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Kytö M, Koivusalo S, Tuomonen H, Strömberg L, Ruonala A, Marttinen P, Heinonen S, Jacucci G. Supporting the Management of Gestational Diabetes Mellitus With Comprehensive Self-Tracking: Mixed Methods Study of Wearable Sensors. JMIR Diabetes 2023; 8:e43979. [PMID: 37906216 PMCID: PMC10646680 DOI: 10.2196/43979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 06/16/2023] [Accepted: 09/14/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is an increasing health risk for pregnant women as well as their children. Telehealth interventions targeted at the management of GDM have been shown to be effective, but they still require health care professionals for providing guidance and feedback. Feedback from wearable sensors has been suggested to support the self-management of GDM, but it is unknown how self-tracking should be designed in clinical care. OBJECTIVE This study aimed to investigate how to support the self-management of GDM with self-tracking of continuous blood glucose and lifestyle factors without help from health care personnel. We examined comprehensive self-tracking from self-discovery (ie, learning associations between glucose levels and lifestyle) and user experience perspectives. METHODS We conducted a mixed methods study where women with GDM (N=10) used a continuous glucose monitor (CGM; Medtronic Guardian) and 3 physical activity sensors: activity bracelet (Garmin Vivosmart 3), hip-worn sensor (UKK Exsed), and electrocardiography sensor (Firstbeat 2) for a week. We collected data from the sensors, and after use, participants took part in semistructured interviews about the wearable sensors. Acceptability of the wearable sensors was evaluated with the Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire. Moreover, maternal nutrition data were collected with a 3-day food diary, and self-reported physical activity data were collected with a logbook. RESULTS We found that the CGM was the most useful sensor for the self-discovery process, especially when learning associations between glucose and nutrition intake. We identified new challenges for using data from the CGM and physical activity sensors in supporting self-discovery in GDM. These challenges included (1) dispersion of glucose and physical activity data in separate applications, (2) absence of important trackable features like amount of light physical activity and physical activities other than walking, (3) discrepancy in the data between different wearable physical activity sensors and between CGMs and capillary glucose meters, and (4) discrepancy in perceived and measured quantification of physical activity. We found the body placement of sensors to be a key factor in measurement quality and preference, and ultimately a challenge for collecting data. For example, a wrist-worn sensor was used for longer compared with a hip-worn sensor. In general, there was a high acceptance for wearable sensors. CONCLUSIONS A mobile app that combines glucose, nutrition, and physical activity data in a single view is needed to support self-discovery. The design should support tracking features that are important for women with GDM (such as light physical activity), and data for each feature should originate from a single sensor to avoid discrepancy and redundancy. Future work with a larger sample should involve evaluation of the effects of such a mobile app on clinical outcomes. TRIAL REGISTRATION Clinicaltrials.gov NCT03941652; https://clinicaltrials.gov/study/NCT03941652.
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Affiliation(s)
- Mikko Kytö
- Helsinki University Hospital IT Management, Helsinki University Hospital, Helsinki, Finland
- Department of Computer Science, University of Helsinki, Helsinki, Finland
| | - Saila Koivusalo
- Department of Gynecology and Obstetrics, Turku University Hospital, Turku, Finland
- Department of Gynecology and Obstetrics, University of Turku, Turku, Finland
- Department of Gynecology and Obstetrics, Helsinki University Hospital, Helsinki, Finland
- Department of Gynecology and Obstetrics, University of Helsinki, Helsinki, Finland
| | - Heli Tuomonen
- Department of Computer Science, University of Helsinki, Helsinki, Finland
| | - Lisbeth Strömberg
- Department of Computer Science, University of Helsinki, Helsinki, Finland
| | - Antti Ruonala
- Department of Computer Science, University of Helsinki, Helsinki, Finland
| | - Pekka Marttinen
- Department of Computer Science, Aalto University, Espoo, Finland
| | - Seppo Heinonen
- Department of Gynecology and Obstetrics, Helsinki University Hospital, Helsinki, Finland
- Department of Gynecology and Obstetrics, University of Helsinki, Helsinki, Finland
| | - Giulio Jacucci
- Department of Computer Science, University of Helsinki, Helsinki, Finland
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Yi L, Xu Y, Eckel SP, O'Connor S, Cabison J, Rosales M, Chu D, Chavez TA, Johnson M, Mason TB, Bastain TM, Breton CV, Dunton GF, Wilson JP, Habre R. Time-activity and daily mobility patterns during pregnancy and early postpartum - evidence from the MADRES cohort. Spat Spatiotemporal Epidemiol 2022; 41:100502. [PMID: 35691658 PMCID: PMC9198358 DOI: 10.1016/j.sste.2022.100502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 03/07/2022] [Accepted: 03/21/2022] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Pregnant women's daily time-activity and mobility patterns determine their environmental exposures and subsequently related health effects. Most studies ignore these and assess pregnancy exposures using static residential measures. METHODS We conducted 4-day continuous geo-location monitoring in 62 pregnant Hispanic women, during pregnancy and early post-partum then derived trips by mode and stays, classified by context (indoor/outdoor, type). Generalized mixed-effect models were used to examine whether these patterns changed over time. RESULTS Women spent on average 17.3 h/day at home. Commercial and service locations were the most popular non-home destinations, while parks and open spaces were seldom visited. Women made 3.5 daily trips (63.7 min/day and approximately 25% were pedestrian-based). Women were less likely to visit commercial and services locations and make vehicle-based trips postpartum compared to the 3rd trimester. CONCLUSION Our findings suggest time-activity patterns vary across pregnancy and postpartum, thus assessing exposures at stationary locations might introduce measurement error.
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Affiliation(s)
- Li Yi
- Spatial Sciences Institute, University of Southern California, United States
| | - Yan Xu
- Spatial Sciences Institute, University of Southern California, United States
| | - Sandrah P Eckel
- Department of Population and Public Health Sciences, University of Southern California, United States
| | - Sydney O'Connor
- Department of Population and Public Health Sciences, University of Southern California, United States
| | - Jane Cabison
- Department of Population and Public Health Sciences, University of Southern California, United States
| | - Marisela Rosales
- Department of Population and Public Health Sciences, University of Southern California, United States
| | - Daniel Chu
- Department of Population and Public Health Sciences, University of Southern California, United States
| | - Thomas A Chavez
- Department of Population and Public Health Sciences, University of Southern California, United States
| | - Mark Johnson
- Department of Population and Public Health Sciences, University of Southern California, United States
| | - Tyler B Mason
- Department of Population and Public Health Sciences, University of Southern California, United States
| | - Theresa M Bastain
- Department of Population and Public Health Sciences, University of Southern California, United States
| | - Carrie V Breton
- Department of Population and Public Health Sciences, University of Southern California, United States
| | - Genevieve F Dunton
- Department of Population and Public Health Sciences, University of Southern California, United States; Department of Psychology, University of Southern California, United States
| | - John P Wilson
- Spatial Sciences Institute, University of Southern California, United States; Department of Population and Public Health Sciences, University of Southern California, United States; Departments of Civil & Environmental Engineering, Computer Science and Sociology, University of Southern California, United States
| | - Rima Habre
- Spatial Sciences Institute, University of Southern California, United States; Department of Population and Public Health Sciences, University of Southern California, United States.
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Abstract
For apparently healthy pregnant women, regular physical activity is recommended. The American College of Obstetricians and Gynecologists (ACOG) created recommendations for physical activity and exercise during pregnancy in 1985. At that time, pregnant women were advised to not exceed a heart rate of 140 beats per minute with physical activity. The heart rate recommendation was subsequently removed with the recommendations published in 1994, 2002, and 2015. In 2020, the ACOG updated its recommendations on physical activity for pregnant and postpartum women. The recommendation included exercising at a "fairly light to somewhat hard" perceived intensity and at less than 60-80% of age-predicted maximum heart rate, usually not exceeding a heart rate of 140 beats per minute. Women often seek advice from healthcare providers on physical activity during pregnancy, yet providers report concern about giving appropriate physical activity guidance. This paper summarizes the key scientific literature on monitoring absolute and relative exercise intensity in relation to the current ACOG recommendations, providing background on intensity-related concepts used in the recommendation. This paper also provides practical guidance to assist healthcare providers in relaying this information to pregnant women.
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Affiliation(s)
- Kelly R. Evenson
- Kelly R. Evenson, Department of
Epidemiology, University of NC, Gillings School of Global Public Health, 123 W
Franklin Street, Building C, Suite 410, Chapel Hill, NC, USA; e-mail:
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da Silva DF, Mohammad S, Hutchinson KA, Adamo KB. Determination of minimal recording period to assess resting heart rate variability during pregnancy. Appl Physiol Nutr Metab 2020; 45:431-436. [DOI: 10.1139/apnm-2019-0351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Traditionally, resting heart rate variability (rHRV) is measured for 10 min using the last 5 min for analyses (e.g., criterion period). It is unknown whether the measurement period can be shortened in pregnant women as there are currently no established standards. We aimed to compare shorter time segments (e.g., from the 1st to 10th minutes) of the parasympathetic index natural logarithm transformation of root mean square of successive R–R differences (Ln rMSSD) with the criterion period in pregnant and nonpregnant women. Twelve pregnant (age: 30.8 ± 3.4 years; gestational age: 20.1 ± 5.0 weeks) and 15 nonpregnant women (age: 29.8 ± 4.0 years) were included. rHRV was measured using a portable heart rate monitor for 10 min while sitting. Ln rMSSD difference/agreement between shorter time segments and criterion period was analyzed. The result observed between the 4th–5th minutes was the shortest time segment not different from/highly agreed with the criterion period in pregnant women (difference [95% confidence interval (CI)]: −0.10 [−0.22 to 0.02]/bias ± 1.96 × SD: −0.06 [−0.38 to 0.25]). In nonpregnant women, the 2nd–3rd-minute segment was the shortest with similar results (difference [95% CI]: −0.04 [−0.15 to 0.07]/bias ± 1.96 × SD: −0.03 [−0.39 to 0.32]). The Ln rMSSD was found to be stable from the 5th–10th minutes and the 3rd–10th minutes in pregnant and nonpregnant women, respectively. A shortened rHRV assessment can increase its applicability in clinical/exercise-training settings. Novelty Ln rMSSD can be measured for 5 min in pregnant women, with the last 1-min segment analyzed. The last 1-min segment from 3 min can be used for rHRV measurement in nonpregnant women. The shortened rHRV assessment can facilitate its applicability in clinical/exercise-training settings.
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Affiliation(s)
- Danilo Fernandes da Silva
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1L 6N5, Canada
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1L 6N5, Canada
| | - Shuhiba Mohammad
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1L 6N5, Canada
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1L 6N5, Canada
| | - Kelly Ann Hutchinson
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1L 6N5, Canada
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1L 6N5, Canada
| | - Kristi Bree Adamo
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1L 6N5, Canada
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Vander Wyst KB, Buman MP, Shaibi GQ, Petrov ME, Reifsnider E, Whisner CM. Resting Energy Expenditure Relationship with Macronutrients and Gestational Weight Gain: A Pilot Study. Nutrients 2020; 12:nu12020450. [PMID: 32053977 PMCID: PMC7071224 DOI: 10.3390/nu12020450] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/05/2020] [Accepted: 02/07/2020] [Indexed: 02/04/2023] Open
Abstract
Resting energy expenditure (REE) comprises 60% of total energy expenditure and variations may be associated with gestational weight gain (GWG) or maternal diet. The objective of this study was to examine the impact of metabolic tracking on GWG and the association with maternal macronutrients. Pregnant women aged 29.8 ± 4.9 years (78.6% non-Hispanic, White) with gestational age (GA) < 17 week were randomized to Breezing™ (n = 16) or control (n = 12) groups for 13 weeks. REE by Breezing™ indirect calorimetry, anthropometrics and dietary intake were collected every two weeks. Early (14–21 weeks), late (21–28 weeks), and overall (14–28 weeks) changes in macronutrients and GWG were calculated. The Breezing™ group had a significantly greater rate of GWG [F (1,23) = 6.8, p = 0.02] in the latter half of the second trimester. Late (−155.3 ± 309.2 vs. 207.1 ± 416.5 kcal, p = 0.01) and overall (−143.8 ± 339.2 vs. 191.8 ± 422.2 kcal, p = 0.03) changes in energy consumption were significantly different between Breezing™ and control groups, respectively. Early changes in REE were positively correlated with overall changes in carbohydrates (r = 0.58, p = 0.02). Regular metabolism tracking alone did not have an impact on GWG. Early shifts in REE might impact GWG later in pregnancy. Investigation in a larger population from preconception through postpartum is needed.
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Affiliation(s)
- Kiley B. Vander Wyst
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA; (K.B.V.W.); (M.P.B.)
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, USA; (G.Q.S.); (M.E.P.); (E.R.)
| | - Matthew P. Buman
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA; (K.B.V.W.); (M.P.B.)
| | - Gabriel Q. Shaibi
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, USA; (G.Q.S.); (M.E.P.); (E.R.)
| | - Megan E. Petrov
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, USA; (G.Q.S.); (M.E.P.); (E.R.)
| | - Elizabeth Reifsnider
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, USA; (G.Q.S.); (M.E.P.); (E.R.)
| | - Corrie M. Whisner
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA; (K.B.V.W.); (M.P.B.)
- Correspondence: ; Tel.: +1-(602)-496-3348
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Denize KM, Akbari P, da Silva DF, Haman F, Adamo KB. Greater energy demand of exercise during pregnancy does not impact mechanical efficiency. Appl Physiol Nutr Metab 2019; 45:493-499. [PMID: 31614094 DOI: 10.1139/apnm-2019-0450] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Pregnant women are recommended to engage in 150 min of moderate-intensity physical activity per week to reduce pregnancy complications. Many women struggle to remain physically active throughout pregnancy, and there is no consensus about whether women adopt a less efficient movement pattern as they progress through pregnancy and experience gestational weight gain. This study assessed the change in energy expenditure and mechanical efficiency in pregnant women (PREG; n = 10) when performing a walking treadmill task in early, mid, and late pregnancy and also compared with an age- and body mass index-matched, nonpregnant (CON; n = 10) group. On average, the PREG group gained within the Institute of Medicine's gestational weight gain guidelines (11.6 ± 3.6 kg) and were all inactive (measured using accelerometry), except for 1 participant, by the third trimester, as per the 2019 Canadian physical activity guidelines for pregnant women. Energy expended to complete the walking task increased throughout pregnancy and was higher than the controls (111.5 ± 24.6 kcal) in mid and late pregnancy (139.0 ± 22.2 kcal, p = 0.02, and 147.3 ± 24.6 kcal, p = 0.005, respectively), but not early pregnancy (129.9 ± 18.9 kcal, p = 0.08). Walking mechanical efficiency was similar within pregnant women at each time point and compared to nonpregnant controls. Our findings add to the growing body of evidence demonstrating that pregnant women can safely perform physical activity by showing that walking mechanical efficiency is unchanged at low to moderate intensities. Novelty Energy demand during exercise increases proportionally to weight gain across pregnancy trimesters. However, mechanical efficiency remains unchanged during low- to moderate-intensity walking.
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Affiliation(s)
- Kathryn M Denize
- Department of Human Kinetics, Faculty of Health Science, University of Ottawa, Ottawa, ON K1N 6N5, Canada.,Department of Human Kinetics, Faculty of Health Science, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Pegah Akbari
- Department of Human Kinetics, Faculty of Health Science, University of Ottawa, Ottawa, ON K1N 6N5, Canada.,Department of Human Kinetics, Faculty of Health Science, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Danilo Fernandes da Silva
- Department of Human Kinetics, Faculty of Health Science, University of Ottawa, Ottawa, ON K1N 6N5, Canada.,Department of Human Kinetics, Faculty of Health Science, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Francois Haman
- Department of Human Kinetics, Faculty of Health Science, University of Ottawa, Ottawa, ON K1N 6N5, Canada.,Department of Human Kinetics, Faculty of Health Science, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Kristi B Adamo
- Department of Human Kinetics, Faculty of Health Science, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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Craemer KA, Sampene E, Safdar N, Antony KM, Wautlet CK. Nutrition and Exercise Strategies to Prevent Excessive Pregnancy Weight Gain: A Meta-analysis. AJP Rep 2019; 9:e92-e120. [PMID: 31041118 PMCID: PMC6424817 DOI: 10.1055/s-0039-1683377] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 12/11/2018] [Indexed: 02/06/2023] Open
Abstract
Objective To evaluate nutrition-only, exercise-only, and nutrition-plus-exercise interventions for optimizing gestational weight gain (GWG) based on the 2009 Institute of Medicine (IOM) guidelines. Study PubMed, Google Scholar, and 2015 Cochrane Review were searched. Analysis of variance was used to determine if significant GWG differences exist between strategies, with additional subanalyses on overweight (OV) or obese women based on 2009 IOM guidelines. Results Of 66 identified studies, 31 contributed data ( n = 8,558). Compared with routine prenatal care, nutrition-only interventions were significantly associated with reduced GWG and are most likely to produce weight gain within IOM recommendations ( p = 0.013). Exercise-only ( p = 0.069) and nutrition-plus-exercise ( p = 0.056) interventions trended toward GWG within IOM guidelines, but did not reach statistical significance. Supervised ( p = 0.61) and unsupervised ( p = 0.494) exercise programs had similar effectiveness. Subanalyses on OV or obese women produced similar results to studies that did not differentiate results based on body mass index: nutrition only ( p = 0.011), exercise only ( p = 0.308), and nutrition plus exercise ( p = 0.129). Conclusion Preventing excessive GWG is crucial, especially for OV or obese women. In the current study, nutrition-based intervention is the health system strategy that showed significant impact on preventing excessive GWG compared with routine prenatal care. Among women who are OV or have obesity, nutrition-only interventions hold the most promise compared with routine prenatal care.
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Affiliation(s)
- Katherine A Craemer
- Department of Integrated Biology, University of Wisconsin - Madison, Madison, Wisconsin.,Department of Obstetrics and Gynecology, University of Wisconsin - Madison, Madison, Wisconsin
| | - Emmanuel Sampene
- Department of Biostatistics and Medical Informatics, University of Wisconsin - Madison, Madison, Wisconsin
| | - Nasia Safdar
- Division of Infectious Disease, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin.,Department of Medicine, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
| | - Kathleen M Antony
- Department of Obstetrics and Gynecology, University of Wisconsin - Madison, Madison, Wisconsin
| | - Cynthia K Wautlet
- Department of Obstetrics and Gynecology, University of Wisconsin - Madison, Madison, Wisconsin
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Isacco L, Miles-Chan JL. Gender-specific considerations in physical activity, thermogenesis and fat oxidation: implications for obesity management. Obes Rev 2018; 19 Suppl 1:73-83. [PMID: 30511503 DOI: 10.1111/obr.12779] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 09/11/2018] [Indexed: 12/25/2022]
Abstract
With current 'one-size-fits-all' obesity prevention and management strategies proving largely ineffective, the focus has shifted towards a more tailored, individualized approach. However, investigation of the mechanisms underlying inter-individual variability in metabolic profile and response to intervention often yield conflicting results. Indeed, it is perhaps surprising that despite at least a century of recognition that sex hormones influence metabolism, firm conclusions regarding the effects of the menstrual cycle, hormonal contraception and menopause on many aspects of energy expenditure and substrate utilization remain to be drawn. In this review, we examine current evidence relating to gender-specific considerations in the promotion of physical activity, thermogenesis and fat oxidation for body-weight regulation, including the relationship between sex hormone status and non-exercise activity thermogenesis - an energy expenditure compartment that is often overlooked in favour of traditional exercise/sport physical activities yet presents a viable target in the search for effective weight management.
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Affiliation(s)
- L Isacco
- Research Unit EA3920 Prognostic Markers and Regulatory Factors of Cardiovascular Diseases and Exercise Performance Health Innovation Platform, University of Bourgogne Franche-Comté, Besançon, France
| | - J L Miles-Chan
- Human Nutrition Unit, School of Biological Sciences, University of Auckland, Auckland, New Zealand
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Krkeljas Z, Moss SJ. Relationship between gait kinematics and walking energy expenditure during pregnancy in South African women. BMC Sports Sci Med Rehabil 2018; 10:11. [PMID: 29946472 PMCID: PMC6006787 DOI: 10.1186/s13102-018-0100-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 06/07/2018] [Indexed: 12/16/2022]
Abstract
Background Various musculoskeletal changes occurring during pregnancy may lead to the change in gait and contribute to the increase in walking energy expenditure. Previous research indicates that changes in gait mechanics may lead to the increase in mechanical work required during walking. However, there is little information to indicate if changes in gait mechanics during pregnancy have impact on active or total energy expenditure. Therefore, the primary aim of this study was to investigate the relationship between changes in gait kinematics and walking energy expenditure in pregnant women. Methods Thirty-five women (mean age = 27.5 ± 6.1 years) volunteered for the study during various stages of pregnancy (1st trimester average = 12.1 ± 2.2 weeks; 2nd trimester = 22.3 ± 2.6 weeks; 3rd trimester = 31.4 ± 2.6 weeks). 3D motion analysis was used to assess changes in kinematic parameters during walking at self-selected pace. Resting metabolic rate, and walking energy expenditure expressed in terms of rate and cost of O2 were analysed with portable metabolic analyser. Results Only medio-lateral deviation of centre of gravity (COGML) increased 13.6% between the 1st and 2nd, and 39.3% between 2nd and 3rd trimester (p ≤ 0.001). However, self-selected walking speed depicted strong significant positive linear relationship with net O2 rate (r = 0.70; p ≤ 0.001), and was strongly associated with the vertical excursion of the COG (r = 0.75, p ≤ 0.001). Conclusions Changes in gait mechanics during pregnancy may lead to an increase in walking energy expenditure. However, the consequent increase in walking energy cost may not be sufficient to offset the natural energy sparing mechanism.
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Affiliation(s)
- Zarko Krkeljas
- 1Physical Activity, Sport and Recreation Research Focus Area, North-West University, Private Bag x6001, Internal Box 481, Potchefstroom, 2520 South Africa.,2Duke Kunshan University, 8 Duke Avenue, Kunshan, Jiangsu Province, 215316 China
| | - Sarah Johanna Moss
- 1Physical Activity, Sport and Recreation Research Focus Area, North-West University, Private Bag x6001, Internal Box 481, Potchefstroom, 2520 South Africa
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Orr TJ, Garland T. Complex Reproductive Traits and Whole-Organism Performance. Integr Comp Biol 2017; 57:407-422. [DOI: 10.1093/icb/icx052] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Yeo S, Walker JS, Caughey MC, Ferraro AM, Asafu-Adjei JK. What characteristics of nutrition and physical activity interventions are key to effectively reducing weight gain in obese or overweight pregnant women? A systematic review and meta-analysis. Obes Rev 2017; 18:385-399. [PMID: 28177566 DOI: 10.1111/obr.12511] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/11/2016] [Accepted: 12/12/2016] [Indexed: 12/29/2022]
Abstract
UNLABELLED Lifestyle interventions targeting gestational weight gain (GWG) report varying degrees of success. To better understand factors influencing efficacy, we reviewed randomized trials specifically among obese and overweight pregnant women. METHODS We conducted a systematic review and a meta-analysis of 32 studies with a pooled population of 5,869 overweight or obese pregnant women. Random effects models were fit to compute the weighted mean difference (WMD) in GWG between groups across studies. Subgroup analyses were conducted to compare intervention efficacy in overweight vs. obese pregnant women, and interventions delivered by prenatal care providers (PCPs) vs. non-PCPs during pregnancy. Moderator analyses ensured. RESULTS Nine (28%) of 32 studies reported significant reductions in GWG in response to intervention. Of these, six (66%) of nine were delivered by PCPs. Overall, the WMD in GWG was -1.71 (95% confidence interval [CI]: -2.55, -0.86) kg. However, interventions delivered by PCPs yielded a significantly greater reduction in GWG compared to interventions delivered by non-PCPs (WMD = -3.88 kg; 95% CI: -7.01, -0.75 vs. -0.80 kg; 95% CI: -1.32, -0.28; p for difference = 0.005). CONCLUSION When PCPs counsel nutrition and physical activity, obese and overweight pregnant women have greater success meeting GWG targets and may be more motivated to modify their behaviour than with other modes of intervention deliveries.
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Affiliation(s)
- SeonAe Yeo
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer S Walker
- Health Science Library, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Melissa C Caughey
- School of Medicine, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amanda M Ferraro
- Undergraduate Program, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Josephine K Asafu-Adjei
- School of Public Health, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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12
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Bell R, Robson P. Lack of a significant relationship between energy intake in pregnancy and gestational weight gain underlines the need for further evaluations of energy metabolism during this time. EVIDENCE-BASED MEDICINE 2016; 21:192. [PMID: 27565942 DOI: 10.1136/ebmed-2016-110471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Rhonda Bell
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Paula Robson
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
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Yeo S, Samuel-Hodge CD, Smith R, Leeman J, Ferraro AM, Asafu-Adjei JK. Challenges of Integrating an Evidence-based Intervention in Health Departments to Prevent Excessive Gestational Weight Gain among Low-income Women. Public Health Nurs 2016; 33:224-31. [PMID: 26918422 DOI: 10.1111/phn.12255] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To examine health departments' (HD) capacity to adapt and implement an intervention to prevent excessive gestational weight gain. DESIGN AND SAMPLE Seventy-seven stakeholders (nurses, nutritionists, social workers, health educators, health directors, and multilingual service providers) in nine HDs participated. A descriptive mixed methods approach was used to collect data at workshops held onsite to introduce the evidence-based intervention (EBI) and discuss its adaptation. MEASURES A survey was administered to assess the intervention's fit with the HDs context. Generalized logit mixed models were used to analyze the survey data. The discussions of adaptation were audiotaped and thematically analyzed to identify factors influencing implementation. RESULTS The majority of stakeholders desired to participate in the training portion of the EBI, but they were reluctant to adopt it, and noted a lack of adequate resources. From the audiotaped narratives, three themes emerged: (1) Patient needs and resources, (2) Perception about adaptability of the EBI, and (3) The complexity of the EBI for pregnant populations. CONCLUSION Although the EBI was effective for low-income nonpregnant populations in southeastern regions, pregnancy and complex antenatal services make this intervention unrealistic to be adapted as a part of prenatal care at HDs.
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Affiliation(s)
- SeonAe Yeo
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Carmen D Samuel-Hodge
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Gillings School of Global Public Health, Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Rachael Smith
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jennifer Leeman
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Amanda M Ferraro
- Undergraduate Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Josephine K Asafu-Adjei
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Gillings School of Global Public Health, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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14
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Krkeljas Z, Moss SJ. Correlating mechanical work with energy consumption during gait throughout pregnancy. BMC Pregnancy Childbirth 2015; 15:303. [PMID: 26589617 PMCID: PMC4654899 DOI: 10.1186/s12884-015-0744-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 11/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Measures of mechanical work may be useful in evaluating efficiency of walking during pregnancy. Various adaptations in the body during pregnancy lead to altered gait, consequently contributing to the total energy cost of walking. Measures of metabolic energy expenditure may not be reliable for measuring energetic cost of gait during pregnancy as pregnancy results in numerous metabolic changes resulting from foetal development. Therefore, the aim of this study is to determine if mechanical work prediction equations correlate with the metabolic energy cost of gait during pregnancy. METHODS Thirty-five (35) women (27.5 ± 6.1 years) gave informed consent for participation in the study at different weeks of gestation pregnancy. Gas exchange and gait data were recorded while walking at a fixed self-selected walking speed. External (Wext) work was estimated assuming no energy transfer between segments, while internal work (Wint) assumed energy transfer between segments. Hence total energy of the body (Wtot) was calculated based on the segmental changes relative to the surrounding, and relative to the centre of mass of the whole body. Equations for mechanical work were correlated with net and gross O2 rate, and O2 cost. RESULTS External, internal and total mechanical energy showed significant positive relationship with gross O2 rate (r = 0.48, r = 0.35; and r = 0.49 respectively), and gross O2 cost (r = 0.42; r = 0.70, and r = 0.62, respectively). In contrast, external, internal and total mechanical energy had no significant relationship with net O2 rate (r = 0.19, r = 0.24, and r = 0.24, respectively). Net O2 cost was significant related Wext (r = 0.49) Wint (r = 0.66) and Wtot (r = 0.62). Energy recovery improved with increase in gait speed. CONCLUSIONS Measures of mechanical work, when adjusted for resting energy expenditure, and walking speed may be useful in comparing metabolic energy consumption between women during pregnancy, or assessment or gait changes of the same individual throughout pregnancy.
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Affiliation(s)
- Zarko Krkeljas
- Physical Activity, Sport and Recreation Research Focus Area, Private Bag x6001, Internal Box 481, North-West University, Potchefstroom, 2520, South Africa.
| | - Sarah Johanna Moss
- Physical Activity, Sport and Recreation Research Focus Area, Private Bag x6001, Internal Box 481, North-West University, Potchefstroom, 2520, South Africa.
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15
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Muktabhant B, Lawrie TA, Lumbiganon P, Laopaiboon M. Diet or exercise, or both, for preventing excessive weight gain in pregnancy. Cochrane Database Syst Rev 2015; 2015:CD007145. [PMID: 26068707 PMCID: PMC9428894 DOI: 10.1002/14651858.cd007145.pub3] [Citation(s) in RCA: 275] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND This is an update of a Cochrane review first published in 2012, Issue 4. Excessive weight gain during pregnancy is associated with poor maternal and neonatal outcomes including gestational diabetes, hypertension, caesarean section, macrosomia, and stillbirth. Diet or exercise interventions, or both, may reduce excessive gestational weight gain (GWG) and associated poor outcomes; however, evidence from the original review was inconclusive. OBJECTIVES To evaluate the effectiveness of diet or exercise, or both, interventions for preventing excessive weight gain during pregnancy and associated pregnancy complications. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (5 November 2014), contacted investigators of the previously identified ongoing studies and scanned reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials (RCTs) of diet or exercise, or both, interventions for preventing excessive weight gain in pregnancy. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We organised RCTs according to the type of interventions and pooled data using the random-effects model in the Review Manager software. We also performed subgroup analyses according to the initial risk of adverse effects related to poor weight control. We performed sensitivity analysis to assess the robustness of the findings. MAIN RESULTS We included 65 RCTs, out of which 49 RCTs involving 11,444 women contributed data to quantitative meta-analysis. Twenty studies were at moderate-to-high risk of bias. Study interventions involved mainly diet only, exercise only, and combined diet and exercise interventions, usually compared with standard care. Study methods varied widely; therefore, we estimated the average effect across studies and performed sensitivity analysis, where appropriate, by excluding outliers and studies at high risk of bias.Diet or exercise, or both, interventions reduced the risk of excessive GWG on average by 20% overall (average risk ratio (RR) 0.80, 95% confidence interval (CI) 0.73 to 0.87; participants = 7096; studies = 24; I² = 52%). This estimate was robust to sensitivity analysis, which reduced heterogeneity, therefore we graded this evidence as high-quality. Interventions involving low glycaemic load diets, supervised or unsupervised exercise only, or diet and exercise combined all led to similar reductions in the number of women gaining excessive weight in pregnancy.Women receiving diet or exercise, or both interventions were more likely to experience low GWG than those in control groups (average RR 1.14, 95% CI 1.02 to 1.27; participants = 4422; studies = 11; I² = 3%; moderate-quality evidence). We found no difference between intervention and control groups with regard to pre-eclampsia (RR 0.95, 95% CI 0.77 to 1.16; participants = 5330; studies = 15; I² = 0%; high-quality evidence); however, maternal hypertension (not a pre-specified outcome) was reduced in the intervention group compared with the control group overall (average RR 0.70, 95% CI 0.51 to 0.96; participants = 5162; studies = 11; I² = 43%; low-quality evidence).There was no clear difference between groups with regard to caesarean delivery overall (RR 0.95, 95% CI 0.88 to 1.03; participants = 7534; studies = 28; I² = 9%; high-quality evidence); although the effect estimate suggested a small difference (5%) in favour of the interventions. In addition, for combined diet and exercise counselling interventions there was a 13% (-1% to 25%) reduction in this outcome (borderline statistical significance).We found no difference between groups with regard to preterm birth overall (average RR 0.91, 95% CI 0.68 to 1.22; participants = 5923; studies = 16; I² = 16%; moderate-quality evidence); however limited evidence suggested that these effect estimates may differ according to the types of interventions, with a trend towards an increased risk for exercise-only interventions.We found no clear difference between intervention and control groups with regard to infant macrosomia (average RR 0.93, 95% CI 0.86 to 1.02; participants = 8598; studies = 27; I² = 0%; high-quality evidence), although the effect estimate suggested a small difference (7% reduction) in favour of the intervention group. The largest effect size occurred in the supervised exercise-only intervention group (RR 0.81, 95% CI 0.64 to 1.02; participants = 2445; studies = 7; I² = 0%), which approached statistical significance (P = 0.07). Furthermore, in subgroup analysis by risk, high-risk women (overweight or obese women, or women with or at risk of gestational diabetes) receiving combined diet and exercise counselling interventions experienced a 15% reduced risk of infant macrosomia (average RR 0.85, 95% CI 0.73 to 1.00; participants = 3252; studies = nine; I² = 0; P = 0.05; moderate-quality evidence)There were no differences in the risk of poor neonatal outcomes including shoulder dystocia, neonatal hypoglycaemia, hyperbilirubinaemia, or birth trauma (all moderate-quality evidence) between intervention and control groups; however, infants of high-risk women had a reduced risk of respiratory distress syndrome if their mothers were in the intervention group (RR 0.47, 95% CI 0.26 to 0.85; participants = 2256; studies = two; I² = 0%; moderate-quality evidence). AUTHORS' CONCLUSIONS High-quality evidence indicates that diet or exercise, or both, during pregnancy can reduce the risk of excessive GWG. Other benefits may include a lower risk of caesarean delivery, macrosomia, and neonatal respiratory morbidity, particularly for high-risk women receiving combined diet and exercise interventions. Maternal hypertension may also be reduced. Exercise appears to be an important part of controlling weight gain in pregnancy and more research is needed to establish safe guidelines. Most included studies were carried out in developed countries and it is not clear whether these results are widely applicable to lower income settings.
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Affiliation(s)
- Benja Muktabhant
- Faculty of Public Health, Khon Kaen UniversityDepartment of Nutrition123 Friendship HighwayKhon KaenKhon KaenThailand40002
| | - Theresa A Lawrie
- World Health OrganizationDepartment of Reproductive Health and ResearchAvenue Appia 20GenevaSwitzerland1201
| | - Pisake Lumbiganon
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
| | - Malinee Laopaiboon
- Khon Kaen UniversityDepartment of Biostatistics and Demography, Faculty of Public Health123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
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16
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Yoo H, Shin D, Song C. Changes in the spinal curvature, degree of pain, balance ability, and gait ability according to pregnancy period in pregnant and nonpregnant women. J Phys Ther Sci 2015; 27:279-84. [PMID: 25642091 PMCID: PMC4305582 DOI: 10.1589/jpts.27.279] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 08/24/2014] [Indexed: 12/02/2022] Open
Abstract
[Purpose] The aim of this study was to investigate the changes in pain intensity, spinal
curvature, and balance and gait ability according to the pregnancy period. [Subjects]
Nineteen pregnant women and fifteen nonpregnant women were recruited in this study.
[Methods] The pain intensity, spinal curvature, gait, and balance of pregnant women were
measured according to the pregnant period (2nd and 3rd trimester). The changes in the
pregnant women were also compared with those in the nonpregnant women. [Results] The pain
intensity and spinal curvature in the third trimester of pregnancy were significantly
increased compared with the second trimester. Only the lumbar spine curvature in the third
trimester pregnancy was significantly greater in the pregnant women than in non-pregnant
women. The gait velocity and cadence in the third trimester of pregnancy showed a
significant decrease compared with the second trimester. The gait speed in the second and
third trimester of pregnancy showed a significant decrease in the pregnant women compared
with nonpregnant women. Balance in the third trimester of pregnancy showed significant
improvement compared with the second trimester. The balance of the pregnant women showed a
significant decrease compare with that nonpregnant women only on unstable surfaces.
[Conclusion] These research findings can be used as basic data for health promotion
programs for sound daily activities in pregnant women.
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Affiliation(s)
- Hyunju Yoo
- Department of Physical Therapy, College of Health and Welfare, Sahmyook University, Republic of Korea
| | - Doochul Shin
- Department of Physical Therapy, College of Health and Welfare, Sahmyook University, Republic of Korea
| | - Changho Song
- Department of Physical Therapy, College of Health and Welfare, Sahmyook University, Republic of Korea
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Furber CM, McGowan L, Bower P, Kontopantelis E, Quenby S, Lavender T. Antenatal interventions for reducing weight in obese women for improving pregnancy outcome. Cochrane Database Syst Rev 2013:CD009334. [PMID: 23440836 DOI: 10.1002/14651858.cd009334.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Being obese and pregnant is associated with substantial risks for the mother and her child. Current weight management guidance for obese pregnant women is limited. The latest recommendations suggest that obese pregnant women should gain between 5.0 and 9.1 kg during the pregnancy period, and weight loss is discouraged. However, observational studies indicate that some obese pregnant women, especially those who are heavier, lose weight during pregnancy. Furthermore, some obese pregnant women may intentionally lose weight. The safety of weight loss when pregnant and obese is not substantiated; some observational studies suggest that risks associated with weight loss such as pre-eclampsia are improved, but others indicate that the incidence of small- for-gestational infants are increased. It is important to evaluate interventions that are designed to reduce weight in obese pregnant women so that the safety of weight loss during this period can be established. OBJECTIVES To evaluate the effectiveness of interventions that reduce weight in obese pregnant women. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2012) and contacted experts in the field. SELECTION CRITERIA Randomised controlled trials, 'quasi-random' studies and cluster-randomised trials comparing a weight-loss intervention with routine care or more than one weight loss intervention. Cross-over trials were not eligible for inclusion. DATA COLLECTION AND ANALYSIS We identified no studies that met the inclusion criteria for this review. MAIN RESULTS There were no included trials. AUTHORS' CONCLUSIONS There are no trials designed to reduce weight in obese pregnant women. Until the safety of weight loss in obese pregnant women can be established, there can be no practice recommendations for these women to intentionally lose weight during the pregnancy period. Further study is required to explore the potential benefits, or harm, of weight loss in pregnancy when obese before weight loss interventions in pregnancy can be designed. Qualitative research is also required to explore dietary habits of obese pregnant women, especially those who are morbidly obese.
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Affiliation(s)
- Christine M Furber
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK.
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18
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Han S, Middleton P, Crowther CA. Exercise for pregnant women for preventing gestational diabetes mellitus. Cochrane Database Syst Rev 2012:CD009021. [PMID: 22786521 DOI: 10.1002/14651858.cd009021.pub2] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) affects a significant number of women each year. GDM is associated with a wide range of adverse outcomes for women and their babies. Recent observational studies have found physical activity during normal pregnancy decreases insulin resistance and therefore might help to decrease the risk of developing GDM. OBJECTIVES To assess the effects of physical exercise for pregnant women for preventing glucose intolerance or GDM. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (2 April 2012), ClinicalTrials.gov (2 April 2012) and the WOMBAT Perinatal Trials Registry (2 April 2012). SELECTION CRITERIA Randomised and cluster-randomised trials assessing the effects of exercise for preventing pregnancy glucose intolerance or GDM. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility, extracted data and assessed the risk of bias of included studies. MAIN RESULTS We included five trials with a total of 1115 women and their babies (922 women and their babies contributed outcome data). Four of the five included trials had small sample sizes with one large trial that recruited 855 women and babies. All five included trials had a moderate risk of bias. When comparing women receiving additional exercise interventions with those having routine antenatal care, there was no significant difference in GDM incidence (three trials, 826 women, risk ratio (RR) 1.10, 95% confidence interval (CI) 0.66 to 1.84), caesarean section (two trials, 934 women, RR 1.33, 95% CI 0.97 to 1.84) or operative vaginal birth (two trials, 934 women, RR 0.83, 95% CI 0.58 to 1.17). No trial reported the infant primary outcomes prespecified in the review.None of the five included trials found significant differences in insulin sensitivity. Evidence from one single large trial suggested no significant difference in the incidence of developing pregnancy hyperglycaemia not meeting GDM diagnostic criteria, pre-eclampsia or admission to neonatal ward between the two study groups. Babies born to women receiving exercise interventions had a non-significant trend to a lower ponderal index (mean difference (MD) -0.08 gram x 100 m(3), 95% CI -0.18 to 0.02, one trial, 84 infants). No significant differences were seen between the two study groups for the outcomes of birthweight (two trials, 167 infants, MD -102.87 grams, 95% CI -235.34 to 29.60), macrosomia (two trials, 934 infants, RR 0.91, 95% CI 0.68 to 1.22), or small-for-gestational age (one trial, 84 infants, RR 1.05, 95% CI 0.25 to 4.40) or gestational age at birth (two trials, 167 infants, MD -0.04 weeks, 95% CI -0.37 to 0.29) or Apgar score less than seven at five minutes (two trials, 919 infants, RR 1.00, 95% CI 0.27 to 3.65). None of the trials reported long-term outcomes for women and their babies. No information was available on health services costs. AUTHORS' CONCLUSIONS There is limited randomised controlled trial evidence available on the effect of exercise during pregnancy for preventing pregnancy glucose intolerance or GDM. Results from three randomised trials with moderate risk of bias suggested no significant difference in GDM incidence between women receiving an additional exercise intervention and routine care.Based on the limited data currently available, conclusive evidence is not available to guide practice. Larger, well-designed randomised trials, with standardised behavioural interventions are needed to assess the effects of exercise on preventing GDM and other adverse pregnancy outcomes including large-for-gestational age and perinatal mortality. Longer-term health outcomes for both women and their babies and health service costs should be included. Several such trials are in progress. We identified another seven trials which are ongoing and we will consider these for inclusion in the next update of this review.
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Affiliation(s)
- Shanshan Han
- ARCH: Australian Research Centre for Health of Women and Babies, Discipline of Obstetrics and Gynaecology, The University ofAdelaide, Adelaide, Australia.
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Phelan S, Jankovitz K, Hagobian T, Abrams B. Reducing excessive gestational weight gain: lessons from the weight control literature and avenues for future research. ACTA ACUST UNITED AC 2012; 7:641-61. [PMID: 22040207 DOI: 10.2217/whe.11.70] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Excessive gestational weight gain is a prevalent problem and an independent predictor of future obesity in both mothers and offspring. Intervention research to prevent excessive gestational weight gain is still in its infancy but results to date have been quite modest. Research in weight control outside of pregnancy over the past 30 years has been more robust and identified several key components of effective programs, including use of caloric restriction, daily diet self-monitoring, self-weighing, behavior therapy and ongoing patient-provider contact. The aim of this article is to summarize intervention components shown to be effective in promoting successful weight control outside of pregnancy and explore potential applications in pregnancy. Available evidence suggests that the strategies shown to be effective for weight control outside of pregnancy may also promote better weight control in pregnancy, but several lines for future investigation remain.
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Affiliation(s)
- Suzanne Phelan
- Kinesiology Department, California Polytechnic State University, San Luis Obispo, CA 93407-0386, USA.
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Gaud MA, Frasquet-Darrieux M, Glomot F, Bucco C, Christin P, Compain F, Pierre F, Ingrand P, Hankard R. Gestational weight gain: arguments for a transgenerational weight-control process. Am J Clin Nutr 2012; 95:529; author reply 529-31. [PMID: 22268022 DOI: 10.3945/ajcn.111.027235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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