Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period

Mitochondrial genetic landscape and its correlation with immune cell infiltration in preeclampsia: Insights from bioinformatics

BACKGROUND

Preeclampsia (PE), a hypertensive pregnancy disorder, remains a leading cause of maternal and perinatal morbidity and mortality. Mitochondria-related placental metabolic dysfunction is implicated in PE, but its mechanistic role is unclear. This study aimed to identify mitochondria-related genes (MRGs) and their possible regulatory mechanisms in PE.

METHODS

Differentially expressed mitochondria-related genes (MRGs) of PE were identified from Gene Expression Omnibus (GEO) dataset GSE114691 and GSE190971. LASSO regression analysis was used to screen key MRGs. Datasets GSE75010 and GSE25906 were used to validate the efficiency of the MRGs predictive model via receiver operating characteristic (ROC) curve analysis. Gene set enrichment analysis (GSEA) was conducted to verify underlying biological pathways in PE. Furthermore, we investigated the correlation analysis of MRGs and immune cell infiltration, as well as the association between the MRGs and clinical features. Single-cell sequencing analysis and immunofluorescence staining were used to verify the expression of critical gene in the placenta.

RESULTS

Five hub MRGs (MOCS1, CYP11A1, GATM, SFXN3, and BCL2L11) showed high diagnostic accuracy for PE and correlated with immune cell infiltration. CYP11A1 was further associated with Hemolysis, Elevated Liver enzymes, Low platelets (HELLP) syndrome and predominantly expressed in extravillous trophoblasts, with upregulated expression in PE placenta.

CONCLUSION

The interaction between MRGs with the immune microenvironment might be vital in the development of PE. Among 5 hub MRGs, CYP11A1 might be a potential biomarker of HELLP syndrome. These findings provide novel insights into the underlying pathophysiology of PE and the discovery of new therapeutic targets.

Traditional Nutritional Beliefs and Practices Among Mothers in Riyadh During the Puerperal Period: a Cross-Sectional Study

Purpose

During the postpartum period, women undergo physical, social, and emotional changes, with misconceptions regarding postpartum nutrition resulting in high neonatal mortality rates. Traditional nutritional beliefs and practices during pregnancy, childbirth, and postnatal care differ among cultures. We assessed nutritional beliefs and practices among mothers during the puerperal period.

Patients and Methods

This descriptive cross-sectional study was conducted from October 2021 to April 2022 using an online survey questionnaire regarding beliefs and practices on nutrition during the puerperal period with a sample of 381 mothers. Descriptive statistics were used to report sociodemographic characteristics and nutritional beliefs and practices. ANOVA and two-sample independent t-test were used to analyze nutritional practices by sociodemographic factors. Simple linear regression was used to predict age-based nutritional beliefs and practices. Pearson correlation was used to compare nutritional beliefs and practices.

Results

Mothers did not avoid food and water after normal delivery. Many preferred Arabic coffee and peel. Age predicted the total scores of nutritional beliefs and practices, with a positive correlation between nutritional beliefs and practices. New mothers followed certain nutritional customs, such as consuming herbs postpartum. Mothers who had only completed high school or less obtained higher scores on nutritional belief evaluations, and those with ≥5 children displayed a greater number of nutritional beliefs. Those who delivered their first and second children naturally prioritized their dietary habits more than those who had a cesarean delivery.

Conclusion

The findings suggest complex relationships among various factors and postpartum dietary choices.

Does becoming a parent reduce sports participation? A longitudinal study of short- and long-term effects

Introduction

Parenthood can have a negative effect on sport behaviour despite the known health benefits of participation in sports. Recent studies have shown that becoming a parent is related to a reduction in exercise. However, this relationship is less clear for men than women. In addition, most studies only focused on short-term effects. Therefore, it is unknown whether these effects remain prevalent one year after becoming a parent.

Method

Using twelve data waves of the Dutch Longitudinal Internet studies for the Social Sciences (LISS) panel, we examined the influence of becoming a parent on sport behaviour in the short- (<1 year) and long-term (>1 year). Given the known differences between men and women, we also examined possible gender differences in this change. Multilevel logistic regression of the data of 6,276 observations for 725 respondents showed that the short- and long-term effects of becoming a parent have different implications for the sport behaviour of men and women.

Results

While men's participation in sports is not affected by parenthood, women initially stop participating in sports, but they start again after one year. Additionally, women's frequency of engagement in sports is reduced when they become mothers. In contrast, the frequency of sport engagement is not affected when men become fathers. From a resource perspective, the results show how limited time and energy can differentially affect the sport behaviour of men and women after they become parents.

Discussion

Together with the different pathways of sport participation in the short- and long-term, these results can inform the development of interventions aimed at sustainable physical activity for new parents.

Obesity and recurrent spontaneous abortion: the crucial role of weight management in pregnancy

Recurrent spontaneous abortion (RSA), characterized by the loss of two or more pregnancies, impacts approximately 1-2% of couples and poses a significant challenge for individuals of childbearing age. The precise mechanisms underlying RSA remain incompletely understood. Concurrently, the global prevalence of obesity is on the rise, with obesity being closely associated with female reproductive disorders and infertility. This study initially examines the pathways through which obesity contributes to RSA, encompassing factors such as embryonic euploid miscarriage, endometrial development, immune function, among others. Furthermore, adipokines and the fat mass and obesity-related (FTO) are identified as potential contributors to RSA. The study also explores the enhancement of pregnancy outcomes through various weight management strategies, with a particular focus on the roles of dietary interventions, physical activity, and weight control during pregnancy. Obesity is closely related to RSA in multiple aspects. Additional clinical prospective and experimental studies are required to explore its precise pathogenesis. Through this review, we aim to provide strategies for improvement and treatment approaches for RSA related to obesity. Through this review, we suggest potential clinical management strategies and research avenues aimed at offering enhancements and therapeutic insights for miscarriages linked to obesity and its associated risk factors.

Safety and efficacy of motor imagery-based physical activity in high-risk pregnancy: A randomized controlled study

OBJECTIVE

This study aimed to investigate the acute effects of motor imagery-based physical activity on maternal well-being, maternal blood pressure, heart rate, oxygen saturation, fetal heart rate, and uterine contractions in women with high-risk pregnancies.

METHODS

This randomized controlled trial was conducted in Izmir Tepecik Education and Research Hospital from August 2023 to January 2024. Seventy-six women with high-risk pregnancies were randomized into two groups: a motor imagery group (n = 38, diaphragmatic-breathing exercise and motor imagery-based physical activity) and a control group (n = 38, diaphragmatic-breathing exercise). Maternal well-being was determined using the Numerical Rating Scale-11. Digital sphygmomanometry was used to measure maternal heart rate and blood pressure, pulse oximetry for oxygen saturation, and cardiotocography for fetal heart rate and uterine contractions. Assessments were performed pre-intervention, mid-intervention, and post-intervention.

RESULTS

There were no significant differences in baseline characteristics between groups (P > 0.05). There was a significant main effect of time in terms of maternal well-being and maternal heart rate (P = 0.001 and P = 0.015). In addition, there was a significant main effect of the group on oxygen saturation (P = 0.025). The overall group-by-time interaction was significant for maternal well-beingm with an effect size of 0.05 (P = 0.041).

CONCLUSION

The combination of diaphragmatic-breathing exercises and a motor imagery-based physical activity program in women with high-risk pregnancies was determined to have no adverse effects on the fetus, did not induce uterine contractions, and resulted in a significant improvement in maternal well-being and oxygen saturation. Thus, imagery-based physical activity can be used in high-risk pregnancies where physical activity and exercise are not recommended.

Prevalence of low back, pelvic girdle, and pelvic floor complaints in pregnant elite athletes: a narrative review

Objective

To investigate the prevalence of low back, pelvic girdle, and pelvic floor complaints in pregnant elite athletes.

Background

Common symptoms during pregnancy include low back pain, pelvic girdle pain, and pelvic floor dysfunction. There has been minimal investigation around the prevalence of these musculoskeletal disorders in the pregnant elite athlete.

Methods

A narrative review was conducted using electronic databases and hand reference searching. Articles were screened based on the inclusion/exclusion criteria.

Results

727 articles were retrieved digitally, while hand and reference searching yielded one article. After removing those that did not fit the inclusion/exclusion criteria, there were a total of three articles.

Summary

Prevalence of these conditions in pregnant elite athletes is variable within the literature. The values appear to change based on trimester, parity, and description of these conditions. Similarly, frequency, duration, and type of exercise may also influence the prevalence. Further investigation is warranted to help guide safe participation in elite sport activity during pregnancy.

Cardiovascular effects of exercise training in pregnant people with a high body mass index: secondary results from a randomised controlled trial (ETIP)

Objectives

We aimed to determine the effectiveness of exercise training during pregnancy on peak oxygen uptake (V̇O2peak), cardiac function and flow-mediated dilatation (FMD) of the brachial artery throughout pregnancy and post partum in individuals with a prepregnancy body mass index (BMI) ≥28 kg/m2.

Trial design

Parallel-group randomised controlled trial (RCT).

Methods

The exercise group in the Exercise Training in Pregnancy (ETIP) RCT was offered 3 weekly supervised exercise sessions comprising 35 min of moderate-intensity treadmill walking followed by 25 min of strength exercises. The intervention started in gestational weeks 12-18 and continued throughout pregnancy. We measured V̇O2peak and FMD at baseline, in gestational weeks 34-37 and 3 months post partum and offered echocardiography in gestational weeks 14, 20, and 32, and 6-8 weeks postpartum.

Results

Of the 91 participants included in ETIP, 87 participants (age: 31.3±4.2 years, BMI: 34.6±4.3 kg/m2) provided data on V̇O2peak, cardiac function and/or FMD. There was no statistically significant effect of exercise training on V̇O2peak in gestational weeks 34-37, with an estimated effect of 1.7 mL/min/kg (95% CI -0.4 to 3.7, p=0.112) or post partum (1.6 mL/min/kg, 95% CI -0.2 to 3.4, p=0.079), compared with the control group. There were no statistically significant between-group differences in either FMD or any of the echocardiographic outcomes. Only 50% of the participants in the exercise group fulfilled our prespecified adherence criteria.

Conclusion

Offering pregnant individuals with BMI ≥28 kg/m2, a supervised exercise intervention did not improve cardiorespiratory fitness, cardiac function or FMD.

Trial registration number

NCT01243554.

Influence of prenatal aquatic activities on fetal outcomes and maternal physical and mental outcomes: a systematic review and meta-analysis

BACKGROUND

Aquatic activities are becoming increasingly popular as a form of exercise during pregnancy. However, the effects of these activities on the physical and mental health outcomes of pregnant women during and after pregnancy as well as fetal outcomes remain unclear. This meta-analysis evaluated the current evidence regarding the effects of aquatic activities during pregnancy on neonatal and maternal outcomes.

METHODS

Three databases (PubMed, Cochrane Central electronic database, Embase) were searched from inception to July 17, 2024 for randomized controlled trials (RCTs) comparing the effects of aquatic activities versus standard prenatal care or no exercise on neonatal and maternal outcomes. Pooled outcome measures were determined using random-effects models.

RESULTS

Ten RCTs including 1949 patients met the criteria for inclusion in this meta-analysis. The results showed that prenatal aquatic activities could significantly improve maternal weight control (mean difference [MD]= -0.91, 95% confidence interval [CI]= -1.64 to -0.18, P = 0.01, I2 = 0.00%), improve maternal quality of life (standard mean difference [SMD] = 0.16, 95%CI = 0.03 to 0.28, P = 0.01, I2 = 0.00%), and extend fetal birth length (MD = 0.48, 95%CI = 0.10 to 0.87, P = 0.01, I2 = 0.00%) compared with standard prenatal care or no exercise, while no significant differences were observed in fetal birth weight, Apgar score at 1 min, Apgar score at 5 min, pH of umbilical cord blood, gestational age, rate of preterm delivery, incidence of postnatal depression and mode of delivery.

CONCLUSIONS

Prenatal aquatic activities can significantly improve maternal weight control and quality of life during pregnancy, and may promote longer birth length. However, additional studies are needed to confirm these findings.

Impact of an exercise program combined with dietary advice on avoiding insulin prescription in women with gestational diabetes: a randomized controlled trial

OBJECTIVE

To assess the effectiveness of an exercise intervention, in addition to standard care, in preventing or delaying insulin prescription in women with gestational diabetes mellitus (GDM).

DESIGN

Randomised controlled trial.

SETTING

University hospital.

POPULATION

Pregnant women at 25-35 weeks of gestation diagnosed with GDM.

METHODS

Women in the intervention group participated in weekly, supervised, 30-45 min exercise sessions and were encouraged to accumulate more than 5000 steps per day, tracked by a pedometer, in addition to receiving usual care. The control group received standard care only.

MAIN OUTCOME MEASURE

Insulin prescription.

RESULTS

From February 2008 through April 2013, 109 women were randomized into the intervention group (n = 57) or the usual care group (n = 52). Two women in the intervention group were excluded from the analysis (one was randomised in error and one was lost to follow-up). Six women never attended the exercise sessions, and two attended fewer than two sessions. However, two-third of women were considered as compliant to the intervention (attended more than 50% of sessions and/or averaged more than 5000 steps/day). The incidence of insulin prescription did not differ between the groups: 31 women (56%) in the intervention group versus 24 women (46%) in the control group (RR 1.22, 95% CI 0.84 to 1.78). The median time from randomization to insulin prescription was also similar between groups (14 days in the intervention group and 13 days in the control group).

CONCLUSION

This study did not demonstrate that an exercise program reduces or delays insulin prescription in women with GDM. Low adherence to the intervention, a small sample size, and the short duration of the program may explain the lack of observed benefit.

REGISTERED

At clinicaltrials.gov, NCT03174340, 02/06/2017.

A smartphone coaching program ("Bouge Grossesse") improves daily physical activity in pregnant women

BACKGROUND

Physical activity has been shown to reduce obstetrical risks however pregnant women reduce their physical activity and sedentary behaviors increase.

OBJECTIVE

Our aim was to evaluate the impact of a smartphone application developed to increase daily physical activity in pregnant women.

METHODS

We enrolled 250 pregnant women in a prospective randomized controlled study. These women were instructed to download either an intervention application called «Bouge Grossesse» (coaching program and a pedometer; n=125) or a Placebo application (pedometer only; n=125). Primary outcome was defined as a daily increase of 2000 steps/day between day 1 and day 90 or 10 000 steps/week between week 1 and week 12. Data was analyzed with intention to treat. Secondary outcomes were the number of steps at week 12 and the evolution of quality of life measured by WHO score, EIFEL score and SPIEGEL scale, and on maternal and fetal outcomes.

RESULTS

Patients were enrolled between August 2017 and February 2019. They were retrospectively registered after September 2018. We found a significant difference in the primary outcome between the two groups in favor of the intervention group (22.4% success vs 3.2% in the control group, P<.001) but only 43 women in the intervention group (34.4%) and 16 women in the placebo group (12.8%) completed the 12-week coaching program. There were no significant differences in the SPIEGEL, EIFEL and WHO scores. The mean number of daily steps at week 12 was significantly higher in the intervention group (6900.0 vs 4371.9, P<.001).

CONCLUSION

The mobile health intervention « Bouge Grossesse » significantly increased physical activity in pregnant women but we observed a high percentage of withdrawals from the 12-week program.

TRIAL REGISTRATION

This clinical trial was registered under the number NCT03688087 ClinicalTrials.gov.

Trimester-specific association between fetal growth and physical activity in pregnant women: total physical activity vs moderate-to-vigorous exercise

OBJECTIVE

To investigate the trimester-specific associations between maternal total physical activity level vs moderate-to-vigorous exercise and fetal growth disorders.

METHODS

We analyzed 2062 mother-neonate pairs participating in the longitudinal China Medical University Birth Cohort Study. The Pregnancy Physical Activity Questionnaire was used to assess the physical activity level of women during the three trimesters. A higher level of total physical activity was defined as meeting or exceeding the cohort-specific 75th percentile, and a higher level of exercise was defined according to the Physical Activity Guidelines for Americans. Fetal growth disorder was defined as small-for-gestational age (SGA) or large-for-gestational age (LGA) at birth.

RESULTS

Of the neonates included in this study, 7.1% were SGA and 15.5% were LGA. A higher level of total physical activity during the first trimester (adjusted relative risk (aRR), 0.62 (95% CI, 0.42-0.91)) and second trimester (aRR, 0.62 (95% CI, 0.41-0.95)) was associated with a lower risk of SGA, and a higher level of total physical activity during the third trimester was associated with a lower risk of LGA (aRR, 0.73 (95% CI, 0.54-0.97)). When analyzing physical activity by subtype, a higher level of occupational physical activity during the first and second trimesters was associated negatively with SGA risk, and higher levels of occupational and low-intensity physical activity during the first trimester were associated negatively with LGA risk. No significant association was found between maternal adherence to the Physical Activity Guidelines for Americans and risk of fetal growth disorders.

CONCLUSIONS

A higher total physical activity level during the first and second trimesters was associated with a decreased risk of SGA, whereas a higher total physical activity level in the third trimester was associated with a decreased risk of LGA. Pregnant women should be advised to increase their total physical activity levels instead of focusing on engaging in only moderate-to-vigorous exercise. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Optimizing labor duration with pilates: evidence from a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Pilates has captured interest due to its possible advantages during pregnancy and childbirth. Although research indicates that Pilates may reduce labor duration, alleviate pain, and improve satisfaction with the childbirth experience, consensus on these outcomes remains elusive, underscoring the necessity for additional studies.

AIM

This systematic review and meta-analysis aimed to assess the impact of Pilates exercises on labor duration among pregnant women.

METHODS

The online database was searched to yield the literature using the terms of 'Pilates', 'childbirth', and 'labor duration', and similar terms including PubMed, Clinical Key, Scopus, Web of Science, Embase, and Cochrane Database of Systematic Reviews up to June 25, 2023. Studies were considered eligible if they were randomized or clinical controlled trials (RCTs/CCTs) published in English, focusing on healthy pregnant women without exercise contraindications. The studies needed to include interventions involving Pilates or exercise movement techniques, a comparison group with no exercise, and outcomes related to labor duration, the period of the active phase, and the second stage of delivery.

RESULTS

Eleven studies, totalling 1239 participants, were included in the analysis. These studies provided high-quality evidence from exercise only RCTs/CCTs. The findings indicated a significant reduction in the active phase of labor (8 RCTs, n = 1195; Mean Difference [MD] = -56.35, 95% Confidence Interval [CI] [-89.46 to -23.25]) and overall labor duration (8 RCTs, n = 898; MD = -93.93, 95% CI [-138.34 to -49.51]) in pregnant women who engaged in Pilates exercises compared to those who did not but doesn't affect on the duration of the second stage of labor (7 RCTs, n = 1135; MD = -0.11, 95% CI [-7.21 to 6.99]).

CONCLUSIONS

While this review primarily addresses the effects of Pilates on healthy and low-risk pregnant women, the findings suggest a potential role for Pilates in shortening labor duration. Therefore, engaging in Pilates or similar physical activities is recommended for pregnant women to potentially facilitate a more efficient labor process.

Predictors of Pregnancy Disclosure in National Collegiate Athletic Association Division III Athletes

CONTEXT

Pregnant athletes cannot receive proper care if they choose to conceal their pregnancy. Unfortunately, many factors may lead an athlete to conceal. Whereas the extant qualitative literature suggests scholarship and sponsorship are prominent factors in the decision to disclose, this research is limited to elite athletes.

OBJECTIVE

To quantitatively examine predictors of pregnancy disclosure beyond scholarship and sponsorship in National Collegiate Athletic Association Division III college athletes.

DESIGN

Cross-sectional study.

SETTING

Midwestern United States.

PARTICIPANTS OR OTHER PARTICIPANTS

Athletes on Division III women's sports teams (N = 127).

MAIN OUTCOME MEASURE(S)

Confidence in the athletic trainer (AT), perceived training and performance changes, athletic identity, and athletic identity during pregnancy. Two separate multiple regression analyses were conducted with the 4 predictors and 2 outcomes: likelihood to disclose and time to disclosure.

RESULTS

Confidence in the AT and athletic identity during pregnancy were significant predictors in both models, whereas the variable of perceived training and performance changes was only significant in the likelihood to disclose model. Athletic identity was not a significant predictor in either model. Results suggest Division III athletes believe they would be more likely to disclose their pregnancy and may disclose sooner if they feel that their AT can properly manage their physical, emotional, and social wellness during the pregnancy. Additionally, disclosure is promoted if they believe they will still be viewed as athletes by themselves and the people around them.

CONCLUSIONS

These findings emphasize the importance of the role of the AT, with implications that formal education of ATs should include the holistic support of the pregnant athlete.

A Study to Assess the Effectiveness of Honey in the Reduction of Constipation and Insomnia among Antenatal Mothers during the Third Trimester of Pregnancy

A quasi-experimental quantitative approach with pre and posttest design was conducted at urban public health center (UPHC). Forty antenatal mothers were recruited and were separated into two groups in experimental and control groups. In both the groups, a pretest was done by assessing the level of the constipation-by-constipation assessment tool. The experimental group were provided with honey with warm water continuously for six days in the morning and evening as the control group received routine care. Posttest was conducted on the 7th day in both groups using the same scale to assess the level of constipation and insomnia. The study result concluded that calculated independent "t" test value of t = 2.327 was found to be statistically significant at P < 0.01 level with posttest level of constipation and insomnia between the experimental and control group.

Benefits of Resistance Training During Pregnancy for Maternal and Fetal Health: A Brief Overview

Research demonstrates resistance training is not only safe but also beneficial for pregnant women. However, exercise recommendations for pregnant women still minimize the importance of resistance exercise and provide minimal guidance. With a large increase in strength-focused sports among women, it is critical to re-evaluate the risk/benefit ratio of these exercises and ensure the latest recommendations reflect the latest clinical research. The purpose of this review is to highlight the safety and benefits of resistance training for both maternal and fetal health, particularly focusing on recent work. Relevant research involving resistance training during pregnancy was accessed and analyzed via a quasi-systematic search. Results demonstrate that appropriate prenatal resistance training can help alleviate some of the common symptoms of pregnancy, such as fatigue, back pain, and poor mental health. Resistance exercise can assist with glucose control in gestational diabetes mellitus, as well as decrease the risk of infant macrosomia and childhood metabolic dysfunction associated with uncontrolled gestational diabetes. Resistance training can also increase the likelihood of a vaginal delivery, which is beneficial for both mother and baby. Concerning fetal health, resistance training increases uterine blood flow, decreases the risk of neonatal macrosomia, and improves cognitive function and metabolic health in childhood. As with all forms of exercise, pregnant women should avoid resistance exercises that involve the supine position for extended bouts of time, trauma (or risk of trauma) to the abdomen, ballistic movements, movements that rely heavily on balance, and conditions that prohibit appropriate temperature control. With these considerations in mind, resistance training's benefits far surpass the lack of risk to the fetus. Resistance training is a safe and effective way to improve and maintain physical fitness during pregnancy and represents no risk to fetal health and development. Thus, healthcare providers should recommend resistance training for pregnant women.

Development of a physical activity prescription course in a Doctor of Pharmacy program

Pharmacists are increasingly becoming the healthcare professional who interacts most regularly with patients who have diseases or disorders for which exercise is an effective and recommended treatment. With the relative scarcity of clinical exercise physiologists in the United States, pharmacists are expected to provide lifestyle advice to their patients, especially in community (i.e. retail) pharmacy settings, but student pharmacists typically receive no formal or informal training in exercise physiology and prescription. To address this deficit, an elective course was developed to provide student pharmacists with the knowledge and skill set that will enable them to apply evidence-based physical activity guidelines in the pharmacy. The course utilized the Exercise is Medicine resources for chronic diseases and disorders that are routinely encountered in community pharmacies, in addition to analysis of interactions between exercise and medications commonly prescribed for these conditions. After completion of the course, students reported being significantly more comfortable discussing physical activity with their patients compared to the start of the course (P < 0.001). Similarly, at the end of the course, 99% of students reported that they felt confident in their ability to apply evidence-based recommendations of common diseases and disorders to their patients. Postcourse student evaluations clearly demonstrated that student pharmacists viewed the course positively and as essential in their professional training. These data highlight the feasibility and efficacy of improving self-perceptions for the provision of physical activity recommendations via an elective course in physical activity prescription in a Doctor of Pharmacy program.NEW & NOTEWORTHY This study describes a new elective course in physical activity prescription for Doctor of Pharmacy students. After completing the course, students reported improved self-perceptions for the provision of physical activity recommendations. This course fills a gap in pharmacy education and this study provides future directions to improve training in lifestyle modifications.

Anesthetic Challenges in a Pregnancy Case With Congenital Kyphoscoliosis

Kyphoscoliosis is a well-known spinal deformity. The abnormal curvature in both the coronal and sagittal planes presents unique challenges during pregnancy. This case discusses the management of a 27-year-old primigravida with thoracolumbar kyphoscoliosis, who underwent an emergency cesarean section at 39.3 weeks of gestation. An interdisciplinary team consisting of an obstetrician, pulmonologist, orthopedic surgeon, anesthesiologist, and physiotherapist collaborated in her care. In such cases, successful outcomes require a tailored approach that prioritizes maternal-fetal well-being and minimizes potential complications associated with complex spinal deformity during pregnancy and childbirth.

The Impact of Medical Physical Training and a Structured Personalized Exercise Training Program on Hemodynamic Parameters and Arterial Stiffness in Pregnant Women

INTRODUCTION

In developed countries, heart disease is the primary cause of maternal mortality during pregnancy. Arterial stiffness, an independent risk factor for atherosclerosis and a predictor of cardiovascular complications, can be assessed using the augmentation index (AIx) and pulse wave velocity (PWV). In this prospective study, we aimed to evaluate diverse hemodynamic parameters and arterial stiffness in pregnant women before and after participating in a structured, personalized exercise training program.

MATERIALS AND METHODS

Forty healthy pregnant women, non-smokers, who agreed to participate daily for 12 weeks in a physical exercise training program under the supervision of a team made up of an obstetrician, a cardiologist, and a physiotherapist were included. Anthropometric characteristics, arterial function, and physical activity data were collected from the participants at two different time points: at the beginning of the exercise training program (T0) and at the end, after 12 weeks (T1).

RESULTS

Upon conducting a statistical analysis, it was discovered that there were noteworthy disparities (p = 0.05) in body mass index, brachial AIx, systolic blood pressure, and pulse pressure values between the two time points. The regression analysis for the AIx brachial values and the PWVao values from Trim II (T0) and Trim III (T1) showed major differences between these two time points; the association between the AIx brachial values in the second and third trimesters of pregnancy revealed a strong direct significant correlation (p < 0.001), and the correlation between the PWVao values in the second (T0) and third trimester (T1) of pregnancy was weak and insignificant (p = 0.12).

CONCLUSIONS

The findings of our study indicate that a personalized exercise training program positively impacts the physical and psychological well-being of pregnant women, leading to a reduction in PWV.

Assessment of dietary-lifestyle patterns and adherence to the USDA recommendations in Lebanese pregnant women amid the economic crisis: Findings from a national representative cross-sectional study

As Lebanon's economic crisis become uncontrollable, Lebanese pregnant women face malnutrition, with many having to skip meals and switch to resort to cheap and unhealthy alternatives altogether. The objectives of the study were to assess the dietary and lifestyle patterns of Lebanese pregnant women and to evaluate their diets compliance with the United States Department of Agriculture (USDA) pregnancy recommendations, before and during the Lebanese escalating economic crisis. A cross-sectional study was conducted between April 2021 and January 2022. A validated self-administrated questionnaire was administered during the first, second and third trimesters of pregnancy among 363 women in all Lebanese governorates. Most of the pregnant women were free of diseases. While the majority did not smoke, 14.1% smoked hookah / shisha during pregnancy. The adherence to the USDA recommendations in our sample did not significantly vary prior to and throughout the socioeconomic crisis, and it was generally low. Only the mean consumption of vegetables increased during the socioeconomic crisis (p<0.05). Regarding physical activity, while the proportion of active women slightly decreased during the socioeconomic crisis, around 55% were still active. In conclusion, higher attention should be given to the dietary habits and health of this critical population, through effective interventions that increase awareness and achieve measurable improvements.

Navigating the 'new normal': what guidelines exist for postpartum return to physical activity and sport? A scoping review

OBJECTIVE

Women are often advised to return to activity (RTA) as early as 6 weeks postpartum, despite undergoing significant physical, physiological and psychological changes. Our objective was to examine existing evidence and clinical practice guidelines to navigate a safe and successful RTA or return to sport (RTS) postpartum.

METHODS

We searched CINAHL, Embase, Medline, PsycINFO and SPORTDiscus and included any secondary studies with recommendations or guidelines for RTA or RTS postpartum. Grey literature and primary sources were excluded. Four reviewers independently screened titles and abstracts, followed by full-text review for eligibility, with conflicts resolved by a third-party reviewer. One reviewer extracted data, which was cross-referenced by another reviewer.

RESULTS

5851 studies were screened, and 33 were included in this scoping review. Most studies stated that RTS postpartum can begin once 'medically safe', around 6 weeks postpartum, but this term was generally left undefined. In addition, most studies recommended engaging in 150 min of moderate-vigorous physical activity per week after 6 weeks postpartum, but the type of exercise recommended was often non-specific.

CONCLUSION

A lack of consistent, evidence-based guidelines exist for RTA or RTS postpartum. Multiple evidence gaps require additional research to inform patient and activity specific guidelines for a safe and successful RTA or RTS postpartum.

Knowledge, attitude and practice of physical exercises among pregnant women attending prenatal care clinics of public health institutions in Hawassa city, Sidama, Ethiopia, in 2021: descriptive cross-sectional study

BACKGROUND

Participating in physical exercise enhances the physical and mental health of pregnant women. Preventing excessive weight gain, decreasing gestational hypertension, reducing back pain and labor complications are some of the main benefits of physical exercise during pregnancy and childbirth. Scrutinizing factors associated with sedentary life style among women during pregnancy could aid to design effective strategies to tackle the problem. Despite its benefit, little is explored about knowledge, attitude and practice of physical exercise among pregnant women in the study setting.

OBJECTIVE

To assess prevalence of knowledge, attitude and practice of physical exercise among pregnant women who visit antenatal care at public health facilities of Hawassa town, Ethiopia, in 2023.

METHODS

Facility based survey was conducted from November-December, in 2021. Data were collected using interview administered and structured questionnaire. Data were cleaned, coded and entered using Epi-data 4.6 and exported into SPSS 25 for analysis. Descriptive statistics was done using frequency count, percentage and mean values of variables. Finally, findings are presented using text, tables and charts.

RESULTS

All of the study subjects completed interview making a response rate of 100% in this study. The mean adequate knowledge score was 42.2%. Positive attitude towards physical exercise during pregnancy was accounted as 63.7% and proportion of good practice of physical exercise was as 35.8%. Regarding practice of exercise, most (95.9%) of the subjects walk, however; only 11(8.9%) women perform pelvic floor exercise were the highest and least practiced physical exercise. Concerning knowledge of exercise, prevent excess weight 72.1% and increasing energy 53.2% were the commonly known benefits of physical exercise. Breathing difficulty (41.3%), chest pain (39.8%) and premature labor (34.0%) were the predominant perceptions of contra-indication of physical exercise during pregnancy.

CONCLUSIONS

In conclusion, the proportion of knowledge, attitude and practice of antenatal exercise is found to be sub-optimum in the study area. Therefore, health education should be enhanced about the benefit of physical exercise during pregnancy.

Effectiveness of a structured exercise intervention in gestational weight gain in pregnant women with overweight and obesity: A systematic review with meta-analysis

OBJECTIVES

To assess the effectiveness of exercise interventions during pregnancy in managing gestational weight gain (GWG), excessive GWG, gestational diabetes (GD), hypertensive disorders, 2-h post-oral glucose tolerance test (OGTT), and birth weight in pregnant women with overweight/obesity (OW/OB).

METHODS

The search strategy was conducted in five electronic databases, restricting to articles published within the past 10 years. Randomized controlled trials comparing exercise intervention with usual prenatal care in pregnant women with OW/OB were considered. Two reviewers extracted data and assessed the risk of bias using version 2 of the Cochrane risk-of-bias tool for randomized trials and the quality of studies using Grading of Recommendations Assessment, Development and Evaluation classification. Continuous data were calculated as mean differences (MDs) and dichotomous data as risk ratios (RRs).

RESULTS

Seven trials comprising 1648 pregnant women were included. Exercise interventions were associated with lower GWG (MD, -1.19 kg [95% confidence interval, CI, -1.79 to -0.60]) and lower incidence of GD (RR, 0.56 [95% CI, 0.40-0.78]). When analyzing excessive GWG, 2-h post-OGTT, birth weight, and hypertensive disorders, there was no statistically significant difference between the exercise and usual care groups. The strength of evidence was considered moderate.

CONCLUSION

Exercise interventions during pregnancy in women with OW/OB were shown to influence GWG and the incidence of GD.

Prevalence and severity of bowel disorders in the third trimester of pregnancy

BACKGROUND

Bowel-related disorders are common conditions associated with pregnancy and are a cause of significant distress and healthcare burden. However, there is a lack of data in the literature about these disorders.

OBJECTIVE

This study aimed to investigate bowel dysfunctions during the third trimester of pregnancy in a large cohort of women using the validated bowel domain of the Italian version of the Pelvic Floor Questionnaire for Pregnant and Postpartum Women.

STUDY DESIGN

This was a secondary analysis of a multicenter cross-sectional study conducted in hospitals in Italy and Italian-speaking Switzerland. Women in the third trimester of pregnancy were asked to complete the Italian Pelvic Floor Questionnaire for Pregnant and Postpartum Women.

RESULTS

During the study period, 927 pregnant women in the third trimester of pregnancy responded to the questionnaire and were included in the analysis. Overall bowel dysfunctions were reported by 29.6% of patients. Constipation was reported by 66.6% of pregnant women, whereas symptoms of obstructed defecation were reported by 49.9% of patients. In contrast, urgency was reported by 41.1% of patients. Incontinence to flatus and incontinence to stool were reported by 45.1% and 2.8% of patients, respectively. Moreover, age >35 years, familiarity with pelvic floor disorders, nicotine abuse, and pelvic floor contraction inability were identified as independent risk factors for at least 1 bowel symptom.

CONCLUSION

Bowel symptoms are extremely common in the third trimester of pregnancy and can greatly affect a patient's quality of life; therefore, bowel symptoms deserve to be investigated and managed properly. The use of validated questionnaires represents a precious tool to investigate functional symptoms that could be very frequent and disabling in this particular period of life for women.

Physical Activity during Preconception Impacts Some Maternal Outcomes-A Cross-Sectional Study on a Population of Polish Women

BACKGROUND

Physical activity is an element of a healthy lifestyle and is safe in most pregnancies. The aim of this study was to assess the impact of physical activity levels before and during pregnancy on pregnancy outcomes for both the mother and child.

METHODS

A cross-sectional survey was conducted on a population of Polish women. An anonymous questionnaire was distributed electronically via maternity and parental Facebook groups.

RESULTS

The final research group included 961 women. The analysis showed that physical activity 6 months before pregnancy was associated with a lower risk of gestational diabetes mellitus (GDM), but physical activity during pregnancy showed no such association. In all, 37.8% of women with low activity in the first trimester, in comparison to 29.4% of adequately active women, gained an excessive amount of weight during pregnancy (p = 0.0306). The results showed no association between activity level and pregnancy duration, type of delivery or newborn birth weight.

CONCLUSIONS

Our study indicates that physical activity during the preconception period is crucial to GDM occurrence.

Determination of Pregnant Women's Physical Activity and Exercise Status During Pregnancy and Affecting Factors

Objective: This study aims to determine pregnant women's physical activity and exercise status during pregnancy and affecting factors. Methods: The research was conducted in a cross-sectional design with 220 low-risk pregnant women who were in their third trimester between March 3 and June 29 2022 at Training and Research Hospital. Research data were collected by face-to-face interview method using the forms developed by the authors. Results: It was seen that among the pregnant women who participated in the research, 35.9% exercised regularly before pregnancy and 25.9% regularly exercised during pregnancy. The most common exercises performed during pregnancy were walking and pilates. The assessment of the physical activity of pregnant women revealed that 80.5% were sedentary. The rate of exercising during pregnancy was 4.04 times (aOR 4.04, 95% CI 1.33-12.27) higher in women with planned pregnancies compared to unplanned pregnancies and 30.57 times higher in women who exercised regularly before pregnancy compared to those who did not do so (aOR 30.57, 95% CI 12.53-74.55). Likewise, compared to those who were obese during pregnancy, non-obese ones were 0.36 times more physically active (aOR 0.36, 95% CI 0.16-0.84). Similarly, it was established that women who exercised before pregnancy were 10.51 times more physically active than those who did not (aOR 10.51, 95% CI 4.60-24.02). Conclusion: In the research, it was concluded that the rates of exercising and being physically active during pregnancy were low, that planned pregnancy and regular exercise before pregnancy increased exercise behavior during pregnancy, and that obesity decreases physical activity.

The "Mother Load" and Return to Sport: A Case Report of Returning to Professional Netball Following Cesarean Section

Background

Increasing numbers of elite female athletes are competing in professional sport, and many wish to become pregnant and return to competitive sport after childbirth. Athletes have a higher risk of pelvic floor dysfunction (PFD) than non-athletes (54% versus 7%) and there is also an increased prevalence in post-partum women compared to nulliparous women (35% versus 2.8-7.9%). Additionally, PFD has been shown to influence athletic performance. High quality evidence for elite athletes is lacking, and there are no exercise guidelines specifically for these women to prepare or effectively guide their safe return to sport (RTS). The purpose of this case report is to detail the management of an elite athlete who presented following cesarean section (CS) with the goal of RTS within 16 weeks.

Case Description

A 27-year-old primiparous Caucasian professional netballer presented at four weeks post- caesarean section (CS) for RTS screening and assessment of pelvic floor muscle (PFM) function. Assessment included readiness and fear of movement screening, dynamic pelvic floor muscle function, structural integrity of the CS wound, levator hiatal dimensions, bladder neck descent, and early global neuromuscular screening. Measures were collected at four weeks, eight weeks, and six months post-partum. The post-partum athlete demonstrated alterations in pelvic floor muscle function, reduced lower limb power and psychological readiness. A functionally staged dynamic and sport specific pelvic floor muscle training program was implemented and adapted to the patient for her early post-partum timeline.

Results

Rehabilitation strategies were effective in achieving the primary outcome of RTS at 16 weeks post-partum with no adverse events reported at 6 months follow-up.

Discussion

This case highlights the need for a holistic and individualised RTS management approach that includes women's and pelvic health risk factors in a professional athlete.

Level of Evidence

5.

Comparison of the Portuguese Version of the Pregnancy Physical Activity Questionnaire (PPAQ) with Accelerometry for Classifying Physical Activity among Pregnant Women with Obesity

In recent years, the number of pregnant women with obesity has increased exponentially; thus, it is important to evaluate and characterize the physical activity levels of this specific group. The aim of this study is to evaluate the reliability and validity of the Portuguese version of the Physical Activity and Pregnancy Questionnaire and Pregnancy Questionnaire in pregnant women with obesity and to classify physical activity using the Physical Activity and Pregnancy Questionnaire and accelerometry. An analytical observational study was carried out between May and August of 2019 at the University Hospital Center of São João, with a sample of 31 pregnant women with obesity (30.9 ± 4.6 years 36.5 ± 4.6 kg/m2 of BMI and 21.5 ± 9 gestational weeks). The physical activity of participants was evaluated using an accelerometer and Physical Activity and Pregnancy Questionnaire at two time points (the first visit at the moment of consultation and the second seven days after, with accelerometer retest), the interclass correlation coefficient was used to test reliability between the Physical Activity and Pregnancy Questionnaire filled out at visit1 and the Physical Activity and Pregnancy Questionnaire filled out at visit2, and Pearson's correlation was used to determine validity between the Physical Activity and Pregnancy Questionnaire and accelerometry. The interclass correlation coefficient values for total activity were 0.95, 0.97 for moderate and 0.58 for vigorous intensities. It ranged from 0.74 for sports/exercise to 0.96 for domestic activities. The Pearson's correlations showed that the Physical Activity and Pregnancy Questionnaire is moderately valid for moderate intensity (r = 0.435). A total of 67.7% of the pregnant women complied with international physical activity recommendations.

Trimester-specific association of perceived indoor air quality with antenatal depression: China Medical University Birth Cohort Study

Antenatal depression is associated with adverse birth and long-term outcomes for mothers and children. Pregnant women spend 90% of time indoors; however, the association between indoor air quality and risk of antenatal depression has not been established. In this study, we aim to determine the total and trimester-specific association of perceived indoor air quality (PIAQ) with antenatal depression. A total of 2166 pregnant women were enrolled during the first trimester and evaluated during the second and third trimesters in the China Medical University Birth Cohort Study, a prospective pre-birth cohort study in northeastern China. PIAQ scores were obtained during each of three trimesters, which a higher score indicated a worse indoor air quality. Antenatal depression was screened using an Edinburgh Postnatal Depression Scale (EPDS) and defined as an EPDS score ≥ 9. Prevalence of antenatal depression was 26.7%, 20.6%, and 20.9% during the first, second, and third trimesters, respectively. A higher PIAQ score was positively associated with a depression score throughout pregnancy (β = 0.27, 95% CI = 0.15-0.39). Trimester-specific adverse PIAQ exposure was associated with a higher depression score in the same trimester, but not with a higher score in a subsequent trimester. A dose-response pattern and incremental increases in risk of depression were observed with calculated adverse PIAQ exposures across all three trimesters, with the highest risk (OR = 3.24; 95% CI = 2.28-4.78) among women with adverse PIAQ across all three trimesters. The hazardous association between adverse PIAQ exposure and risk of depression were less pronounced among women with higher physical activity levels (P for interaction < 0.001). The results of present study provided important evidence that pregnant women's mental health was linked to indoor air quality during pregnancy. These findings could be helpful in the development of guidelines to prevent antenatal depression by improving indoor air quality.

The effect of a childbirth preparation program including posture correction and stretching movements on lordosis and lumbar pain

AIM

The study aimed at evaluating the effect of posture correction and stretching movements on lordosis and lumbar pain in pregnant women.

BACKGROUND

An increased lumbar lordosis during pregnancy is considered one of the most common causes of lumbar pain.

METHODS

This quasi-experimental study was performed on 66 pregnant women referred to health centers in Tabriz, Iran, from November 2020 to June 2021. The participants were randomly assigned to the intervention and control groups. The intervention group received training of posture correction movements and stretching exercises during pregnancy from 16 to 18 to 35-37 weeks of pregnancy in six sessions for 45-60 min. The data were collected using a flexible ruler and a visual analog scale. Independent t-tests, repeated measures ANOVA, and ANCOVA tests were used.

RESULTS

The mean (standard deviation: SD) of lumbar lordosis increased from 45.12 (2.07) to 54.97 (2.20) in the intervention group at 35-37 weeks and changed from 44.28 (2.03) to 55.54 (3.39) in the control group at 35-37 weeks (adjusted mean difference: -1.24, 95% confidence interval: -2.48 to -0.005, P = 0.04). The mean (SD) of lumbar pain at 28-30 weeks was 2.80 (1.72) in the intervention group and 3.74 (2.23) in the control group (P = 0.09). However, the mean (SD) of lumbar pain at 35-37 weeks in the intervention group 4.38 (2.45) was significantly lower than that in the control group 5.83 (2.96) (P = 0.04).

CONCLUSION

This study provides evidence for the potential health benefits of training posture correction and stretching movements on controlling lumbar lordosis and reducing lumbar pain during pregnancy.

Maximizing Recovery in the Postpartum Period: A Timeline for Rehabilitation from Pregnancy through Return to Sport

Increased participation and duration in sport has become commonplace for women with their involvement often including the transition to motherhood in the peak of their athletic careers. No rehabilitation models that assess the full spectrum of pregnancy to postpartum have been developed for women to assist in safe exercise progressions that reduce postpartum symptoms and optimize performance during the return to full activity. Referral to physical therapy both in the prenatal and postnatal period is currently not considered standard of care to reduce prevalence of symptoms such as musculoskeletal pain, diastasis recti, and pelvic floor dysfunction which may ultimately interfere with physical activity and performance. This commentary presents a timeline and suggested progression for exercise participation to improve awareness of the musculoskeletal changes that occur after labor and delivery. The concepts covered may increase the understanding of how to manage pregnant and postpartum athletes from a musculoskeletal perspective and serve as a starting point for establishing appropriate and guided rehabilitation for safe return to sport after childbirth.

Exercise During Pregnancy: Knowledge and Beliefs Among Females in Saudi Arabia

Background Exercise during pregnancy helps to promote health benefits for both the mother and fetus. One of the concerns among Saudi pregnant women is physical inactivity. The objective of this study was to assess females' knowledge, beliefs, and practices toward exercise during pregnancy in Saudi Arabia. Also, we investigated the most common barriers to exercising during pregnancy. Methods The study was a cross-sectional study that included all Saudi females aged 18 years and above and excluded non-Saudi females and those aged less than 18 years. A self-administered survey was distributed on social media platforms. The collected data were coded and analyzed using SPSS version 23 (IBM Corp., Armonk, NY). Results A total of 1207 participants were enrolled in the study. In regards to general knowledge and awareness levels, 1002 (83%) participants had a high level of knowledge and awareness, and 205 (17%) had a low level of knowledge and awareness. Exercise during pregnancy is essential was agreed on by 853 (70.7%) participants. The most reported sources of information on prenatal exercise were found to be websites, as reported by 56.7% of the participants. About 42.4% of the participants were sometimes exercising during pregnancy. The most common type of antenatal exercise was found to be walking, as mentioned by 83.5% of the participants. The most commonly reported barrier to practicing antenatal exercises was found to be fatigue, as reported by 53.9% of the participants, and lack of time. Age was found to be significantly associated with the level of beliefs, awareness, and knowledge regarding antenatal care. A statistically significant association was found between marital status and level of beliefs, awareness, and knowledge regarding antenatal care with married participants tending to be having a higher level of knowledge and awareness compared to other groups. Occupation and level of beliefs, awareness, and knowledge regarding antenatal care were found to be significantly associated. Conclusion We found good general knowledge and awareness levels regarding exercise during pregnancy. Beliefs toward exercise during pregnancy were below average. Future studies on how to promote regular exercise during pregnancy are recommended.

Therapeutic exercise versus other modalities for prevention and treatment of low back, pelvic girdle, and lumbopelvic pain during pregnancy: A review protocol

Background

The female body changes during pregnancy to create a favorable environment for fetal development which may result in musculoskeletal disorder and painful symptoms in the lumbopelvic region.

Objective

To analyze the evidence of therapeutic exercise versus other modalities to prevent and treat LBP, LGP, and LPP during pregnancy.

Methods

Full text randomized controlled trials (RCT) evaluating interventions to prevent or treat LBP, PGP, and LPP during pregnancy (any gestational age) that comparing therapeutic exercises with usual care or other modalities to reduce the incidence or severity of LBP or PGP or both during pregnancy will be included. 5 electronic databases will be searched to identify studies. Assess risk of bias in each study using the Cochrane Handbook for Systematic Reviews of Interventions and quality of overall body of evidence for all primary outcomes will be assessed for all comparisons using the approach outlined in GRADE Handbook.

A Cross-Sectional Study Examining the Association between Physical Activity and Perinatal Depression

Background and Objectives: International organisations recommend that women without illness should have regular moderate-intensity physical exercise throughout their pregnancy and postpartum period as a measure to prevent possible pathologies in both the mother and the newborn. Physical activity during pregnancy reduces the likelihood of depression during pregnancy and after childbirth, benefiting both the pregnant woman and the foetus. However, most pregnant women are known to be inactive. The Pregnancy Physical Activity Questionnaire (PPAQ) analyses the level of physical activity of pregnant women. These data are correlated with the variable depression, for which the Edinburgh Postnatal Depression Scale (EPDS) during pregnancy was used. Materials and Methods: The research employed a cross sectional study design on ninety-nine pregnant women. Results: The data on physical activity in relation to depression in those pregnant women who had not previously suffered from depression were 719.29 METS min/wk compared with 624.62 METS min/wk in those who had. And for pregnant women who suffered from depression at the time of the study, their physical activity was 698.25 METS min/wk, while those who did not suffer from depression reached 826.57 METS. Conclusions: Pregnant women without depression are much more active. A favourable employment situation or a high level of education is directly related to higher physical activity. Physical activity and higher energy expenditure occur at home, as opposed to activity carried out as transport, exercise or at work.

Sports Obstetrics: Implications of Pregnancy in Elite Sportswomen, a Narrative Review

Increasing numbers of females are participating in elite sports, with a record number having competed at the Tokyo Olympic Games. Importantly, the ages of peak performance and fertility are very likely to coincide; as such, it is inevitable that pregnancy will occur during training and competition. Whilst there is considerable evidence to promote regular exercise in pregnancy, with benefits including a reduction in hypertensive disorders, gestational diabetes, and reduced rates of post-natal depression, few studies have been conducted which include elite athletes. Indeed, there are concerns that high-intensity exercise may lead to increased rates of miscarriage and preterm labour, amongst other pregnancy-related complications. There is minimal guidance on the obstetric management of athletes, and consequently, healthcare professionals frequently adopt a very conservative approach to managing such people. This narrative review summarises the evidence on the antenatal, intrapartum, and postpartum outcomes in elite athletes and provides recommendations for healthcare providers, demonstrating that generally, pregnant athletes can continue their training, with a few notable exceptions. It also summarises the physiological changes that occur in pregnancy and reviews the literature base regarding how these changes may impact performance, with benefits arising from pregnancy-associated cardiovascular adaptations at earlier gestations but later changes causing an increased risk of injury and fatigue.

The Main Changes in Pregnancy—Therapeutic Approach to Musculoskeletal Pain

Background and Objectives: During pregnancy, women undergo various physiological and anatomical changes that are accentuated as the pregnancy progresses, but return to their previous state a few weeks/months after the pregnancy. However, a targeted therapeutic approach is needed. Most of the time, during this period, these changes precipitate the appearance of pain, musculoskeletal pain being the most common. Pregnant women should avoid treating musculoskeletal pain with medication and should choose alternative and complementary methods. Exercise along with rest is the basis for treating chronic musculoskeletal pain. Side effects of physical therapy are rare and, in addition, it is not contraindicated in pregnant women. The benefits of this type of treatment in combating pain far outweigh the risks, being an easy way to improve quality of life. The objective of this article is to discuss the management of musculoskeletal pain during pregnancy, to identify the main musculoskeletal pain encountered in pregnant women along with drug treatment, and to expose the beneficial effects of alternative and complementary methods in combating pain. Materials and Methods: A literature search was conducted using medical databases, including PubMed, Google Scholar, and ScienceDirect, using the keywords “changes of pregnancy”, “musculoskeletal pain”, “pregnancy pain”, “pain management”, “pharmacological approach”, “alternative and complementary treatment” and specific sites. Information was collected from studies whose target population included pregnant women who complained of musculoskeletal pain during the 9 months of pregnancy; pregnant women with other pathologies that could increase their pain were not included in this review. Results: The articles related to the most common non-obstetric musculoskeletal pain in pregnancy along with pharmacological treatment options and alternative and complementary methods for musculoskeletal pain management during pregnancy were selected. Conclusions: The results were used to guide information towards the safest methods of therapy but also to raise awareness of the treatment criteria in order to compare the effectiveness of existing methods. Treatment must consider the implications for the mother and fetus, optimizing non-pharmacological therapeutic options.

The Effect of Core Exercise Using Online Videoconferencing Platform and Offline-Based Intervention in Postpartum Woman with Diastasis Recti Abdominis

To investigate the efficacy of exercise intervention using a real-time video conferencing platform (ZOOM) on inter-recti distance, abdominal muscle thickness, static trunk endurance, and maternal quality of life, 37 women with diastasis recti between six months and one year postpartum were randomly divided into the online (n = 19) and offline (n = 18) groups. The online group underwent 40-min trunk stabilization exercise sessions twice a week for six weeks, through a real-time video conference platform, while the offline group attended the same program in person. The inter-recti distance and muscle thickness between the abdominal muscles were measured by rehabilitation ultrasound imaging, the Torso endurance test was used to compare the static trunk endurance, and the maternal quality of life questionnaire (MAPP-QOL, score) was applied. Significant improvements were observed in the inter-recti distance between the rectus abdominis, abdominal muscle thickness, static trunk endurance, and maternal quality of life in both groups (p < 0.001); a more significant improvement was observed in the offline group. No significant differences were observed between groups except for the left rectus abdominis thickness and Psychological/Baby and Relational/Spouse-Partner subscale in the maternal quality of life index (p > 0.05). Exercise interventions delivered in a real-time videoconferencing platform are effective at improving the inter-recti distance, trunk stability, and quality of life in postpartum women and may be an alternate to face-to-face intervention.

Relationship between physical activity and mental health in women after childbirth: a cross-sectional exploratory study

Background

Physical activity (PA) is recommended for women after childbirth. However, it is unknown whether PA, such as housework and child-rearing, is associated with mental health. This study aimed to measure daily PA in women 2 months postpartum as well as investigate the relationship between daily PA and mental health.

Methods

In this cross-sectional quantitative exploratory study conducted between September 2017 and May 2018, 110 women were approached for participation. Mental health was evaluated using the General Health Questionnaire-28, and PA measurements were performed using accelerometers that the participants wore for 2 days. Welch’s t-test and linear regression analysis were performed to assess the relationship between PA and mental health.

Results

This study included 99 participants. The mean amount of daily activities from housework and child-rearing was 3.21 ± 1.14 metabolic equivalent of tasks (METs)-h/day and that of time spent sitting was at least 7.5 h/12.5 h. PA time spent in light child-rearing and housework activities was significantly longer among multiparous women than among primiparous women (t =  − 3.41). PA time comprising the duration of moderate (3 METs) or more vigorous PA was 73 min/day. No significant relationship between mental health and PA was observed. However, the amount of daily activities tended to increase with an improvement in mental health. The amount of daily activities exceeded 3 METs-h/day regardless of the mental health status.

Conclusions

No significant relationship was found between the amount of daily activities and mental health. The former increased as the latter improved. The amount of daily activities met the standard recommended by the World Health Organization, regardless of the mental health status.

Preconception leisure-time physical activity and family history of stroke and myocardial infarction associate with preterm delivery: findings from a Norwegian cohort

Background

Preterm birth poses short and long-term health consequences for mothers and offspring including cardiovascular disease sequelae. However, studies evaluating preexisting family history of cardiovascular disease and risk factors, such as physical activity, as they relate prospectively to risk of delivering preterm are lacking.

Objectives

To evaluate whether preconception past-year weekly leisure-time physical activity or a family history of stroke or of myocardical infarction prior to age 60 years in first degree relatives associated, prospectively, with preterm delivery.

Design

Cohort study. Baseline data from Cohort Norway (1994–2003) health surveys were linked to the Medical Birth Registry of Norway for identification of all subsequent births (1994–2012). Logistic regression models provided odds ratios (OR) and 95% confidence intervals (CI) for preterm delivery (< 37 weeks gestation); multinomial logistic regression provided OR for early preterm (< 34 weeks) and late preterm (34 through to end of 36 weeks gestation) relative to term deliveries.

Results

Mean (SD) length of time from baseline health survey participation to delivery was 5.6 (3.5) years. A family history of stroke associated with a 62% greater risk for late preterm deliveries (OR 1.62; CI 1.07–2.47), while a family history of myocardial infarction associated with a 66% greater risk of early preterm deliveries (OR 1.66; CI 1.11–2.49). Sensitivity analyses, removing pregnancies complicated by hypertensive disorders of pregnancy, diabetes mellitus, and stillbirth deliveries, gave similar results. Preconception vigorous physical activity of three or more hours relative to less than 1 h per week associated with increased risk of early preterm delivery (OR 1.52; 95% CI 1.01–2.30), but not late or total preterm deliveries. Light physical activity of three or more hours per week relative to less activity prior to pregnancy was not associated with early, late, or total preterm deliveries.

Conclusions

Results suggest that family history of cardiovascular disease may help identify women at risk for preterm delivery. Further, research is needed regarding preconception and very early pregnancy vigorous physical activity and associated risks.

Facilitators, Barriers, and Structural Determinants of Physical Activity in Nulliparous Pregnant Women: A Qualitative Study

Aims & Backgrounds. Reduced physical activity in pregnant women is highly stemmed from their misconceptions and attitudes during pregnancy. This study is aimed at recognizing the facilitators, barriers, and structural factors that influence activity among pregnant women. Participants & Methods. This qualitative study was conducted from January to June 2020 in nulliparous pregnant women. Forty participants selected randomly from the Pounak Health Center of Tehran City, Iran, answered open-ended questions about the obstacles that deprived them of physical activity during pregnancy. Data were analyzed by MAXQDA 12 software. Findings. 620 primary codes, 42 secondary codes, 11 subthemes, and 6 themes were extracted. These themes were divided into the PEN-3 categories: facilitators, barriers, and structural factors. The nurture factors as facilitators had communication and support from others as subthemes. Barriers consisted of sociocultural (participate in pregnancy class with a companion, social beliefs, and culture of poverty), socioeconomic (financial problems), and individual factors (physical, psychoemotional, and spiritual dimensions), and structural factors consisted of environmental (equipment) and organizational (possibilities in health centers) factors. Conclusion. Lack of awareness and misinformation, accessibility obstacles, and economic problems are the worst physical activity barriers during pregnancy. Being among other pregnant women and the physicians' recommendations are the best facilitators of physical activity during pregnancy.

Impact of Hypertensive Disorders of Pregnancy on Stillbirth and Other Perinatal Outcomes: A Multi-Center Retrospective Study

Objective: The aim of the study is to assess the impact of hypertensive disorders of pregnancy on stillbirths and other perinatal outcomes among women in Karachi, Pakistan.

Methodology: This was a retrospective cohort study conducted at two tertiary care hospitals, Aga Khan Hospital (AKU) and Liaquat National Hospital (LNH) in Karachi, Pakistan. The primary outcome variable of this study was stillbirth. Other outcomes assessed in this study included preterm birth, low birth weight, and early neonatal death.

Results: Data of a total of 840 women were included in this study; 280 (33.33%) women had hypertensive disorders of pregnancy and 560 (66.67%) were normotensive. Among women who had hypertensive disorders of pregnancy, the adjusted odds ratio (AOR) of having a stillbirth was two times more than that for normotensive women (AOR=2.62, 95% CI=1.46-4.40), four times for low birth weight (AOR=4.23, 95% CI=2.88-6.20), five times for early neonatal death (AOR=5.03, 95% CI=2.40-10.50) and six times for pre-term birth (AOR=5.16, 95% CI=3.42-7.79).

Conclusion: The current study found that incidence of stillbirth, low birth weight, pre-term birth, and neonatal mortality is higher in mothers with hypertensive disorders of pregnancy than normotensive mothers.

Effectiveness of face-to-face physiotherapy training and education for women who are undergoing elective caesarean section: a randomized controlled trial

BACKGROUND

Caesarean Section (CS) is associated with numerous post-operative problems. The current literature reveals that physiotherapy interventions such as pelvic floor rehabilitation and post-surgical rehabilitation enable enhanced recovery in the post-operative period. The purpose of this study was to investigate the effectiveness of face-to-face physiotherapy training and education prior to elective CS in improving post-operative outcomes.

METHODS

A single blind parallel randomized controlled study was carried out at De Soysa Hospital for Women (DSHW), Colombo. Fifty-four women who were to undergo elective CS were recruited to the study. The women in the intervention group (n = 27) received face-to-face physiotherapy training and education; the control group (n = 27) received only the standard nursing care. Outcome measures such as perception of post-operative pain, dosage of additional analgesics required, pain upon returning to functional activities and lengths of hospital stay were collected. Results were analyzed using IBM SPSS 20 using descriptive statistics and independent samples t-test.

RESULTS

Mean post-operative pain score (control group; 4.2±0.46 vs. intervention group; 1.7±0.7) and doses of additional analgesics required were significantly higher in the control group than that of the intervention group. Pain upon returning to functional activities decreased significantly within 2 days in both groups, and values were lower in the intervention group. The intervention group showed a shorter hospital stay than the control group (control group;3.9 ± 0.3 vs. intervention group;3.00 ± 0.0) (p < 0.05).

CONCLUSIONS

Face-to-face physiotherapy training and education prior to elective CS appears to be a promising intervention to improve the post-operative outcomes by reducing post-operative pain, doses of additional analgesics required, pain upon returning to functional activities and lengths of hospital stay.

TRIAL REGISTRATION

SLCTR/2019/029-APPL/2019/028 ; Registered on 6th of September 2019.

Effect of aerobic exercise on frequency of vaginal birth: A meta-analysis

Background/Aim. Pregnancy is a state where different morphological and physiological changes occur in a pregnant woman's body. There are many factors that have an effect on maintaining a healthy pregnancy. Physical activity is one of the possible factors that can have an impact on the quality of life during pregnancy. Healthy pregnant women, without medical or obstetric complications, are advised to exercise in a moderate and proper manner. The aim of this meta-analysis was to evaluate the impact of continuous aerobic exercise on the frequency of vaginal birth in healthy pregnant women with normal body mass index (BMI) values. Methods. This meta-analysis was based on a systematic review and selection of randomized clinical trials. The affect of physical exercise was assessed using the "RStudio" programming language and environment. Heterogeneity of studies was assessed by Q statistics. Possible publication bias of studies was identified. The primary outcome analysis was related to the frequency of vaginal birth, while the secondary outcome analysis was related to BMI in the first measurement and total weight gain after the second measurement. The suitability of 10 individual studies is shown by graphical and statistical analysis of the extracted data. Results. Physically active pregnant women who exercised with light to moderate intensity 3 times a week (35?60 minutes), had a more frequent vaginal birth than sedentary pregnant women (67.4% vs. 60.5; relative risk (RR) 1.11, 95% confidence interval (CI), 1.04?1.18). RR was statistically significantly different from unit (p = 0.002). All pregnant women had optimal BMI values in the first measurement before intervention. Also, all pregnant women gained the recommended number of kilograms during pregnancy. Conclusion. Analysis of selected individual studies showed that continuous aerobic physical exercise during the second and third trimesters does not have a negative effect on measured outcome of pregnancy. Physically active pregnant women were more likely to give birth vaginally than sedentary pregnant women.

Reconstructing Neanderthal diet: The case for carbohydrates

Evidence for plants rarely survives on Paleolithic sites, while animal bones and biomolecular analyses suggest animal produce was important to hominin populations, leading to the perspective that Neanderthals had a very-high-protein diet. But although individual and short-term survival is possible on a relatively low-carbohydrate diet, populations are unlikely to have thrived and reproduced without plants and the carbohydrates they provide. Today, nutritional guidelines recommend that around half the diet should be carbohydrate, while low intake is considered to compromise physical performance and successful reproduction. This is likely to have been the same for Paleolithic populations, highlighting an anomaly in that the basic physiological recommendations do not match the extensive archaeological evidence. Neanderthals had large, energy-expensive brains and led physically active lifestyles, suggesting that for optimal health they would have required high amounts of carbohydrates. To address this anomaly, we begin by outlining the essential role of carbohydrates in the human reproduction cycle and the brain and the effects on physical performance. We then evaluate the evidence for resource availability and the archaeological evidence for Neanderthal diet and investigate three ways that the anomaly between the archaeological evidence and the hypothetical dietary requirements might be explained. First, Neanderthals may have had an as yet unidentified genetic adaptation to an alternative physiological method to spare blood glucose and glycogen reserves for essential purposes. Second, they may have existed on a less-than-optimum diet and survived rather than thrived. Third, the methods used in dietary reconstruction could mask a complex combination of dietary plant and animal proportions. We end by proposing that analyses of Paleolithic diet and subsistence strategies need to be grounded in the minimum recommendations throughout the life course and that this provides a context for interpretation of the archaeological evidence from the behavioral and environmental perspectives.

Effects of Exercise during Pregnancy on Postpartum Depression: A Systematic Review of Meta-Analyses

Simple Summary

Postpartum depression (PPD) is a public health problem. Exercise is a nonpharmacologic alternative to deal with PPD. This study conducted a systematic review of previous meta-analyses and an exploratory pooled analysis regarding the effects of exercise on depressive symptoms among women during the postpartum period. We searched for previous meta-analyses of experimental studies. Of the 52 records selected, we included five in the analyses, because they were focused on PPD. From the results, it was clear that exercise had a significant but small effect on depressive symptoms. This study shows that exercise is effective in reducing PPD symptoms.

Abstract

Postpartum depression (PPD) is a public health issue. Exercise is a nonpharmacologic alternative to deal with PPD. This study conducted a systematic review of previous meta-analyses and an exploratory pooled analysis regarding the effects of exercise on depressive symptoms among women during the postpartum period. We searched for previous meta-analyses of randomised controlled trials on PubMed, Web of Science and Scopus, date of inception to 31 May 2021. The methodological quality was assessed using the Assessment of Multiple Systematic Reviews 2 (AMSTAR2) instrument. We pooled the standardised mean differences from the selected studies. Of the 52 records screened, five were included. The results revealed a significant moderate effect of exercise on depressive symptoms among women during the postpartum period (SMD = −0.53; 95% CI: −0.80 to −0.27, p < 0.001). The pooled effect of the five meta-analyses established that exercise had a significant, small effect on depressive symptoms (SMD = −0.41; 95% CI: −0.50 to −0.32, p < 0.001). Our study indicates that exercise is effective in reducing PPD symptoms. Compared with traditional control approaches (psychosocial and psychological interventions), exercise seems have a superior effect on PPD symptoms. The implications of the present synthesis of past meta-analytical findings to guide health policies and research are discussed.

The impact of physical activity during pregnancy on labor and delivery

BACKGROUND

Physical activity in pregnancy is associated with decreased risks of adverse pregnancy outcomes such as gestational diabetes and preeclampsia. However, the relationship between the amount and type of physical activity during pregnancy and subsequent labor outcomes remains unclear.

OBJECTIVE

This study aimed to test the hypothesis that higher levels of physical activity across different lifestyle domains in pregnancy are associated with a shorter duration of labor.

STUDY DESIGN

This study is a secondary analysis of a prospective cohort study in which patients with singleton pregnancies without a major fetal anomaly were administered the Kaiser Physical Activity Survey in each trimester. The Kaiser Physical Activity Survey was designed specifically to quantify various types of physical activities in women and includes 4 summative indices-housework/caregiving, active living habits, sports, and occupation. The study included women at full-term gestations admitted for induction of labor or spontaneous labor. The primary outcome of this analysis was duration of the second stage of labor. Secondary outcomes were duration of the active stage, prolonged first and second stage, mode of delivery, rates of second-stage cesarean delivery, operative vaginal delivery, severe perineal lacerations, and postpartum hemorrhage. These outcomes were compared between patients with and without high physical activity levels, defined as overall Kaiser Physical Activity Survey score ≥75th percentile in the third trimester. Multivariable logistic regression was used to adjust for obesity and epidural use. In addition, a subgroup analysis of nulliparous patients was performed.

RESULTS

A total of 811 patients with complete Kaiser Physical Activity Survey data in the third trimester were included in this analysis. The median Kaiser Physical Activity Survey score was 9.5 (8.2-10.8). Of the 811 patients, 203 (25%) had higher levels of physical activity in pregnancy. There was no difference in the duration of the second stage of labor between patients with and without higher physical activity levels (1.29±2.94 vs 0.97±2.08 hours; P=.15). The duration of active labor was significantly shorter in patients with higher levels of physical activity (5.77±4.97 vs 7.43±6.29 hours; P=.01). Patients with higher physical activity levels were significantly less likely to have a prolonged first stage (9.8% vs 19.4%; P<.01; adjusted relative risk, 0.55; 95% confidence interval, 0.34-0.83). However, rates of prolonged second-stage cesarean delivery, operative vaginal deliveries, and perineal lacerations were similar between the 2 groups.

CONCLUSION

Patients who are more physically active during pregnancy have a shorter duration of active labor.

Professional Exercise Recommendations for Healthy Women Who Are Pregnant: A Systematic Review

Background: Exercise in pregnancy favorably affects maternal and fetal outcomes, yet only 50% of women receive exercise guidance during prenatal care and 15% are told to stop exercising. Reasons for clinician reluctance to recommend exercise include safety concerns and ambiguity of recommendations. To better inform clinicians, this systematic review assembled a consensus exercise prescription (ExRx) for healthy pregnant women framed by the Frequency, Intensity, Time, and Type (FITT) principle. Methods: In April 2021, PubMed, Scopus, SPORTDiscus, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Cochrane databases were searched. Reports were eligible if: (1) targeted healthy pregnant women, (2) framed the ExRx by the FITT, and (3) published by a professional society from 2000 to 2021 in English. The Appraisal of Guidelines for Research and Evaluation II tool assessed risk of bias. Results: Twelve reports of poor to good quality were included. Nine societies conducted systematic reviews, but only three provided a detailed, transparent description of the review conducted. Although the FITT varied, the most common was most days of the week, moderate intensity, 30 minutes/session to accumulate 150 minutes/week, and aerobic, resistance, and flexibility exercise with three societies advising neuromotor exercise. All professional societies specified activities to avoid and eight societies included contraindications to exercise. Conclusions: This systematic review produced a consensus ExRx for healthy pregnant women to better inform clinicians about advising their patients to exercise during pregnancy. Future research is needed to determine the upper limits of exercise while pregnant and provide better informed guidance relating to safety concerns for women who are pregnant.