the intervention groups did not reach the recommended level in pregnancy. Changing the intervention to online due to COVID-19 restrictions did not affect MVPA level but increased exercise participation.

Trial Registration

ClinicalTrials.gov NCT03679130; https://clinicaltrials.gov/ct2/show/NCT03679130

International Registered Report Identifier (IRRID)

RR2-10.1136/bmjopen-2020-043671

Translation and cultural adaptation of the Pregnancy Physical Activity Questionnaire into Danish using the dual-panel approach: comparison with outcomes from an alternative translation approach

Objective

Physical activity reduces the risk of pregnancy-related complications. However, pregnant women often reduce their physical activity levels and do not follow the WHO’s physical activity recommendations during pregnancy. To support pregnant women in monitoring physical activity, the self-administered Pregnancy Physical Activity Questionnaire was developed in the US. We translated and cross-cultural adapted the questionnaire using the dual approach method. Meanwhile, and without knowing this, another Danish group simultaneously translated the questionnaire using the method described by Beaton et al. The aim is to present our data and discuss the unplanned purpose of comparing the results from using two different translation methods.

Results

We translated and cross-culturally adapted the Pregnancy Physical Activity Questionnaire to Danish with the following findings. Two additional items for cycling were included. Three items about spending time on a computer, reading, writing or talking on the phone were not feasible in terms of differentiating between them and these were merged into one item. The item ‘Taking care of an older adult’ was found to be irrelevant in a Danish setting and was removed. Adaptions were similar comparing the two methods. Consequently, using the dual-panel and the methods suggested by Beaton et al. yield similar results when translating and cultural adapting the PPAQ.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13104-021-05640-6.

Structured supervised exercise training or motivational counselling during pregnancy on physical activity level and health of mother and offspring: FitMum study protocol

INTRODUCTION

A physically active lifestyle during pregnancy improves maternal and offspring health but can be difficult to follow. In Denmark, less than 40% of pregnant women meet physical activity (PA) recommendations. The FitMum study aims to explore strategies to increase PA during pregnancy among women with low PA and assess the health effects of PA. This paper presents the FitMum protocol, which evaluates the effects of structured supervised exercise training or motivational counselling supported by health technology during pregnancy on PA level and health of mother and offspring.

METHODS AND ANALYSIS

A single-site three-arm randomised controlled trial that aims to recruit 220 healthy, pregnant women with gestational age (GA) no later than week 15 and whose PA level does not exceed one hour/week. Participants are randomised to one of three groups: structured supervised exercise training consisting of three weekly exercise sessions, motivational counselling supported by health technology or a control group receiving standard care. The interventions take place from randomisation until delivery. The primary outcome is min/week of moderate-to-vigorous intensity PA (MVPA) as determined by a commercial activity tracker, collected from randomisation until GA of 28 weeks and 0-6 days, and the secondary outcome is gestational weight gain (GWG). Additional outcomes are complementary measures of PA; clinical and psychological health parameters in participant, partner and offspring; analyses of blood, placenta and breastmilk samples; process evaluation of interventions; and personal understandings of PA.

ETHICS AND DISSEMINATION

The study is approved by the Danish National Committee on Health Research Ethics (# H-18011067) and the Danish Data Protection Agency (# P-2019-512). Findings will be disseminated via peer-reviewed publications, at conferences, and to health professionals via science theatre performances.

TRIAL REGISTRATION NUMBER

NCT03679130.

PROTOCOL VERSION

This paper was written per the study protocol version 8 dated 28 August 2019.