Impact of physical activity during pregnancy on obstetric outcomes in obese women

Relationships Between Perinatal Physical Activity and Pain During Labor and Postpartum

Objective: Physical activity (PA) and pain are bidirectionally related during pregnancy. There are limited data on how prenatal changes in PA relate to labor and postpartum pain. The current study examined associations between PA change from the second to third trimester (increasing vs. decreasing) with (1) labor pain, (2) postpartum hospitalization pain, and (3) the likelihood of increasing versus decreasing PA at 6-months postpartum (relative to the third trimester). Methods: A sample of pregnant people with overweight/obesity were enrolled in a longitudinal study between 12- and 20-weeks' gestation (n = 257). A subsample, with at least three pain ratings documented (n = 233), were included in the current analysis. PA change was characterized with the Paffenbarger. Pain was assessed regularly during labor and postpartum hospitalization from 0 (no pain) to 10 (most pain). Labor and postpartum pain were summarized using minimum/maximum pain ratings, percent improvement in pain following analgesia, and overall pain burden. t-Tests compared pain between the PA groups, and chi-square analyses examined the likelihood of increasing versus decreasing PA at 6-months postpartum. Results: The increasing PA group (n = 52; 22%) reported lower minimum pain scores (d = 0.46) during postpartum hospitalization. Most individuals with decreasing PA between trimesters two and three reported increasing PA at 6-months postpartum. Conclusion: Relative to individuals with decreasing PA, individuals with increasing PA experienced less pain during postpartum hospitalization highlighting potential benefits of prenatal PA for postpartum recovery.

The effect of caring intervention (physical activity, diet and counseling) on gestational diabetes for pregnant women with metabolic syndrome

OBJECTIVE

Metabolic syndrome and its indexes is one of the critical health problems during pregnancy. This study aimed to examine the effects of a care intervention program on pregnancy outcome in pregnant women with Metabolic Syndrome during 2017-2018.

METHODS

This randomized clinical trial study was conducted in 120 singleton pregnant women with metabolic syndrome. The participants were selected using purposive sampling method from pregnant women referred to two health centers of Babol. They were randomly divided in two control and intervention groups (60 samples in each group). Intervention group received one motivational interview session for 120 min, two consultation sessions with expert for nutritional recommendations based on Nutrition Guidelines of Ministry of Health for Pregnant Women. They were also theoretically and practically provided by three training sessions for physical activity and pregnancy exercises combining pelvic floor muscles, bodybuilding, muscle strengthening, stretching, and relaxation and walking activities. To follow up on the intervention, the researcher made a phone call with the participants in intervention group every 10 days to two weeks. Pregnancy outcomes were assessed using SPSS software.

RESULTS

The obtained results showed that there was a significant difference between the two groups in maternal complications including gestational diabetes, hospitalization due to gestational diabetes, nutritional diet for gestational diabetes, pregnancy weight gain and 2-hour post-prandial blood glucose test (p ≤ .01). There was no significant difference in terms of demographic, midwifery and metabolic syndrome indices between the intervention and control groups.

CONCLUSION

The results of the study indicated that intervention program improved the maternal pregnancy outcome such as gestational diabetes and weight gain during the pregnancy in the intervention group. This program had no adverse effects for the mother who is consistent with pregnancy health objectives.

Physical Activity and Risk of Cesarean Delivery in Hispanic Women

BACKGROUND

Rates of cesarean delivery continue to increase among Hispanics, the largest minority group in the United States. Prior studies of the relationship between physical activity and cesarean delivery have been conflicting, limited by questionnaires not validated for pregnancy, and conducted primarily among non-Hispanic whites.

METHODS

We evaluated this association among participants (n = 1313) in Proyecto Buena Salud, a prospective cohort of Hispanic women conducted from 2006 to 2011. Physical activity was measured via the Pregnancy Physical Activity Questionnaire.

RESULTS

In total, 320 (24.4%) participants delivered via cesarean. In multivariable analyses, increasing levels of sedentary activity in mid/late pregnancy were associated with higher odds of cesarean delivery (odds ratio = 1.54; 95% confidence interval, 1.02-3.33; P_trend = .05); however, there were no clear patterns between physical activity and cesarean delivery. When we repeated the analysis excluding planned cesarean deliveries (n = 126), high levels of prepregnancy moderate-intensity physical activity (odds ratio = 0.61; 95% confidence interval, 0.38-0.99) and increasing moderate-intensity physical activity in mid/late pregnancy (P_trend = .03) were associated with reduction in odds. Increasing levels of household/caregiving physical activity in pre and mid/late pregnancy were associated with a 50% reduction in odds (P_trend < .05).

CONCLUSIONS

In this prospective cohort of Hispanics, sedentary activity increased odds of cesarean delivery, and moderate-intensity and household/caregiving physical activity reduced odds of unplanned cesarean deliveries.

Appropriate Interventions for Pregnant Women with Indicators of Metabolic Syndrome on Pregnancy Outcomes: A Systematic Review

Metabolic syndrome (MetS), a series of symptoms, including abdominal obesity, impaired glucose tolerance and insulin metabolism, hypertension, and dyslipidemia, is considered as the risk of developing cardiovascular disease and diabetes that can predispose a pregnant women to serious health problem, women in the developed as well as the developing countries. This study was aimed to investigate the effects of appropriate interventions on pregnant women with indicators of MetS to further improve the outcome of pregnancy. This systematic review was performed to extract articles of randomized controlled trials (RCT) on pregnant women with indicators of (MetS) and focusing on physical activity, dietary or lifestyle interventions on maternal health or perinatal outcomes, with searching in the Web of Science, PubMed, CDSR, Scopus, and Google Scholar were investigated. Two researchers independently evaluated the quality of the studies, being presented in all the articles and ranked the studies as high/low quality; the level of evidence was based on the number of high-quality studies and the coordination of the obtained results. Then, 17 articles, which met the inclusion criteria, were selected; among these, 7 articles studied the physical activity, 3 articles reviewed diets, 6 probed the lifestyle interventions, and 1 article was on counseling. In general, evidence suggested how the physical activity and proper diet impacts on proper weight gain during pregnancy, prevents maternal complications, and improves the outcome of pregnancy. According to the results of this systematic review, proper interventions during pregnancy can have a positive effect on maternal weight gain and the general health condition of pregnant women with indicators of MetS.

Origins in the Womb: Potential Role of the Physical Therapist in Modulating the Deleterious Effects of Obesity on Maternal and Offspring Health Through Movement Promotion and Prescription During Pregnancy

Maternal obesity and associated metabolic disease contribute to adverse outcomes in women and their offspring, and many of these outcomes have significant acute and chronic implications for both mother and neonate. Targeted movement (ie, physical activity or exercise training) during pregnancy has been shown to be safe and effective for improving many of these outcomes in women at a healthy weight and women who are obese. However, movement prescription and advice during pregnancy are often not addressed by health care providers; this situation creates a unique opportunity for physical therapists to use their expertise in movement with patients who are pregnant. The objective of this article is to briefly review the adverse maternal and neonatal outcomes associated with maternal obesity, the benefits of intentional maternal movement during pregnancy for women who are obese, the evidence-based guidelines for prescribing intentional movement during pregnancy for women who are obese, and the potential for physical therapists to become the driving force behind a necessary increase in movement levels in women who are pregnant. Physical therapists can play a significant role in encouraging movement in women who are healthy and women who have metabolic challenges during pregnancy and thus assist in combating the vicious cycle of obesity by improving maternal and offspring health.