Walking in pregnancy and prevention of insomnia in third trimester using pedometers: study protocol of Walking_Preg project (WPP). A randomized controlled trial

BACKGROUND

Previous studies in pregnancy have not focused in evaluating the effect of walking during pregnancy and prevention of insomnia. Our general objective is to determine the effect of a walking program in preventing the appearance of insomnia in the third trimester of pregnancy, increasing sleep quality and improving quality of life throughout pregnancy.

METHODS

Randomized Controlled trial in parallel in healthy sedentary pregnant women (n = 265), Walking_Preg Project (WPP), from university hospital in Granada, Spain. At 12th gestational week (GW), they will be invited to participate and randomly assigned to one of the three arms of study: the intervention group I1 (pedometer, goal of 11,000 steps/day), intervention group I2 (pedometer, no goal) and control (no pedometer). Duration of intervention: 13-32 GW. At 12th, 19th and 31st GW the average steps/day will be measured in groups I1 and I2. At 13th, 20th and 32nd GW, Athens Insomnia Scale (AIS), Pittsburgh Sleep Quality Index (PSQI), Adherence to Mediterranean Diet (AMD), physical activity (short IPAQ), quality of life (PSI), and consumption of toxic substances (caffeine, illegal drugs, alcohol and tobacco) will be collected. Student t test or Mann-Whitney U will be used to compare 19th and 31st GW mean of daily steps between I1 and I2 groups. To compare differences between groups in terms of frequency of insomnia/quality of life for each trimester of pregnancy, Pearson's Chi-square test or Fisher's exact test will be used. To determine differences in hours of sleep and quality of sleep throughout each trimester of pregnancy, analysis of variance or Friedman test will be used. McNemar-Bowker test will be used to assess differences in life quality in pre-post analyses in the 3 arms. We will use Stata 15 statistical software.

DISCUSSION

promoting walking in second half of pregnancy through use of pedometer and health pre-registration of a goal to be achieved -'10,000-11,000 steps a day'- should prevent appearance of insomnia in third trimester, will increase sleep quality and quality of life in pregnant women.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03735381 . Registered 8th November, 2018.

[Epidural analgesia and the rate of cesarean delivery]

OBJECTIVES

To assess the influence of epidural analgesia on the increased rate of cesarean delivery and to analyze associated factors.

PATIENTS AND METHOD

Prospective study enrolling 1,714 women in labor to whom epidural analgesia was offered; 719 received epidural analgesia and 995 did not. We recorded age, weight, height, parity, gestational age, duration of labor, manner of onset of labor, delivery, birth weight, Apgar score and pH in the umbilical artery and vein. Student t, Hotteling's t2 and chi-squared tests were used to compare the results. Multiple logical regression analysis was used to determine the variable or variables having the most effect on the rate of cesarean delivery.

RESULTS

Labor lasted longer in the group of women who received epidural analgesia than in those who did not (234 +/- 90 versus 181 +/- 43 minutes) and the epidural group had significantly higher rates of induced labor (50% versus 15%), instrument-assisted delivery (19% versus 5%) and cesarean delivery (21% versus 8%). Cesarean sections were more frequent among women whose labor was induced and in nulliparous women in both groups. Logical regression analysis showed that epidural analgesia was the most significant variable affecting delivery by cesarean section. The next most influential variable was induction of labor. Parity was not significantly related to delivery by cesarean.

CONCLUSIONS

Epidural analgesia increased the likelihood of cesarean delivery in our study. The same factors that most often encourage women to accept epidural analgesia (induced labor, greater pain, prolonged labor, etc.) may predict increased likelihood of cesarean delivery.