Five Dimensions of Needs for Help: The Efficacy of a Technology-Based Intervention Among Asian American Breast Cancer Survivors

Cancer survivors including Asian American breast cancer survivors have reported their high needs for help during their survivorship process. With the COVID-19 pandemic, the necessity of technology-based programs to address their needs for help without face-to-face interactions has been highlighted. The purpose of this randomized intervention study was to determine the efficacy of a technology-based program in reducing various types of needs for help among this specific population. This was a randomized clinical trial with repeated measures. A total of 199 participants were included in the data analysis. The recruitment settings included both online and offline communities/groups for Asian Americans. The needs for help were assessed using the Support Care Needs Survey-34 Short Form (SCNS) subscales measuring psychological, information, physical, support, and communication needs. Data analysis was conducted through an intent-to-treat approach. In the mixed effect models, psychological needs, information needs, physical needs, and communication needs decreased over time (P < .001). However, there were no significant group * time effects. Social support significantly mediated the effects of a technology-based intervention on psychological, information, and support needs at the pre-test and the post-1 month. This study supported significant decreases in the needs for help of Asian American breast cancer survivors by a technology-based intervention. Further studies are needed with other racial/ethnic groups of cancer survivors to confirm the efficacy of a technology-based intervention in reducing cancer survivors' needs for help during their survivorship process.

Longitudinal Changes of Depressive Symptoms in Sedentary Women Who Exercised During Pregnancy

Introduction

Prenatal depression is a common disorder; however, little is known about how depressive symptoms manifest during pregnancy, including when symptoms present and what symptoms are common. This study aimed to better understand prenatal depressive symptoms during pregnancy in the postpartum period, as well as how exercise, such as walking and stretching, can improve depressive symptoms during pregnancy and the postpartum period.

Methods

A total of 55 women were assessed using the Beck Depression Inventory-II for depressive symptoms at 16 weeks, 28 weeks, and 2 months postpartum. Sedentary pregnant women at-risk for preeclampsia were randomly assigned to either a stretching or walking group for 40 minutes five times a week from 18 weeks of gestation until birth. The primary analyses were analysis of variance and mixed-effects models.

Results

All depressive symptoms decreased throughout pregnancy during the postpartum period, although this trend was not statistically significant. Cognitive-affective and somatic depressive symptoms had different trajectories during pregnancy into the postpartum period, but no significant difference was found. Statistically significant improvements were observed in loss of energy and change in sleeping pattern for the walking and stretching groups.

Conclusion

The finding that physical activity improves the depressive symptoms' loss of energy and changes in sleeping patterns during pregnancy aligns with the existing literature, but little research has examined how individual depressive symptoms change throughout pregnancy into the postpartum period. Gaining a better understanding of the trajectories and manifestations of depressive symptoms during pregnancy and the postpartum period is essential for improving detection and treatment practices. Understanding when and how depressive symptoms are present is critical for the clinical diagnosis of this disorder.

A randomized controlled trial testing a virtual program for Asian American women breast cancer survivors

A culturally tailored virtual program could meet the survivorship needs of Asian American women breast cancer survivors (AABC). This study aims to determine the efficacy of a culturally tailored virtual information and coaching/support program (TICAA) in improving AABC's survivorship experience. A randomized clinical trial (NCT02803593) was conducted from January 2017 to June 2020 among 199 AABC. The intervention group utilized TICAA and the American Cancer Society [ACS] website while the control group used only ACS website for 12 weeks. The outcomes were measured using the SCNS-34SF (needs; primary), the MSAS-SF (symptoms; secondary), and the FACT-B (quality of life; secondary). The data were analyzed using an intent-to-treat approach. The intervention group showed significant reductions in their needs from the baseline (T0) to post 4 weeks (T1) and to post 12 weeks (T2). Although the changes were not statistically significant, the intervention group had decreased symptoms from T0 to T2 while the control group had an increase in their symptoms. The intervention group had a significant increase in their quality of life from T0 to T2. A culturally tailored virtual program could therefore improve quality of life in AABC patients. Trial Registration: To Enhance Breast Cancer Survivorship of Asian Americans (TICAA), NCT02803593, https://clinicaltrials.gov/ct2/show/NCT02803593?titles=TICAA&draw=2&rank=1.

Relationship between healing status and microbial dissimilarity in wound and peri-wound skin in pressure injuries

AIM

Wound infection is the most serious cause of delayed healing for patients with pressure injuries. The wound microbiota, which plays a crucial role in delayed healing, forms by bacterial dissemination from the peri-wound skin. To manage the bioburden, wound and peri-wound skin care has been implemented; however, how the microbiota at these sites contribute to delayed healing is unclear. Therefore, we investigated the relationship between healing status and microbial dissimilarity in wound and peri-wound skin.

METHODS

A prospective cohort study was conducted at a long-term care hospital. The outcome was healing status assessed using the DESIGN-R® tool, a wound assessment tool to monitor the wound healing process. Bacterial DNA was extracted from the wound and peri-wound swabs, and microbiota composition was analyzed using 16S rRNA gene analysis. To evaluate microbial similarity, the weighted UniFrac dissimilarity index between wound and peri-wound microbiota was calculated.

RESULTS

Twenty-two pressure injuries (7 deep and 15 superficial wounds) were included in the study. For deep wounds, the predominant bacteria in wound and peri-wound skin were the same in the healing wounds, whereas they were different in all cases of hard-to-heal wounds. Analysis based on the weighted UniFrac dissimilarity index, there was no significant difference for healing wounds (p = 0.639), while a significant difference was found for hard-to-heal wounds (p = 0.047).

CONCLUSIONS

Delayed healing is possibly associated with formation of wound microbiota that is different in composition from that of the skin commensal microbiota. This study provides a new perspective for assessing wound bioburden.

Association of left atrial ejection fraction and cardiovascular outcomes in Asian patients with hypertrophic cardiomyopathy

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): National University of Singapore Yong Loo Lin School of Medicine's Junior Academic Fellowship Scheme

Background

The optimal method of risk stratification of hyp­ertrophic cardiomyopathy (HCM) patients, especially in the Asian population, is unknown. Left atrial ejection fraction (LAEF) is an emerging risk marker for cardiovascular outcomes. This study aimed to investigate whether LAEF was associated with cardiovascular outcomes in Asian patients with HCM.

Methods

This was a retrospective cohort study performed in a tertiary academic centre involving 291 consecutive patients diagnosed with HCM between 2010 and 2017. We collected the relevant clinical characteristics of these patients and retrospectively analysed the index transthoracic echocardiograms for novel left atrial indices including LAEF. We obtained the maximum (LAVmax) and minimum left atrial volumes (LAVmin) using the biplane method of disks in apical 4- and 2-chamber views. LAEF was derived by dividing the difference between LAVmax and LAVmin by LAVmax. We assessed the patients for outcomes of (1) heart failure requiring admission, and (2) a composite of adverse outcomes including all-cause mortality, ventricular tachycardia / ventricular fibrillation (VT/VF) events, appropriate device therapy if an implantable cardioverter defibrillator (ICD) was implanted, stroke and heart failure hospitalization.

Results

The patients had a mean age of 59.0 ± 16.7 years-old at diagnosis and had a male preponderance (71.2%). The most common comorbidities were hypertension, diabetes mellitus and ischemic heart disease. On univariable logistic regression analysis, maximum and minimum left atrial volume index (LAVI) as well as LAEF showed a significant association with heart failure and the predefined composite outcome. On Cox regression analysis adjusting for variables of age, sex, left ventricular ejection fraction (LVEF), left ventricular maximal wall thickness &gt;30mm, significant left ventricular outflow tract (LVOT) gradient of &gt; 30mmHg and more than moderate mitral regurgitation, maximum and minimum LAVI as well as LAEF retained an association with heart failure admission but only minimum LAVI and LAEF were associated with the composite outcome [(OR 0.019, 95% CI 0.02-0.230, p=0.002), (OR 0.226, 95% CI 0.053-0.960, p=0.044), (OR 1.030, 95% CI 1.016-1.045, p&lt;0.001), and (OR 1.016, 95% CI 1.005-1.026, p=0.004) respectively].

Conclusion

LAEF was an independently associated with congestive heart failure as well as a composite of adverse outcomes in Asian patients with HCM.

Factors Associated with the Local Increase of Skin Temperature, 'Hotspot,' of Callus in Diabetic Foot: A Cross-Sectional Study

BACKGROUND

Increased local skin temperature (hotspot) on a callus site as detected by thermography is a well-known precursor of diabetic foot ulcers. This study aimed to determine the factors associated with callus hotspots in order to predict the risk of callus hotspots and then provide information for specific interventions.

METHODS

In this cross-sectional study, 1,007 patients' data from a diabetic foot prevention clinic between April 2008 and March 2020 were used. Data regarding patients' characteristics, foot calluses, and callus hotspots were collected and analyzed. Callus and callus hotspot were confirmed from foot photos and thermographs, respectively. A callus hotspot was defined as a relative increase in temperature compared to the skin surrounding the callus on the thermograph. Plantar pressure was measured with a pressure distribution measurement system. A generalized linear mixed model was used to identify the factors associated with callus hotspots.

RESULTS

Among the 2,014 feet, 28.5% had calluses, and 18.5% of feet with calluses had callus hotspots. The factors associated with callus hotspots were number of calluses (Adjusted odds ratio (aOR): 1.540, P = .003), static forefoot peak plantar pressure (SFPPP) (aOR: 1.008, P = .001), and body mass index (aOR: 0.912, P = .029).

CONCLUSIONS

Patients with a higher SFPPP were more likely to have callus hotspots suggesting that SFPPP might contribute to callus inflammation. SFPPP has the potential to be a useful predictor of callus hotspots in people with diabetes and at the same time provide information for off-loading interventions to prevent callus hotspots.

Low-Intensity Exercise and Pregnancy Outcomes: An Examination in the Nurses' Health Study II

Background: The benefit of low-intensity exercise (LIE) during pregnancy is poorly understood at a time when few women participate in moderate or vigorous exercise. Using data from the Nurses' Health Study II (NHSII), we tested the hypothesis that women who engaged in more LIE before and during pregnancy experience fewer pregnancy complications.

Methods: Among 116,429 U.S. female registered nurses (25–42 years of age) who were enrolled in NHSII in 1989, we included participants (36–50 years of age) who reported in 2001 or 2005 that they were pregnant and completed questionnaires about pregnancy “low-intensity exercise (yoga, stretching, toning),” and who in 2009, provided a full pregnancy outcome history. Multivariable-adjusted relative risk (RR) and 95% confidence intervals (CIs) were calculated between LIE and adverse pregnancy outcomes using log-binomial regression models.

Results: Among 225 eligible pregnant participants, 71 (31.6%) reported engaging in any LIE. LIE was associated with lower preterm birth, but not significantly associated with pregnancy loss or other adverse pregnancy outcomes. The RR for any LIE for preterm birth was 0.31 (95% CI: 0.09–1.07), with a significant dose–response association [RR = 0.65 (95% CI: 0.48–0.89) per every 30-minute session]. Some suggestive inverse associations were also observed for other adverse pregnancy outcomes: the RR for any LIE for low birthweight was 0.35 (95% CI: 0.08–1.48); for preeclampsia/gestational hypertension was 0.51 (95% CI: 0.13–1.96); and for gestational diabetes was 0.64 (95% CI: 0.25–1.64).

Conclusion: Pregnant women can include yoga, stretching, and toning exercise for promoting wellbeing.

Validation and development of models using clinical, biochemical and ultrasound markers for predicting pre-eclampsia: an individual participant data meta-analysis

BACKGROUND

Pre-eclampsia is a leading cause of maternal and perinatal mortality and morbidity. Early identification of women at risk is needed to plan management.

OBJECTIVES

To assess the performance of existing pre-eclampsia prediction models and to develop and validate models for pre-eclampsia using individual participant data meta-analysis. We also estimated the prognostic value of individual markers.

DESIGN

This was an individual participant data meta-analysis of cohort studies.

SETTING

Source data from secondary and tertiary care.

PREDICTORS

We identified predictors from systematic reviews, and prioritised for importance in an international survey.

PRIMARY OUTCOMES

Early-onset (delivery at < 34 weeks' gestation), late-onset (delivery at ≥ 34 weeks' gestation) and any-onset pre-eclampsia.

ANALYSIS

We externally validated existing prediction models in UK cohorts and reported their performance in terms of discrimination and calibration. We developed and validated 12 new models based on clinical characteristics, clinical characteristics and biochemical markers, and clinical characteristics and ultrasound markers in the first and second trimesters. We summarised the data set-specific performance of each model using a random-effects meta-analysis. Discrimination was considered promising for C-statistics of ≥ 0.7, and calibration was considered good if the slope was near 1 and calibration-in-the-large was near 0. Heterogeneity was quantified using I ² and τ². A decision curve analysis was undertaken to determine the clinical utility (net benefit) of the models. We reported the unadjusted prognostic value of individual predictors for pre-eclampsia as odds ratios with 95% confidence and prediction intervals.

RESULTS

The International Prediction of Pregnancy Complications network comprised 78 studies (3,570,993 singleton pregnancies) identified from systematic reviews of tests to predict pre-eclampsia. Twenty-four of the 131 published prediction models could be validated in 11 UK cohorts. Summary C-statistics were between 0.6 and 0.7 for most models, and calibration was generally poor owing to large between-study heterogeneity, suggesting model overfitting. The clinical utility of the models varied between showing net harm to showing minimal or no net benefit. The average discrimination for IPPIC models ranged between 0.68 and 0.83. This was highest for the second-trimester clinical characteristics and biochemical markers model to predict early-onset pre-eclampsia, and lowest for the first-trimester clinical characteristics models to predict any pre-eclampsia. Calibration performance was heterogeneous across studies. Net benefit was observed for International Prediction of Pregnancy Complications first and second-trimester clinical characteristics and clinical characteristics and biochemical markers models predicting any pre-eclampsia, when validated in singleton nulliparous women managed in the UK NHS. History of hypertension, parity, smoking, mode of conception, placental growth factor and uterine artery pulsatility index had the strongest unadjusted associations with pre-eclampsia.

LIMITATIONS

Variations in study population characteristics, type of predictors reported, too few events in some validation cohorts and the type of measurements contributed to heterogeneity in performance of the International Prediction of Pregnancy Complications models. Some published models were not validated because model predictors were unavailable in the individual participant data.

CONCLUSION

For models that could be validated, predictive performance was generally poor across data sets. Although the International Prediction of Pregnancy Complications models show good predictive performance on average, and in the singleton nulliparous population, heterogeneity in calibration performance is likely across settings.

FUTURE WORK

Recalibration of model parameters within populations may improve calibration performance. Additional strong predictors need to be identified to improve model performance and consistency. Validation, including examination of calibration heterogeneity, is required for the models we could not validate.

STUDY REGISTRATION

This study is registered as PROSPERO CRD42015029349.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 72. See the NIHR Journals Library website for further project information.

St. Luke's International University and University of North Carolina at Chapel Hill collaboration project to develop the first DNP program in Japan

We report an international collaborative project to develop the first Doctor of Nursing Practice (DNP) program in Japan. We described the development and implementation of the first DNP program at the St. Luke's International University in Tokyo and the collaboration with the University of North Carolina at Chapel Hill in the United States. Faculty perceptions in both parties gradually evolved from the traditional perspective of international collaboration to the transitional and the beginning of the holistic partnership perspectives. The collaboration resulted in an innovative DNP program that directly addressed the gap between nursing education programs and Japan's clinical needs. The collaborative project cultivated a holistic international partnership. Rather than reporting a manual for international collaboration, we present our reflections and outcomes as narratives that others could use to achieve a holistic global partnership.

Association between change in maternal physical activity during pregnancy and infant size, in a sample overweight or obese women

Physical activity (PA) naturally declines during pregnancy and its effects on infant size are unclear, especially in overweight or obese pregnancies, a low-active subpopulation that tends deliver heavier infants. The objective of this study was to evaluate changes in prenatal PA and infant birthweight in a group of overweight or obese pregnant women. We employed a prospective analysis using data from a randomized controlled exercise trial (2001 to 2006) in sedentary, overweight or obese pregnant women in Michigan. Women with complete data on peak oxygen consumption, daily PA (via pedometers) and birthweight were included in the analyses. Change in PA was estimated via repeated measures analyses, and then its influence on infant birthweight was assessed via linear regression. Eighty-nine pregnant women were included and considered low-active (6,579.91 ± 2379.17 steps/day). PA declined from months 4 to 8 (-399.73 ± 371.38 steps∙day^-1∙month^-1). Analyses showed that the decline in PA (β = -0.28 g, 95%CI: -0.70, 0.25 g, p = .35) was not associated with birthweight. The findings of this study demonstrated that the decline in maternal PA during mid- to late-pregnancy, in overweight or obese women, was unrelated to infant birthweight. Future investigations should employ rigorous measurements of PA and infant anthropometry in this subpopulation.

Effects of Static Stretching Exercise on Lumbar Flexibility and Central Arterial Stiffness

BACKGROUND

Previous studies have demonstrated that arterial stiffness is associated with lumbar flexibility (LF). Stretching exercise targeted to improve LF may have a beneficial effect on reducing arterial stiffness.

OBJECTIVES

We examined the effects of a single bout of a structured, static stretching exercise on arterial stiffness, LF, peripheral and central blood pressure (BP), and heart rate (HR) and tested the association between LF and central arterial stiffness.

METHOD

The study had a pretest-posttest design without a control group. Thirty healthy women followed a video demonstration of a 30-minute whole-body stretching exercise. Carotid-femoral pulse wave velocity (cf-PWV), augmentation index, LF, peripheral and central BP, and HR were measured before and after the stretching exercise.

RESULTS

One bout of a static stretching exercise significantly reduced cf-PWV (t29 = 2.708, P = .011) and HR (t29 = 7.160, P = .000) and increased LF (t29 = 12.248, P < .000). Augmentation index and peripheral and central BP also decreased but did not reach statistical significance. Despite no association found between cf-PWV and LF, the larger increase in LF the subjects had, the larger decrease in cf-PWV they had after exercise (r = 0.500, P = .005).

CONCLUSIONS

Study findings highlight the potential benefit of a static stretching exercise on central arterial stiffness, an independent predictor of cardiovascular morbidity. Static stretching exercise conducted in the sitting position may be used as an effective intervention to reduce cardiovascular risk after a cardiac event or for patients whose sympathetic function should not be overly activated or whose gaits are not stable.

Impact of maternal education on response to lifestyle interventions to reduce gestational weight gain: individual participant data meta-analysis

OBJECTIVES

To identify if maternal educational attainment is a prognostic factor for gestational weight gain (GWG), and to determine the differential effects of lifestyle interventions (diet based, physical activity based or mixed approach) on GWG, stratified by educational attainment.

DESIGN

Individual participant data meta-analysis using the previously established International Weight Management in Pregnancy (i-WIP) Collaborative Group database (https://iwipgroup.wixsite.com/collaboration). Preferred Reporting Items for Systematic reviews and Meta-Analysis of Individual Participant Data Statement guidelines were followed.

DATA SOURCES

Major electronic databases, from inception to February 2017.

ELIGIBILITY CRITERIA

Randomised controlled trials on diet and physical activity-based interventions in pregnancy. Maternal educational attainment was required for inclusion and was categorised as higher education (≥tertiary) or lower education (≤secondary).

RISK OF BIAS

Cochrane risk of bias tool was used.

DATA SYNTHESIS

Principle measures of effect were OR and regression coefficient.

RESULTS

Of the 36 randomised controlled trials in the i-WIP database, 21 trials and 5183 pregnant women were included. Women with lower educational attainment had an increased risk of excessive (OR 1.182; 95% CI 1.008 to 1.385, p =0.039) and inadequate weight gain (OR 1.284; 95% CI 1.045 to 1.577, p =0.017). Among women with lower education, diet basedinterventions reduced risk of excessive weight gain (OR 0.515; 95% CI 0.339 to 0.785, p = 0.002) and inadequate weight gain (OR 0.504; 95% CI 0.288 to 0.884, p=0.017), and reduced kg/week gain (B -0.055; 95% CI -0.098 to -0.012, p=0.012). Mixed interventions reduced risk of excessive weight gain for women with lower education (OR 0.735; 95% CI 0.561 to 0.963, p=0.026). Among women with high education, diet based interventions reduced risk of excessive weight gain (OR 0.609; 95% CI 0.437 to 0.849, p=0.003), and mixed interventions reduced kg/week gain (B -0.053; 95% CI -0.069 to -0.037,p<0.001). Physical activity based interventions did not impact GWG when stratified by education.

CONCLUSIONS

Pregnant women with lower education are at an increased risk of excessive and inadequate GWG. Diet based interventions seem the most appropriate choice for these women, and additional support through mixed interventions may also be beneficial.

Yoga's Biophysiological Effects on Lower Urinary Tract Symptoms: A Scoping Review

BACKGROUND AND OBJECTIVES

Yoga is a mind and body practice that includes relaxation, meditation, breathing exercises, and body postures. It can be effective in enhancing the functioning of several body systems, including the lower urinary tract. Normal lower urinary tract functioning depends in part on the coordination of the bladder, urethra, pelvic floor and other muscles, and the nerves that control them. Lower urinary tract dysfunction can lead to symptoms, that is, stress urinary incontinence (UI), urinary frequency, nocturia, urinary urgency with and without incontinence, and mixed UI. Recent evidence suggests that yoga can improve lower urinary tract symptoms (LUTS). Thus, we performed a scoping review of the literature with regard to the evidence for the effects of yoga on LUTS and factors that may mediate yoga's effects on LUTS with the goal to identify gaps in knowledge regarding the relationship between yoga practice and LUTS.

METHODS

The authors employed the PRISMA extension for Scoping Reviews (PRISMA-ScR) methodological approach, proposed by Tricco et al., by searching the electronic databases, PubMed, Embase, and PsycINFO, for articles using the following keywords: yoga, urinary incontinence, urinary tract, bladder, and urethra. We assessed the quality of the studies using the Joanna Briggs Institute Critical Appraisal Checklist.

RESULTS

Of the 172 articles we found, 8 articles met the inclusion criteria and were reviewed. We found that, despite the use of different protocols, yoga may reduce certain LUTS by increasing the strength of pelvic floor muscle and/or regulating the autonomic nervous system and activating the central nervous system.

CONCLUSIONS

Yoga is a noninvasive practice that may improve some LUTS. Rigorous studies are needed to determine the specific mechanisms through which yoga may affect LUTS.

Associations between maternal physical activity and fitness during pregnancy and infant birthweight

Prenatal physical activity (PA) reduces the risk of delivering infants with a birthweight ≥4000 g among normal-weight pregnant women, but evidence on the impact of maternal cardiorespiratory fitness (CRF) on birthweight remains equivocal among overweight or obese (OW/OB) pregnant women. The purpose of this study was to evaluate the relationship between maternal prenatal PA and CRF and birthweight in OW/OB pregnant women. Data from a randomized controlled exercise intervention trial in sedentary, OW/OB pregnant women were used. Women with complete data (n = 89) on birthweight, peak oxygen consumption (at 17 weeks), and daily PA were selected for analyses. Multiple linear regression models were performed to determine the independent and joint associations of maternal PA and CRF with birthweight while adjusting for gestational age, weight gain, and group allocation. On average, participants were 32 years old, OW/OB (BMI 29.97 ± 7.14 kg/m2), unfit (VO2peak: 19.85 ± 3.35 ml O2 kg-1 min-1), and led low active lifestyles (6579.91 ± 2379.17 steps/day). Analyses showed that maternal PA (steps·day-1·month-1) (β = 0.03 g, 95% CI: -0.03, 0.08 g) and CRF (ml O2·kg-1·min-1) (β = -8.8 g, 95%CI: -42.2, 24.5 g) were neither independently nor jointly (β = 0.006 g, 95%CI: -0.005, 0.02 g) associated with birthweight. Maternal PA and CRF during pregnancy were not related to birthweight in OW/OB pregnant women. The limited variability in maternal PA and CRF and low dose of PA may explain the null findings of this study. Given the paucity of studies examining these relationships in OW/OB pregnant women, more research is warranted.

Effects of antenatal diet and physical activity on maternal and fetal outcomes: individual patient data meta-analysis and health economic evaluation

BACKGROUND

Diet- and physical activity-based interventions in pregnancy have the potential to alter maternal and child outcomes.

OBJECTIVES

To assess whether or not the effects of diet and lifestyle interventions vary in subgroups of women, based on maternal body mass index (BMI), age, parity, Caucasian ethnicity and underlying medical condition(s), by undertaking an individual patient data (IPD) meta-analysis. We also evaluated the association of gestational weight gain (GWG) with adverse pregnancy outcomes and assessed the cost-effectiveness of the interventions.

DATA SOURCES

MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects and Health Technology Assessment database were searched from October 2013 to March 2015 (to update a previous search).

REVIEW METHODS

Researchers from the International Weight Management in Pregnancy Collaborative Network shared the primary data. For each intervention type and outcome, we performed a two-step IPD random-effects meta-analysis, for all women (except underweight) combined and for each subgroup of interest, to obtain summary estimates of effects and 95% confidence intervals (CIs), and synthesised the differences in effects between subgroups. In the first stage, we fitted a linear regression adjusted for baseline (for continuous outcomes) or a logistic regression model (for binary outcomes) in each study separately; estimates were combined across studies using random-effects meta-analysis models. We quantified the relationship between weight gain and complications, and undertook a decision-analytic model-based economic evaluation to assess the cost-effectiveness of the interventions.

RESULTS

Diet and lifestyle interventions reduced GWG by an average of 0.70 kg (95% CI -0.92 to -0.48 kg; 33 studies, 9320 women). The effects on composite maternal outcome [summary odds ratio (OR) 0.90, 95% CI 0.79 to 1.03; 24 studies, 8852 women] and composite fetal/neonatal outcome (summary OR 0.94, 95% CI 0.83 to 1.08; 18 studies, 7981 women) were not significant. The effect did not vary with baseline BMI, age, ethnicity, parity or underlying medical conditions for GWG, and composite maternal and fetal outcomes. Lifestyle interventions reduce Caesarean sections (OR 0.91, 95% CI 0.83 to 0.99), but not other individual maternal outcomes such as gestational diabetes mellitus (OR 0.89, 95% CI 0.72 to 1.10), pre-eclampsia or pregnancy-induced hypertension (OR 0.95, 95% CI 0.78 to 1.16) and preterm birth (OR 0.94, 95% CI 0.78 to 1.13). There was no significant effect on fetal outcomes. The interventions were not cost-effective. GWG, including adherence to the Institute of Medicine-recommended targets, was not associated with a reduction in complications. Predictors of GWG were maternal age (summary estimate -0.10 kg, 95% CI -0.14 to -0.06 kg) and multiparity (summary estimate -0.73 kg, 95% CI -1.24 to -0.23 kg).

LIMITATIONS

The findings were limited by the lack of standardisation in the components of intervention, residual heterogeneity in effects across studies for most analyses and the unavailability of IPD in some studies.

CONCLUSION

Diet and lifestyle interventions in pregnancy are clinically effective in reducing GWG irrespective of risk factors, with no effects on composite maternal and fetal outcomes.

FUTURE WORK

The differential effects of lifestyle interventions on individual pregnancy outcomes need evaluation.

STUDY REGISTRATION

This study is registered as PROSPERO CRD42013003804.

FUNDING

The National Institute for Health Research Health Technology Assessment programme.

Ethnicity influences cardiovascular outcomes and complications in patients with type 2 diabetes

AIM

To determine whether cardiovascular outcomes in type 2 diabetes (T2D) differ according to ethnicity, and whether ethnicity influences the effect of gender on these outcomes in Caucasians, East-Southeast-Asians, Middle-Easterners, South-Asians and Pacific-Islanders.

METHODS

We compared demographics, HbA1c, lipid profile, renal function markers, and prevalence of macrovascular and microvascular complications between ethnic groups. Cross-sectional data was prospectively collected from 204 consecutive patients at Westmead Hospital's T2D clinic from April-October 2015. Univariate analysis was performed using chi-squared test for categorical data, and Mann-Whitney-U or Kruskal-Wallis test for continuous data.

RESULTS

Compared to Caucasians, South-Asians were diagnosed younger, were currently younger, had lower body-mass-index (BMI) and better renal function but higher rates of non-ST-elevation myocardial infarction (STEMI, 21.7% versus 3.5%, p<0.05). East-Southeast-Asians had lower BMI but more nephropathy than Caucasians (59% versus 39%, p<0.05). East-Southeast-Asian males had fewer CVD than Caucasians, but this protection was absent in East-Southeast-Asian females. Middle-Easterners had more non-STEMI than Caucasians (5.3% vs 3.5%, p<0.05). Middle-Eastern females were not at lower CVD risk than males. Caucasians had most PVD (20% versus 6%, p<0.05).

CONCLUSIONS

Ethnicity influences rates of diabetes-related complications. Female CVD protection is altered in some groups. Ethnicity should be considered in assessing CVD and complications risk.

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

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.

Abstract WP383: The Effect of Stretching on Pulse Wave Velocity

Introduction: Large-artery stiffness is an independent predictor of hypertension which is a leading cause of excess cardiovascular morbidity and mortality. Carotid-femoral pulse wave velocity (cf-PWV) is considered the ‘gold-standard’ measure of arterial stiffness because it measures along the aorto-iliac pathway, which makes the largest contribution to the arterial buffering function. While there is well-documented evidence on the health benefits of aerobic and resistance exercise, the information for the effect of stretching on arterial stiffness is limited. Previous studies have shown that arterial stiffness is associated with trunk flexibility. Stretching exercise targeted to improve flexibility may exert a beneficial effect on reducing arterial stiffness.

Purpose: This study aimed (1) to determine the association between trunk flexibility and arterial stiffness and (2) to examine whether one bout of stretching exercise will increase trunk flexibility and decrease arterial stiffness.

Methods: Thirty healthy women (mean age = 44.37 years) were instructed to follow a 20-minute DVD demonstration of whole-body stretching. Before and after stretching, cf-PWV and trunk flexibility were measured by using the SphygmoCor system and by sit-and-reach test, respectively, as well as systolic and diastolic blood pressure (SBP and DBP) and heart rate (HR) by using a Welch Allyn Monitor. All data were measured after taking a 10-minute rest in a supine position.

Results: cf-PWV was not related to trunk flexibility, however, cf-PWV was significantly decreased after stretching compared with before stretching (mean difference [MD]=.63, , p=.01). Trunk flexibility was also significantly increased after stretching (MD=-3.08, p=.00). Furthermore, while SBP and DBP did not change significantly, HR was significantly reduced after stretching compared with before stretching (MD=3.12, p=.00).

Conclusions: Our results showed that one bout of stretching exercise had significant effects on reducing arterial stiffness and heart rate. Further testing of long-term effects of stretching exercise is warranted for development of preventative interventions to reduce arterial stiffness, an important subclinical biomarker of cardiovascular disease.

Effect of tailored dietary guidance for pregnant women on nutritional status: A double-cohort study

This double cohort study aimed to evaluate the effect of tailored dietary guidance for pregnant women on dietary intake, nutritional status, and infant birth weight. Healthy pregnant women were recruited at an antenatal clinic during two phases over 2 years. The historical controls were analyzed a year prior to the intervention group. In both groups, data were collected at 19-26 gestational weeks (baseline) and at 34-37 gestational weeks (outcome measurement). The intervention included the following: (a) assessments of maternal dietary nutritional intake using the brief self-administered diet history questionnaire, (b) individual feedback based on the assessments of maternal nutritional status, (c) tailored guidance for a healthy diet, (d) original cooking recipes, and (e) goal sharing. Mann-Whitney U test was used to compare the outcome data between the groups. Of the 378 eligible women, 309 women had follow-up questionnaire data. Blood samples were obtained from 202 women. Despite a lack of improvement in reported dietary intake, plasma eicosapentaenoic acid (p = .002), docosahexaenoic acid (p < .001), arachidonic acid (p < .001), and dihomo-gamma-linolenic acid (p < .001) concentrations as well as maternal weight gain (p = .019) were significantly higher in the intervention group. However, serum folate (p = .031) concentration was significantly lower in the intervention group, and there were no significant differences between the groups in 25-hydroxy vitamin D levels, blood count, average birth weight, and rate of low birth weight infants. Assessment-based tailored guidance individualized to maternal dietary intake might partially contribute to improved nutrition in pregnant women.

Dietary interventions in overweight and obese pregnant women: a systematic review of the content, delivery, and outcomes of randomized controlled trials

CONTEXT

Interventions targeting maternal obesity are a healthcare and public health priority.

OBJECTIVE

The objective of this review was to evaluate the adequacy and effectiveness of the methodological designs implemented in dietary intervention trials for obesity in pregnancy.

DATA SOURCES

A systematic review of the literature, consistent with PRISMA guidelines, was performed as part of the International Weight Management in Pregnancy collaboration.

STUDY SELECTION

Thirteen randomized controlled trials, which aimed to modify diet and physical activity in overweight and obese pregnant women, were identified.

DATA SYNTHESIS

There was significant variability in the content, delivery, and dietary assessment methods of the dietary interventions examined. A number of studies demonstrated improved dietary behavior in response to diet and/or lifestyle interventions. Nine studies reduced gestational weight gain.

CONCLUSION

This review reveals large methodological variability in dietary interventions to control gestational weight gain and improve clinical outcomes in overweight and obese pregnant women. This lack of consensus limits the ability to develop clinical guidelines and apply the evidence in clinical practice.

[Microsurgery in children]

While we celebrated the fortieth anniversary of the first free flap in children, new techniques emerged in reconstructive surgery (NPT, artificial dermis…) and reduced microsurgery procedures. However, microsurgery in children as in adults still have clinical applications in reconstructive surgery. Free flaps remain essential in clinical situations where they are the only ones to provide capacity for growth and stability scarring, two elements essential to the future quality of life of the children.

The influence of FKBP5 genotype on expression of FKBP5 and other glucocorticoid-regulated genes, dependent on trauma exposure

The FK506 binding protein 51 (FKBP5), an intrinsic regulator of the glucocorticoid receptor, has been associated with pathological behaviors particularly in the context of childhood trauma (CT), via a putatively regulatory polymorphism, rs1360780. However, trans- and cis-acting effects of this locus and its interaction with CT are incompletely understood. To study its effects on the expression of glucocorticoid-regulated genes including FKBP5, we used lymphoblastoid cell lines (LCLs) derived from 16 CT-exposed patients with greater than two substance dependence/suicidal behavior diagnoses (casesCT+) and 13 non-CT-exposed controls (controlsCT-). This study in LCLs measures long-term trait-like differences attributable to genotype or lasting epigenetic modification. Through analysis of differential allelic expression (DAE) using an FKBP5 3'-UTR reporter single nucleotide polymorphism (SNP), rs3800373, that is in strong linkage disequilibrium with rs1360780, we confirmed that the rs1360780 risk allele (A) (or conceivably that of a linked SNP) leads to higher FKBP5 expression in controlsCT-. Intriguingly, casesCT+ did not show DAE, perhaps because of a genotype-predicted difference in FKBP5 DNA methylation restricted to casesCT+. Furthermore, through correlation analyses on FKBP5 expression at baseline and after induction by dexamethasone, we observed that casesCT+ had lower induction of FKBP5 expression, indicating that overall they may have strong ultra-short negative-feedback. Only casesCT+ showed an effect of rs1360780 genotype on expression of FKBP5 and other glucocorticoid-regulated genes. Together, these results confirm that the rs1360780 locus alters FKBP5 expression and further that in trans-fashion this locus affects the expression of other glucocorticoid-regulated genes after a glucocorticoid challenge. The CT exposure appears to be essential for trans-effects of rs1360780 on glucocorticoid-regulated genes.

Challenges of Integrating an Evidence-based Intervention in Health Departments to Prevent Excessive Gestational Weight Gain among Low-income Women

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.

Adequacy of Prenatal Care and Gestational Weight Gain

BACKGROUND

The goal of prenatal care is to maximize health outcomes for a woman and her fetus. We examined how prenatal care is associated with meeting the 2009 Institute of Medicine (IOM) guidelines for gestational weight gain.

SAMPLE

The study used deidentified birth certificate data supplied by the North Carolina State Center for Health Statistics. The sample included 197,354 women (≥18 years) who delivered singleton full-term infants in 2011 and 2012.

METHODS

A generalized multinomial model was used to identify how adequate prenatal care was associated with the odds of gaining excessive or insufficient weight during pregnancy according to the 2009 IOM guidelines. The model adjusted for prepregnancy body size, sociodemographic factors, and birth weight.

RESULTS

A total of 197,354 women (≥18 years) delivered singleton full-term infants. The odds ratio (OR) for excessive weight gain was 2.44 (95% CI 2.37-2.50) in overweight and 2.33 (95% CI 2.27-2.40) in obese women compared with normal weight women. The OR for insufficient weight gain was 1.15 (95% CI 1.09-1.22) for underweight and 1.34 (95% CI 1.30-1.39) for obese women compared with normal weight women. Prenatal care at the inadequate or intermediate levels was associated with insufficient weight gain (OR: 1.32, 95% CI 1.27-1.38; OR: 1.15, 95% CI 1.09-1.21, respectively) compared with adequate prenatal care. Women with inadequate care were less likely to gain excessive weight (OR: 0.88, 95% CI 0.86-0.91).

CONCLUSIONS

Whereas prenatal care was effective for preventing insufficient weight gain regardless of prepregnancy body size, educational background, and racial/ethnic group, there were no indications that adequate prenatal care was associated with reduced risk for excessive gestational weight gain. Further research is needed to improve prenatal care programs for preventing excess weight gain.

One Dimensional(1D)-to-2D Crossover of Spin Correlations in the 3D Magnet ZnMn2O4

We report on the intriguing evolution of the dynamical spin correlations of the frustrated spinel ZnMn₂O₄. Inelastic neutron scattering and magnetization studies reveal that the dynamical correlations at high temperatures are 1D. At lower temperature, these dynamical correlations become 2D. Surprisingly, the dynamical correlations condense into a quasi 2D Ising-like ordered state, making this a rare observation of two dimensional order on the spinel lattice. Remarkably, 3D ordering is not observed down to temperatures as low as 300 mK. This unprecedented dimensional crossover stems from frustrated exchange couplings due to the huge Jahn-Teller distortions around Mn³⁺ ions on the spinel lattice.

Is Attitude a Key Factor to Consider When Designing Physical Activity Interventions for Black Adolescent Girls

Chronic diseases continue to be disproportionately higher in Black women in comparison with other ethnic groups, with physical inactivity being linked to the growing incidences of many of these diseases. The review of the literature indicates that attitude which is shaped by beliefs, self-efficacy, and cultural factors is a key variable in promoting physical activity (PA) in Black adolescent girls. Specific aims of this review were to identify PA interventions designed specifically for adolescent girls, with an emphasis on Black adolescent girls, and to identify what factor promotes PA in this group. The long-term goal is to use the information from this review to design effective PA programs aimed at Black adolescent girls. Physical activity and fitness were improved in four of the interventions in this review that focused on enhanced self-efficacy, goal setting, social support, and measures aimed at changing attitudes. Overall, this review shows that more effective interventions targeting Black adolescent girls are needed that consider the cultural factors (beliefs, self-efficacy, and family dynamics) that shape one’s attitude toward being physically active.

Adapting the Pregnancy Physical Activity Questionnaire for Japanese pregnant women

OBJECTIVE

To assess the psychometric properties of the Pregnancy Physical Activity Questionnaire (PPAQ) for women who read and speak Japanese.

DESIGN

This longitudinal study used a self-report questionnaire and quantitative biometric and instrumental measurements (actigraph) to assess the reliability and criterion validity.

SETTING

A university hospital in Tokyo, Japan.

PARTICIPANTS

Sixty-nine pregnant women living in Tokyo and its suburbs were recruited.

METHODS

The test-retest reliability of the Japanese version of the Pregnancy Physical Activity Questionnaire (PPAQ-J) was evaluated through intraclass correlation coefficients (ICCs) between PPAQ-J results administered three times (at recruitment, 7 and 14 days later). Criterion validity was assessed by comparing results to actigraph measures using Spearman's correlation coefficients. Participants wore the actigraph over the 2-week research period. Data from 58 participants were analyzed for test-retest reliability. The data of 54 participants were used to analyze criterion validity.

RESULTS

The ICCs for the first and second and for the first and third PPAQ-J questionnaires were ≥0.56 for total activity and activities broken down by intensity and type (in metabolic equivalents [METs] × hours/day). To evaluate criterion validity, Spearman's correlation coefficients were calculated between the first measurement of the PPAQ-J and three published cut-points used to classify actigraph data (minutes/day); correlations ranged from .02 to .35 for total activity, -.21 to -.25 for vigorous activity, -.09 to .38 for moderate activity, and .01 to .28 for light activity.

CONCLUSION

The PPAQ-J is a psychometrically sound and comprehensive measure of physical activity in pregnant Japanese women.

Guidelines for Physical Activity during Pregnancy: Comparisons From Around the World

INTRODUCTION

Women attain numerous benefits from physical activity during pregnancy. However, due to physical changes that occur during pregnancy, special precautions are also needed. This review summarizes current guidelines for physical activity among pregnant women worldwide.

METHODS

We searched PubMed (MedLINE) for country-specific governmental and clinical guidelines on physical activity during pregnancy through the year 2012. We cross-referenced with articles referring to guidelines, with only the most recent included. An abstraction form was used to extract key details and summarize.

RESULTS

In total, 11 guidelines were identified from nine countries (Australia, Canada, Denmark, France, Japan, Norway, Spain, United Kingdom, United States). Most guidelines supported moderate intensity physical activity during pregnancy (10/11) and indicated specific frequency (9/11) and duration/time (9/11) recommendations. Most guidelines provided advice on initiating an exercise program during pregnancy (10/11). Six guidelines included absolute and relative contraindications to exercise. All guidelines generally ruled-out sports with risks of falls, trauma, or collisions. Six guidelines included indications for stopping exercise during pregnancy.

CONCLUSION

This review contrasted pregnancy-related physical activity guidelines from around the world, and can help to inform new guidelines as they are created or updated, and facilitate the development of a worldwide guideline.

The effects of exercise during pregnancy: theories, evidence, and interventions

Physical activities provide women a way to improve their health and intervene in disease processes during pregnancy. This chapter briefly describes pathophysiological models and then examines current research on the effects of physical activity on prevention and treatment of gestational diabetes and preeclampsia. The chapter then reviews cognitive behavioral theories and current literature on the effects of behavioral interventions on physical activity in pregnancy. The literature helps to explain the pathophysiological mechanisms through which physical activity mediates disease processes and the behavioral interventions through which physical activity can be introduced and sustained during pregnancy. Throughout the chapter, both pathophysiological models and behavioral theories are viewed as part of a socioecologic model that encompasses pregnancy and physical activity.

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.

Experiences with epidural anesthesia of Japanese women who had childbirth in the United States

PURPOSE

Cultural views are purported to be critical barriers to the use of epidural anesthesia during childbirth in Japan, even though it is not routinely available. We sought to understand the importance of the asserted cultural barriers for Japanese women living in Michigan in the United States where access to epidural anesthesia is routine.

METHODS

We used a mixed-methods approach including self-administered, cross-sectional mail surveys and semi-structured qualitative interviews. Participants were Japanese women who received prenatal care at the University of Michigan Japanese Family Health Program.

RESULTS

Of 78 participants in the mail survey, 63% used epidural anesthesia. Positive influences to have epidural anesthesia came from friends (58%), husbands (42%), and knowledge of the epidural anesthesia experiences of others (50%). Seventeen respondents participated in qualitative interviews. Most had learned little about epidural anesthesia while living in Japan, and some respondents had heard unsettling rumors. Many mentioned obtaining their first detailed knowledge about epidural anesthesia from friends in the United States, and expressed fear or concerns about the side effects of anesthesia. Thirteen out of fourteen interviewed participants who used or wanted epidural anesthesia expressed a desire to use it for the next childbirth.

CONCLUSIONS

While Japanese women in this United States setting considered previously reported cultural barriers to epidural anesthesia for birth pain, many chose to have it during their labor. This finding implicates limited access as a barrier at least as important as cultural barriers to epidural anesthesia use in Japan.

Effect of exercise on vascular superoxide dismutase expression in high-risk pregnancy

Endothelial dysfunction of the maternal vasculature induced by pro-oxidants may contribute to the development of preeclampsia. Obesity results in vascular inflammation and oxidative stress and is therefore a risk factor for preeclampsia. Regular exercise is known to induce antioxidants. We recently demonstrated that stretchers (subjects who performed low-intensity exercises) had a lower incidence of preeclampsia as opposed to walkers (moderate-intensity exercise; 2.6% versus 14.6%). We now seek to determine the possible protective mechanisms. We hypothesized that stretchers will have higher vascular levels of the antioxidant superoxide dismutase (SOD) and plasma transferrin levels, an antioxidant marker. We conducted immunohistochemical analyses of blood vessels embedded in fat biopsy samples obtained during cesarean sections from women who were randomized to either stretching ( N = 6) or walking ( N = 5) exercises. In addition, levels of plasma transferrin were measured. SOD expression was increased ( P < 0.05) in stretchers [106.3 (interquartile range 84.2 to 127.8 arbitrary units (AU)] when compared with that of walkers [56.92 (interquartile range 46.35 to 82.32 AU)]. Transferrin levels continued to increase throughout gestation only among the stretchers. There appears to be a higher antioxidant protective effect in subjects who performed low-intensity exercise during pregnancy.

Prenatal stretching exercise and autonomic responses: preliminary data and a model for reducing preeclampsia

PURPOSE

Preeclampsia is a leading cause of perinatal mortality and morbidity, and it increases maternal risk for future cardiovascular disease. The purpose of the study was to explore the relationships among stretching exercise, autonomic cardiac response, and the development of preeclampsia.

DESIGN

Secondary data analysis.

METHODS

Heart rate and pulse pressure were longitudinally examined in this secondary data analysis among women who engaged in stretching exercise daily from 18 weeks of gestation to the end of pregnancy compared with women who did walking exercise daily during the same time period. A total of 124 women were randomized to either stretching (n=60) or walking (n=64) in the parent study.

FINDINGS

Heart rates in the stretching group were consistently lower than those in the walking group.

CONCLUSIONS

Based on the results of this secondary data analyses, a physiologic framework for possible beneficial effects of stretching exercise by enhancing autonomic responses on reducing risks for preeclampsia is proposed and discussed.

CLINICAL RELEVANCE

If the protective effect is established, stretching exercise can be translated into nursing intervention for prenatal care.

Translation and cross-cultural adaptation of the Pregnancy Physical Activity Questionnaire (PPAQ) to Japanese

The aim of this study was to conduct a translation and cross-cultural adaptation of the Japanese version of the Pregnancy Physical Activity Questionnaire (PPAQ) that consisted of 36 items. We translated and adapted the PPAQ to the Japanese culture. This procedure included a forward step (stages I and II, translations and synthesis), quality control (stage III, back translation, and stage IV, expert committee review), and pre-testing (stage V). In the pre-test, the preliminary Japanese version was tested on ten Japanese pregnant subjects. The content, semantic, technical, conceptual, and experiential equivalents of cultural adaptation were discussed by the research members at each step. In the results section, one new item was added to address "riding a bicycle in order to go to a certain place other than for recreation or exercise", because many Japanese women often use a bicycle. The average age of the pregnant subjects in the pre-test was 32.7 years of age. The response time ranged from 5 to 15 min. Two subjects responded that they rode a bicycle under the new item. The preliminary Japanese version of the questionnaire was revised to reflect the opinions of pregnant subjects for cross-cultural adaptation, including the semantic, experiential, and technical equivalents. The consensus of content and conceptual equivalents of the pre-final version of PPAQ by discussion among the research members was obtained throughout these processes. The original developer approved all revisions. In conclusion, the pre-finalized Japanese version of the PPAQ was indicated to have cross-cultural equivalency with the original English version.