2019 Canadian guideline for physical activity throughout pregnancy

Association between regular physical activity during pregnancy and perinatal outcomes: A population-based cohort study

Introduction

Regular physical activity during pregnancy is associated with several maternal and neonatal health benefits. However, most studies focus on specific forms of exercise in low-risk populations, limiting generalizability.

Objective

To investigate associations between regular physical activity during singleton pregnancy and perinatal outcomes using a national perinatal registry.

Methods

A population-based cohort study was conducted using data from the Slovenian National Perinatal Information System (2013-2022), which included 190,331 singleton pregnancies. Regular physical activity was defined as any form of physical activity at least twice weekly throughout pregnancy. The outcomes analyzed included preterm birth (<37 and <32 weeks), preeclampsia, gestational hypertension, gestational diabetes mellitus (GDM), pelvic girdle pain, small-for-gestational-age (SGA) and large-for-gestational-age (LGA) neonates, cesarean delivery, urinary incontinence postpartum, and Apgar scores < 7 at 5 minutes. Multivariate logistic regression adjusted for parity, maternal age, BMI, prepregnancy hypertension and diabetes, and gestational weight gain.

Results

Regular physical activity during pregnancy was reported by 69 % of the women. It was significantly associated with reduced odds of preterm birth (<37 weeks, aOR 0.658; <32 weeks, aOR 0.393), preeclampsia (aOR 0.719), gestational hypertension (aOR 0.708), pelvic girdle pain (aOR 0.808), SGA (aOR 0.903), LGA (aOR 0.902) and low Apgar scores (aOR 0.638). Physically active women with GDM were less likely to require insulin (aOR 0.768). No significant associations were found with cesarean delivery or urinary incontinence.

Conclusion

Regular physical activity during pregnancy, regardless of specific type, was associated with improved perinatal outcomes without safety concerns. These findings highlight the potential benefits of encouraging physical activity during pregnancy in diverse populations.

Insights Into the Health of Postpartum Airmen From the U.S. Air Force Fitness Database

INTRODUCTION

Physical fitness is an integral part of military readiness, and failure to meet military Physical Fitness Assessment (PFA) standards can severely damage or end careers. Postpartum active duty service members experience a drop in PFA scores and passing rates compared to their pre-pregnancy assessments. Each branch recently extended recovery time to 12 months, but more research is required to see if this change alone is enough to return both active duty and reserve component postpartum personnel to their own preconception PFA outcomes (scores, passing rates, and injury rates) and those of a control group of nullpartum female airmen.

MATERIALS AND METHODS

The Air Force Fitness Management System II database contains PFA records including demographic data and PFA outcomes among airmen from the total force: active duty, Air Force Reserve (AFR), and Air National Guard (ANG). We extracted data from 2015 to 2019 for three successive PFAs per individual, consisting of 12,971 records for perinatal Airmen and 308,155 records for nulliparous female airmen. We calculated overall PFA scores, passing rates, and exemption rates for active duty and AFR/ANG postpartum and nullpartum airmen, and then performed regressions to determine if differences between these groups persisted when accounting for demographic and prior physical fitness variables.

RESULTS

Although 92% of postpartum airmen scored high enough to pass the PFA, their scores decreased from pretest scores by a larger margin than those for nullpartum airmen. Out of a possible 100 points, postpartum AFR/ANG members' scores decreased more (-4.5 points) than active duty scores (-2.8 points), while nullpartum members' scores decreased by -0.4 and -0.7, respectively. Nullpartum passing rates remained stable but decreased for both active duty and AFR/ANG postpartum airmen (-4% and -8%). Active duty postpartum airmen experienced a larger increase in component exemptions, which may indicate injury, (+8%) than nullpartum female airmen (+6%). These results were maintained when we controlled for age, officer status, previous pregnancies, and prior physical fitness. Compared with active duty nullpartum female airmen, active duty and AFR/ANG postpartum women had lower scores (-3.23, -6.79), and more than twice the odds of failure (2.44 and 5.42 times higher). AFR/ANG generally are less than half as likely to have a component exemption, but active duty postpartum airmen had 29% higher odds of having a component exemption than nullpartum active duty airmen.

CONCLUSION

Even with a 12-month recovery period, postpartum airmen fare worse on all PFA outcome dimensions studied compared to nulliparous airmen and with preconception selves. Perinatal airmen with more experience, education, and access to resources have better PFA outcomes. The U.S. Air Force should consider a comprehensive maternal wellness program including physical fitness programming and medical preventative health accessible to total force perinatal airmen. This would increase operational readiness, retainability, and well-being while decreasing musculoskeletal injuries and associated medical costs.

Exceeding the guidelines: A descriptive study of exercise, pregnancy, maternal and neonatal health outcomes in elite and recreational athletes

BACKGROUND

Exercise during pregnancy is associated with numerous health benefits. However, guidelines for elite and recreational athletes, who often exceed general recommendations regarding intensity, duration, and frequency are lacking, and potential risks remain unclear. The aim of the study was to describe exercise levels, pregnancy, and maternal and neonatal health outcomes in elite and recreational athletes.

METHOD

This study was part of the Strong Mama research project, which was carried out in Oslo, Norway, between October 2022 and February 2024. Sixty athletes (10 elite and 50 recreational) participated in the study. They completed an online survey during late pregnancy and participated in a structured telephone interview six weeks postpartum. The survey and interview collected data on exercise habits, pregnancy experiences, and maternal and neonatal health outcomes.

RESULTS

The athletes maintained high exercise levels during pregnancy, with elite athletes exercising an average of 11.6 h per week (SD 3.2) and recreational athletes exercising 7.0 h per week (SD 2.4). Most athletes resumed exercising within six weeks postpartum. Almost all pregnancies were planned, including six which involved fertility treatment. Most women (76.7%) had spontaneous onset of labor and vaginal deliveries to term (between 36 and 42 weeks). The mean birthweight was 3487 (SD 519.4, range 2600-4775) grams. Two of the elite athletes were diagnosed with gestational diabetes mellitus and two with hypertension during pregnancy. None of the 50 recreational athletes reported any pregnancy complications.

CONCLUSION

High levels of exercise during pregnancy did not seem to negatively impact maternal or neonatal health in this descriptive sample of Norwegian elite and recreational athletes. However, more research is needed to confirm these findings.

The Impact of Overweight and Obesity on Pregnancy: A Narrative Review of Physiological Consequences, Risks and Challenges in Prenatal Care, and Early Intervention Strategies

BACKGROUND

While substantial literature exists on the intersection of overweight/obesity (OWO) and pregnancy, much of it focuses on specific aspects, making it difficult to maintain an overview of clinically relevant factors for optimal care of OWO women throughout pregnancy.

OBJECTIVES

To provide a comprehensive synthesis of the existing literature, covering the full spectrum of clinically relevant information needed to manage OWO women from preconception to birth.

METHODS

For this narrative review a literature search was conducted on PubMed in January 2025. Eligible studies included full-text English articles with data from human subjects, with no restrictions on publication date.

FINDINGS

The impact of OWO on pregnancy is multifaceted, encompassing four interrelated themes: physiological consequences, emerging risks, challenges in prenatal care, and intervention strategies. OWO women exhibit differences in metabolic and inflammatory pathways compared to normal-weight women, reflected in altered laboratory tests. When managing gestational diabetes and preeclampsia, obesity-related characteristics must be considered. Clinicians need to be alert of obesity-mediated fetal complications, including overgrowth, malformations, stillbirth, and preterm birth, while navigating challenges in ultrasound measurements. Interventions during the preconception and prenatal periods provide key opportunities to optimize maternal weight and reduce the risk of long-term disease development.

CONCLUSION

The review's insights enhance clinical practice and call on researchers and policymakers to prioritize strategies that offer early counseling for obese pregnant women. These initiatives aim to optimize outcomes for both mother and child and contribute to combating the global obesity crisis.

Effects of strength training on quality of life in pregnant women: A systematic review

INTRODUCTION

Physical activity is known to improve physical and psychological outcomes in pregnant women. While aerobic exercise is typically emphasized in physical activity guidelines for pregnant women, emerging research suggests that strength training may offer unique benefits beyond those provided by aerobic exercise alone. This systematic review aimed to systematically explore the effects and characteristics of strength training interventions on the health-related quality of life of pregnant women, with the goal of informing more comprehensive and specific exercise guidelines.

MATERIAL AND METHODS

A systematic literature search was conducted across PubMed, Web of Science, and EBSCO Host databases without time restrictions, following PRISMA guidelines (PROSPERO ID: CRD42024511477). Nine randomized controlled trials met the inclusion criteria, involving a total of 1581 participants.

RESULTS

The studies reviewed demonstrated that strength training during pregnancy can mitigate excessive weight gain, alleviate low back and sciatic pain, enhance mood, and improve various aspects of health-related quality of life. These aspects include physical activity levels, muscular strength, flexibility, sleep quality, energy expenditure, and psychological well-being.

CONCLUSIONS

Despite these promising findings, this review highlights the need for standardized methodologies and detailed reporting in future research. Incorporating strength training into general exercise recommendations for pregnant women has the potential to optimize maternal health outcomes such as muscle strength, weight gain, physical activity levels, low back pain, pelvic pain, fatigue, anxiety, energy levels, vitality, sleep duration, and health status.

Physical activity (PA) during pregnancy in Greece

OBJECTIVE

To evaluate the amount and types of physical activity (PA) performed by Greek women during pregnancy and assess the validity and reliability of the Greek version of the Pregnancy Physical Activity Questionnaire (PPAQ).

STUDY DESIGN

This prospective study comprised two stages. The first stage was the completion of the PPAQ Greek version twice, with a one-week interval between the two rounds, to assess internal consistency and reproductivity. The validity was evaluated by comparing the PPAQ results with data from smartwatches that recorded step counts and metabolic equivalent tasks (METs). The second stage included pregnant women from various regions of Greece that completed the PPAQ once during their pregnancy. The level of PA during pregnancy and consistency with the international PA recommendations was evaluated with the use of METs.

RESULTS

A total of 1058 pregnant women filled the PPAQ Greek version, while eighteen women randomly participated in the reliability and validity analyses of the PPAQ. Results from the PPAQ completed one week apart showed strong agreement (Intraclass Correlation Coefficient [ICC]: 0.82-0.96). A comparison between the PPAQ results and smartwatch data revealed no significant differences in PA levels (correlation coefficient: 0.542; p = 0.022). The median total PA for all the participants was 142.1 MET-hours/week (interquartile range: 106.04 MET-hours/week). PA levels increased with advancing gestation in sports/exercise (1st vs. 2nd trimester, p = 0.048; 2nd vs. 3rd trimester, p < 0.001), occupational activities (1st vs. 3rd trimester, p < 0.001; 2nd vs. 3rd trimester, p = 0.024), and transportation activities (1st vs. 3rd trimester, p < 0.001; 2nd vs. 3rd trimester, p < 0.001). Moderate-to-vigorous intensity activities also increased with gestational age (p = 0.023, 95 % confidence interval [CI]: 0.1-1.4; p = 0.045, 95 % CI: 0-0.08, respectively). Women were more active in household/caregiving activities across all trimesters (p = 0.017; 95 % CI: 0.09-0.95). Women with higher educational levels were more likely to engage in sports/exercise (p = 0.039, 95 % CI: -3.3 to -0.08) and had higher overall PA levels (p = 0.029, 95 % CI: 0.37-6.3). However, only 14.8 % of the participants met the international PA recommendations for pregnancy.

CONCLUSION

The Greek version of the PPAQ is a reliable tool for assessing PA in pregnant Greek women. Higher educational levels and advanced gestational age were found to be associated with increased PA levels. However, only a small proportion of pregnant Greek women met the international PA recommendations, highlighting the need for targeted interventions.

Impact of postpartum physical activity on maternal anthropometrics: a systematic review and meta-analysis

OBJECTIVE

This systematic review and meta-analysis examined the relationship between postpartum exercise and maternal postpartum anthropometrics.

DESIGN

Systematic review with random-effects meta-analysis and meta-regression.

STUDY ELIGIBILITY CRITERIA

Online databases were searched from database inception until 12 January 2024. Randomised controlled trials (RCTs) written in any language were eligible if they contained information on the population (postpartum women and people); intervention (frequency, intensity, duration, volume or type of exercise, alone ('exercise-only') or in combination with other interventions (eg, dietary; 'exercise+cointervention')); comparator (no exercise) and outcomes (anthropometric measures including weight, postpartum weight retention (PPWR), body mass index (BMI), fat mass, lean body mass (LBM), body fat percentage, waist circumference, hip circumference or waist-hip ratio).

RESULTS

64 RCTs (n=12 684 participants) from 20 countries were included. Moderate to high certainty of evidence showed that exercise-only interventions reduced weight by 1.34 kg (18 studies, n=771; 95% CI -2.06 to -0.61, I2 0%), BMI by 0.73 kg/m2 (14 studies, n=662; 95% CI -1.21 to -0.25, I2 60%) and fat mass by 1.55 kg (5 studies, n=135; 95% CI -3.01 to -0.09, I2 0%) compared with no exercise. The duration of the exercise interventions ranged from 3 months to 3 years. Dose-response analysis found 560 MET-min/week of exercise (eg, 120 min/week of brisk walking) was associated with 1 kg/m2 reduction in BMI. Low certainty of evidence showed that exercise-only interventions had no effect on LBM (5 RCTs, n=135; standardised mean difference -0.13; 95% CI -0.48, 0.21, I2 0%) compared with no exercise.

CONCLUSIONS

These findings highlight physical activity as an effective intervention to improve postpartum anthropometrics and reduce PPWR.

PROSPERO REGISTRATION NUMBER

CRD42022359282.

Impact of postpartum physical activity on maternal depression and anxiety: a systematic review and meta-analysis

OBJECTIVE

To examine the influence of postpartum exercise on maternal depression and anxiety.

DESIGN

Systematic review with random effects meta-analysis and meta-regression.

DATA SOURCES

Online databases up to 12 January 2024, reference lists, recommended studies and hand searches.

ELIGIBILITY CRITERIA

Randomised controlled trials (RCTs) and non-randomised interventions of any publication date or language were included if they contained information on the Population (postpartum people), Intervention (subjective or objective measures of frequency, intensity, duration, volume, type, or mode of delivery of exercise), Comparator (no exercise or different exercise measures), and Outcome (postpartum depression, anxiety prevalence, and/or symptom severity).

RESULTS

A total of 35 studies (n=4072) were included. Moderate certainty evidence from RCTs showed that exercise-only interventions reduced the severity of postpartum depressive symptoms (19 RCTs, n=1778, SMD: -0.52, 95% CI -0.80 to -0.24, I2=86%, moderate effect size) and anxiety symptoms (2 RCTs, n=513, SMD: -0.25, 95% CI -0.43 to -0.08, I2=0%, small effect size), and the odds of postpartum depression by 45% (4 RCTs, n=303 OR 0.55, 95% CI 0.32 to 0.95, I2=0%) compared with no exercise. No included studies assessed the impact of postpartum exercise on the odds of postpartum anxiety. To achieve at least a moderate reduction in the severity of postpartum depressive symptoms, postpartum individuals needed to accumulate at least 350 MET-min/week of exercise (eg, 80 min of moderate intensity exercise such as brisk walking, water aerobics, stationary cycling or resistance training).

CONCLUSIONS

Postpartum exercise reduced the severity of depressive and anxiety symptoms and the odds of postpartum depression.

"It's More than Just Exercise": Psychosocial Experiences of Women in the Conscious 9 Months Specifically Designed Prenatal Exercise Programme-A Qualitative Study

Background/Objectives: Physical activity during pregnancy is recognised for its benefits to maternal and foetal health. However, adherence to prenatal exercise programmes is often low due to psychological, physical, and social barriers. This study explored the experiences of women who successfully completed a tailored prenatal exercise programme, "Conscious 9 Months", aiming to identify factors enabling adherence and providing recommendations for future programme development. Methods: A descriptive qualitative research design was employed using semi-structured, in-depth interviews with ten participants who completed the programme between 2017 and 2019. Thematic Analysis was conducted to explore their experiences. Results: Participants emphasised the transformative nature of the programme, which extended far beyond physical exercise. Three interconnected domains emerged: psychosocial, physical, and psychoeducational. The present article focuses on the psychosocial domain, highlighting the significance of exercising in a group of pregnant women as a key source of support. Additionally, the atmosphere played a crucial role in facilitating the participants' regular attendance. Finally, the findings indicate that the programme fostered lasting social connections that extended beyond its formal completion. Conclusions: A holistic approach that integrates physical activity with social and emotional support can foster a sense of community and enhance long-term adherence. The design of future programmes should prioritise small group sizes to facilitate peer support and create a safe and welcoming atmosphere to encourage emotional expression. Additionally, sustained engagement beyond pregnancy through follow-up initiatives, family involvement, and postnatal movement programmes can further reinforce long-term participation and promote lasting health benefits for both mothers and their children.

Psychometric properties of the Chinese version of the Get Active Questionnaire for Pregnancy and its companion form to assess physical activity readiness

INTRODUCTION

Engaging in physical activity is essential for a healthy pregnancy. A reliable tool is necessary to enhance the assessment and counseling of safe physical activity. This study aimed to translate the original English Get Active Questionnaire for Pregnancy (GAQ-P) and its companion Health Care Provider Consultation Form for Prenatal Physical Activity (cHCP-CF-PPA) into simplified Chinese language and evaluate the psychometric properties in Chinese pregnant women.

METHODS

The Brislin's model of translation was employed to translate the GAQ-P/cHCP-CF-PPA tool. We conducted a cross-sectional study at a tertiary women's hospital in Shanghai, China, enrolling a convenience sample of 325 pregnant women across all trimesters to evaluate the psychometric properties of the GAQ-P/cHCP-CF-PPA. Reliability was assessed through test-retest reliability and inter-rater reliability, while validity was examined using content validity, known-groups validity, and criterion validity. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated using PARmed-X for Pregnancy as the gold standard.

RESULTS

Regarding content validity, the GAQ-P had an average S-CVI/UA of 0.81 (I-CVIs: 0.83-1.0), while the cHCP-CF-PPA exhibited an average S-CVI/UA of 0.87 (I-CVIs: 0.83-1.0). The GAQ-P/cHCP-CF-PPA scores effectively distinguished women recommended for physical activity from those with contraindications. The Spearman's correlations between the GAQ-P/cHCP-CF-PPA and the PARmed-X for Pregnancy were 0.851 for absolute contraindications and 0.847 for relative contraindications. The test-retest reliability score was 0.759 for physical activity contraindications, and 0.953 for inter-rater reliability. The sensitivity of the GAQ-P/cHCP-CF-PPA was determined to be 90.00%, with a specificity of 98.31%. The positive predictive value was 78.26%, while the negative predictive value reached 99.32%.

CONCLUSION

The Chinese version of the GAQ-P/cHCP-CF-PPA is a reliable and valid tool for assessing physical activity readiness in pregnant women.

Associations between vaping during pregnancy and perinatal outcomes: A systematic review and meta-analysis

Despite numerous studies linking prenatal vaping to adverse perinatal outcomes, a systematic assessment for critical comparison remains absent. To investigate these associations, we conducted a systematic search of studies assessing perinatal outcomes in mothers and/or neonates exposed to vaping during pregnancy compared to those in women without prenatal vaping exposure through MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library, PROSPERO, and Google Scholar until July 5, 2024. We performed inverse-variance random-effects meta-analyses for maternal and neonatal outcomes of 23 studies with a total of 924,376 participants with 7552 reporting vaping-only use during pregnancy. Prenatal vaping was associated with 53 % higher odds of an adverse maternal outcome (OR: 1.53; 95 % CI: 1.27-1.85; I2 = 80 %), particularly with decreased breastfeeding (OR: 0.53; 95 % CI: 0.38-0.72; I2 = 45 %) and reduced prevalence of adequate prenatal care (OR: 0.69; 95 % CI: 0.56-0.86; I2 = 82 %). Prenatal vaping was also associated with a similarly 53 % higher odds of an adverse neonatal outcome (OR: 1.53; 95 % CI: 1.34-1.76; I2 = 45 %), such as low birth weight (OR: 1.56; 95 % CI: 1.28-1.93; I2: 15 %), preterm birth (OR: 1.49; 955 CI: 1.27-1.76; I2: 0 %), and small for gestational age (OR: 1.48; 955 CI: 1.16-1.89; I2: 70 %). This is the first comprehensive systematic review and meta-analysis demonstrating vaping during pregnancy as a risk factor for increased odds of both maternal and neonatal outcomes and underscores the urgency to address awareness and regulations of vaping and its potential harms to both humans and the environment. REGISTRATION: PROSPERO CRD42023446266.

Retrospective Analysis of Balance Parameters in Pregnant Women: A Sub-Analysis of a Randomized Controlled Trial

Objectives: Altered body biomechanics during pregnancy can lead to balance impairments and an increased risk of falls. Clinical exercise interventions can help regulate these biomechanical changes. Methods: A total of 101 pregnant participants (exercise group: n = 50; control group: n = 51) were retrospectively analyzed over an 8-week follow-up period. Single-leg balance parameters, including AP sway, ML sway, total body sway, OSD, and center of pressure velocity and acceleration, were assessed considering limb dominance. Measurements were taken at baseline and week 8. Repeated-measures ANOVA was used to analyze time-group interactions, with significance set at p < 0.001. The biomechanical impacts of participant height and body mass on center of pressure dynamics were also considered. Results: The exercise group (EG) demonstrated significant improvements in all balance parameters compared to the control group (CG) (p < 0.001), except for non-dominant anterior-posterior (AP) sway (p = 0.512). In the EG, medio-lateral (ML) and AP sway of the non-dominant limb were minimized, whereas these parameters were significantly increased in the CG. Although both groups exhibited an increased one-leg stance duration (OSD), the improvement was more pronounced in the EG. The controlled improvements observed in the EG suggest a protective effect of exercise on balance, particularly in the dominant limb. Conclusions: Clinical exercise interventions during pregnancy enhance balance parameters, reduce fall risk, and improve functional mobility. These findings suggest that structured exercise programs not only support maternal well-being but also improve reactive balance control. Given the biomechanical changes throughout pregnancy, future studies should examine the center of pressure velocity, acceleration, and the influence of maternal anthropometrics on postural stability to refine exercise recommendations.

Exercise in early pregnancy among women with migraine: A hospital-based cross-sectional study

OBJECTIVE

Migraine is one of the most common pain disorders among women of childbearing age. While medical treatment might be necessary for some during pregnancy, non-pharmacological approaches, such as exercise, are generally recommended. We aimed to assess the association between migraine and exercise behaviours, adherence to the national recommendations for exercise, and the type of exercise undertaken during early pregnancy within a cohort of Danish women.

METHODS

We performed a cross-sectional study using patient-reported questionnaire data from The Copenhagen Pregnancy Cohort (2013-2019). Logistic regression analyses were applied to assess associations between migraine and the selected outcomes, with adjustment for relevant confounders.

RESULTS

We included 24,017 pregnancies. Women with migraine were more likely to refrain from exercise in early pregnancy compared to those without (46.4% vs 40.8%) (aOR 1.26, 95% CI 1.12-1.41). Additionally, they were more likely not to meet the national recommendations for exercise (62.9% vs 57.8%), (aOR 1.27, 95% CI 1.13-1.42). The differences were consistent among women with migraine with aura (MA) and migraine without aura (MO), respectively. Women with and without migraine participated in similar types of exercise during early pregnancy.

CONCLUSIONS

Our findings indicate that women with migraine were less likely to engage in exercise and to adhere to the national recommendations of exercise, compared to those without. Findings were similar for women with MA and MO. The types of exercise performed did not differ between groups.

Maternal exercise programs placental miR-495-5p-mediated Snx7 expression and kynurenic acid metabolic pathway induced by prenatal high-fat diet: Based on miRNA-seq, transcriptomics, and metabolomics

Poor intrauterine environments increase the prevalence of chronic metabolic diseases in offspring, whereas maternal exercise is an effective measure to break this vicious intergenerational cycle. Placenta is increasingly being studied to explore its role in maternal-fetal metabolic cross-talk. The association between placental miRNA and offspring development trajectories has been established, yet the specific role and mechanism thereof in maternal exercise-induced metabolic protection remain elusive. Here, C57BL/6 female mice were subjected to either a normal control or a high-fat diet (HFD), half of the HFD-fed dams were housed with voluntary wheel running for 3 weeks before and during gestation. At embryonic day 18.5, we sacrificed parturient mice and then conducted miRNA-seq, transcriptomic, and metabolomic profiling of the placenta. Our data revealed that maternal HFD resulted in significant alterations in both miRNA and gene expressions, as well as metabolic pathways of the placenta, whereas prenatal exercise negated these perturbations. The common differentially expressed transcripts among three groups were enriched in multiple critical pathways involving energy expenditure, signal transduction, and fetal development. Through integrated analysis of multiomics data, we speculated that maternal exercise reversed the suppression of miR-495-5p induced by HFD, thereby inhibiting miR-495-5p-targeted Snx7 and modulating kynurenic acid production. These datasets provided novel mechanistic insight into how maternal exercise positively affects the metabolic homeostasis of offspring. The discovered important miRNAs, mRNAs, and metabolites could be promising predictive and therapeutic targets for protecting offspring metabolic health.

Association of physical activity during pregnancy with labor and delivery in nulliparous patients

Background

Physical activity during pregnancy is a positive behavior for improving pregnancy outcomes, yet the relationship between physical activity during pregnancy and labor is still debated.

Objective

This study aimed to test our hypothesis that a higher level of physical activity during pregnancy is associated with a shorter labor duration.

Study design

This was a prospective cohort study of pregnant women with singleton pregnancies and no contraindications to physical activity during pregnancy. physical activity according to type and intensity were evaluated with the Chinese version of the Pregnancy Physical Activity Questionnaire. This questionnaire categorizes physical activities into different types and intensities and quantifies them. The primary study outcome was labor duration. The secondary outcomes were delivery mode, conversion from vaginal delivery to cesarean section, prolonged second stage of labor, perineal tears, episiotomy, and postpartum hemorrhage within 24 hours. Generalized additive models were used to identify both linear and nonlinear relationships between physical activity during pregnancy and labor. A segmented linear model was employed to calculate the saturation effect. Stratified logistic regression was used for subgroup analysis.

Results

In total, 226 women participated in the physical activity survey during pregnancy and gave birth at our hospital. The energy expenditure of physical activity during pregnancy was 145.70 (111.92, 181.69) weekly energy expenditure (MET-h•wk-1). After full adjustment for covariates, a nonlinear relationship was observed between physical activity during pregnancy and the duration of the first stage of labor. Different correlations were observed when the energy expenditure of physical activity during pregnancy was 142.28 MET-h•wk-1. In the two-part regression model, the inflection point of physical activity during pregnancy was at 142.28 MET-h•wk-1. When the energy expenditure of physical activity during pregnancy exceeded 142.28 MET-h•wk-1, each standard deviation increase in physical activity was associated with a decrease of 149.85 minutes in the duration of the first stage of labor (β:-149.85, 95 % CI: -247.54 to -52.17, P = 0.0080).

Conclusions

A nonlinear relationship between physical activity during pregnancy and duration of the first stage of labor ha been identified.When physical activity exceeds 142.28 MET-h•wk-1, each additional standard deviation reduces the first stage of labor by 149.85 minutes. Physical activity is not limited to exercise programs; daily activities such as cleaning, shopping, and walking to and from work are effective ways to increase energy expenditure and help individuals achieve the recommended level of physical activity.

Physical activity during pregnancy: key beliefs to support intervention

Background

Physical activity (PA) provides maternal and fetal health benefits, but only 27.5% of Canadian pregnant women meet PA recommendations. Theory-based interventions like the theory of planned behavior (TPB) are useful in explaining what drives behavior. The first objective of this study was to validate the TPB model to predict prenatal moderate-to-vigorous physical activity (MVPA), including testing of the novel interaction between intention and perceived behavioral control (PBC). The second objective was to identify which specific beliefs predict intention toward prenatal MVPA to support intervention.

Method

We used a prospective correlational design. Healthy pregnant women completed two electronic questionnaires: at baseline, to assess TPB constructs, and one month later, to assess MVPA practice. Structural equation modeling was conducted with Latent Moderated Structural Equations. The interaction was interpreted with the pick-a-point method and the Johnson-Neyman graphical method.

Results

The sample consists of 193 women (M age = 31.2±3.6). Results indicate that prenatal MVPA at one month was marginally predicted by intention (β = 0.149; p < 0.10) and PBC (β = 0.322; p < 0.05, MVPA R 2 = 20%), but when their interaction was added to the model, MVPA R 2 increased to 44%. Specifically, the relationship between intention and MVPA is stronger when PBC is high (0.5 standard deviation over the mean). In the full model including the interaction, attitude (β = 0.59; p < 0.001), subjective norm (β = 0.20; p < 0.01) and PBC (β = 0.26; p < 0.05) all made a significant contribution to predicting MVPA intention (R 2  = 88%). Finally, the following beliefs displayed significant indirect paths toward the intention of being physically active: behavioral beliefs: unlikely to be more tired and likely feel better mentally; normative beliefs: approval from friends and from mother/father; and control beliefs: being tired and missing social support.

Conclusion

Interventions aiming to promote regular MVPA during pregnancy should prioritized the six significant beliefs identified to significantly predict intention toward prenatal MVPA.

2025 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

BACKGROUND

The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2025 AHA Statistical Update is the product of a full year's worth of effort in 2024 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. This year's edition includes a continued focus on health equity across several key domains and enhanced global data that reflect improved methods and incorporation of ≈3000 new data sources since last year's Statistical Update.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Mediating role of fall fear and exercise self-efficacy in the nexus between low back pain knowledge and kinesiophobia in pregnancy-related low back pain pregnant women

To explore relationships among low back pain knowledge, fall fear, exercise self-efficacy and kinesiophobia in pregnant women with pregnancy-related low back pain (PLBP) through a chain mediating model. This study used a cross-sectional survey and utilized convenience sampling from August to December 2023 at a third-class hospital in Wuxi, China. A total of 325 PLBP pregnant women were chosen as the subjects of this study. Sociodemographics and information about low back pain knowledge, low back pain knowledge, fall fear, exercise self-efficacy, and kinesiophobia were collected. Path analysis was used to analyze the cross-sectional data. The results of this study found that low back pain knowledge can directly affect kinesiophobia (β = -0.489, p < 0.001). Fall fear and exercise self-efficacy play a significant mediating role between low back pain knowledge and kinesiophobia, with an overall mediating effect value of 0.202. After including fall fear and exercise self-efficacy, the direct effect value of low back pain knowledge on kinesiophobia was - 0.287. Low back pain knowledge in PLBP pregnant women can significantly and negatively predict their kinesiophobia. Between low back pain knowledge and kinesiophobia, there was not only an independent mediating effect of fall fear and exercise self-efficacy but also a chain mediating effect.

Factors influencing childbirth self-efficacy and vaginal delivery rates in Chongqing: An observational study

This study aims to investigate the current status of childbirth self-efficacy among pregnant women in Chongqing Municipality, analyze the factors affecting childbirth self-efficacy, and provide relevant measures and evidence to improve childbirth self-efficacy and increase the rate of natural vaginal deliveries among pregnant women. This observational study employed a questionnaire survey method, involving 1142 pregnant women who underwent prenatal examinations at 6 hospitals in Chongqing in February 2023. Participants accessed the "Wen-Juan-Xing" app by scanning a QR code to fill out the questionnaire. Of the 1142 questionnaires distributed, 1086 were returned as valid, yielding a valid rate of 95.10%. The mean score on the Chinese Childbirth Self-Efficacy Inventory was 241.86 ± 60.25, while the mean score on the Perceived Social Support Scale among pregnant women was 67.05 ± 11.84. Planning for vaginal delivery and engaging in recommended prenatal exercises were identified as positive influencing factors for childbirth self-efficacy. Furthermore, a positive correlation was observed between childbirth self-efficacy and social support among pregnant women (P < .05). Engaging in recommending prenatal exercise and increasing social support among pregnant women can enhance their childbirth self-efficacy and promote a higher rate of natural vaginal childbirth.

Physical activity and heat stress shape water needs in pregnant endurance athletes

Background and objectives

Pregnancy, heat stress, and physical activity (PA) are all known to independently increase human water requirements. We hypothesize that climate conditions and behavioral strategies interact to shape water needs in highly active pregnancies.

Methodology

We recruited 20 female endurance runners who were pregnant (8-16 weeks gestational age; n = 13) or planning to be pregnant (n = 7) for an observational, prospective cohort study. At three timepoints in the study (preconception, 8-16 weeks, and 32-35 weeks), we measured water turnover (WT) using the deuterium dilution and elimination technique, PA using ActiGraph wGT3X-BT accelerometers, and heat index (HI) using historical temperature and humidity data. We also compared athletes to nonathletes from a previously published study.

Results

Athletes maintained high WT from preconception through the end of pregnancy. PA was positively associated with WT among athletes for preconception and early pregnancy time periods but not for the third trimester. HI weakly moderated the relationship between PA and WT in predicting a more positive slope in hotter and more humid weather conditions. WT in athletes was higher than in nonathletes, but this difference attenuated during the third trimester, as nonathletes increased their WT.

Conclusions and implications

Athletes experience higher WT with greater levels of PA, and this relationship is somewhat stronger in higher HI conditions. With the threat of climate change expected to exacerbate extreme heat conditions, evidence-based, global policies are required for particularly vulnerable populations.

Maternal and fetal responses to acute high-intensity resistance exercise during pregnancy

OBJECTIVE

To examine maternal and fetal cardiovascular responses to high-intensity resistance exercise in pregnancy.

METHODS

10 healthy pregnant (26.4±3.2 weeks gestation) and 10 healthy non-pregnant individuals were recruited (34.8±6 and 33.5±2.9 years, respectively). At least 48 hours after baseline strength testing to determine 10-repetition maximum (10 RM), participants completed 10 repetitions of barbell back squat, bench press and deadlift at 70%, 80% and 90% of 10 RM with free breathing, followed by 10 repetitions at 90% 10 RM with a Valsalva manoeuvre. Maternal heart rate was monitored continuously. Fetal heart rate, umbilical systolic/diastolic (S/D) ratio, resistive index (RI) and pulsatility index (PI), as well as maternal blood pressure, glucose and lactate were assessed immediately before and after exercise.

RESULTS

The amount of weight lifted and the rate of perceived exertion by pregnant and non-pregnant participants were similar throughout each exercise. Maternal heart rate increased with the amount of weight lifted, peaking with the use of the Valsalva manoeuvre (squat: 137.3±8.4 bpm; bench press: 110.5±10.4 bpm; deadlift: 130.7±9.0 bpm). Fetal bradycardia was not observed, and fetal heart rate did not change from pre-to-post exercise (squat: p=0.639; bench press: p=0.682; deadlift: p=0.847). Umbilical blood flow metrics, such as RI, remained within normal ranges throughout each set of squats (p=0.642), bench press (p=0.287) and deadlifts (p=0.614).

CONCLUSION

Our findings suggest that high-intensity resistance exercises are well tolerated by both mother and fetus, including while using the Valsalva manoeuvre.

Patterns of physical activity, sedentary behavior, and sleep across pregnancy before and during two COVID pandemic years

BACKGROUND

Physical activity is recommended during pregnancy, and high sedentary behavior and poor sleep may increase the risk of pregnancy complications. Activity patterns and sleep were negatively impacted by the COVID pandemic in many segments of the population, but the impact of the pandemic on pregnant people is understudied. We aimed to compare patterns of physical activity, sedentary time, and sleep during pregnancy between a pre-COVID and a COVID-era cohort.

METHODS

Physical activity, sedentary time, and sleep in each trimester of pregnancy were compared between two parallel prospective observational cohorts using identical collection methods. Pre-COVID participants (n=111) were recruited in 2017-2019 and COVID-era participants (n=117) from 2021-2023. Physical activity and sedentary time were measured using the activPAL3 micro accelerometer, and sleep duration was self-reported. Between-cohort comparisons were conducted using linear regression for each behavior in each trimester. Within-COVID-era cohort linear regression analyses assessed whether activity patterns differed as pandemic-era restrictions were eased.

RESULTS

Participant demographics were similar between cohorts except for self-reported income. Adjusted mean moderate-to-vigorous physical activity was 57-77 min/week higher in each trimester in pre-COVID compared to COVID-era participants (p<0.001); adjusted mean sedentary time was 0.77-1.13 hours/day lower in each trimester (p<0.01) and sleep duration was 0.8 hours/day lower in the third trimester in the pre-COVID compared to COVID-era cohort (p<0.05). Within the COVID-era cohort, no significant within-trimester differences were detected across the pandemic years.

CONCLUSIONS

Pregnant participants during the COVID pandemic were less active and more sedentary than their pre-pandemic counterparts, and this trend was still detected years after the pandemic began. A more sedentary lifestyle during pregnancy may have health implications, and prenatal care providers should help pregnant people identify strategies to adopt an active lifestyle in the context of pandemic-era barriers.

The physical activity and sedentary behavior among pregnant women in Macao: A cross-sectional study

OBJECTIVE

The current investigation sought to elucidate the prevalence and contributing factors of sedentary behavior among pregnant women in Macao, a densely populated region characterized by a distinctive fusion of Eastern and Western cultures and a thriving global economy.

METHODS

Through a cross-sectional study design, a total of 306 expectant mothers were recruited via various social media platforms and completed a sociodemographic questionnaire alongside the Chinese version of the Pregnancy Physical Activity Questionnaire.

RESULTS

The findings revealed that sedentary activities accounted for a relatively small proportion (7.8%) of the participants' total activity energy expenditure. Interestingly, employment status emerged as a significant determinant, with employed pregnant women exhibiting a 57.9% lower risk of being sedentary compared to their unemployed counterparts. Moreover, multiparous women (those with two or more children) were approximately 9 times more likely to meet moderate-intensity activity standards than nulliparous women.

CONCLUSION

These insights highlight the importance of tailoring physical activity interventions to address the specific needs and challenges faced by primiparous women and those who are unemployed during pregnancy, with a view to enhancing education on the potential hazards associated with sedentary habits and promoting active lifestyles within this unique sociocultural context.

A systematic review of the clinical practice guidelines for the assessment, management and treatment of eating disorders during the perinatal period

BACKGROUND

Eating disorders during the perinatal period can pose significant risks to both the mother and the baby. Clinical practice guidelines include statements of expected practice intending to improve effectiveness and quality of care within health care services. This systematic review aimed to identify and synthesise current clinical practice guideline recommendations on the assessment, management and treatment of eating disorders during the perinatal period.

METHODS

Three bibliographic databases and five guideline repository databases were searched alongside the grey literature. Guidelines were screened against eligibility criteria and recommendations for the assessment, management or treatment of eating disorders during the perinatal period were extracted. All included guidelines were assessed for quality using the AGREE-II tool. Recommendations were analysed and summarised using narrative synthesis.

RESULTS

From the 242 records screened, 17 met inclusion criteria. Guideline quality ranged from three out of seven to seven out of seven. Six overall recommendations were formed from the narrative synthesis of data: 1) Early detection: recognising the signs and symptoms, 2) Assessment and screening: a three-pronged approach, 3) Educating and supporting the mother: the importance of knowledge, 4) Cross-system collaboration, 5) Psychological, pharmacological and medical treatment, and 6) Continued monitoring.

CONCLUSION

Perinatal eating disorder guideline recommendations were fairly consistent but showed considerable variability in quality and depth of recommendations. Recommendations require further contextualisation, to allow them to be operationalised and implemented within services. The review findings provide an initial framework for health care professionals responsible for supporting women with eating disorders during the perinatal period, and have several implications for policy, service delivery and health outcomes for women and their families.

The effects of dance on maternal childbirth: a systematic review and meta-analysis

BACKGROUND

Previous guidelines have clearly stated that dance is safe and beneficial during pregnancy and for childbirth. However, due to the small sample size of individual studies and different interventions, there were inconsistencies about the effect of dance on maternal childbirth.

METHODS

We included studies evaluating the effect of dance on women in labor. Risk of bias was assessed using the revised Risk of bias assessment tool for randomized controlled trials (RCTs). Data analyses was performed using Review Manager Software version 5.4.

RESULTS

A total of 12 RCTs comprising 1,486 pregnant women were included in the analysis. We found that the rate of natural childbirth and satisfaction with delivery were higher in the dance group than in the control group.The pain at 30 min and at 60 min after the intervention were lower in the dance group than in the control group. Meanwhile, the duration of the first stage, the second stage and the total labor duration was shorter in the dance group than in the control group.However, there were no statistically significant differences in the pain at 90 min after intervention, the duration of the third stage, and the rate of the normal 1-minute Apgar scores > 7 points between the two groups.

CONCLUSIONS

Dance during labor could reduce labor pain to an extent, shorten the duration of labor, promote natural childbirth, and improve satisfaction with labor, with no adverse effects on neonatal outcomes.

TRIAL REGISTRATION

The protocol for this review was prospectively registered in the international prospective register of systematic reviews (PROSPERO) under the registration number CRD42022351001.

Enhancing physical activity during pregnancy using a multi-theory model: a study protocol for a randomised controlled trial in China

BACKGROUND

Physical inactivity is a global concern and poses serious health risks. Physical inactivity is exacerbated and affects the health of both generations during the special period of pregnancy. Appropriate physical activity (PA) intervention programmes based on health behaviour change theory are lacking. This study aims to evaluate the effectiveness of a PA intervention based on the multi-theory model (MTM) by assessing changes in PA levels, MTM constructs, exercise self-efficacy, quality of life, prenatal depressive symptoms, gestational weight gain and pregnancy and delivery outcomes.

METHODS AND ANALYSIS

This single-centre, parallel, randomised, controlled trial will be conducted at a tertiary care institution in Hangzhou, China. A total of 72 pregnant women without contraindications to exercise at 14-27 weeks+6 days of gestation will be included. Participants will be randomly assigned to either the intervention or control group. The intervention group will engage in a 12 week PA intervention programme based on the MTM and delivered through WeChat, while the control group will receive standard antenatal care. Data will be collected at baseline, 6 weeks of the intervention, 12 weeks of the intervention and within 1 week of delivery. The primary outcomes will include PA levels measured by accelerometers and the PA in Pregnancy Questionnaire, along with the constructs of the MTM. Secondary outcomes will comprise exercise self-efficacy during pregnancy, quality of life, prenatal depressive symptoms, gestation weight gain and pregnancy and delivery outcomes. Data analysis will adhere to the Consolidated Standards of Reporting Trials 2010 statement and follow the intention-to-treat principle.

ETHICS AND DISSEMINATION

The study followed the ethical guidelines approved by the ethics committee of Women's Hospital School of Medicine Zhejiang University (IRB-20230254-R, Approval Date: 27 July 2023). The results of the study will be submitted for publication and dissemination in a peer-reviewed journal. Participants will receive clarification regarding the study objectives, procedures and will be asked to sign informed consent in written form before the start of the study.

TRIAL REGISTRATION NUMBER

ChiCTR2400080843. Prospectively registered on 8 February 2024.

Effects of exercise on vascular remodelling and fetal growth in uncomplicated and abortion-prone mouse pregnancies

Studies in humans and rodents show exercise in pregnancy can modulate maternal blood pressure, vascular volume, and placental efficiency, but whether exercise affects early uteroplacental vascular adaptations is unknown. To investigate this, CBA/J female mice mated with BALB/c males to generate healthy uncomplicated pregnancies (BALB/c-mated) or mated with DBA/2J males to generate abortion-prone pregnancies (DBA/2J-mated), were subjected to treadmill exercise (5 days/week, 10 m/min, 30 min/day for 6 weeks before and throughout pregnancy), or remained sedentary. In uncomplicated pregnancies, exercise caused symmetric fetal growth restriction in fetuses evidenced by reductions in fetal weight, crown-to-rump length, abdominal girth and biparietal diameter. Placental insufficiency was indicated by reduced fetal: placental weight ratio and increased glycogen cell content in the junctional zone of placentas of exercised BALB/c-mated mice on gestational day (GD)18.5. In abortion-prone pregnancy, exercise increased placental efficiency, but the number of late-pregnancy resorptions were elevated. Effects of paternal genotype independent of exercise were evidenced by a greater number of resorptions, poorer spiral artery remodelling, and larger placentas in the DBA/2J-mated compared to BALB/c-mated mice. Effects of exercise independent of paternal genotype included increased implantation sites at both mid and late pregnancy, accompanied by decreased junctional zone areas of placentas. Our findings show that exercise before and during pregnancy in mice can have different effects on fetal outcomes, depending on the paternal and/or fetal genotype. This suggests that the underlying mechanisms are responsive to fetal cues.

The Effect of Clinical Exercise Training on Plantar Pressure, the Subtalar Joint, and the Gait Cycle in Pregnant Women: Randomized Clinical Trial

Background/Objectives: This study aims to examine the effects of clinical exercise training on foot plantar pressure, the subtalar joint, and the gait cycle during pregnancy. Methods: The study was planned as a randomized, controlled, and single-blind study. Participants' demographic information, obstetric evaluation, physical activity level, fall history, and pain evaluation were recorded. Foot plantar pressure, the subtalar joint, and the gait cycle were measured through pedobarography at Gait Laboratory. The control group was recommended walking. Clinical exercise training was given to the study group 2 days a week for eight weeks. Evaluations were made on day 0 and the day corresponding to the end of week 8. Results: The study was completed with 50 people in the study group (age: 29.7 ± 3.8 years) and 51 in the control group (age: 29.1 ± 6.1 years). As a result of the parametric and non-parametric tests performed before and after the exercise, it was observed that there was a statistically significant difference between the two groups in weight, BMI, pain score, static plantar pressure, dynamic plantar pressure, subtalar joint flexibility, duration of the walking period, and multistep walking speed (p < 0.01). The two groups had a significant difference only in the dominant midfoot plantar pressure (p > 0.05). Conclusions: According to our research, weight control and pain relief are observed in women who engage in clinical exercise in the second trimester of pregnancy; plantar pressure and subtalar joint flexibility are preserved, the walking period does not increase, and the multistep walking speed can be maintained after eight weeks.

Physical Activity and Weight Gain During Pregnancy: Is This Association Modified by Sleep?

Objective To evaluate the cross-sectional association of physical activity during pregnancy with gestational weight gain and verify if associations are modified by levels of sleep duration and efficiency. Methods: Mothers who were participants of the 2015 Pelotas (Brazil) Birth Cohort study were analyzed. Physical activity (PA) and sleep were measured using the nondominant wrist accelerometer model wGT3X-BT (ActiGraph, Pensacola, FL). Moderate-to-vigorous activities were measured in bouts of 5 minutes (MVPA 5-min bout). Activities were characterized as sustained and overall physical activity was expressed in mg, and MVPA (non-bouted) activities were characterized as not sustained. Sleep was presented as minute bouts, sleep time window, total sleep time, and sleep efficiency. Gestational weight gain (GWG) was calculated by a woman's weight at the end of gestation minus the pre-pregnancy weight. Linear regression models were used to evaluate the association between PA and GWG. Stratification by sleep characteristics in tertiles was performed. Results: The analytical sample included 1,938 women with information for PA, sleep, and GWG. The mean GWG was 12,030 g (SD = 6658.8). After adjustments, for every 15 minutes of sustained physical activity (MVPA 5-min bout), the GWG decreased by 591.3 g [β= -591.3 (95%CI: -1,147.1; -35.5). A statistically significant association was observed between 15 minutes of sustained physical activity (MVPA 5-min bout) and GWG in the second and third tertiles of healthier sleep efficiency. Conclusion: MVPA with 5-min bouts is associated with lower GWG. The GWG reduction was greater in the higher sleep efficiency strata.

Effects of a behavioral intervention on physical activity, diet, and health-related quality of life in postpartum women with elevated weight: results of the HIPP randomized controlled trial

BACKGROUND

Approaches to improve physical activity (PA), diet, and health-related quality of life (HRQOL) during postpartum in diverse women with elevated weight are needed.

METHODS

Health In Pregnancy and Postpartum (HIPP) was a randomized controlled trial that followed African American and white women with overweight or obesity from pregnancy through 12 months postpartum. Participants were randomized to a behavioral intervention grounded in social cognitive theory (n = 112) or standard care (n = 107). From enrollment (≤ 18 weeks gestation) through 6 months postpartum, the intervention group received two in-depth counseling sessions (one each during pregnancy and postpartum), counseling calls, behavioral podcasts, and access to a private Facebook group, while the standard care group received monthly mailings and podcasts focused on healthy pregnancy and infant development. PA (SenseWear armband), diet (ASA24), and HRQOL (SF-12) measurements were obtained from blinded assessors at baseline and 6- and 12-months postpartum. Linear or quantile regression models, depending on conformity to normality assumptions, were used to test differences between behavioral intervention and standard groups in PA outcomes (minutes/day of total PA, light PA, and moderate-to-vigorous intensity PA (MVPA), and total steps/day), dietary outcomes (diet quality and six measures of dietary intake), and HRQOL at 6- and 12-months postpartum, controlling for baseline values, race, parity, weight status, education, maternal age, gestational age, and caloric intake (for most diet models).

RESULTS

There were no statistically significant differences by group for any PA, diet, or HRQOL outcomes at 6 or 12 months postpartum. Irrespective of group assignment, all PA outcomes improved from pregnancy to postpartum, as did kcals and the mental component of HRQOL. Furthermore, while not statistically significant, virtually all PA outcomes, except MVPA at 12 months, and several dietary outcomes, including diet quality, had patterns favoring the intervention group but with small effect sizes.

CONCLUSIONS

Postpartum PA, diet, and HRQOL did not differ significantly between women in the behavioral intervention group and those in the standard care group. Given the increased responsibilities and stress that women face during the postpartum period, this appears to be a challenging time to make lifestyle changes.

TRIAL REGISTRATION

This trial was registered at ClinicalTrials.gov on 10/09/2014. Identifier: NCT02260518.

Barriers and Facilitators of Physical Activity in Pregnancy and Postpartum Among Iranian Women: A Scoping Review

Inactivity during pregnancy and postpartum is largely a result of women's attitudes and misunderstandings of physical activity, especially in Iran. This scoping review critically assesses the barriers and facilitators influencing physical activity among pregnant and postpartum Iranian women to provide the basis for future physical activity interventions. Ten databases and platforms were searched up to 1 June 2024: Medline, SportDISCUS, PsycINFO, EMBASE, CINAHL, Cochrane Review Database, Clinical Trial, SID, ISC, and Web of Science. Grey literature sources were included to retrieve original publications on barriers and facilitators during pregnancy and postpartum among Iranian women. The search resulted in 2470 identified studies screened for inclusion criteria. After screening both abstracts and full texts, 33 of the studies were included, and data were extracted and charted. Findings were summarized in alignment with the objectives. The results show that the basic physical activity barriers are intrapersonal, interpersonal, and environmental factors. Facilitating factors include using E-learning resources and combined interventions to educate women and provide awareness of the existence of exercise classes. Social and emotional support by family members and other women in the same situation can be effective. Overall, the study of obstacles to and enablers of physical activity during pregnancy and postpartum is ongoing. In addition to highlighting the present situation in Iran, this study identifies further opportunities for future research on the development of appropriate interventions to reduce the barriers and strengthen the facilitators for physical activity among pregnant and postpartum Iranian women with trained groups, including skilled healthcare providers.

Effects of different physical exercise types on health outcomes of individuals with hypertensive disorders of pregnancy: a prospective randomized controlled clinical study

OBJECTIVE

To explore the impacts of different types of physical exercise on health outcomes of individuals with hypertensive disorders of pregnancy (HDPs).

METHODS

Forty individuals with HDPs admitted to a tertiary hospital providing maternal and pediatric care between July 2023 and March 2024 were enrolled in this prospective randomized controlled clinical study and completed a ≥4-week intervention. Data were collected before the intervention and before delivery. Participants were assigned randomly to control (no exercise intervention), aerobic exercise (AE), resistance training (RT), and AE + RT groups. All participants downloaded a mobile health-education app for gestational hypertension developed by our research group. Exercise videos in the app guided participants' performance of different types of exercise. General information; physical activity and sleep quality data; morning blood pressure, lipid profiles, and urinary micro-albumin/creatinine ratios; serum soluble fms-like tyrosine kinase 1 (sFlt-1), placental growth factor (PlGF), and advanced oxidation protein product (AOPP) concentrations; and pregnancy outcome data were collected and compared among groups.

RESULTS

After the intervention, the physical activity status, sleep quality, morning blood pressure, lipid profiles, urinary micro-albumin/creatinine ratios, and pregnancy outcomes differed significantly among all groups comparing with control (all p < .05). In the three exercise groups, the serum sFlt-1, PlGF, and AOPPs levels improved significantly (all p < .05). All differences were most pronounced in the AE + RT group.

LIMITATIONS

The study period was relatively short. The further long-term follow-up research is needed. A larger sample size study is also needed.

CONCLUSIONS

The study results suggest that AE + RT interventions are beneficial for individuals with HDPs in clinical settings, and could be implemented with careful consideration of individuals' specific conditions.

Stable pelvic floor muscle training improves urinary incontinence in women with gestational diabetes mellitus

BACKGROUND

Gestational diabetes mellitus (GDM) is a common metabolic disease that contributes to urinary incontinence (UI) in pregnant women. The aim of this study was to investigate the therapeutic potential of stable pelvic floor muscle (PFM) training with transverse abdominal muscle for pregnancy-specific UI in patients with GDM.

METHODS

This was a randomised controlled trial. A total of 73 pregnant women with GDM and pregnancy-specific UI were screened, 35 of whom received stable PFM training with transverse abdominal muscle in the second trimester. After six weeks of training, UI status was assessed by the quantity of fluid loss and the International Consultation on Incontinence Questionnaire short form (ICI-Q-SF), and the quality of life was evaluated by the Incontinence Quality of Life Questionnaire score. Additionally, the thickness of the transverse abdominal muscle was measured by ultrasonography.

RESULTS

At 6 weeks later, the quantity of fluid loss and ICI-Q-SF score were significantly lower, and the overall healing rate was significantly higher in the training group than those in the control group. The training also significantly improved the quality of life, especially in terms of behavioural limitation and psychosocial impact. Additionally, the thickness of transverse abdominal muscle under the status of maximal contractions of transverse abdominal muscle and PFM was significantly higher in the training group than in the control group after 6 weeks.

CONCLUSIONS

Stable PMF training with transverse abdominal muscle alleviated UI and improved the quality of life in patients with GDM. The thickening of transverse abdominal muscle induced by the training contributes to the remission of UI through the cooperation of PMF.

Running for two (or three!): the journey of an ultramarathoner across two pregnancies

There is a lack of evidence regarding the safety of long-duration and vigorous-intensity physical activity during pregnancy, such as that required during an ultramarathon. This case study is the first to examine the training, performance, health, and delivery outcomes for an ultramarathoner across two successive pregnancies (one twin and one singleton) that were delivered when the athlete was 41 and 43 yr, respectively. During her twin pregnancy, she ran an average of 91.72 ± 23.17 km across 9.06 ± 2.38 h/wk. Both twins were normal for gestational age and delivered at 37 wk. Twin 2 experienced mild hypoxic-ischemic encephalopathy but made a full recovery following treatment. Twin pregnancy increases the risk of this complication, and there is no evidence to suggest that it is associated with vigorous-intensity endurance activity. During her singleton pregnancy, the participant's distance and pace increased, running on average 157.80 ± 14.69 km across 14.08 ± 1.60 h/wk. She also competed in five races including three ultramarathons and ranked well, with no adverse events during or following each of the races. She delivered prematurely (36 wk and 6 days), but her baby was normal for gestational age.NEW & NOTEWORTHY This study provides the first description of a pregnant female ultramarathoner's training patterns, performance outcomes, and health and birthing outcomes across two pregnancies.

An Explanatory Model of Weight Management Behaviors During Pregnancy: A Cross-sectional Study

PURPOSE

This study aims to create and validate a model explaining gestational weight gain and management behaviors using Ajzen's Theory of Planned Behavior, assessing the model's fit with actual data and examining the influences of various factors.

METHODS

Employing a correlational research design, data were collected and analyzed from 396 primigravida who were at least 36 weeks and agreed to participate in the study from April 15, 2022, to August 15, 2022, through an online questionnaire. SPSS 26.0 was used to analyze the general characteristics of participants, descriptive statistics of variables, reliability of tools, and correlation of variables. AMOS 28.0 was used to verify the hypothesis and to assess the fitness of hypothetical models.

RESULTS

The modified model fitness was χ2/df = 3.29, goodness-of-fit index = .93, standardized root-mean-square residual = .06, root- mean -square error of approximation = .08, comparative fit index = .92, Tucker-Lewis index = .88, PNFI = .62. All hypotheses were statistically significant. The more positive attitude toward weight management behaviors (β = .52, p < .001), the higher perceived behavioral control (β = .21, p = .011) and subjective norms (β = .31, p = .034) were shown to have a significant effect on weight management behavioral intentions. They explained 77% of the variance in weight management behavioral intention. Weight management intentions (β = .63, p < .001) and perceived behavioral control (β = .52, p = .003) significantly influenced weight management behaviors, explaining 79% of the behavior variance. Enhanced weight management behaviors significantly reduced gestational weight gain accounting for 31% of the variance in gestational weight gain (β = -.56, p < .001).

CONCLUSION

Establishing a nursing intervention strategy that addresses attitude, subjective norms, and perceived behavioral control is crucial as these factors enhance weight management intentions and behaviors, thereby facilitating appropriate gestational weight gain and reducing pregnancy complications.

Barriers, attitudes and perceptions to physical activity among pregnant women in Ibadan, Nigeria and the associated factors: a mixed method study

BACKGROUND

Physical activity has several health benefits during pregnancy. However, it remains low among pregnant women because of various barriers. This study assessed the attitude, perception, barriers to physical activity during pregnancy and the associated factors.

METHOD

We conducted a cross-sectional study using a sequential explanatory mixed method among 465 pregnant women attending antenatal care from four healthcare facilities in Ibadan, Nigeria. Data was collected using a pretested interviewer-administered questionnaire, and we conducted four focus group discussions. Using the Barriers to Physical Activity during Pregnancy Scale questionnaire, we assessed the barriers based on the socioecological theory. The explanatory variables included sociodemographic characteristics, obstetric factors, past obstetric history and physical activity-related issues. Data were analysed using univariate and bivariate methods (independent T-tests and ANOVA), and multiple linear regression was at 5% significance. We applied thematic content analysis to qualitative data.

RESULTS

The mean age of the participants was 29.22 + 5.01 years. The mean ± SD of the total physical activity barrier score (PABS) was 85.35 ± 22.82. The PABS for the subscales were intrapersonal barriers (34.46 ± 8.79), non-pregnancy intrapersonal barriers (14.47 ± 5.67), and interpersonal barriers (11.67 ± 4.25), environmental, political and organisational barriers (24.766 ± 8.82). The significant relationships between the total score of physical activity barriers and religion (p < 0.030), education (p < 0.000), complaints in pregnancy (p < 0.043), antenatal admission in the hospital (p < 0.004), physical activity advice (p < 0.018), pre-pregnancy physical activity (p < 0.000). Factors associated with physical activity barrier score were maternal education: adjusted β: - 15.26, 95% CI: - 27.83; - 2.69; p = 0.017, antenatal admission adjusted β: 12.20, 95% CI 3.74; 20.67, p = 0.005 pre-pregnancy physical activity: adjusted β: - 12.27, 95% CI - 1.6.5; - 7.99, p = 0.001. Significant themes that emerged in the perception of pregnant women towards physical activity are understanding physical activity, personal experience of physical activity, barriers experienced by pregnant women, the role of support, perceived benefits, and information from health care workers.

CONCLUSION

Our study showed that pregnant women attending antenatal clinics in Ibadan, Nigeria, face various barriers to physical activity during pregnancy. Using the socioecological framework, the most commonly reported barriers by our respondents were intrapersonal and environmental barriers. Sociodemographic characteristics, pre-pregnancy physical activity, and antenatal admission were significant factors associated with the total barrier scores of respondents. Healthcare professionals should be trained in promoting physical activity during pregnancy. Tailored interventions are necessary to promote physical activity among pregnant women in Nigeria, including the training of health workers.

The development of multidisciplinary convalescence recommendations after childbirth: a modified Delphi study

BACKGROUND

Evidence suggests that postpartum recovery takes longer than 6 weeks. However, evidence-based recommendations regarding postpartum recovery are lacking. Current research mainly focuses on shortening hospital stay after childbirth, neglecting outpatient recovery.

OBJECTIVE

This study aimed to develop multidisciplinary recommendations on convalescence after vaginal and cesarean delivery using a modified Delphi method to improve recovery after childbirth.

STUDY DESIGN

Multidisciplinary experts employed in different medical organizations involved in care and guidance of patients during postpartum recovery participated in the study. The panel included 16 experts (5 gynecologists, 2 senior residents, 4 midwives, 2 maternity nurses, 2 general practitioners, and 1 pelvic floor physical therapist) and representatives from medical organizations. Detailed recommendations on convalescence after uncomplicated vaginal delivery and uncomplicated cesarean delivery were developed. In addition, a list with 35 potential affecting factors that could delay recovery was presented to identify circumstances in which the convalescence recommendation should be adapted. Recommendations were based on a literature review and a modified Delphi procedure among 16 experts. Multidisciplinary consensus of at least 67% was achieved on convalescence recommendations for 27 relevant functional activities after childbirth.

RESULTS

Multidisciplinary consensus on convalescence recommendations was reached for 26 of 27 functional activities for uncomplicated vaginal and cesarean delivery after 6 Delphi rounds and 2 group discussions. In total, 7 out of 32 affecting factors were deemed as independent factors that may delay recovery and therefore change the convalescence recommendations. The recommendations were deemed feasible by representatives from the same medical organizations as the panel.

CONCLUSION

Multidisciplinary consensus on recommendations regarding convalescence after uncomplicated vaginal delivery and uncomplicated cesarean delivery was achieved.

Maternal physical activity in healthy pregnancy: Effect on fetal oxygen supply

AIM

We review evidence for effects of physical activity before and during gestation on the course of pregnancy and ask if there are circumstances where physical activity can stress the fetus due to competition for oxygen and energy substrates.

RESULTS

We first summarize physiological responses to exercise in nonpregnant people and known physiological adaptations to pregnancy. Comparing the two, we conclude that physical activity prior to and continuing during gestation is beneficial to pregnancy outcome. The effect of starting an exercise regimen during pregnancy is less easy to assess as few studies have been undertaken. Results from animal models suggest that the effects of maternal exercise on the fetus are transient; the fetus can readily compensate for a short-term reduction in oxygen supply.

CONCLUSION

In general, we conclude that physical activity before and during pregnancy is beneficial, and exercise started during pregnancy is unlikely to affect fetal development. We caution, however, that there are circumstances where this may not apply. They include the intensive exercise regimens of elite athletes and pregnancies at high altitudes where hypoxia occurs even in the resting state.

Progress in physical activity research, policy, and surveillance in Canada: The global observatory for physical activity - GoPA!

BACKGROUND

The purpose of this paper is to examine the evolution of physical activity research and the comprehensiveness of national physical activity policies and surveillance systems in Canada.

METHODS

A systematic review was conducted by the Global Observatory for Physical Activity (GoPA! ) on physical activity and health publications between 1950 and 2019. Findings from Canada were extracted and included in the present analysis. The number of articles published, female researcher involvement in authorship, author institution affiliations, and publication themes were examined. Policies were evaluated by determining if there was a standalone physical activity plan and if national guidelines existed. Surveillance systems were assessed for periodicity, instruments used, and age inclusivity.

RESULTS

Out of 23,000 + publications analyzed worldwide; 1,962 included data collected in Canada. Physical activity research in Canada increased considerably from the 2000s to 2010s (543 articles vs. 1,288 articles), but an apparent stabilization has been observed more recently. Most physical activity publications in Canada focused on surveillance (37%), with fewer articles on policy (8%) and interventions (7%). The proportion of female first authors increased from 38% in the 1980s to 60% in the last decade. However, females remain the minority for senior authors. With respect to policy, "A Common Vision" is Canada's national plan, which has a singular policy focus on physical activity. National surveillance data is collected regularly with both the Canadian Health Measures Survey (CHMS) and the Canadian Community Health Survey. In addition to self-report, the CHMS also collects accelerometer data from participants.

CONCLUSION

Through collaborative and coordinated action, Canada remains well equipped to tackle physical inactivity. Continued efforts are needed to enhance sustained awareness of existing physical activity promotion resources to increase physical activity.

Compliance with 24 h Movement Behavior Guidelines for Pregnant Women in Saudi Arabia: The Role of Trimester and Maternal Characteristics

BACKGROUND

Complying with 24 h movement behavior guidelines for pregnant women may prevent pregnancy complications. This single time point, cross-sectional investigation assessed compliance with the 24 h movement behavior guidelines in pregnant women in Saudi Arabia and examined the role of trimester and maternal characteristics.

METHODS

Pregnant women (n = 935; age = 30 ± 5.6 years; first trimester = 24.1%, second trimester = 33.9%, third trimester = 42.0%) self-reported their characteristics (nationality, region, degree, occupation, smoking status, health status, having children, previous birth). The short-version International Physical Activity Questionnaire, Sedentary Behavior Questionnaire, and Pittsburgh Sleep Quality Index Questionnaire measured moderate physical activity (MPA), sedentary behavior (SB), and sleep duration, respectively. Compliance with the 24 h movement behavior guidelines was reported using frequencies and percentages. Prevalence ratios compared the prevalence of compliance by trimester and maternal characteristics.

RESULTS

Approximately half of the participants did not comply with MPA or sleep duration guidelines (n = 524, [56.0%] and n = 424, [45.5%], respectively). In contrast, about two-thirds of participants (n = 648, [69.3%]) adhered to the SB guideline. Only 154 (16.5%) participants complied with all 3 24 h movement behavior guidelines. Pregnant women in their second trimester, living in Al-Ahsa Governorate, and currently smoking with a bachelor's degree were the most likely to comply with the guidelines.

CONCLUSIONS

These findings underscore the need for tailored efforts to promote healthy 24 h movement behavior guidelines for pregnant women in Saudi Arabia, especially early in pregnancy, while accounting for important maternal characteristics.

Cool mama: Temperature regulation during high-intensity interval running in pregnant elite and recreational athletes

Background

Regular exercise during pregnancy is beneficial, but athletes often exceed the recommended 150 min of moderate-intensity activity, incorporate high-intensity exercises. The upper limit for exercise intensity and duration on fetal and maternal safety remains uncertain. A concern is a maternal core body temperature of >39.0 °C, potentially increase the risk of heat-related fetal malformations and complications during pregnancy. Blood flow redirection for thermoregulation could compromise fetal cardiovascular function, increasing the risk of miscarriage and preterm labor. This study evaluated whether pregnant women (gestational weeks 25-35) were at risk of exceeding a core body temperature of 39.0 °C during high-intensity running. We also investigated effects on skin temperature, fluid loss, and thermal sensation, comparing pregnant athletes to non-pregnant controls.

Methods

In this comparative cross-sectional study, 30 elite and recreational athletes (pregnant n = 15) completed up to five high-intensity treadmill-intervals. Core and skin temperature were continuously measured. Body weight was utilized to calculate the amount of fluid loss.

Results

Highest core body temperature were 38.76 °C and 39.56 °C in one pregnant and non-pregnant participant, respectively. Pregnant participants had lower core body temperatures (mean difference -0.47 °C, p ≤ 0.001) initially and a smaller increase (0.10 °C, p ≤ 0.003) during later intervals compared with the non-pregnant controls. Pregnant participants also showed a greater increase in skin temperature (4.08 ± 0.72 °C vs. 3.25 ± 0.86 °C, p = 0.008) and fluid loss (0.81 ± 0.19 L vs. 0.50 ± 0.12 L, p˂0.001).

Conclusion

Physiological changes in pregnancy may enhance thermoregulation, indicating that high-intensity interval runs are unlikely to pose a risk of exceeding a core body temperature of 39 °C for pregnant athletes.

Are pelvic-abdominal mechanics exercises effective for cesarean delivery rate and postpartum pelvic floor function: A randomized controlled trial

OBJECTIVES

To examine the effectiveness of pelvic-abdominal mechanics exercise in reducing cesarean section rates and preventing pelvic floor dysfunction in primiparous women.

DESIGN

Randomized controlled trial.

METHODS

A single-center prospective study was conducted among 200 primiparous participants (aged 18-38 years) who undertook formal card-issuing maternity tests between June 1, 2022, and June 30, 2023. Participants were divided into two groups: exercise (intervention) and control using the random number table method. Participants of the intervention group performed pelvic-abdominal mechanics exercise at least 1 h each time per week for three months. Participants of the control group did not perform any pelvic-abdominal mechanics exercise during pregnancy. This study conducted a comprehensive evaluation from three perspectives, including maternal and neonatal health outcomes during delivery, the recovery status of pelvic floor muscles at 42 days postpartum, and the quality of life during late pregnancy (36-38 weeks) and 42 days postpartum.

RESULTS

A significant difference was found in delivery outcomes. The cesarean section rates are significantly higher (p < 0.05) in the control group (36 %) than in the exercise group (19 %). At 42 days postpartum, pelvic floor assessment showed that the exercise group had significantly better results in pelvic floor muscle strength compared to the control group, with statistical significance (p < 0.05).

CONCLUSIONS

Pelvic-abdominal mechanics exercise lowers the rate of cesarean section and improves postpartum pelvic floor function.

Sprint interval training in the postpartum period maintains the enhanced cardiac output of pregnancy: A case study

During pregnancy an increased cardiac output (Q ̇ $\dot{Q}$ ) and blood volume (BV) occur to support fetal growth. IncreasedQ ̇ $\dot{Q}$ and BV also occur during chronic endurance exercise training and benefit performance. We investigated if sprint interval training (SIT) undertaken early postpartum maintains the elevatedQ ̇ $\dot{Q}$ and BV of pregnancy and benefits performance. The participant, a competitive field hockey player and former cyclist, visited our laboratory at 2 weeks of gestation (baseline) and postpartum pre-, mid- and post-intervention (PPpre, PPmid and PPpost). Delivery was uncomplicated and she felt ready to start the SIT programme 5 weeks postpartum. Inert gas rebreathing was used to measure peak exerciseQ ̇ $\dot{Q}$ (Q ̇ $\dot{Q}$ peak);V ̇ O 2 peak ${{\dot{V}}_{{{{\mathrm{O}}}_{\mathrm{2}}}{\mathrm{peak}}}}$ was measured with a metabolic cart; and postpartum haematological values were measured with carbon monoxide rebreathing. The 18 SIT sessions progressed from four to eight sprints at 130% ofV ̇ O 2 peak ${{\dot{V}}_{{{{\mathrm{O}}}_{\mathrm{2}}}{\mathrm{peak}}}}$ peak power output.Q ̇ $\dot{Q}$ peak increased from baseline at all postpartum time points (baseline 16.2 vs. 17.5, 16.8 and 17.2 L/min at PPpre, PPmid and PPpost, respectively). RelativeV ̇ O 2 peak ${{\dot{V}}_{{{{\mathrm{O}}}_{\mathrm{2}}}{\mathrm{peak}}}}$ remained below baseline values at all postpartum measurements (baseline 44.9 vs. 41.0, 42.3 and 42.5 mL/kg/min at PPpre, PPmid and PPpost, respectively) whereas absoluteV ̇ O 2 peak ${{\dot{V}}_{{{{\mathrm{O}}}_{\mathrm{2}}}{\mathrm{peak}}}}$ rapidly reached baseline values postpartum (baseline 3.19 vs. 3.12, 3.23 and 3.18 L/min at PPpre, PPmid and PPpost, respectively). Postpartum BV (5257, 4271 and 5214 mL at PPpre, PPmid and PPpost, respectively) and Hbmass (654, 525 and 641 g at PPpre, PPmid and PPpost, respectively) were similar between PPpre and PPpost but decreased alongsideQ ̇ $\dot{Q}$ peak at PPmid. Peak power was returned to pre-pregnancy values by intervention end (302 vs. 303 W, baseline vs. PPpost). These findings show that SIT undertaken early postpartum defends the elevatedQ ̇ $\dot{Q}$ peak of pregnancy and rapidly returns absoluteV ̇ O 2 peak ${{\dot{V}}_{{{{\mathrm{O}}}_{\mathrm{2}}}{\mathrm{peak}}}}$ and peak power to baseline levels.

Physical activity levels and influencing factors among pregnant women in China: A systematic review and meta-analysis

BACKGROUND

Physical activity during pregnancy has been recommended as an effective measure to prevent various pregnancy complications. However, global physical activity participation during pregnancy is not optimal, and the factors influencing physical activity participation during pregnancy need to be further investigated. In China, where there are no localized guidelines for physical activity during pregnancy, the prevalence of meeting recommended physical activity levels among Chinese pregnant women is still unclear.

OBJECTIVES

This study aimed to comprehensively review the prevalence of meeting recommended physical activity levels among pregnant women in China and to further explore the factors influencing physical activity participation during pregnancy.

DESIGN

This was a systematic review and meta-analysis.

METHODS

A systematic review was conducted in both English and Chinese databases from inception until August 1, 2023. Two reviewers independently screened literature, assessed study eligibility and extracted data. The Agency for Healthcare Research and Quality was used to evaluate methodological quality of included studies. The pooled prevalence was calculated using a random-effects model. Subgroup analyses were conducted to explore sources of heterogeneity.

RESULTS

A total of 12 cross-sectional studies, including 11,323 Chinese pregnant women with a mean age ranging from 27.0 to 33.0 years, met the inclusion criteria. The prevalence of meeting recommended physical activity levels among pregnant women in China was 21.0 % (95 % confidence interval (CI):12.5 %-29.5 %). A higher prevalence of meeting recommended physical activity levels was observed among pregnant women who were in their second trimester, who were living in the southern region, who were assessed by validated questionnaires, and who used 150 min physical activity per week as a criterion for meeting recommendation.

CONCLUSIONS

The findings suggested a low prevalence of meeting recommended physical activity levels among Chinese pregnant women, which was affected by a variety of factors. It is recommended that further research be conducted in the future to explore physical activity intervention strategies for women of childbearing age before and during pregnancy based on the factors affecting physical activity to improve physical activity compliance, maternal and child health and population quality.

REGISTRATION NUMBER

CRD42022372722 (PROSPERO).

The German version of the Pregnancy Physical Activity Questionnaire: a translation, cross-cultural adaptation, reliability and validity assessment

BACKGROUND

Validated and internationally standardised measurement instruments are a prerequisite for ensuring that physical activity during pregnancy is comparable and for deriving physical activity recommendations. In Germany, there has been no adapted version of the internationally used Pregnancy Physical Activity Questionnaire (PPAQ) until now. This study's aim centred around translating the original English version into German (PPAQ-G) and determining its reliability as well as validity in a German population.

METHODS

The PPAQ was translated into German using the forward-backwards technique. Its reliability and validity were tested. Thirty-four correctly completed questionnaires were analysed. The test-retest reliability was presented using the intraclass correlation coefficient (ICC) and Spearman correlation coefficient. Validity was tested by using accelerometer (n = 23) and determined by Spearman correlation coefficient.

RESULTS

In the transcultural adjustment, two questions were amended to describe intensity more precisely, and two other questions were adapted to reflect the units of measurement used in Germany. The ICC indicated a reliability of r = 0.79 for total activity (without sitting), and the intensity subcategories ranged from r = 0.70 (moderate-intensity activities) to r = 0.90 (sitting). Although, validity assessment showed no significant correlation for sedentary, moderate or vigorous intensity, there were significant correlations for total activity (light and above; r = 0.49; p < 0.05) and for light activity (r = 0.65; p < 0.01).

CONCLUSIONS

The PPAQ-G showed good reliability for use on pregnant German women and a moderately accurate measurement of physical activity. It can be used nationally for epidemiological studies, and it also enables international comparisons of physical activity during pregnancy.

TRIAL REGISTRATION

DRKS00023426; Registration date 20 May 2021.

Dyslipidemia management in women of reproductive potential: An Expert Clinical Consensus from the National Lipid Association

Cardiovascular disease (CVD) is the leading cause of death among women and its incidence has been increasing recently, particularly among younger women. Across major professional society guidelines, dyslipidemia management remains a central tenet for atherosclerotic CVD prevention for both women and men. Despite this, women, particularly young women, who are candidates for statin therapy are less likely to be treated and less likely to achieve their recommended therapeutic objectives for low-density lipoprotein cholesterol (LDL-C) levels. Elevated LDL-C and triglycerides are the two most common dyslipidemias that should be addressed during pregnancy due to the increased risk for adverse pregnancy outcomes, such as preeclampsia, gestational diabetes mellitus, and pre-term delivery, as well as pancreatitis in the presence of severe hypertriglyceridemia. In this National Lipid Association Expert Clinical Consensus, we review the roles of nutrition, physical activity, and pharmacotherapy as strategies to address elevated levels of LDL-C and/or triglycerides among women of reproductive age. We include a special focus on points to consider during the shared decision-making discussion regarding pharmacotherapy for dyslipidemia during preconception planning, pregnancy, and lactation.

[Review of nutrition and hydration in relation to physical exercise during pregnancy]

Introduction

Studies on nutritional recommendations for pregnant women who exercise are scarce. The objective of this article is not to focus on the diet of pregnant women as a whole, but to review those aspects of it that may be related to physical exercise. To this end, the nutritional and hydration recommendations contained in the main clinical practice guides on physical exercise during pregnancy are collected, including the first Spanish guides. Likewise, the energy requirements required by pregnant women who perform physical exercise during pregnancy for adequate gestational weight gain are addressed, aspects related to macronutrients in the aforementioned population group, and two specific topics, such as nutritional needs in the adolescent who practices physical exercise during pregnancy and eating disorders in pregnant athletes It is concluded by stating that pregnant women who exercise regularly should eat a varied and balanced diet, such as the Mediterranean diet, avoid long periods of fasting to avoid the appearance of hypoglycemia and maintain adequate fluid intake before, during and after physical exercise. Pregnant adolescents who engage in physical exercise require nutritional supervision to achieve adequate gestational weight gain. The pregnant athlete with an eating disorder has a higher risk of complications during pregnancy and childbirth, gynecological, fetal and neonatal, and, therefore, requires close monitoring by specialists in maternal-fetal medicine.

Recent Findings on Exercise Therapy for Blood Glucose Management in Patients with Gestational Diabetes

Inadequate management of blood glucose levels in gestational diabetes mellitus (GDM) poses risks for both pregnant women and the developing fetus. Attaining appropriate blood glucose control is crucial to mitigate potential adverse outcomes. This study aimed to consolidate the latest guidelines from representative professional societies, providing insights into exercise therapy for GDM patients and suggesting potential avenues for future research. The review was conducted with up-to-date exercise guidelines from prominent societies, such as the American College of Obstetricians and Gynecologists (ACOG), the Society of Obstetricians and Gynecologists of Canada (SOGC), the Canadian Society for Exercise Physiology (CSEP), the American College of Sports Medicine, the American Diabetes Association (ADA), and the Korean Diabetes Association. The ACOG and SOGC/CSEP recommend 150 min of low to moderate intensity exercise, 3-4 times a week, combining aerobic and resistance exercises. All guidelines advise against activities involving sudden directional changes, physical contact, a risk of falling, and exercises performed lying down. Despite cautions from the ADA and ACOG on blood glucose fluctuations during physical activity, the lack of specific methods and recommendations from other societies reveals a notable gap in evidence-based guidelines for GDM. For effective and safe blood glucose management in GDM patients, further research should be conducted on the exercise-related precautions outlined for GDM patients. Establishing ample evidence would facilitate the development of customized exercise guidelines for GDM patients.

The mediating effect of e-health literacy on social support and behavioral decision-making on glycemic management in pregnant women with gestational diabetes: a cross-sectional study

Background

Social support and e-health literacy are closely related to individual health behaviors, while behavior is premised on decision-making. Few studies have identified the relationships among social support, e-health literacy, and behavioral decision-making, and the nature of these relationships among pregnant women with gestational diabetes remains unclear. Therefore, this study aimed to investigate relationships among social support, e-health literacy, and glycemic management behavioral decisions in pregnant women with gestational diabetes.

Methods

Using continuous sampling, an online cross-sectional survey was conducted among pregnant women with gestational diabetes who met the inclusion and exclusion criteria at four Class 3 hospitals in Fujian Province from October to December 2023. A structured questionnaire was used to collect data on general characteristics, socioeconomic status, social support, e-health literacy, and behavioral decision-making regarding glycemic management. Descriptive statistical analyses, correlation analyses, and mediation effects were used to assess associations.

Results

A total of 219 pregnant women with gestational diabetes participated, and 217 valid results were obtained. The level of glycemic management behavior decision-making in women with gestational diabetes was positively correlated with e-health literacy (r = 0.741, p < 0.01) and with perceived social support (r = 0.755, p < 0.01). E-health literacy was positively correlated with perceived social support (r = 0.694, p < 0.01). The indirect effect of perceived social support on glycemic management behavior decisions through e-health literacy (a*b) was 0.153, accounting for 38% of the total effect.

Conclusion

Social support and e-health literacy in pregnant women with gestational diabetes are related to behavioral decision-making in glycemic management. The results of this study provide a reference for developing targeted measures to improve glycemic management behaviors in pregnant women with gestational diabetes, which is crucial for achieving sustainable glycemic management.