Physical activity and mood during pregnancy

Association Between Physical Activity During Pregnancy and Perinatal Depressive Symptoms in Pregnant Individuals With Overweight and Obesity

INTRODUCTION

Current research on the association between physical activity and perinatal depression is inconclusive. This study examined the association between objectively measured physical activity during pregnancy and perinatal depressive symptoms among individuals with overweight and obesity.

METHODS

Data came from the Health in Pregnancy and Postpartum study (N = 205). Physical activity was measured using the SenseWear Armband at 16 weeks' or fewer and 32 weeks' gestation and categorized into 1) never meeting 2018 physical activity guidelines, 2) meeting the guidelines at one time point, or 3) meeting the guidelines at both time points. Antenatal depressive symptoms were assessed at 32 weeks' gestation, and postpartum depressive symptoms were assessed at 6 and 12 months postpartum using the Edinburgh Postnatal Depression Scale. A score of 10 or higher was defined as probable at least minor depression (hereafter, probable depression).

RESULTS

Nearly one-half of the participants (45.4%) met physical activity guidelines both in early and late pregnancy. Pregnant individuals who met physical activity guidelines at one (adjusted odds ratio, 0.07; 95% confidence interval, 0.01-0.76) or both time points (adjusted odds ratio, 0.08; 95% confidence interval, 0.01-0.69) during pregnancy had lower odds of probable depression at 6 months postpartum than individuals who never met physical activity guidelines during pregnancy. No significant associations were found between prenatal physical activity and probable antenatal or postpartum depression at 12 months.

CONCLUSIONS

Antenatal physical activity was associated with lower odds of probable depression at 6 months after childbirth. Physicians should use evidence-based strategies to encourage pregnant people, especially those who are at risk for postpartum depression, to meet physical activity guidelines.

A Comprehensive Review on Social Inequalities and Pregnancy Outcome-Identification of Relevant Pathways and Mechanisms

Scientific literature tends to support the idea that the pregnancy and health status of fetuses and newborns can be affected by maternal, parental, and contextual characteristics. In addition, a growing body of evidence reports that social determinants, measured at individual and/or aggregated level(s), play a crucial role in fetal and newborn health. Numerous studies have found social factors (including maternal age and education, marital status, pregnancy intention, and socioeconomic status) to be linked to poor birth outcomes. Several have also suggested that beyond individual and contextual social characteristics, living environment and conditions (or "neighborhood") emerge as important determinants in health inequalities, particularly for pregnant women. Using a comprehensive review, we present a conceptual framework based on the work of both the Commission on Social Determinants of Health and the World Health Organization (WHO), aimed at describing the various pathways through which social characteristics can affect both pregnancy and fetal health, with a focus on the structural social determinants (such as socioeconomic and political context) that influence social position, as well as on intermediary determinants. We also suggest that social position may influence more specific intermediary health determinants; individuals may, on the basis of their social position, experience differences in environmental exposure and vulnerability to health-compromising living conditions. Our model highlights the fact that adverse birth outcomes, which inevitably lead to health inequity, may, in turn, affect the individual social position. In order to address both the inequalities that begin in utero and the disparities observed at birth, it is important for interventions to target various unhealthy behaviors and psychosocial conditions in early pregnancy. Health policy must, then, support: (i) midwifery availability and accessibility and (ii) enhanced multidisciplinary support for deprived pregnant women.

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

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

Psychometric Properties of the Persian Version of Pregnancy Symptoms Inventory (PSI)

The aim of this study was to determine the psychometric properties of the Persian version of pregnancy symptoms inventory. A methodological study. This study was conducted on 220 pregnant women. Construct validity was measured by exploratory factor analysis and confirmatory factor analysis. Reliability was measured by intra-class correlation coefficient and internal consistency. Since the items 12 (snoring) and 16 (thrush) failed to obtain the minimum principal axis factoring in exploratory factor analysis, they were removed from the Persian version. Confirmatory factor analysis showed a good fit for the extracted model. Cronbach's alpha was .94 for the frequency items and .95 for the limitation items. Intra-class correlation coefficient was between .58 and 1 for frequency items and between .73 and 1 for limitation items. The Persian version of pregnancy symptoms inventory was a valid and reliable scale to be used for Iranian pregnant women.

Sleep and physical activity from before conception to the end of pregnancy in healthy women: a longitudinal actigraphy study

BACKGROUND

Sleep and physical activity changes are common in pregnancy, but longitudinal data starting before conception are scarce. Our aim was to determine the changes of the daily total sleep time (TST) and physical activity duration (PAD) from before conception to end of pregnancies in respect of pregestational maternal factors.

METHODS

This longitudinal observational study formed part of the CONIMPREG research project and recruited healthy women planning to become pregnant. Sleep and physical activity were recorded around-the-clock for ≥4 days via actigraphy before conception and during each trimester of pregnancy. Data were adjusted according to pregestational maternal body composition, parity and age.

RESULTS

Among 123 women with eligible data, the unadjusted mean (95% confidence interval) TST increased from 415.3 min (405.5-425.2 min) before conception to 458.0 min (445.4-470.6 min) in the 1st trimester, remaining high through the 2nd and 3rd trimesters. Variation was substantial before conception (±2SD range: 307-523 min). The unadjusted mean PAD before conception was 363.7 min (±2SD range: 120-608 min), decreasing sharply to 262.1 min in the first trimester and more gradually thereafter. Vigorous and moderate activity decreased more than light activity. TST and PAD were significantly associated with age, parity, and pregestational body fat percentage; lean body mass was negatively correlated with TST. Results were generally unaffected by seasonal variations.

CONCLUSION

Marked variations were found in pregestational TST and PAD. Healthy women slept ≥30 min longer during pregnancy, while PAD decreased by ≥ 90 min in early pregnancy and continued to decrease thereafter.

Acceptability and Feasibility of a Sedentary Behavior Reduction Program during Pregnancy: A Semi-Experimental Study

Physical activity (PA) during pregnancy is associated with maternal benefits. Therefore, innovative strategies that promote PA are needed. This study investigated the acceptability and feasibility of a sedentary behavior (SB) reduction program during pregnancy. The study employed a semi-experimental research design using historical control subjects. The intervention group program consisted of individual face-to-face guidance, automatic alerts during SB from wearable devices, and self-monitoring of SB patterns, from 20 gestation weeks to delivery. PA and SB, assessed using a wearable device, were compared with those of the control group at 24–27 (T1) and 32–35 (T2) weeks of gestation. In 56 women, the mean wearing time was 90.2 days in the intervention phase. The response rate to automatic SB alerts was 55.5% at T1 and 63.0% at T2. Self-monitoring more than twice or thrice a week was 77.8% at T1 and 59.3% at T2. There was no significant difference in the cumulative SB time at T2 between the two groups (F = 2.31, p = 0.132). This program appears to be acceptable and feasible for pregnant women; however, SB reduction effect of the intervention remains unclear. Improvements to increase the response rate to automatic SB alerts and the frequency of self-monitoring are needed.

Analysis of the Impact of the Confinement Resulting from COVID-19 on the Lifestyle and Psychological Wellbeing of Spanish Pregnant Women: An Internet-Based Cross-Sectional Survey

(1) Background: This study aimed to analyze the impact of the confinement due to the COVID-19 pandemics on the eating, exercise, and quality-of-life habits of pregnant women. (2) Methods: This was an internet-based cross-sectional survey which collected information about adherence to the Mediterranean diet, physical exercise, health-related quality of life (HRQoL), and perceived obstacles (in terms of exercise, preparation for delivery, and medical appointments) of pregnant women before and after the confinement. The survey was conducted in 18–31 May 2020. (3) Results: A total of 90 pregnant women participated in this study. There was a significant decrease in the levels of physical activity (p < 0.01) as well as in HRQoL (p < 0.005). The number of hours spent sitting increased by 50% (p < 0.001), 52.2% were unable to attend delivery preparation sessions because these had been cancelled. However, there were no significant differences in the eating pattern of these women (p = 0.672). Conclusions: These results suggest the need to implement specific online programs to promote exercise and reduce stress, thus improving the HRQoL in this population, should similar confinements need to occur again for any reason in the future.

Pregnancy Induces an Earlier Chronotype in Both Mice and Women

Daily rhythms generated by endogenous circadian mechanisms and synchronized to the light-dark cycle have been implicated in the timing of birth in a wide variety of species. Although chronodisruption (e.g., shift work or clock gene mutations) is associated with poor reproductive outcomes, little is known about circadian timing during pregnancy. This study tested whether daily rhythms change during full-term pregnancies in mice and women. We compared running wheel activity continuously in both nonpregnant ( n = 14) and pregnant ( n = 13) 12- to 24-week-old C57BL/6NJ mice. We also monitored wrist actigraphy in women ( N = 39) for 2 weeks before conception and then throughout pregnancy and measured daily times of sleep onset. We found that on the third day of pregnancy, mice shift their activity to an earlier time compared with nonpregnant dams. Their time of daily activity onset was maximally advanced by almost 4 h around day 7 of pregnancy and then shifted back to the nonpregnant state approximately 1 week before delivery. Mice also showed reduced levels of locomotor activity during their last week of pregnancy. Similarly, in women, the timing of sleep onset was earlier during the first and second trimesters (gestational weeks 4-13 and 14-27) than before pregnancy and returned to the prepregnant state during the third trimester (weeks 28 until delivery). Women also showed reduced levels of locomotor activity throughout pregnancy. These results indicate that pregnancy induces changes in daily rhythms, altering both time of onset and amount of activity. These changes are conserved between mice and women.

Moderate Physical Activity in an Aquatic Environment During Pregnancy (SWEP Study) and Its Influence in Preventing Postpartum Depression

INTRODUCTION

Postpartum depression (PPD) can begin within 6 weeks postpartum (International Classification of Diseases, 10th Revision) and represents a significant health problem for mothers.

AIM

To determine whether physical activity during pregnancy alleviates PPD.

METHOD

Randomized controlled trial in which the exercise group practiced moderate physical exercise in an aquatic environment (1-hour sessions, 3 days a week), following the recommendations of the SWEP method.

RESULTS

The results observed in the Edinburgh Postnatal Depression Scale were significant between the exercise group and the control group ( p < .001). In addition, significant differences were observed according in body mass index between the exercise group and control group in the overweight and obesity categories ( p < .05).

CONCLUSION

Women who perform moderate physical exercise in an aquatic environment are at lower risk of PPD than sedentary women. Overweight and obesity among sedentary women during pregnancy are closely associated with positive screening for PPD.

Exercise frequency and maternal mental health: Parallel process modelling across the perinatal period in an Australian pregnancy cohort

OBJECTIVE

Since the potential mental health benefits of exercise during pregnancy remain unclear, this study examined longitudinally the bidirectional relationship between exercise and maternal mental health symptoms during the perinatal period, and included adjustment for both depression and antidepressant treatment.

METHODS

Data were collected across pregnancy (first and third trimesters) and the postpartum (six and 12 months) for 258 women drawn from an Australian pregnancy cohort, the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS). The women were assessed for depression using the EPDS, anxiety using the STAI and a clinical diagnostic interview (SCID-IV), and self-reported use of antidepressants. Exercise was measured using self-reported weekly frequency of 30-min bouts of moderate to vigorous exercise, and data were analyzed using parallel process growth curve modelling.

RESULTS

On average, women's weekly exercise frequency declined during pregnancy, returning to first trimester levels by 12 months postpartum. Women with depression and taking antidepressants reported lower first trimester exercise compared to control women. However, where non-medicated depressed women remained lower and continued to decline to 12 months, women taking antidepressants reported increasing levels of exercise during the perinatal period. Notably, a steeper decline in exercise frequency during the perinatal period was associated with a faster rate of increase in depressive and anxiety symptoms.

CONCLUSIONS

This study is the first to examine the longitudinal interaction between exercise and mental health symptoms across the perinatal period. These preliminary findings demonstrate potential benefits for depressive and anxious symptoms when maintaining levels of early-pregnancy exercise throughout pregnancy and the postpartum.

Physical activity and depressive symptoms during pregnancy among Latina women: a prospective cohort study

BACKGROUND

Latina women are at increased risk for antenatal depressive disorders, which are common during pregnancy and are associated with elevated risk for poor maternal health and birth outcomes. Physical activity is a potential mechanism to reduce the likelihood of depressive symptoms. The purpose of the study was to assess whether total and domain-specific physical activity in early pregnancy reduced risk for elevated antenatal depressive symptoms in mid-late pregnancy in a population of Latina women at high-risk for depression.

METHODS

Data from 820 Latina participants in the prospective cohort study Proyecto Buena Salud was examined using multivariable logistic regression. Total, moderate/vigorous, and domain-specific physical activity (household/caregiving, occupational, sports/exercise, transportation) were assessed using the Pregnancy Physical Activity Questionnaire. The Edinburgh Postnatal Depression Scale was used to assess depressive symptoms and identify women with elevated symptoms indicative of at least probable minor depression and probable major depression.

RESULTS

A total of 25.9% of participants experienced at least probable minor depression and 19.1% probable major depression in mid-late pregnancy. After adjusting for important risk factors, no significant associations were observed between total physical activity (4th Quartile vs.1st Quartile OR = 1.02, 95% CI = 0.61, 1.71; p-trend = 0.62) or meeting exercise guidelines in pregnancy (OR = 0.96, 95% CI = 0.65, 1.41) and at least probable minor depression; similarly, associations were not observed between these measures and probable major depression. There was a suggestion of increased risk of probable major depression with high levels of household/caregiving activity (4th Quartile vs 1st Quartile OR = 1.51, 95% CI = 0.93, 2.46), but this was attenuated and remained not statistically significant after adjustment. When we repeated the analysis among women who did not have elevated depressive symptoms in early pregnancy (n = 596), findings were unchanged, though a nonsignificant protective effect was observed for sport/exercise activity and probable major depression in fully adjusted analysis (OR = 0.63, 95% CI = 0.30, 1.33).

CONCLUSION

Among Latina women at high-risk for antenatal depression, early pregnancy physical activity was not associated with elevated depressive symptoms in mid-to-late pregnancy.

Rationale and study protocol for Unidas por la Vida (United for Life): A dyadic weight-loss intervention for high-risk Latina mothers and their adult daughters

BACKGROUND

Half of Mexican-American women are under-active and nearly 78% are overweight/obese. The high lifetime risk of developing type 2 diabetes necessitates a culturally appropriate lifestyle intervention.

PURPOSE

Unidas por la Vida is a novel dyadic intervention that capitalizes on the centrality of family in Latino culture to mobilize an existing family dyad as a resource for health behavior change. The intervention aims to improve health behaviors and promote weight loss in two at-risk members of the same family: mothers with type 2 diabetes and their overweight/obese adult daughters who are at risk for developing diabetes.

METHODS

Participants (N = 460 mother-adult daughter dyads) will be randomized into one of three conditions: 1) dyadic participation (mothers-daughters) in a lifestyle intervention; 2) individual participation (mothers alone; unrelated daughters alone) in a lifestyle intervention; and 3) mother-daughter dyads in a minimal intervention control group.

RESULTS

The primary outcome is weight loss. Secondary outcomes include physical activity, dietary intake, physiological measures (e.g. HbA1c), and body composition. Both the dyadic and individual interventions are expected to produce greater weight loss at 6, 12, and 18 months than those in minimal intervention control group, with women assigned to the dyadic intervention expected to lose more weight and to maintain the weight loss longer than women assigned to the individual intervention.

CONCLUSION

Because health risks are often shared by multiple members of at-risk families, culturally appropriate, dyadic interventions have the potential to increase the success of behavior change efforts and to extend their reach to multiple family members.

TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT02741037.

The association of exercise during pregnancy with trimester-specific and postpartum quality of life and depressive symptoms in a cohort of healthy pregnant women

Few published studies have examined the relationship between exercise during pregnancy, quality of life (QOL), and postpartum depressive symptoms in healthy pregnant women. A prospective cohort of 578 healthy pregnant women were followed during their pregnancy through 6 months postpartum. Levels of self-reported exercise and QOL before, during, and following pregnancy were assessed using standardized questionnaires during each trimester of pregnancy and 6 months postpartum. Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) at 28 weeks gestation and 6 weeks postpartum. Participants were classified as having "sufficient exercise" if they achieved at least 150 min of exercise per week. Sufficient exercisers reported significantly higher ratings on most domains of QOL during each trimester of pregnancy and in the postpartum follow-up, compared with insufficient exercisers. There were no significant between-group differences in depressive symptoms. In examining the impact of exercise during each trimester, active women who became sedentary during their third trimester demonstrated a decline in their QOL. Achieving recommended levels of exercise during pregnancy was associated with higher QOL during pregnancy and the postpartum in healthy pregnant women. Decreasing the amount of exercise during pregnancy was associated with reduced QOL. These results suggest that it may be important for health care professionals to counsel healthy pregnant women about both the benefits of being physically active during pregnancy, and to provide guidance on how to remain physically active during a healthy pregnancy.

Strategies for Dealing with Missing Accelerometer Data

Missing data is a universal research problem that can affect studies examining the relationship between physical activity measured with accelerometers and health outcomes. Statistical techniques are available to deal with missing data; however, available techniques have not been synthesized. A scoping review was conducted to summarize the advantages and disadvantages of identified methods of dealing with missing data from accelerometers. Missing data poses a threat to the validity and interpretation of trials using physical activity data from accelerometry. Imputation using multiple imputation techniques is recommended to deal with missing data and improve the validity and interpretation of studies using accelerometry.

Midwives understanding of physical activity guidelines during pregnancy

OBJECTIVE

to examine the current level of understanding held by midwives regarding the NICE physical activity guidelines in the UK, and to investigate the physical activity guidance given to women during pregnancy.

DESIGN

an 11 question online survey comprising of a mixture of closed and open ended questions.

SETTING

data reflects participants sampled across the United Kingdom.

PARTICIPANTS

fifty-nine midwives completed the online survey MEASUREMENTS AND FINDINGS: an electronic survey was used to explore the midwives understanding of physical activity guidelines during pregnancy, and the advice they offered to women in their care. Qualitative content analysis was used to gain a more in-depth understanding of midwife knowledge. Two per cent of midwives correctly identified the physical activity guidelines, with 44% giving partially correct responses, 25% giving incorrect responses and 29% unsure of what the guidelines are. Despite the low level of correct responses, 59% of respondents reported they were confident or very confident in answering questions regarding physical activity. Only 4% of respondents reported having access to continual professional development (CPD) in the area of PA guidance.

KEY CONCLUSIONS

there appears to be a misplaced confidence amongst midwives in their knowledge of the NICE PA guidelines for pregnancy.

IMPLICATIONS FOR PRACTICE

as physical inactivity can be detrimental for the health of both mother and baby, there is a clear need for better dissemination of the current and future NICE physical activity guidelines in primary health care settings. The current study determined a substantial lack of CPD in the area of PA guidance, which may be a contributing factor to the lack of knowledge of the guidelines. As such, increasing CPD may in turn improve the accuracy of the advice given to pregnant women and consequently benefit the health of both mother and baby.

Randomized Face-to-Face vs. Home Exercise Interventions in Pregnant Women with Gestational Diabetes

OBJECTIVES

Evaluate effects of a theoretically-based, semi-intensive (Face-to-Face; F2F) exercise intervention and minimum-contact (Home) exercise intervention to the standard care (Control) on exercise, its motivational determinants, blood glucose levels, and insulin use of pregnant women with gestational diabetes mellitus (GDM).

DESIGN

Randomized control trial with two intervention arms and control (standard care).

METHOD

Participants (N=65) were randomized to a Control (standard prenatal care/GDM dietary counseling), Home (standard care + phone education/support + home exercise), or F2F (standard care + on-site education/support + guided exercise with instructor on 2 days/week) group from ~20 weeks gestation to delivery. Assessments of exercise and motivational determinants were obtained at baseline (20-weeks gestation) and follow-up (32-weeks gestation). Blood glucose levels (fasting/postprandial mg/dL) and insulin use were extrapolated from medical records.

RESULTS

At the 32-week follow-up, the F2F group had significantly higher exercise min, pedometer steps/day, and motivational determinants (attitude, subjective norm, perceived control, intention) than controls (p's < .05) and significantly higher exercise min and subjective norm than the Home group (p's < .05); these effect sizes were medium-large (η2 = .11-.23). There was a medium effect (η2 = .13) on postprandial blood glucose at 36-weeks gestation with the F2F group having lower values than controls. Although not significant, the F2F group started insulin later (33 weeks gestation) than the Home (27 weeks) and Control (31 weeks) groups.

CONCLUSION

A theoretically-based, F2F exercise intervention has multiple health benefits and may be the necessary approach for promoting exercise motivation and behavior among GDM women.

Effects of tobacco exposure on perinatal suicidal ideation, depression, and anxiety

Background

Previous studies have stressed the importance of tobacco exposure for the mood disorders of depression and anxiety. Although a few studies have focused on perinatal women, none have specifically considered the effects of smoking and secondhand smoke exposure on perinatal suicidal ideation. Thus, this study aimed to investigate the relationships of smoking/secondhand smoke exposure status with suicidal ideation, depression, and anxiety from the first trimester to the first month post partum.

Methods

This cross-sectional study based on self-reported data was conducted at five hospitals in Taipei, Taiwan from July 2011 to June 2014. The questionnaire inquired about women’s pregnancy history, sociodemographic information, and pre-pregnancy smoking and secondhand smoke exposure status, and assessed their suicidal ideation, depression, and anxiety symptoms. Logistic regression models were used for analysis.

Results

In the 3867 women in the study, secondhand smoke exposure was positively associated with perinatal depression and suicidal ideation. Compared with women without perinatal secondhand smoke exposure, women exposed to secondhand smoke independently exhibited higher risks for suicidal ideation during the second trimester (odds ratio (OR) = 7.63; 95 % confidence interval (CI) = 3.25–17.93) and third trimester (OR = 4.03; 95 % CI = 1.76–9.23). Women exposed to secondhand smoke had an increased risk of depression, especially those aged 26–35 years (OR = 1.71; 95 % CI = 1.27–2.29).

Conclusions

Secondhand smoke exposure also considerably contributes to adverse mental health for women in perinatal periods, especially for the severe outcome of suicidal ideation. Our results strongly support the importance of propagating smoke-free environments to protect the health of perinatal women.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3254-z) contains supplementary material, which is available to authorized users.

A follow-up study to assess the determinants and consequences of physical activity in pregnant women of Cuenca, Spain

BACKGROUND

In recent years, the influence of physical exercise on pregnancy outcomes has been widely debated. Despite the numerous studies addressing the relationship between maternal physical activity and pregnancy outcomes, the evidence for consistent and significant impact of regular exercise during pregnancy on fetal growth remains lacking. The aims of this study were, first, to assess the level of physical activity performed throughout the pregnancy by objective (accelerometer) and self-reported (questionnaire) measurements, and, second, to ascertain pre-pregnancy physical activity levels, to estimate the relationship between levels of physical activity and some pregnancy and neonatal outcomes.

METHODS/DESIGN

This was a prospective cohort study. Participants were pregnant women (n = 194) aged 18 to 40 years who attended for three quarterly appointments for pregnancy ultrasound scans at the Virgen de la Luz Hospital in Cuenca, Spain. All participants provided written informed consents to participate in the study. Physical activity during the pregnancy follow-up was assessed by a self-reported Pregnancy Physical Activity Questionnaire and sleep log; also objectively by a GT3X accelerometer (ActiGraph). Furthermore, pregnancy symptoms inventory, nutritional behavioural assessment, socio-demographic characteristics, and anthropometry and body composition were measured. At the end of the follow up, the following main outcomes were determined: pregnancy outcomes (incidence of gestational diabetes mellitus, pre-eclampsia, pregnancy-induced hypertension, weight gain during pregnancy, type of delivery, and neonatal outcomes (gestational age, birth weight, gender, Apgar score 1 min/5 min, type of resuscitation (I/II/III/IV), and pH of umbilical cord blood). Descriptive statistics for cross-sectional data, linear mixed regression models for absolute differences in changes baseline-final measurements were used as statistical analyses.

DISCUSSION

Although the effectiveness of physical activity programmes on improving maternal and neonatal outcomes has heretofore been studied, the impact of free time physical activity during pregnancy has not been assessed using objective measures. This paper reports the design of a prospective cohort study that aims to assess the physical activity levels of pregnant women, and to estimate the relationship between those physical activity levels with maternal and neonatal outcomes. This study could contribute to providing evidence for the formulation of recommendations for physical activity for pregnant women.

Exercise during pregnancy protects against hypertension and macrosomia: randomized clinical trial

BACKGROUND

The prevalence of all pregnancies with some form of hypertension can be up to 10%, with the rates of diagnosis varying according to the country and population studied and the criteria used to establish the diagnosis. Prepregnancy obesity and excessive gestational weight gain (GWG) of all body mass index (BMI) categories have been associated with maternal hypertensive disorders and linked to macrosomia (>4000 g) and low birthweight (<2500 g). No large randomized controlled trial with high adherence to an exercise program has examined pregnancy-induced hypertension and these associated issues. We investigated whether women adherent (≥80% attendance) to an exercise program initiated early showed a reduction in pregnancy-induced hypertension and excessive GWG in all prepregnancy BMI categories, and determined if maternal exercise protected against macrosomia and low birthweight.

OBJECTIVE

We sought to examine the impact of a program of supervised exercise throughout pregnancy on the incidence of pregnancy-induced hypertension.

STUDY DESIGN

A randomized controlled trial was used. Women were randomized into an exercise group (N = 382) or a control group (N = 383) receiving standard care. The exercise group trained 3 d/wk (50-55 min/session) from gestational weeks 9-11 until weeks 38-39. The 85 training sessions involved aerobic exercise, muscular strength, and flexibility.

RESULTS

High attendance to the exercise program regardless of BMI showed that pregnant women who did not exercise are 3 times more likely to develop hypertension (odds ratio [OR], 2.96; 95% confidence interval [CI], 1.29-6.81, P = .01) and are 1.5 times more likely to gain excessive weight if they do not exercise (OR, 1.47; 95% CI, 1.06-2.03, P = .02). Pregnant women who do not exercise are also 2.5 times more likely to give birth to a macrosomic infant (OR, 2.53; 95% CI, 1.03-6.20, P = .04).

CONCLUSION

Maternal exercise may be a preventative tool for hypertension and excessive GWG, and may control offspring size at birth while reducing comorbidities related to chronic disease risk.

Physical activity, depressed mood and pregnancy worries in European obese pregnant women: results from the DALI study

BACKGROUND

The purpose of this study was to examine the association between mental health status (i.e. depressed mood and pregnancy-related worries) and objectively measured physical activity levels in obese pregnant women from seven European countries.

METHODS

Baseline data from the vitamin D and lifestyle intervention for the prevention of gestational diabetes mellitus (DALI) study were used. Time spent in moderate-to-vigorous physical activity (MVPA) and sedentary behaviour was measured with accelerometers. Depressed mood was measured with the WHO well-being index (WHO-5) and pregnancy-related worries with the Cambridge Worry Scale (CWS). In addition, socio-demographic characteristics, lifestyle factors, and perceptions and attitude regarding weight management and physical activity were measured. Linear regression analyses were performed to assess the association of mental health status with MVPA and sedentary behaviour.

RESULTS

A total of 98 obese pregnant women from Austria, Belgium, Ireland, Italy, Poland, Spain and the Netherlands were included. Women had a mean age of 31.6 ± 5.8 years, a pre-pregnancy BMI of 34.1 ± 4.3 kg/m(2), and were on average 15.4 ± 2.8 weeks pregnant. WHO-5 scores indicative of depressed mood (<50) were reported by 27.1 % of the women and most frequently endorsed pregnancy-related worries pertained to own and the baby's health. Women with good well-being spent 85% more time in MVPA compared to women with a depressed mood (P = 0.03). No differences in MVPA levels were found for women with no, some, or many pregnancy worries. Depressed mood and pregnancy-related worries were not associated with sedentary behaviour.

CONCLUSIONS

These findings suggest that in pregnant women who are obese, a depressed mood, but not pregnancy-related worries, may be associated with less physical activity. The combined risk of poor mental health and low physical activity levels makes women vulnerable for pregnancy complications. Whether a depressed mood may be a barrier for improving physical activity warrants further study.

A Program of Exercise Throughout Pregnancy. Is it Safe to Mother and Newborn?

Purpose.

The aim of the present study was to examine the influence of a program of moderate physical exercise throughout pregnancy on maternal and fetal parameters.

Design.

The study design was a randomized controlled trial.

Setting.

The study took place at the Hospital of Fuenlabrada in Madrid, Spain.

Sample.

Analyzed were 200 pregnant women (31.54 ± 3.86 years), all of whom had uncomplicated and singleton gestation. Of these subjects, 107 were allocated to the exercise group (EG) and 93 to the control group (CG).

Intervention.

Women from EG participated in a physical conditioning program throughout pregnancy, which included a total of 55- to 60-minute weekly sessions, 3 days per week.

Measures.

Pregnancy outcomes. Maternal: gestational age, weight gain, type of delivery, blood pressure during pregnancy, gestational diabetes (n/%). Fetal: birth weight, birth size, head circumference, Apgar score, pH of umbilical cord.

Analysis.

Student's unpaired t-test and χ2 test were used; p values of ≤ .05 indicated statistical significance. Cohen's d was used to determine the effect size.

Results.

There were significantly more pregnant women in the CG who gained excessive weight during their pregnancies than in the EG group (CG: N = 31, 35.6% versus N = 22, 21.2%; χ2 = 4.95; p =.02). The effect size was small (Phi value =.16). Other pregnancy outcome showed no differences between groups.

Conclusion.

A regular and moderate physical exercise program throughout pregnancy is not a risk to maternal and fetal well-being, and it helps to control excessive weight gain.

The relationship between postnatal depression, sociodemographic factors, levels of partner support, and levels of physical activity

BACKGROUND

postnatal depression (PND) is defined as a psychological mood disorder that occurs in a mother within 6 weeks of her giving birth. It refers to an episode that causes mood disturbance and it could begin in, or extend into, the postpartum period. It is thought to have a high impact upon the mother's health as well as the family's functioning and the child's development. Socio-demographic, psych-social, and physical activity factors may all contribute to postpartum mood and ability to cope with responsibilities. The primary aim of this study was to determine which of these factors predicted PND in postpartum women. A secondary aim was to identify the socio-demographic and psycho-social predictors of physical activity in postpartum women.

METHODS

The study used a cross-sectional correlational design. A sample of 150 postpartum women was sent a package of six standardized questionnaires.

RESULTS

There was no association between physical activity and PND; however, older mothers, mothers of younger children, mothers who are less reluctant to ask for help, and mothers who are more satisfied with the help they get experience lower levels of PND. Mothers of older babies, mothers with more children, and less educated mothers are more likely to engage in caregiving activities, whereas mothers with fewer children and higher levels of partner support are more likely to engage in occupational activities. None of the socio-demographic factors or any of the parenting factors predicted levels of sporting activity.

Healthy eating and lifestyle in pregnancy (HELP): a protocol for a cluster randomised trial to evaluate the effectiveness of a weight management intervention in pregnancy

Background

Approximately 1 in 5 pregnant women in the United Kingdom are obese. In addition to being associated generally with poor health, obesity is known to be a contributing factor to pregnancy and birth complications and the retention of gestational weight can lead to long term obesity.

This paper describes the protocol for a cluster randomised trial to evaluate whether a weight management intervention for obese pregnant women is effective in reducing women’s Body Mass Index at 12 months following birth.

Methods/design

The study is a cluster randomised controlled trial involving 20 maternity units across England and Wales. The units will be randomised, 10 to the intervention group and 10 to the control group. 570 pregnant women aged 18 years or over, with a Body Mass Index of +/=30 (kg/m²) and between 12 and 20 weeks gestation will be recruited. Women allocated to the control group will receive usual care and two leaflets giving advice on diet and physical activity. In addition to their usual care and the leaflets, women allocated to the intervention group will be offered to attend a weekly 1.5 hour weight management group, which combines expertise from Slimming World with clinical advice and supervision from National Health Service midwives, until 6 weeks postpartum.

Participants will be followed up at 36 weeks gestation and at 6 weeks, 6 months and 12 months postpartum. Body Mass Index at 12 months postpartum is the primary outcome. Secondary outcomes include pregnancy weight gain, quality of life, mental health, waist-hip ratio, child weight centile, admission to neonatal unit, diet, physical activity levels, pregnancy and birth complications, social support, self-regulation and self-efficacy. A cost effectiveness analysis and process evaluation will also be conducted.

Discussion

This study will evaluate the effectiveness of a theory-based intervention developed for obese pregnant women. If successful the intervention will equip women with the necessary knowledge and skills to enable them to make healthier choices for themselves and their unborn child.

Trial registration

Current Controlled Trials: ISRCTN25260464

Date of registration: 16^th April 2010.

Antenatal maternal mental health as determinant of postpartum depression in a population based mother-child cohort (Rhea Study) in Crete, Greece

PURPOSE

Antenatal maternal mental health has been identified as an important determinant of postpartum depression (PPD). We investigated the occurrence of depression both antenatally and postnatally and examined whether maternal trait anxiety and depression during pregnancy were associated with PPD at 8 weeks postpartum in a prospective mother-child cohort (Rhea Study) in Crete, Greece.

METHODS

438 women completed the Edinburgh Postnatal Depression Scale (EPDS) and the Trait subscale of the State-Trait Anxiety Inventory (STAI-Trait) questionnaires assessing antenatal depression and anxiety, respectively, during the third trimester of pregnancy as well as the EPDS at 8 weeks postpartum.

RESULTS

The prevalence of women with probable depression (EPDS score ≥13) was 16.7 % at 28-32 weeks of pregnancy and 13.0 % at 8 weeks postpartum. A per 5 unit increase in the STAI-Trait subscale increased the odds for PPD by 70 % (OR = 1.70, 95 % CI 1.41, 2.05), whereas a per unit increase in EPDS during pregnancy increased the odds for PPD by 27 % (OR = 1.27, 95 % CI 1.19, 1.36).

CONCLUSIONS

Our findings suggest that antenatal maternal psychological well-being has a significant effect on PPD, which might have important implications for early detection during pregnancy of women at risk for postpartum depression.

Changes in leisure time physical activity during pregnancy compared to the prior year

To quantify changes in leisure time physical activity (LTPA) type, frequency, duration and intensity during the first half of pregnancy as compared with the year prior to pregnancy. A cross sectional study was conducted at the Maternal University Hospital in Granada, Spain. A total of 1,175 healthy pregnant women attending a scheduled visit during the 20-22nd gestational week were enrolled in the study. Information about socio-demographic, obstetric and life-style variables during the previous year and the first half of pregnancy were collected. LTPA was quantified by assigning metabolic equivalents to each activity according to frequency, intensity and duration. The prevalence of women who met the optimal physical activity recommendations before and during pregnancy was calculated, and the McNemar-Bowker symmetry test was used to assess changes in type, frequency, intensity and duration of activities between the two periods. Some sort of LTPA was performed before and during pregnancy by 68.6% of the pregnant women. Respectively, just 27.5% and 19.4% of women fulfilled LTPA recommendations prior to pregnancy and during pregnancy; 12.6% of the women meeting recommendations prior to pregnancy later did not meet those recommendations during gestation, and 4.5% showed the reverse trend. A light increase in walking as a LTPA, and a decrease in the rest of the LTPA type activities, were seen during pregnancy. Some 13.4% of women changed from moderate--the year before- to light LTPA- during pregnancy. Pregnancy involved a decrease in LTPA, not only regarding frequency, but also duration and intensity.

Well-being in pregnancy: an examination of the effect of socioeconomic, dietary and lifestyle factors including impact of a low glycaemic index dietary intervention

BACKGROUND/OBJECTIVE

Well-being has been linked to the quality of diet and lifestyle in adults; however, there is a paucity of data in pregnancy. The aim of this study was to examine the relationship between well-being and socioeconomic status, diet and lifestyle during pregnancy and to consider the effect of intervention with low glycaemic index (GI) diet on well-being.

SUBJECTS/METHODS

This was a cohort analysis of 619 participants of the ROLO study (Randomised cOntrol trial of LOw GI diet versus no dietary intervention to prevent recurrence of fetal macrosomia). The following data were collected: educational attainment, dietary intakes (food frequency questionnaire), physical activity (self-reported) and well-being (WHO-5-Item Wellbeing Index--expressed as a percentage).

RESULTS

Well-being was positively associated with education and physical activity. Third-level education was associated with a 3.07-point higher well-being percentage score, and each day that an individual achieved >30 min walking per week was associated with a 1.10-point increase in percentage well-being score, Radj(2) 2.4% (F=7.260, P=0.001). The intervention low GI group had a significantly lower percentage well-being score than the usual diet group (56.3% vs 59.9%, P=0.015). No correlation was noted between well-being and GI status calculated from food diaries (P=0.469). Well-being was not associated with micronutrient intake.

CONCLUSIONS

Well-being in pregnancy was independently and positively associated with education and physical activity and negatively associated with low GI dietary intervention. These findings have significance not only for women at risk of low mood but also for healthcare professionals when counselling women about the importance of healthy lifestyle in pregnancy.

Green space, social inequalities and neonatal mortality in France

Background

Few studies have considered using environmental amenities to explain social health inequalities.

Nevertheless, Green spaces that promote good health may have an effect on socioeconomic health inequalities. In developed countries, there is considerable evidence that green spaces have a beneficial effect on the health of urban populations and recent studies suggest they can have a positive effect on pregnancy outcomes. To investigate the relationship between green spaces and the spatial distribution of infant mortality taking account neighborhood deprivation levels.

Methods

The study took place in Lyon metropolitan area, France. All infant deaths that occurred between 2000 and 2009 were geocoded at census block level. Each census block was assigned greenness and socioeconomic deprivation levels. The spatial–scan statistic was used to identify high risk cluster of infant mortality according to these neighborhood characteristics.

Results

The spatial distribution of infant mortality was not random with a high risk cluster in the south east of the Lyon metropolitan area (p<0.003). This cluster disappeared (p=0.12) after adjustment for greenness level and socioeconomic deprivation, suggesting that these factors explain part of the spatial distribution of infant mortality. These results are discussed using a conceptual framework with 3 hypothetical pathways by which green spaces may have a beneficial effect on adverse pregnancy outcomes: (i) a psychological pathway, (ii) a physiological disruption process and (iii) an environmental pathway.

Conclusions

These results add some evidence to the hypothesis that there is a relationship between access to green spaces and pregnancy outcomes but further research is required to confirm this.

Exercise in obese pregnant women: positive impacts and current perceptions

Overweight and obesity have significant implications during pregnancy and childbirth. The objective of this review was to provide a comprehensive overview of the effect of physical activity on pregnancy outcomes, the change of physical activity during pregnancy, and women's perception of being physically active during pregnancy, with a particular focus on women who are overweight or obese. Many studies have investigated the beneficial effect of exercise during pregnancy, including reduced risk of gestational diabetes, preeclampsia, and operative birth, in addition to improved cardiovascular function, overall fitness, psychological well-being, and mood stability. Benefits for the infant include reduced risks of prematurity and improved fetal growth, although there is more limited information about longer-term health benefits for both women and infants. The existing literature examining physical activity patterns during pregnancy has generally focused on women of all body mass index categories, consistently indicating a reduction in activity over the course of pregnancy. However, the available literature evaluating physical activity during pregnancy among women who are overweight or obese is more limited and contradictory. A number of studies identified barriers preventing women from being active during pregnancy, including pregnancy symptoms, lack of time, access to child care, and concerns about their safety and that of their unborn baby. Conversely, significant enablers included positive psychological feelings, family influence, and receiving advice from health professionals. Very few studies have provided insights about perceptions of being active during pregnancy in the overweight and obese population. There is a need for a detailed description of physical activity patterns during pregnancy in women who are overweight or obese, and more randomized trials evaluating exercise interventions for women who are overweight or obese, with a focus on clinical outcomes.

Effects of a stability ball exercise programme on low back pain and daily life interference during pregnancy

BACKGROUND

most pregnant women experience back pain during pregnancy, a serious issue that negatively impacts life quality during pregnancy. Research into an exercise intervention programme targeting low back pain and daily life interference is lacking.

OBJECTIVE

this study evaluates how a stability ball exercise programme influences low back pain and daily life interference across the second and third pregnancy trimester.

METHODS

the study was non-randomised and controlled, examining a target population of low-risk pregnancy women between 20 and 22 weeks of gestation located in a regional hospital in northern Taiwan. All participants had at least minimal low back pain, no prior history of chronic low back pain before pregnancy, and no indications of preterm labour. In total, 89 individuals participated: 45 in the control group and 44 in the experimental group (who attended an antenatal stability ball exercise programme). This programme lasted 12 weeks, composed of at least three sessions per week. Fitness workouts lasted from 25 to 30 minutes. The women completed their basic personal information, the Brief Pain Inventory-Short Form, and the Family Exercise Support Attitude Questionnaire.

RESULTS

after adjusting for demographic data and antenatal exercise status by propensity scores, experimental-group women who participated in the antenatal stability ball exercise programme reported significantly less low back pain and daily life interferences than the control group at 36 weeks of gestation.

DISCUSSION

the inclusion of stability ball exercises during pregnancy may reduce pregnancy low back pain and boost daily life functions. This stability ball exercise programme provides health-care professionals with an evidence-based intervention.

Influence of a single physical exercise class on mood states of pregnant women

The aim of the research was to define the influence of a single physical exercise class on mood states of pregnant women and to establish the socio-demographic and personality predictors of mood changes. The sample was comprised of a total of 109 pregnant women aged 19-37 years. Of the group, 62 women participated in physical exercise for pregnant women (the experimental group) and 47 women participated in traditional childbirth education classes (the control group). Emotional states were assessed with the UWIST Mood Adjective Checklist; personality traits were measured with the NEO-FFI, LOT-R and STAI questionnaires. Socio-demographic data were collected with a survey developed by the authors. A single physical exercise class improved the emotional state of pregnant women significantly more than a traditional childbirth education class. Within the experimental group, a significant improvement of mood was observed in all dimensions, while in the control group only hedonic tone increased. Greater improvements in mood can be expected in a group of women who are younger, less optimistic, and who evaluate their health better but physical fitness worse. As a single session of exercise helps improve the mood of pregnant women, this may be an effective strategy to prevent the deterioration of mood state during pregnancy.

Physical activity and pregnancy: past and present evidence and future recommendations

PURPOSE

In this review, we provide researchers and practitioners with an overview of the physical activity and pregnancy literature to promote prenatal physical activity, improve measurement, further elucidate the role of activity in reducing maternal health complications, and inform future research.

METHOD

We examined past and present physical activity and pregnancy studies and highlight key papers with a focus on maternal health outcomes to best inform physical activity promotion efforts.

RESULTS

We discuss: (a) historical overview of prenatal physical activity relative to the physical activity guidelines, how they have changed over time, and how evidence of the effect of prenatal activity on maternal/fetal health outcomes has affected clinical recommendations; (b) existing tools and challenges associated with measuring prenatal physical activity; (c) empirical evidence on multilevel determinants of prenatal activity to guide future intervention work; (d) empirical evidence of prenatal activity on adverse maternal outcomes (gestational diabetes mellitus, preeclampsia, excessive gestational weight gain) from observational and intervention studies; and (e) summary/recommendations for future research and practice.

CONCLUSIONS

The physical activity and pregnancy literature has evolved over the past 50 years, and there is sufficient empirical evidence to support the promotion of moderate-to-vigorous prenatal physical activity for maternal health benefits. Future studies and interventions should be carefully designed, theoretically driven, and include validated and reliable activity measures. Researchers and practitioners should also consider the multifaceted determinants and outcomes of prenatal physical activity and intervene to promote physical activity before, during, and after pregnancy.

Review of self-reported physical activity assessments for pregnancy: summary of the evidence for validity and reliability

BACKGROUND

Epidemiological studies and surveillance systems of pregnant women often rely on collection of physical activity through self-report. This systematic review identified and summarised self-reported physical activity assessments with evidence for validity and reliability among pregnant women.

METHODS

Peer-reviewed articles published through 2011 were included if they assessed validity and/or reliability of an interviewer- or self-administered physical activity questionnaire or diary among pregnant women.

RESULTS

We identified 15 studies, including 12 studies that assessed questionnaires and 4 studies that assessed diaries, conducted in Australia, Finland, Norway, the U.K., the U.S. and Vietnam. For questionnaires, 92% (11/12) assessed mode, all assessed frequency and/or duration and 58% (7/12) collected information on perceived intensity. All but one study (92%) assessed validity of the questionnaires. Questionnaires compared with objective measures (accelerometers, pedometers) ranged from slight to fair agreement, while comparison with other self-reported measures ranged from substantial to almost perfect agreement. Five studies (42%) assessed test-retest reliability of the questionnaires, ranging from substantial to almost perfect agreement. The four studies on diaries were all assessed for validity against objective measures, ranging from slight to substantial agreement.

CONCLUSIONS

Selection of valid and reliable physical activity measures that collect information on dose (type, frequency, duration, intensity) is recommended to increase precision and accuracy in detecting associations of physical activity with maternal and fetal outcomes.

Comparisons in perceived importance of and needs for maternal gestational weight information between african american and caucasian pregnant women

This study compared the perceived importance of and needs for maternal gestational weight information between African American and Caucasian pregnant women. A secondary analysis of data from 113 pregnant women (82 African Americans and 31 Caucasians) attending an inner-city prenatal clinic was conducted for this study. Perceived importance of and needs for information were measured in five areas: (1) nutrition, (2) prenatal vitamins, (3) rest/activity balance, (4) exercise, and (5) appropriate weight gain. African American women demonstrated significantly higher perceived importance of and needs for information on rest/activity balance and appropriate weight gain than Caucasian women. Exercise information was rated lower in importance but was most needed by both African American and Caucasian women. Education programs about maternal gestational weight need to be cognizant of ethnic women's needs.

Prenatal exercise research

In this review of recent research on prenatal exercise, studies from several different countries suggest that only approximately 40% of pregnant women exercise, even though about 92% are encouraged by their physicians to exercise, albeit with some 69% of the women being advised to limit their exercise. A moderate exercise regime reputedly increases infant birthweight to within the normal range, but only if exercise is decreased in late pregnancy. Lower intensity exercise such as water aerobics has decreased low back pain more than land-based physical exercise. Heart rate and blood pressure have been lower following yoga than walking, and complications like pregnancy-induced hypertension with associated intrauterine growth retardation and prematurity have been less frequent following yoga. No studies could be found on tai chi with pregnant women even though balance and the risk of falling are great concerns during pregnancy, and tai chi is one of the most effective forms of exercise for balance. Potential underlying mechanisms for exercise effects are that stimulating pressure receptors during exercise increases vagal activity which, in turn, decreases cortisol, increases serotonin and decreases substance P, leading to decreased pain. Decreased cortisol is particularly important inasmuch as cortisol negatively affects immune function and is a significant predictor of prematurity. Larger, more controlled trials are needed before recommendations can be made about the type and amount of pregnancy exercise.

Factors Associated With Exercise Participation and Attitudes to Exercise Among Pregnant Smokers

Objective: We assessed exercise levels and psychosocial aspects of exercise among pregnant smokers. Methods: A cross-sectional telephone survey of 88 pregnant smokers assessed levels of participation in exercise and psychosocial aspects of exercise; namely, self-efficacy, beliefs, perceived social support, perceived barriers, intentions and stage of change. Results: The women reported slightly higher levels of physical activity than for the general population of young women. The vast majority of women interviewed reported that exercise was important in their pregnancy, that they intended exercising regularly during pregnancy and were interested in exercise classes as an aid to smoking cessation. Fatigue was the most commonly reported barrier to physical activity during pregnancy, followed by ‘it takes too much time’, ‘uncomfortable when I exercise’ or ‘not sure what to do’. The vast majority of women expressed very little confidence and social support towards exercising. Conclusion: The results suggest that there is potential for using physical activity as an aid to smoking cessation during pregnancy. However, such interventions would need to be sufficiently intensive to address perceived barriers to exercise, lack of social support, low self-efficacy and be tailored to different stages of pregnancy.

Accuracy of physical activity monitors in pregnant women

PURPOSE

To determine the step count accuracy of three pedometers and one accelerometer in pregnant women during treadmill walking.

METHODS

Participants were 30 women in the second or third trimester (20-34 wk) who were screened for pregnancy-related risk factors. Each participant was fitted with a belt containing three physical activity monitors: Yamax Digiwalker SW-200 (DW), New Lifestyles NL 2000 (NL), and GT3X ActiGraph accelerometer (ACT). The Omron HJ-720ITC (HJ) was placed in the pants' front pocket. Participants walked at 54, 67, 80, and 94 m · min for 2 min each. Actual steps were determined by an investigator using a hand-tally counter. The mean percent of steps recorded was calculated for each device at each speed and compared. Pearson correlations were used to determine the effect of body mass index and tilt angle on pedometer accuracy.

RESULTS

There was a significant interaction between speed and device (F9,20 = 7.574, P < 0.001). Across all speeds, the NL and HJ had the lowest error. The ACT and DW underestimated the actual steps taken, particularly at the slower walking speeds. At 54 m · min, the ACT averaged 77.5% of steps and the DW averaged 56.9% of steps. Significant differences in the mean percent of steps recorded were found between devices at all speeds. Body mass index was only significantly correlated with percent of steps recorded by the NL, and there were no significant correlations between steps recorded and tilt angle.

CONCLUSIONS

In pregnant women, the ACT and DW had more error than the NL and HJ. On the basis of these results, the NL and HJ should be considered for use in further research studies and physical activity programs that focus on walking during pregnancy.

Effects of Exercise on Depression During Pregnancy and Postpartum: A Review

Approximately 13% of pregnant women and 10% to 15% of postpartum women report depression. Research indicates that exercise is efficacious for treating depression among adults in general; however, less is known regarding the efficacy of exercise for treating depression during pregnancy and the postpartum phase. In this article, the authors review the available studies examining the effect of exercise on mood and depressive symptoms during pregnancy and postpartum. The authors identified 4 studies examining the effect of exercise on mood during pregnancy and 9 studies examining exercise and depression in the postpartum phase. A majority of these studies indicated that exercise may be beneficial for improving mood; however, the studies had significant limitations, including lack of randomization, small sample sizes, and lack of control for contact time. Additional research is needed to better understand the effect of exercise on depression during pregnancy and the postpartum phase. Taken together, because of the potential benefits of exercise on mood during pregnancy and postpartum and the general health benefits of exercise, health care providers should encourage their healthy pregnant and postpartum patients to exercise. The authors provide practical suggestions for depression screening and exercise counseling for pregnant and postpartum women.

Exercise during pregnancy improves maternal health perception: a randomized controlled trial

OBJECTIVE

We have studied the effect of moderate physical activity that is performed by healthy women during their entire pregnancy on their perception of health status.

STUDY DESIGN

Eighty sedentary women were assigned randomly to either an exercise group (n = 40) or a control group (n = 40). Maternal perception of health status and several pregnancy outcomes were recorded.

RESULTS

Significant differences (P = .03) were found between study groups in the percentage of women who perceived their health status as "very good"; the values that corresponded to the exercise group (n = 18; 54.5%) were better than those of the control group (n = 9; 27.3%). In addition, the women of the exercise group gained less weight (11,885 ± 3146 g) than those of the control group (13,903 ± 2113; P = .03).

CONCLUSION

A moderate physical activity program that is performed over the first, second, and third trimester of pregnancy improves the maternal perception of health status.

Physical activity and depressive symptoms among pregnant women: the PIN3 study

Prenatal depression confers health risks for both mother and family. Physical activity may promote better mental health; however, few studies have examined the influence of physical activity on prenatal depression. Data from 1,220 women enrolled in the third Pregnancy, Infection, and Nutrition Study (2001-2005) were used to examine the associations between overall and domain-specific moderate-to-vigorous physical activity (MVPA) and depressive symptoms during pregnancy. Self-reported, past week physical activity assessed at 17-22 weeks' gestation was modeled in logistic regression with self-reported depressive symptoms assessed by the Center for Epidemiologic Studies-Depression Scale at 24-29 weeks' gestation. Active women with ≤2.67 h/week of total MVPA had almost half the odds of having high depressive symptoms as compared to women with no MVPA (odds ratio [OR] = 0.56, 95% confidence interval [CI] = 0.38, 0.83). Increased odds of elevated depressive symptoms were found for women participating in some but ≤2.25 h/week of adult and child care MVPA (OR = 1.84; 95% CI = 1.08, 3.11) and >1 h of indoor household MVPA (OR = 1.63, 95% CI = 0.99, 2.70) when compared to women with no MVPA. While overall MVPA may play a role in reducing the odds of developing elevated depressive symptoms, adult and child care and indoor household activities may increase it.

Antenatal depression: a rationale for studying exercise

BACKGROUND

Major depressive disorder (MDD) in pregnancy or antenatal depression poses unique treatment challenges and has serious consequences for mothers, unborn babies, and families when untreated. This review presents current knowledge on exercise during pregnancy, antidepressant effects of exercise, and the rationale for the specific study of exercise for antenatal depression.

METHOD

A systematic literature review was performed using English language articles published in Medline, PsycINFO, CINAHL, and the Cochrane Library from 1985 to January 2010.

RESULTS

There is a broad literature supporting the antidepressant effects of exercise, but a paucity of studies specifically for antenatal depression. A small number of observational studies have reported that regular physical activities improve self-esteem and reduce symptoms of anxiety and depression during pregnancy. To date, there have not been randomized controlled studies of exercise for the treatment of MDD in pregnant women.

CONCLUSIONS

Systematic studies are needed to assess exercise as a treatment alternative for MDD during pregnancy. In consideration of the benefits of exercise for the mother and baby, and the burden of depression, studies are needed to determine the role of exercise for pregnant women with depression.

Physical activity, health-related quality of life and depression during pregnancy

This study examines physical activity patterns among women, from pre-pregnancy to the second trimester of pregnancy, and the relationship between physical activity status based on physical activity guidelines and health-related quality of life (HRQoL) and depression over pregnancy. 56 healthy pregnant women self-reported physical activity, HRQoL and depression at 10-15 and 19-24 weeks of pregnancy and physical activity before pregnancy. Whereas vigorous leisure physical activity decreased after conception, moderate leisure physical activity and work related physical activity remained stable over time. The prevalence of recommended physical activity was 39.3% and 12.5% in the 1st and 2nd trimesters of pregnancy respectively, and 14.3% pre-pregnancy. From the 1st to the 2nd pregnancy trimester, most physical HRQoL dimensions scores decreased and only mental component increased, independently of physical activity status. No changes in mean depression scores were observed. These data suggest that physical activity patterns change with pregnancy and that physical and mental components are differentially affected by pregnancy course, independently of physical activity status.