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McLean MK, Petek BJ, McGrath L, McGill E, Lane AD. Perinatal Exercise and Cardiovascular Disease Risk. JACC. ADVANCES 2025; 4:101776. [PMID: 40359645 DOI: 10.1016/j.jacadv.2025.101776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Revised: 03/27/2025] [Accepted: 03/28/2025] [Indexed: 05/15/2025]
Abstract
The purpose of this narrative review was to summarize perinatal exercise guidelines and associations of perinatal physical activity and/or exercise with cardiovascular disease (CVD) risk. Observational studies, randomized controlled trials, systematic reviews, and meta-analyses were included. Gaps in literature and suggestions for future studies were identified. Despite concordant international guidelines, data to support nuanced activity advice for some subgroups are limited. Perinatal physical activity and exercise are consistently recommended to combat traditional CVD risk factors during the perinatal period, like excessive gestational weight gain, high blood pressure, and high blood glucose. Physical activity and exercise appear to improve nontraditional risk factors such as poor sleep and depression. Data are emerging regarding associations with some pregnancy-specific factors, such as placental characteristics. Further research investigating associations with pregnancy-specific CVD risk factors and associations in the longer term, as well as data to support uptake, adherence, and resistance exercise prescription is warranted.
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Affiliation(s)
- Marnie K McLean
- Department of Applied Exercise Science, School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Bradley J Petek
- Adult Congenital Heart Disease, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Lidija McGrath
- Adult Congenital Heart Disease, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Emily McGill
- University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Abbi D Lane
- Department of Applied Exercise Science, School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA.
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Pahlavani HA, Laher I, Weiss K, Knechtle B, Zouhal H. Physical exercise for a healthy pregnancy: the role of placentokines and exerkines. J Physiol Sci 2023; 73:30. [PMID: 37964253 PMCID: PMC10718036 DOI: 10.1186/s12576-023-00885-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/20/2023] [Indexed: 11/16/2023]
Abstract
Complications such as diabetes and preeclampsia can occur during pregnancy. Moderate-intensity exercise can prevent such complications by releasing placentokines and exerkines, such as apelin, adiponectin, leptin, irisin, and chemerin. Exercise and apelin increase thermogenesis and glucose uptake in pregnancy by activating AMPK, PI3K, PGC-1α, AKT1, UCP3, and sarcolipin. Exercise increases apelin levels to reduce preeclampsia symptoms by increasing eNOS, NO, placental growth factor (PlGF), and VEGF and decreasing levels of fms-like tyrosine kinase 1 (sFlt-1), soluble endoglin (sEng), and oxidative stress. A negative relationship has been reported between plasma leptin and VO2peak/kg and VO2peak in women with gestational diabetes. In active women, decreases in leptin levels reduce the risk of preeclampsia by ~ 40%. Higher adiponectin levels are associated with greater physical activity and lead to increased insulin sensitivity. Increased adiponectin levels in preeclampsia and exercise counteract inflammatory and atherogenic activities while also having vascular protective effects. Exercise increases irisin levels that correlate negatively with fasting glucose, insulin concentration, and glycosylated hemoglobin levels. Irisin augments mRNA expression levels of UCP1 and cell death-inducing DNA fragmentation factor-like effector A (cidea) to cause browning of adipose tissue, increased thermogenesis, and increased energy consumption. Irisin concentrations in mothers with preeclampsia in the third trimester negatively correlate with systolic and diastolic blood pressure. Expression levels of chemerin, IL-6, and TNF-α are increased in gestational diabetes, and the increases in chemerin in late pregnancy positively correlate with the ratio of sFlt-1 to PlGF as a marker of preeclampsia. The effects of physical exercise on placentokines and exerkines in women at various stages of pregnancy remain poorly understood.
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Affiliation(s)
| | - Ismail Laher
- Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Katja Weiss
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland.
- Medbase St Gallen Am Vadianplatz, Vadianstrasse 26, 9001, St. Gallen, Switzerland.
| | - Hassane Zouhal
- Movement Sport, Health and Sciences Laboratory (M2S) UFR-STAPS, University of Rennes 2-ENS Cachan, Charles Tillon, France.
- Institut International Des Sciences Du Sport (2IS), Irodouer, France.
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Brown JY, Drakeley S, Duncan M, Knapp WP, Schefter ZJ, Barker N, Rouse CE, Maron B, Edelman ER, Valente AM, Economy KE. Moderate intensity exercise in pregnant patients with cardiovascular disease: A pilot study. Am Heart J 2023; 262:66-74. [PMID: 37072104 DOI: 10.1016/j.ahj.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/06/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Exercise in pregnancy has proven health benefits, yet the safety of exercise in patients with pre-existing cardiovascular disease (CVD) has not been established. Our aim was to determine the feasibility and safety profile of moderate intensity exercise during pregnancy in patients with CVD, compared with those without CVD. METHODS This is a prospective single center pilot study of a moderate intensity exercise regimen, with data collection through wearable fitness trackers and personal exercise logs in pregnant patients with and without pre-existing CVD. The primary outcome was Doppler umbilical artery systolic to diastolic (S/D) ratio measured between 32 and 34 weeks' gestation. The secondary outcomes were adverse maternal and fetal events, trends in wearable fitness tracker data, C-reactive protein levels, and weight changes. RESULTS At baseline, the CVD group (62% congenital heart disease) took part in more prepregnancy walking, less weightlifting, and had a higher body mass index compared to the control group, and on average walked 539 fewer steps per day during pregnancy than the control group. Resting heart rate (HR) was found to increase in both groups up to 30 weeks' gestation. The cardiovascular disease group displayed an overall lower exercise intensity, as measured by the ability to increase HR with exercise over resting heart rate 1 hour prior to exercise at study baseline (45% vs 59% P < .001). Umbilical artery S/D ratio was normal in both groups. No differences were seen in adverse events between groups. CONCLUSIONS This pilot study of moderate intensity exercise in pregnant individuals with pre-existing CVD demonstrated that patients with CVD were not able to increase their HR during exercise throughout pregnancy compared to those in the control group. Although a small study group, this data supports the hypothesis that exercise interventions during pregnancy for patients with CVD are feasible without evidence abnormal fetal Doppler profiles. Further studies using wearable fitness trackers may provide the opportunity to understand how to safely tailor exercise programs to pregnant individuals with CVD.
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Affiliation(s)
- Jonathan Y Brown
- Harvard-MIT Biomedical Engineering Center, Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA.
| | - Sheila Drakeley
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Madeline Duncan
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - William P Knapp
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Zoë J Schefter
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Nancy Barker
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | | | - Bradley Maron
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA
| | - Elazer R Edelman
- Harvard-MIT Biomedical Engineering Center, Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA; Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA
| | - Anne M Valente
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA
| | - Katherine E Economy
- Department of Medicine, Harvard Medical School, Boston, MA; Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Brigham and Women's Hospital, Boston, MA
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Zhu Z, Xie H, Liu S, Yang R, Yu J, Yan Y, Wang X, Zhang Z, Yan W. Effects of physical exercise on blood pressure during pregnancy. BMC Public Health 2022; 22:1733. [PMID: 36096756 PMCID: PMC9469521 DOI: 10.1186/s12889-022-14074-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/22/2022] [Indexed: 12/03/2022] Open
Abstract
Objective Effect of physical exercise on pregnant women currently has become a hot topic in prenatal health care. In this study, A meta-analysis was conducted on account of Randomized Controlled Trial (RCT). It focused on evaluating the effect of physical exercise intervention on blood pressure so that could provide certain evidence for health care during pregnancy. Methods Results of relevant studies were retrieved from PubMed, Embase, Web of Science and the Cochrane Library, and all of these included studies were evaluated according to the Cochrane collaboration’s tool for assessing the risk of bias. Stata 15.1 was used for meta-analysis, and mean difference (MD) was used as statistic for pooled analysis. The effect values were combined by conventional meta-analysis and Bayesian meta-analysis respectively, and the consistency of pooled results was considered as well. Results A total of 18 RCT studies were included in the quantitative analysis. The conventional meta-analysis showed differences in blood pressure between intervention group and control group (P < 0.05). Systolic and diastolic blood pressures of intervention group were 3.19 mmHg (95% CI: -5.13, -1.25) and 2.14 mmHg (95% CI: -4.26, -0.03) lower than that of control group, respectively. Bayesian meta-analysis showed that both systolic and diastolic pressure among intervention group decreased by 3.34 mmHg (95% CrI: -5.15, -1.56) and 2.14 mmHg (95% CrI: -3.79, − 0.50), respectively. Subgroup analysis supported that as long as healthy pregnant women participated in exercises, their blood pressure could be slightly regulated, while hypertension susceptible pregnant women significantly lowered blood pressure. Conclusion Exercise intervention during pregnancy is beneficial to lower or normalize blood pressure, and this research provides clues for follow-up studies.
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Affiliation(s)
- Zhu Zhu
- Jiangsu Vocational Institute of Commerce, Nanjing, 211168, China
| | - Hang Xie
- Office of Clinical Research Center, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Shiping Liu
- Department of Orthopedics, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Ruizhe Yang
- Department of Public Health, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Juan Yu
- Department of Medicine, Gansu University of Chinese Medicine, Dingxi, 743000, China
| | - Yiping Yan
- College of Mathematics and Statistics, Northwest Normal University, Lanzhou, 730070, China
| | - Xu Wang
- Department of Endocrinology, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Zhihua Zhang
- Yunyang People's Hospital of Danyang, Danyang, 212300, China.
| | - Wu Yan
- Department of Children Health Care, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China.
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Seneviratne SN, Rajindrajith S. Fetal programming of obesity and type 2 diabetes. World J Diabetes 2022; 13:482-497. [PMID: 36051425 PMCID: PMC9329845 DOI: 10.4239/wjd.v13.i7.482] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/18/2021] [Accepted: 06/03/2022] [Indexed: 02/06/2023] Open
Abstract
The prevalence of obesity and type 2 diabetes mellitus has increased rapidly over the past few decades, and prevention efforts have not been successful. Fetal programming involves the earliest stage of obesity development, and provides a novel concept to complement other strategies for lifelong prevention of obesity and type 2 diabetes mellitus. The World Health Organization now advocates a life-course approach to prevent/control obesity, starting with pre-conceptional and antenatal maternal health. Maternal overnutrition, gestational diabetes mellitus and excessive gestational weight gain lead to fetal overgrowth, and "programs" the offspring with an increased risk of obesity and type 2 diabetes mellitus in childhood and adulthood. This review summarizes current data on fetal programming of obesity and type 2 diabetes mellitus including potential causative factors, mechanisms and interventions to reduce its impact.
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Affiliation(s)
| | - Shaman Rajindrajith
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka
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Zhao SK, Yeung EH, Ouidir M, Hinkle SN, Grantz KL, Mitro SD, Wu J, Stevens DR, Chatterjee S, Tekola-Ayele F, Zhang C. Recreational physical activity before and during pregnancy and placental DNA methylation-an epigenome-wide association study. Am J Clin Nutr 2022; 116:1168-1183. [PMID: 35771992 PMCID: PMC9535520 DOI: 10.1093/ajcn/nqac111] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 04/22/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Physical activity (PA) prior to and during pregnancy may have intergenerational effects on offspring health through placental epigenetic modifications. We are unaware of epidemiologic studies on longitudinal PA and placental DNA methylation. OBJECTIVES We evaluated the association between PA before and during pregnancy and placental DNA methylation. METHODS Placental tissues were obtained at delivery and methylation was measured using HumanMethylation450 Beadchips for participants in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies-Singletons among 298 participants. Using the Pregnancy Physical Activity Questionnaire, women recalled periconception PA (past 12 mo) at 8-13 wk of gestation and PA since last visit at 4 follow-up visits at 16-22, 24-29, 30-33, and 34-37 wk. We conducted linear regression for associations of PA at each visit with methylation controlling for false discovery rate (FDR). Top 100 CpGs were queried for enrichment of functional pathways using Ingenuity Pathway Analysis. RESULTS Periconception PA was significantly associated with 1 CpG site. PA since last visit for visits 1-4 was associated with 2, 2, 8, and 0 CpGs (log fold changes ranging from -0.0319 to 0.0080, after controlling for FDR). The largest change in methylation occurred at a site in TIMP2 , which is known to encode a protein critical for vasodilation, placentation, and uterine expansion during pregnancy (log fold change: -0.05; 95% CI: -0.06, -0.03 per metabolic equivalent of task-h/wk at 30-33 wk). Most significantly enriched pathways include cardiac hypertrophy signaling, B-cell receptor signaling, and netrin signaling. Significant CpGs and enriched pathways varied by visit. CONCLUSIONS Recreational PA in the year prior and during pregnancy was associated with placental DNA methylation. The associated CpG sites varied based on timing of PA. If replicated, the findings may inform the mechanisms underlying the impacts of PA on placenta health. This study was registered at clinicaltrials.gov as NCT00912132.
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Affiliation(s)
- Sifang Kathy Zhao
- Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | | | - Marion Ouidir
- Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Stefanie N Hinkle
- Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Katherine L Grantz
- Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Susanna D Mitro
- Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Jing Wu
- Glotech, Inc, Rockville, MD, USA
| | - Danielle R Stevens
- Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Suvo Chatterjee
- Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Fasil Tekola-Ayele
- Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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Choi KW, Kim HH, Basu A, Kwong ASF, Hernandez-Diaz S, Wyszynski DF, Koenen KC. COVID-19 perceived impacts on sleep, fitness, and diet and associations with mental health during pregnancy: A cross-national study. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021; 7:100288. [PMID: 34927121 PMCID: PMC8670882 DOI: 10.1016/j.jadr.2021.100288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 10/31/2022] Open
Affiliation(s)
- Karmel W Choi
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America.,Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital.,Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Hannah H Kim
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Archana Basu
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Alex S F Kwong
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland, UK
| | - Sonia Hernandez-Diaz
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | - Karestan C Koenen
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
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Campos MDSB, Buglia S, Colombo CSSDS, Buchler RDD, Brito ASXD, Mizzaci CC, Feitosa RHF, Leite DB, Hossri CAC, Albuquerque LCAD, Freitas OGAD, Grossman GB, Mastrocola LE. Position Statement on Exercise During Pregnancy and the Post-Partum Period - 2021. Arq Bras Cardiol 2021; 117:160-180. [PMID: 34320089 PMCID: PMC8294738 DOI: 10.36660/abc.20210408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
| | - Susimeire Buglia
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil.,Hospital do Coração (HCOR), São Paulo, SP - Brasil
| | | | - Rica Dodo Delmar Buchler
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil.,Ergometria DASA, São Paulo, SP - Brasil
| | | | | | | | - Danielle Batista Leite
- Real Hospital Português, Recife, PE - Brasil.,Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE - Brasil
| | | | | | | | - Gabriel Blacher Grossman
- Hospital Moinhos de Vento, Porto Alegre, RS - Brasil.,Clínica Cardionuclear, Porto Alegre, RS - Brasil
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Babili MG, Amerikanou C, Papada E, Christopoulos G, Tzavara C, Kaliora AC. The effect of prenatal maternal physical activity and lifestyle in perinatal outcome: results from a Greek study. Eur J Public Health 2021; 30:328-332. [PMID: 31860072 DOI: 10.1093/eurpub/ckz223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Several maternal characteristics, including lifestyle, have been associated with perinatal outcomes and birth anthropometric characteristics of the offspring. This study aimed to identify whether physical activity (PA) and other lifestyle parameters of the mother are associated with the pregnancy outcomes or with the infant's birth anthropometric characteristics. METHODS Participants were recruited in Mitera Maternity Hospital, Athens, Greece. Socio-demographic, medical history and anthropometric assessment took place. PA during pregnancy was assessed with the Pregnancy Physical Activity Questionnaire. Dietary assessment was conducted with the Food Frequency Questionnaire and adherence to the Mediterranean diet was evaluated with the MedDiet score. Birth weight and gestational age data were also collected. RESULTS Sedentary-intensity activity scores increased with increased educational level, while moderate-intensity activity scores decreased with increased educational level. Pregnant women who delivered large for gestational age infants had lower sports activity score. Higher vigorous and sports activity score was demonstrated in cases with a vaginal delivery compared with caesarean section. PA score was significantly and positively correlated with several nutrient intakes and PA was higher in women with a healthier nutritional pattern. Increased MedDiet scores were found in mothers with increased educational level. CONCLUSIONS Overall, PA was higher in women with a healthier nutritional pattern. An increased vs. a low activity level during pregnancy is positively associated with vaginal delivery and with the size of the offspring.
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Affiliation(s)
- Maria G Babili
- Department of Dietetics and Nutritional Science, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Charalampia Amerikanou
- Department of Dietetics and Nutritional Science, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Efstathia Papada
- Department of Dietetics and Nutritional Science, School of Health Science and Education, Harokopio University, Athens, Greece
| | | | - Chara Tzavara
- Department of Dietetics and Nutritional Science, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Andriana C Kaliora
- Department of Dietetics and Nutritional Science, School of Health Science and Education, Harokopio University, Athens, Greece
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Kundu S, Jharna DE, Banna MHA, Khan MSI. Factors associated with dietary diversity and physical activity of pregnant women in Bangladesh: A cross‐sectional study at an antenatal care setting. LIFESTYLE MEDICINE 2021. [DOI: 10.1002/lim2.41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Satyajit Kundu
- Department of Biochemistry and Food Analysis Patuakhali Science and Technology University Patuakhali Bangladesh
| | - Dilruba Easmin Jharna
- Department of Biochemistry and Food Analysis Patuakhali Science and Technology University Patuakhali Bangladesh
| | - Md. Hasan Al Banna
- Department of Food Microbiology Patuakhali Science and Technology University Patuakhali Bangladesh
| | - Md Shafiqul Islam Khan
- Department of Food Microbiology Patuakhali Science and Technology University Patuakhali Bangladesh
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Bhattacharjee J, Mohammad S, Adamo KB. Does exercise during pregnancy impact organs or structures of the maternal-fetal interface? Tissue Cell 2021; 72:101543. [PMID: 33940567 DOI: 10.1016/j.tice.2021.101543] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/07/2021] [Accepted: 04/10/2021] [Indexed: 12/12/2022]
Abstract
Exercise during pregnancy has been shown to be associated with improved health outcomes both during and after pregnancy for mother and fetus across the lifespan. Increasing physical activity and reducing sedentary behaviour during pregnancy have been recommended by many researchers and clinicians-alike. It is thought that the placenta plays a central role in mediating any positive or negative pregnancy outcomes. The positive outcomes obtained through prenatal exercise are postulated to result from exercise-induced regulation of maternal physiology and placental development. Considerable research has been performed to understand the placenta's role in pregnancy-related diseases, such as preeclampsia, fetal growth restriction, and gestational diabetes mellitus. However, little research has examined the potential for healthy lifestyle and behavioural changes to improve placental growth, development, and function. While the placenta represents the critical maternal-fetal interface responsible for all gas, nutrient, and waste exchange between the mother and fetus, the impact of exercise during pregnancy on placental biology and function is not well known. This review will focus on prenatal exercise and its promising influence on the structures of the maternal-fetal interface, with particular emphasis on the placenta. Potential molecular mechanistic hypotheses are presented to aid future investigations of prenatal exercise and placental health.
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Affiliation(s)
- Jayonta Bhattacharjee
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Shuhiba Mohammad
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Kristi B Adamo
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
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12
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Hancerliogullari N, Kansu-Celik H, Asli Oskovi-Kaplan Z, Kisa B, Engin-Ustun Y, Ozgu-Erdinc AS. Optimal maternal neck and waist circumference cutoff values for prediction of gestational diabetes mellitus at the first trimester in Turkish population; a prospective cohort study. Gynecol Endocrinol 2020; 36:1002-1005. [PMID: 32274939 DOI: 10.1080/09513590.2020.1750003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Aims: To investigate if the maternal neck (NC) and waist (WC) circumferences measured in the first trimester of pregnancy have a predictive value in diagnosing gestational diabetes mellitus (GDM).Materials and methods: In this prospective study NC and WC of pregnant women were measured at 11-14th weeks. GDM was evaluated with a two-step oral glucose tolerance test at 24-28th weeks.Result: A total of 525 women were recruited; 49(9%) developed GDM. NC was positively correlated with WC (r: 0.583, p < .001), BMI (r: 0.533, p < .001), age (r: 0.123, p = .002), parity (r: 0.170, p < .001), and 50 g OGTT levels (r: 0.206, p < .001). Regarding the area under receiver operating characteristic (ROC) curve (AUC) analysis of NC and WC for predicting GDM were 0.585 (95% confidence interval (CI): 0.50-0.66, p = .043), and 0.693 (95%CI: 0.61-0.76, p < .001). The optimal cut off level of maternal NC was >38.5 cm, with 69% sensitivity and 45% specificity, and WC was >84.50 cm with a sensitivity of 78% and a specificity of 54%. Increased WC >84.50 cm (OR: 3.58, 95% CI:1.77-7.27; p < .001) and age >25 (OR: 3.05, 95% CI:1.38-6.72; p = .006) were independent predictors for the development of GDM adjusted for age, gravidity, parity, BMI, and NC.Conclusion: Maternal NC and WC were significantly higher in women with GDM; however, only maternal WC was a significant predictive marker for GDM in low-risk pregnant women.
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Affiliation(s)
- Necati Hancerliogullari
- Ministry of Health, Department of Obstetrics and Gynecology, Ankara City Hospital, Ankara, Turkey
| | - Hatice Kansu-Celik
- Ministry of Health, Department of Obstetrics and Gynecology, Ankara City Hospital, Ankara, Turkey
| | - Z Asli Oskovi-Kaplan
- Ministry of Health, Department of Obstetrics and Gynecology, Ankara City Hospital, Ankara, Turkey
| | - Burcu Kisa
- Ministry of Health, Department of Obstetrics and Gynecology, Ankara City Hospital, Ankara, Turkey
| | - Yaprak Engin-Ustun
- Etlik Zubeyde Hanim Women's Health Education and Research Hospital, Ankara, Turkey
| | - A Seval Ozgu-Erdinc
- Ministry of Health, Department of Obstetrics and Gynecology, Ankara City Hospital, Ankara, Turkey
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de Oliveira Santini C, Imakawa TDS, Duarte G, Quintana SM, Moisés ECD. Do the body mass index and the diagnosis of gestational diabetes mellitus influence the level of physical activity during pregnancy and postpartum? PLoS One 2019; 14:e0220947. [PMID: 31398219 PMCID: PMC6688803 DOI: 10.1371/journal.pone.0220947] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 07/28/2019] [Indexed: 12/16/2022] Open
Abstract
Obesity and lack of physical exercise are associated with the increase of diabetes mellitus in women of reproductive age and during the gestational period. The objective of the present study was to evaluate physical activity levels during the pregnancy and postpartum periods and the influence of body mass index (BMI) in women with gestational diabetes mellitus (GDM) or low risk pregnancy. The Pregnancy Physical Activity Questionnaire (PPAQ), translated and validated for Portuguese, was used for the evaluation of physical activity (PA) level. The sample was stratified according to preconception BMI and the presence or absence of diagnosis of GDM, resulting in four groups with 66 participants each: low risk pregnancy (LRP) with normal weight (BMI ≥ 18.5 and ≤ 24 kg/m2), LRP and overweight/obese (BMI ≥ 25 kg/m2), GDM with normal weight and GDM with overweight/obese. The level of PA of each participant was measured as Metabolic Equivalent of Task (MET) during the preconceptional period (T0), in the third trimester of gestation (T1), and three months after delivery (T2). The comparison of the MET values showed that the values found in the evaluation three months after delivery (T2) were higher than 1.00 (1.10 MET for the LRP-normal weight, 1.06 MET for LRP-overweight/obese, 1.02 MET for the GDM- normal weight, 1.07 MET for the GDM-overweight/obese). On the pre-gestational (T0) and third trimester (T1) analyzes, the values were less than 1.00 MET. The analysis between groups in relation to BMI and diagnosis of GDM showed no difference.
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Affiliation(s)
- Cibele de Oliveira Santini
- Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Geraldo Duarte
- Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Silvana Maria Quintana
- Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Elaine Christine Dantas Moisés
- Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Tinius RA, López JD, Cade WT, Stein RI, Haire-Joshu D, Cahill AG. Patient and obstetric provider communication regarding weight gain management among socioeconomically disadvantaged African American women who are overweight/obese. Women Health 2019; 60:156-167. [PMID: 31096872 DOI: 10.1080/03630242.2019.1616044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
To examine the communication between obstetric providers and their socioeconomically disadvantaged, African American patients who are overweight and obese during pregnancy, and whether this communication relates to outcomes. Pregnant patients and their obstetric providers were surveyed between October 2012 and March 2016 at Washington University School of Medicine in St. Louis, MO. Percent agreement between patients' and obstetric providers' survey responses was analyzed and measured (κ coefficient). Descriptive and multilevel logistic regression analyses aimed at identifying the relation of perceived communication between providers and patients to gestational weight gain, diet, and exercise during pregnancy. A total of 99 pregnant women and 18 obstetric providers participated in the study. Significant lack of agreement was observed between patients and obstetric providers regarding communication about weight gain recommendations, risk factors associated with excessive weight gain, what constitutes adequate exercise per week, exercise recommendations, dietary recommendations, and risk factors associated with a poor diet. Our findings suggest patients were not receiving intended messages from their obstetric providers. Thus, more effective patient-obstetric provider communication is needed regarding gestational weight gain, exercise and dietary recommendations among overweight/obese, socioeconomically disadvantaged, African American women.
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Affiliation(s)
- Rachel A Tinius
- School of Kinesiology, Recreation, and Sport, Western Kentucky University, Bowling Green, KY, USA.,Program in Physical Therapy, Washington University in St Louis, St. Louis, MO, USA
| | - Julia D López
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - W Todd Cade
- Program in Physical Therapy, Washington University in St Louis, St. Louis, MO, USA
| | - Richard I Stein
- Department of Internal Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Debra Haire-Joshu
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Alison G Cahill
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
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15
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Kansu-Celik H, Ozgu-Erdinc AS, Kisa B, Findik RB, Yilmaz C, Tasci Y. Prediction of gestational diabetes mellitus in the first trimester: comparison of maternal fetuin-A, N-terminal proatrial natriuretic peptide, high-sensitivity C-reactive protein, and fasting glucose levels. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2019; 63:121-127. [PMID: 31038593 PMCID: PMC10522132 DOI: 10.20945/2359-3997000000126] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 02/20/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We investigated the utility of maternal fetuin-A, N-terminal proatrial natriuretic peptide (pro-ANP), high-sensitivity C-reactive protein (hs-CRP), and fasting glucose levels at 11-14 gestation weeks for predicting pregnancies complicated by gestational diabetes mellitus (GDM). SUBJECTS AND METHODS This prospective cohort study included 327 low-risk pregnant women who completed antenatal follow-up at a tertiary research hospital between January and April 2014. Maternal blood samples were collected between 11-14 gestational weeks in the first trimester of pregnancy and then stored at -80 °C until further analyses. During follow-up, 29 (8.8%) women developed GDM. The study population was compared 1:2 with age- and body mass index-matched pregnant women who did not develop GDM (n = 59). Fasting plasma glucose (FPG) levels and serum fetuin-A, pro-ANP, and hs-CRP levels were measured using automated immunoassay systems. RESULTS There was a significant negative correlation between fetuin-A and hs-CRP (CC = -0.21, p = 0.047) and a positive correlation between FPG and hs-CRP (CC = 0.251, p = 0.018). The areas under the receiver operating characteristic curve for diagnosing GDM were 0.337 (p = 0.013), 0.702 (p = 0.002), and 0.738 (p < 0.001) for fetuin-A, hs-CRP, and FPG, respectively. The optimal cut-off values were > 4.65, < 166, and > 88.5 mg/dL for maternal hs-CRP, fetuin-A, and FPG, respectively. CONCLUSION Reduced fetuin-A, elevated hs-CRP, and FPG levels in women in the first trimester can be used for the early detection of GDM. Further research is needed before accepting these biomarkers as valid screening tests for GDM.
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Affiliation(s)
- Hatice Kansu-Celik
- University of Health SciencesZekai Tahir Burak Health Practice Research CenterAnkaraTurkeyUniversity of Health Sciences, Zekai Tahir Burak Health Practice Research Center, Ankara, Turkey
| | - A. Seval Ozgu-Erdinc
- University of Health SciencesZekai Tahir Burak Health Practice Research CenterAnkaraTurkeyUniversity of Health Sciences, Zekai Tahir Burak Health Practice Research Center, Ankara, Turkey
| | - Burcu Kisa
- University of Health SciencesZekai Tahir Burak Health Practice Research CenterAnkaraTurkeyUniversity of Health Sciences, Zekai Tahir Burak Health Practice Research Center, Ankara, Turkey
| | - Rahime Bedir Findik
- University of Health SciencesZekai Tahir Burak Health Practice Research CenterAnkaraTurkeyUniversity of Health Sciences, Zekai Tahir Burak Health Practice Research Center, Ankara, Turkey
| | - Canan Yilmaz
- Gazi University Faculty of MedicineDepartment of Medical BiochemistryAnkaraTurkeyGazi University Faculty of Medicine, Department of Medical Biochemistry, Ankara, Turkey
| | - Yasemin Tasci
- University of Health SciencesZekai Tahir Burak Health Practice Research CenterAnkaraTurkeyUniversity of Health Sciences, Zekai Tahir Burak Health Practice Research Center, Ankara, Turkey
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16
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Kintiraki E, Goulis DG. Gestational diabetes mellitus: Multi-disciplinary treatment approaches. Metabolism 2018; 86:91-101. [PMID: 29627447 DOI: 10.1016/j.metabol.2018.03.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 03/25/2018] [Accepted: 03/27/2018] [Indexed: 02/08/2023]
Abstract
Gestational diabetes mellitus (GDM) is the most common metabolic disease of pregnancy, associated with several perinatal complications. Adequate glycemic control has been proved to decrease risk of GDM-related complications. Several studies have shown the beneficial effect of exercise and medical nutrition treatment on glycemic and weight control in GDM-affected women. Moreover, pharmacological agents, such as insulin and specific oral anti-diabetic agents can be prescribed safely during pregnancy, decreasing maternal blood glucose and, thus, perinatal adverse outcomes. Multi-disciplinary treatment approaches that include both lifestyle modifications (medical nutritional therapy and daily physical exercise) and pharmacological treatment, in cases of failure of the former, constitute the most effective approach. Insulin is the gold standard pharmacological agent for GDM treatment. Metformin and glyburide are two oral anti-diabetic agents that could serve as alternative, although not equal in terms of effectiveness and safety, treatment for GDM. As studies on short-term safety of metformin are reassuring, in some countries it is considered as first-line treatment for GDM management. More studies are needed to investigate the long-term effects on offspring. As safety issues have been raised on the use of glyburide during pregnancy, it must be used only when benefits surpass possible risks.
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Affiliation(s)
- Evangelia Kintiraki
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Forsum E, Janerot-Sjöberg B, Löf M. MET-values of standardised activities in relation to body fat: studies in pregnant and non-pregnant women. Nutr Metab (Lond) 2018; 15:45. [PMID: 29951109 PMCID: PMC6011259 DOI: 10.1186/s12986-018-0281-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 06/04/2018] [Indexed: 11/10/2022] Open
Abstract
Background Physical activity is associated with health in women. Published MET-values (MET: metabolic equivalent of task) may assess physical activity and energy expenditure but tend to be too low for subjects with a high total body fat (TBF) content and therefore inappropriate for many contemporary women. The MET-value for an activity is the energy expenditure of a subject performing this activity divided by his/her resting energy expenditure, often assumed to be 4.2 kJ/kg/h. Relationships between TBF and MET have been little studied although overweight and obesity is common in women. Available data indicate that MET-values decrease during pregnancy but more studies in pregnant contemporary women are needed. Subjects and methods Using indirect calorimetry we measured energy expenditure and assessed MET-values in women, 22 non-pregnant (BMI: 18–34) and 22 in gestational week 32 (non-pregnant BMI: 18–32) when resting, sitting, cycling (30 and 60 watts), walking (3.2 and 5.6 km/h) and running (8 km/h). Relationships between TBF and MET-values were investigated and used to predict modified MET-values. The potential of such values to improve calculations of total energy expenditure of women was investigated. Results The resting energy expenditure was below 4.2 kJ/kg/h in both groups of women. Women in gestational week 32 had a higher resting energy metabolism (p < 0.001) and 7–15% lower MET-values (p < 0.05) than non-pregnant women. MET-values of all activities were correlated with TBF (p < 0.05) in non-pregnant women and modified MET-values improved estimates of total energy expenditure in such women. In pregnant women, correlations (p ≤ 0.03) between TBF and MET were found for running (8 km/h) and for walking at 5.6 km/h. Conclusions Our results are relevant when attempts are made to modify the MET-system in contemporary pregnant and non-pregnant women. MET-values were decreased in gestational week 32, mainly due to an increased resting energy metabolism and studies describing how body composition affects the one MET-value (i.e. the resting energy metabolism in kJ/kg/h) during pregnancy are warranted. Studies of how pregnancy and TBF affect MET-values of high intensity activities are also needed. Corrections based on TBF may have a potential to improve the MET-system in non-pregnant women.
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Affiliation(s)
- Elisabet Forsum
- 1Department of Clinical and Experimental Medicine, Linköping University, 581 85 Linköping, SE Sweden
| | - Birgitta Janerot-Sjöberg
- 2Division of Cardiovascular Medicine, Department of Medical and Health Science, Linköping University, Linköping, Sweden.,3Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.,4Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Marie Löf
- 5Department of Biosciences and Nutrition, Karolinska Institute, Huddinge, Sweden.,6Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Jones HA, Eddy LD, Rabinovitch AE, Snipes DJ, Wilson SA, Parks AM, Karjane NW, Svikis DS. Attention-deficit/hyperactivity disorder symptom clusters differentially predict prenatal health behaviors in pregnant women. J Clin Psychol 2018; 74:665-679. [PMID: 28945932 DOI: 10.1002/jclp.22538] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 08/09/2017] [Accepted: 08/16/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To date, most investigations of mental health in pregnant women have focused on depression or substance use. This study aimed to (a) delineate the relationships between symptoms of attention-deficit/hyperactivity disorder (ADHD) and prenatal health behaviors and (b) explore whether the symptom clusters of ADHD differentially predict prenatal health behaviors (e.g., physical strain, healthy eating, prenatal vitamin use). METHOD A total of 198 pregnant women (mean age = 27.94 years) completed measures of ADHD symptoms, prenatal health behaviors, and depression. RESULTS Inattention, hyperactivity, and impulsivity/emotional lability all evidenced significant relationships with the prenatal health behaviors, each differentially predicting different prenatal health behaviors. CONCLUSION As decreased engagement in adequate prenatal health behaviors puts both the mother and fetus at risk for negative birth outcomes, future research should work to develop a brief ADHD screen to be used in obstetric clinics and should investigate these relationships within a sample of women with a diagnosis of ADHD.
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Clarke MA, Joshu CE. Early Life Exposures and Adult Cancer Risk. Epidemiol Rev 2018; 39:11-27. [PMID: 28407101 DOI: 10.1093/epirev/mxx004] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 01/19/2017] [Indexed: 12/14/2022] Open
Abstract
Very little is known about the influence of early life exposures on adult cancer risk. The purpose of this narrative review was to summarize the epidemiologic evidence relating early life tobacco use, obesity, diet, and physical activity to adult cancer risk; describe relevant theoretical frameworks and methodological strategies for studying early life exposures; and discuss policies and research initiatives focused on early life. Our findings suggest that in utero exposures may indirectly influence cancer risk by modifying biological pathways associated with carcinogenesis; however, more research is needed to firmly establish these associations. Initiation of exposures during childhood and adolescence may impact cancer risk by increasing duration and lifetime exposure to carcinogens and/or by acting during critical developmental periods. To expand the evidence base, we encourage the use of life course frameworks, causal inference methods such as Mendelian randomization, and statistical approaches such as group-based trajectory modeling in future studies. Further, we emphasize the need for objective exposure biomarkers and valid surrogate endpoints to reduce misclassification. With the exception of tobacco use, there is insufficient evidence to support the development of new cancer prevention policies; however, we highlight existing policies that may reduce the burden of these modifiable risk factors in early life.
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20
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Rao M, Zeng Z, Tang L. Maternal physical activity before IVF/ICSI cycles improves clinical pregnancy rate and live birth rate: a systematic review and meta-analysis. Reprod Biol Endocrinol 2018; 16:11. [PMID: 29415732 PMCID: PMC5803901 DOI: 10.1186/s12958-018-0328-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/29/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE This meta-analysis was aimed to evaluate the association between maternal physical activity before IVF/ICSI cycles and reproductive outcomes. METHODS We searched databases of PubMed, EMBASE and Web of Science electronic databases, and ongoing trials up to November 2017 to identify studies that focused on the relationship between maternal physical activity before IVF/ICSI cycles and reproductive outcomes, including implantation rate, clinical pregnancy rate, miscarriage rate and live birth rate. Odds ratio (OR) with 95% confidence intervals, were calculated to assess the results of each outcome. RESULTS Eight published studies encompassing 3683 infertile couples undergoing IVF/ICSI treatment were included into the analysis. There was an increasing, but not statistically significant, trend in implantation rate for physically active women when compared with physically inactive women (OR = 1.95, 95% CI 0.99-3.83, I2 = 77%). No significant difference was found in miscarriage rate between physically active women and physically inactive women (OR = 0.76, 95% CI 0.41-1.44, I2 = 49%). However, rates of clinical pregnancy and live births in physically active women were significantly higher than those in physically inactive women (OR = 1.96, 95% CI 1.40, 2.73, I2 = 42% and OR = 1.95, 95% CI 1.06-3.59, I2 = 82%, respectively). Subgroup analysis helped to confirm these results. CONCLUSIONS Female physical activity before IVF/ICSI cycles was associated with increased rates of clinical pregnancy and live births, whereas only a small but not statistically significant increase was found in implantation rate, and no effect was shown on miscarriage rate.
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Affiliation(s)
- Meng Rao
- Department of reproduction and genetics, the First Affiliated Hospital of Kunming Medical University, No. 295 Xi Chang road, Kunming, 650032, China
| | - Zhengyan Zeng
- Department of Neurology, the First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
| | - Li Tang
- Department of reproduction and genetics, the First Affiliated Hospital of Kunming Medical University, No. 295 Xi Chang road, Kunming, 650032, China.
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Embaby H, Elsayed E, Fawzy M. Insulin Sensitivity and Plasma Glucose Response to Aerobic Exercise in Pregnant Women at Risk for Gestational Diabetes Mellitus. Ethiop J Health Sci 2018; 26:409-414. [PMID: 28446846 PMCID: PMC5389055 DOI: 10.4314/ejhs.v26i5.2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM) is one of the common complications that occur during pregnancy. Early intervention is essential to prevent the development of the disease in the non-pregnant state but also helpful in preventing the occurrence of GDM. The aim of the study was to assess the effect of aerobic exercises on insulin sensitivity and fasting plasma glucose level in pregnant women with risk for gestational diabetes mellitus. Materials and Methods Forty multigravidae women between 20–24 weeks of gestation with risk for GDM were randomly selected (age range was 25–35 years), body mass index ranged from 30–35 kg/m2. Women were divided into two equal groups: intervention group (A), which followed an aerobic exercise program in the form of walking on treadmill, three times weekly until the end of 37 weeks of gestation in addition to diet control. Control group (B) which received diet control with usual care given by obstetricians and midwives. Evaluation of the women in both groups was carried out before and after treatment program through assessment of fasting blood glucose and insulin levels. Results There was a highly statistically significance decrease in fasting blood glucose level, fasting insulin level in both groups where the p value was 0.0001 favoring group (A). Conclusion Moderate intensity of aerobic exercises were effective in reducing fasting blood glucose level and fasting insulin level in pregnant women with risk for gestational diabetes mellitus.
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Affiliation(s)
- Heba Embaby
- Department of Physical Therapy, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, KSA.,Department of Physical Therapy for Obstetrics and Gynecology, Faculty of Physical Therapy, Cairo University
| | - Enas Elsayed
- Department of Physical Therapy, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, KSA.,Department of Physical Therapy for Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy, Cairo University
| | - Mohamed Fawzy
- Department of Physical Therapy, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, KSA
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Garnæs KK, Mørkved S, Salvesen KÅ, Salvesen Ø, Moholdt T. Exercise training during pregnancy reduces circulating insulin levels in overweight/obese women postpartum: secondary analysis of a randomised controlled trial (the ETIP trial). BMC Pregnancy Childbirth 2018; 18:18. [PMID: 29310617 PMCID: PMC5759335 DOI: 10.1186/s12884-017-1653-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 12/29/2017] [Indexed: 11/17/2022] Open
Abstract
Background The primary aim was to investigate if supervised exercise training during pregnancy could reduce postpartum weight retention (PPWR) three months after delivery in overweight and obese women. We also measured circulating markers of cardiometabolic health, body composition, blood pressure, and physical activity level. Methods This was a secondary analysis of a randomised controlled trial in which 91 women with BMI ≥ 28 kg/m2 were allocated 1:1 to an exercise program or a control group. Women in the exercise group were prescribed three weekly, supervised sessions of 35 min of moderate intensity walking/running followed by 25 min of resistance training. The control group received standard maternal care. Assessments were undertaken in early pregnancy, late pregnancy, and three months postpartum. PPWR was defined as postpartum body weight minus early pregnancy weight. Results Seventy women participated three months after delivery, and PPWR was −0.8 kg in the exercise group (n = 36) and −1.6 in the control group (n = 34) (95% CI, −1.83, 3.84, p = 0.54). Women in the exercise group had significantly lower circulating insulin concentration; 106.3 pmol/l compared to the control group; 141.4 pmol/l (95% CI, −62.78, −7.15, p = 0.01), and showed a tendency towards lower homeostatic measurement of insulin resistance (HOMA2-IR) (3.5 vs. 5.0, 95% CI, −2.89, 0.01, p = 0.05). No women in the exercise group compared to three women in the control group were diagnosed with type 2 diabetes postpartum (p = 0.19). Of the women in the exercise group, 46.4% reported of exercising regularly, compared to 25.0% in the control group (p = 0.16). Conclusions Offering supervised exercise training during pregnancy among overweight/obese women did not affect PPWR three months after delivery, but reduced circulating insulin levels. This was probably due to a higher proportion of women being active postpartum in the exercise group. Trial registration ClinicalTrials.gov (NCT01243554), registration date: September 6, 2010. Electronic supplementary material The online version of this article (10.1186/s12884-017-1653-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kirsti K Garnæs
- Department of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Box 8905, 7491, Trondheim, Norway
| | - Siv Mørkved
- Department of Public Health and General Practice, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Research Department, St. Olavs Hospital Trondheim University Hospital, Trondheim, Norway
| | - Kjell Å Salvesen
- Institute of clinical and molecular medicine, Norwegian University of Science and Tecnology, Trondheim, Norway.,Department of Obstetrics and Gynaecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Øyvind Salvesen
- Department of Public Health and General Practice, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Trine Moholdt
- Department of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Box 8905, 7491, Trondheim, Norway. .,Department of Obstetrics and Gynaecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
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Lindqvist M, Persson M, Mogren I. "Longing for individual recognition" - Pregnant women's experiences of midwives' counselling on physical activity during pregnancy. SEXUAL & REPRODUCTIVE HEALTHCARE 2017; 15:46-53. [PMID: 29389501 DOI: 10.1016/j.srhc.2017.12.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/26/2017] [Accepted: 12/09/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aims to explore among pregnant women were their experiences of lifestyle counselling provided by a midwife in antenatal care, addressing health promotion with special focus on physical activity during pregnancy, and factors influencing the trustworthiness of counselling conducted by a midwife. METHODS This qualitative study collected data from 14 pregnant, primiparous or multiparous women in gestational week 35-36 using in-depth interviews. The data were collected in Sweden in 2015. Qualitative content analysis was applied. RESULTS The theme "Longing for fulfilment of individual needs and expectations" emerged during analysis, including four categories; "Being exposed to unsatisfying counselling"; "Appreciating supportive and trustworthy counselling"; "Wrestling with cultures", and "Dealing with physical activity in daily life". The results indicated that some participants experienced limited counselling that was characterized by lack of knowledge, support, and trustworthiness in the midwife. Other participants reported valuable encouragement and support by the midwife. Participants were longing for individual recognition instead of receiving general advice on physical activity that was designed for all pregnant women. CONCLUSIONS Individual counselling on physical activity during pregnancy based on the participant's individual needs was desired. On the contrary, the participants could experience the midwife as having her own agenda, insufficient knowledge and primarily focusing on medical surveillance. There is a need of increased level of knowledge among midwives in antenatal care, regarding lifestyle and lifestyle change during pregnancy. This may enhance promotion of a healthy lifestyle for the pregnant woman during counselling.
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Affiliation(s)
- Maria Lindqvist
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, 901 87 Umeå, Sweden.
| | | | - Ingrid Mogren
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, 901 87 Umeå, Sweden.
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Jiang X, Liu M, Song Y, Mao J, Zhou M, Ma Z, Qian X, Han Z, Duan T. The Institute of Medicine recommendation for gestational weight gain is probably not optimal among non-American pregnant women: a retrospective study from China. J Matern Fetal Neonatal Med 2017; 32:1353-1358. [PMID: 29172881 DOI: 10.1080/14767058.2017.1405388] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate whether the Institute of Medicine (IOM) recommended gestational weight gain (GWG) range is optimal among Chinese singleton pregnant women. METHODS For the purpose of a retrospective observational study, data on 8209 mature singleton deliveries in Shanghai from January 2014 to December 2016 were extracted from medical records in terms of clinical performance. All cases were categorized as undergainers, appropriate-gainers, and above-gainers according to IOM recommended gestational weight gain range after stratification of maternal BMI and proportions of three categories were calculated. Comparisons of maternal and neonatal outcome were conducted among three categories and the associations of those outcome including risks of low birth weight (LBW) and macrosomia (MAC) with GWG were estimated by logistic regression analysis. To examine the applicability of IOM recommendation for Chinese pregnant women, the accumulated risk of LBW and MAC was displayed by stacked column chart and comparison was made among GWG category. The joint predicted risk (JPR) curve of both LBW and MAC in relation to GWG (continuous measurement) was plotted to demonstrate the relation of lowest JPR corresponding GWG with IOM range. RESULTS The IOM recommended weight gain was achieved only by 3502 (42.7%) pregnant women and 41.6% gained excessive weight during pregnancy, especially for the overweight and obese women, the proportions of above-gainers mounting to 65.7 and 75.9%, respectively. By multivariate analysis GWG significantly influenced the risk of MAC and caesarean section. Although the association between the risk of LBW and GWG was not significant, p value reached .051. The risk of delivering macrosomia and caesarean section doubled when GWG exceeded the IOM rang. Appropriate gainers did not always gain the lowest joint risk of low birth weight and macrosomia from stacked column chart and it is obvious that the GWG point according to the lowest JPR was always located left to the IOM recommended range for each BMI category from the JPR curve chart in relation to GWG. CONCLUSIONS The IOM recommended GWG range is possibly too much for Chinese singleton pregnant population for each BMI category. It is necessary to build different gestational weight gain standards for specific ethnic population.
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Affiliation(s)
- Xiang Jiang
- a Department of Obstetrics and Gynecology , Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine , Shanghai , China
| | - Ming Liu
- a Department of Obstetrics and Gynecology , Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine , Shanghai , China
| | - Yuehua Song
- a Department of Obstetrics and Gynecology , Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine , Shanghai , China
| | - Jing Mao
- a Department of Obstetrics and Gynecology , Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine , Shanghai , China
| | - Mulan Zhou
- a Department of Obstetrics and Gynecology , Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine , Shanghai , China
| | - Zhenfang Ma
- a Department of Obstetrics and Gynecology , Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine , Shanghai , China
| | - Xiaohu Qian
- a Department of Obstetrics and Gynecology , Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine , Shanghai , China
| | - Zhimin Han
- a Department of Obstetrics and Gynecology , Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine , Shanghai , China
| | - Tao Duan
- a Department of Obstetrics and Gynecology , Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine , Shanghai , China
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Thompson EL, Vamos CA, Daley EM. Physical activity during pregnancy and the role of theory in promoting positive behavior change: A systematic review. JOURNAL OF SPORT AND HEALTH SCIENCE 2017; 6:198-206. [PMID: 30356571 PMCID: PMC6189011 DOI: 10.1016/j.jshs.2015.08.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/16/2015] [Accepted: 07/10/2015] [Indexed: 05/28/2023]
Abstract
BACKGROUND Physical activity (PA) during pregnancy provides physical and psychological benefits for mother and child. U.S. guidelines recommend ≥30 min of moderate exercise for healthy pregnant women most days of the week; however, most women do not meet these recommendations. Theory assists in identifying salient determinants of health behavior to guide health promotion interventions; however, the application of theory to examine PA among pregnant women has not been examined cohesively among multiple levels of influence (e.g., intrapersonal, interpersonal, neighborhood/environmental, and organizational/political). Subsequently, this systematic review aims to identify and evaluate the use of health behavior theory in studies that examine PA during pregnancy. METHODS Articles published before July 2014 were obtained from PubMed and Web of Science. Inclusion criteria applied were: (1) empirically-based; (2) peer-reviewed; (3) measured factors related to PA; (4) comprised a pregnant sample; and (5) applied theory. Fourteen studies were included. Each study's application of theory and theoretical constructs were evaluated. RESULTS Various theories were utilized to explain and predict PA during pregnancy; yet, the majority of these studies only focused on intrapersonal level determinants. Five theoretical frameworks were applied across the studies-all but one at the intrapersonal level. Few determinants identified were from the interpersonal, neighborhood/environmental, or organizational/political levels. CONCLUSION This systematic review synthesized the literature on theoretical constructs related to PA during pregnancy. Interpersonal, community, and societal levels remain understudied. Future research should employ theory-driven multi-level determinants of PA to reflect the interacting factors influencing PA during this critical period in the life course.
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Dubé C, Aguer C, Adamo K, Bainbridge S. A role for maternally derived myokines to optimize placental function and fetal growth across gestation. Appl Physiol Nutr Metab 2017; 42:459-469. [DOI: 10.1139/apnm-2016-0446] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Exercise during pregnancy is associated with improved health outcomes for both mother and baby, including a reduced risk of future obesity and susceptibility to chronic diseases. Overwhelming evidence demonstrates a protective effect of maternal exercise against fetal birth weight extremes, reducing the rates of both large- and small-for-gestational-age infants. It is speculated that this protective effect is mediated in part through exercise-induced regulation of maternal physiology and placental development and function. However, the specific mechanisms through which maternal exercise regulates these changes remain to be discovered. We hypothesize that myokines, a collection of peptides and cytokines secreted from contracting skeletal muscles during exercise, may be an important missing link in the story. Myokines are known to reduce inflammation, improve metabolism and enhance macronutrient transporter expression and activity in various tissues of nonpregnant individuals. Little research to date has focused on the specific roles of the myokine secretome in the context of pregnancy; however, it is likely that myokines secreted from exercising skeletal muscles may modulate the maternal milieu and directly impact the vital organ of pregnancy—the placenta. In the current review, data in strong support of this potential role of myokines will be presented, suggesting myokine secretion as a key mechanism through which maternal exercise optimizes fetal growth trajectories. It is clear that further research is warranted in this area, as knowledge of the biological roles of myokines in the context of pregnancy would better inform clinical recommendations for exercise during pregnancy and contribute to the development of important therapeutic interventions.
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Affiliation(s)
- Chantal Dubé
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Céline Aguer
- Institut de recherche de l’Hôpital Montfort, Ottawa, ON K1K 0T1, Canada
- Biochemistry, Microbiology and Immunology department, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Kristi Adamo
- School of Human Kinetics, University of Ottawa, Ottawa, ON K1N 1A2, Canada
- Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada
| | - Shannon Bainbridge
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
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27
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From apelin to exercise: emerging therapies for management of hypertension in pregnancy. Hypertens Res 2017; 40:519-525. [PMID: 28381873 DOI: 10.1038/hr.2017.40] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 02/20/2017] [Accepted: 02/21/2017] [Indexed: 01/03/2023]
Abstract
Studies over the last couple of decades have provided exciting new insights into mechanisms underlying the pathogenesis of preeclampsia. In addition, several novel and innovative molecules and ideas for management of the syndrome have also come forth. While our basic understanding of the initiating events of preeclampsia continues to be placental ischemia/hypoxia stimulating the release of a variety of factors from the placenta that act on the cardiovascular and renal systems, the number of candidate pathways for intervention continues to increase. Recent studies have identified apelin and its receptor, APJ, as an important contributor to the regulation of cardiovascular and fluid balance that is found to be disrupted in preeclampsia. Likewise, continued studies have revealed a critical role for the complement arm of the innate immune system in placental ischemia induced hypertension and in preeclampsia. Finally, the recent increase in animal models for studying hypertensive disorders of pregnancy has provided opportunities to evaluate the potential role for physical activity and exercise in a more mechanistic fashion. While the exact quantitative importance of the various endothelial and humoral factors that mediate vasoconstriction and elevation of arterial pressure during preeclampsia remains unclear, significant progress has been made. Thus, the goal of this review is to discuss recent efforts towards identifying therapies for hypertension during pregnancy that derive from work exploring the apelinergic system, the complement system as well as the role that exercise and physical activity may play to that end.
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Mode of Delivery according to Leisure Time Physical Activity before and during Pregnancy: A Multicenter Cohort Study of Low-Risk Women. J Pregnancy 2017; 2017:6209605. [PMID: 28386483 PMCID: PMC5366794 DOI: 10.1155/2017/6209605] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 01/10/2017] [Accepted: 03/01/2017] [Indexed: 11/17/2022] Open
Abstract
Objectives. To examine the association between maternal leisure time physical activity and mode of delivery. Study Design. Population-based multicentre cohort. From the Danish Dystocia Study, we included 2,435 nulliparous women, who delivered a singleton infant in cephalic presentation at term after spontaneous onset of labor in 2004-2005. We analysed mode of delivery according to self-reported physical activity at four stages, that is, the year before pregnancy and during first, second, and third trimester, in logistic regression models. Further, we combined physical activity measures at all four stages in one variable for a proportional odds model for cumulative logits. Main Outcome Measures. Mode of delivery (emergency caesarean section; vacuum extractor; spontaneous vaginal delivery). Results. The odds of emergency caesarean section decreased with increasing levels of physical activity with statistically significant trends at all four time stages except the third trimester. This tendency was confirmed in the proportional odds model showing 28% higher odds of a more complicated mode of delivery among women with a low activity level compared to moderately active women. Conclusions. We found increasing leisure time physical activity before and during pregnancy associated with a less complicated delivery among low-risk, nulliparous women.
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Newton ER, May L. Adaptation of Maternal-Fetal Physiology to Exercise in Pregnancy: The Basis of Guidelines for Physical Activity in Pregnancy. CLINICAL MEDICINE INSIGHTS. WOMEN'S HEALTH 2017; 10:1179562X17693224. [PMID: 28579865 PMCID: PMC5428160 DOI: 10.1177/1179562x17693224] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 01/20/2017] [Indexed: 12/28/2022]
Abstract
Only 50 years ago obstetric care providers and women had many concerns regarding whether exercise during pregnancy created a harmful competition for substrate resources between the fetus and the mother. Animal and human research in the past 50 years, which includes acute and chronic aerobic exercise during pregnancy, has a reassuring margin of safety throughout gestation in women. Maternal physiology adapts to pregnancy changes involving the cardiorespiratory and glucometabolic alterations. Due to these changes, pregnant women have slight differences in response to acute exercise sessions. Chronic exposure to aerobic exercise before and during pregnancy is associated with numerous maternal and neonatal adaptations which may have short- and long-term benefits to maternal and child health. On the basis of the consistent evidence of safety of exercise during pregnancy, multiple nations and health care organizations, including the American College of Obstetrics and Gynecology, recommend moderate exercise for 20 to 30 minutes most days of the week. Despite the 15 to 20 years since the first recommendations were made, only 10% to 15% of pregnant women meet this recommendation. It seems there may be 2 foci for failure to achieve these exercise recommendations: patient specific and culturally driven and/or obstetric provider not recommending regular exercise due to lack of knowledge or motivation. This article addresses the provider knowledge by a review of the normal (at rest) physiologic adaptation to pregnancy. Then, we provide a detailed description of the type and intensity of controlled experiments that document the safety of exercise during pregnancy. The short- and long-term benefits are reviewed, including the safety in moderate-risk women.
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Affiliation(s)
- Edward R Newton
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Brody School of Medicine and Vidant Medical Center, East Carolina University, Greenville, NC, USA
| | - Linda May
- Foundational Sciences and Research, East Carolina University, Greenville, NC, USA
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Yamamoto S, Kagawa K, Hori N, Akezaki Y, Mori K, Nomura T. Preliminary validation of an exercise program suitable for pregnant women with abnormal glucose metabolism: inhibitory effects of Tai Chi Yuttari-exercise on plasma glucose elevation. J Phys Ther Sci 2017; 28:3411-3415. [PMID: 28174463 PMCID: PMC5276772 DOI: 10.1589/jpts.28.3411] [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: 06/22/2016] [Accepted: 08/23/2016] [Indexed: 12/16/2022] Open
Abstract
[Purpose] There is insufficient evidence related to exercise programs that are safe and
efficacious for pregnant women with abnormal glucose metabolism. Tai Chi Yuttari-exercise
is an exercise program with validated safety and efficacy in improving physical function
in the elderly. In this study, we investigated this program’s inhibitory effects on plasma
glucose elevation when it was adapted to a pregnancy model. [Subjects and Methods] Twelve
18- to 19-year-old females without a history of pregnancy were randomly assorted into two
groups: an intervention group, for which six subjects were outfitted with mock-pregnancy
suits and asked to perform Tai Chi Yuttari-exercise, and a control group who did not
perform exercise. The intervention group had a mean Borg Scale score of 11.1 ± 0.9 during
the exercise. [Results] No significant intragroup differences were observed in fasting,
baseline, or post-intervention/observation plasma glucose levels. On the other hand, the
intergroup change in plasma glucose levels after intervention/observation was significant
when comparing the intervention and control groups: −1.66 ± 7.0 and 9.42 ± 6.57 mg/dl,
respectively. [Conclusion] Tai Chi Yuttari-exercise appears to effectively inhibit plasma
glucose elevation at intensity and movement levels that can be safely applied to pregnant
women with abnormal glucose metabolism.
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Affiliation(s)
- Sachina Yamamoto
- Department of Rehabilitation Sciences, Kansai University of Welfare Sciences, Japan
| | - Kyoko Kagawa
- Department of Rehabilitation Sciences, Kansai University of Welfare Sciences, Japan
| | - Naohi Hori
- Department of Rehabilitation Sciences, Kansai University of Welfare Sciences, Japan
| | - Yoshiteru Akezaki
- Department of Rehabilitation Sciences, Kansai University of Welfare Sciences, Japan; Therapeutic Exercise Research Laboratory, Kansai University of Welfare Sciences, Japan
| | - Kohei Mori
- Department of Rehabilitation Sciences, Kansai University of Welfare Sciences, Japan; Therapeutic Exercise Research Laboratory, Kansai University of Welfare Sciences, Japan
| | - Takuo Nomura
- Department of Rehabilitation Sciences, Kansai University of Welfare Sciences, Japan; Therapeutic Exercise Research Laboratory, Kansai University of Welfare Sciences, Japan
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Lindqvist M, Lindkvist M, Eurenius E, Persson M, Ivarsson A, Mogren I. Leisure time physical activity among pregnant women and its associations with maternal characteristics and pregnancy outcomes. SEXUAL & REPRODUCTIVE HEALTHCARE 2016; 9:14-20. [PMID: 27634659 DOI: 10.1016/j.srhc.2016.03.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 02/15/2016] [Accepted: 03/31/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Physical activity during pregnancy is generally considered safe and beneficial for both the pregnant woman and her fetus. The overall aim was to investigate pregnant women's pre-pregnancy and early pregnancy physical activity and its associations with maternal characteristics and pregnancy outcomes. METHODS This cross-sectional study combined data from the Maternal Health Care Register in Västerbotten (MHCR-VB) and the Salut Programme Register (Salut-R). Data were collected from 3,868 pregnant women living in northern Sweden between 2011 and 2012. RESULTS Almost half of the participants (47.1%) achieved the recommended level of physical activity. Compared to the women who did not achieve the recommended level of exercise, these women had lower BMI, very good or good self-rated health, and a higher educational level. No significant associations could be established between physical activity levels and GDM, birth weight, or mode of delivery. CONCLUSIONS Positively, a considerably high proportion of Swedish pregnant women achieved the recommended level of physical activity. Factors associated with recommended physical activity level were BMI ≤30 kg/m(2), very good or good self-rated health, and higher educational level. Our findings emphasize the need for health care professionals to early detect and promote fertile and pregnant women towards health-enhancing physical activity, especially those with low levels of physical activity and overweight/obesity, to improve overall health in this population.
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Affiliation(s)
- Maria Lindqvist
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, 901 87 Umeå, Sweden.
| | - Marie Lindkvist
- Department of Statistics, Umeå University, 901 87 Umeå, Sweden; Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden
| | - Eva Eurenius
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden
| | | | - Anneli Ivarsson
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden
| | - Ingrid Mogren
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, 901 87 Umeå, Sweden
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Community level predictors of physical activity among women in the preconception period. Matern Child Health J 2016; 19:1584-92. [PMID: 25636646 DOI: 10.1007/s10995-015-1668-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Although physical activity is a key behavior targeted during the preconception period given its significant impact on pregnancy/birth outcomes and psychological well-being, few women meet national guidelines. While intrapersonal factors influencing physical activity among this population have been studied, community factors remain unexplored. The objective of this study was to examine community level predictors of physical activity among preconception women. Data from Add Health were limited to women (Wave III; age 18-28; n = 7,596) and excluded respondents who were pregnant, physically disabled, and missing data. The outcome variable was ≥5 instances of moderate-vigorous physical activity (MVPA) in 1 week. Community predictor variables included neighborhood-level structural and social determinants (e.g., socio-demographic composition; landscape diversity; urbanization; access to resources; crime; vehicle availability). Multilevel logistic regression modeling was used to estimate the odds of engaging in ≥5 instances of MVPA. Few women (26 %) reported ≥5 instances of MVPA in 1 week. Adjusted multilevel analysis revealed women in the preconception period were more likely to report high MVPA when living in communities with larger population densities (OR 1.34, 95 % CI 1.02-1.77) and median household income greater than $50,000 (OR 1.33, 95 % CI 1.06-1.66). Additionally, a significant inverse trend was found between high MVPA and proportion of the community without a high school diploma. Findings suggest that neighborhood composition may have an impact on preconception physical activity status. Implications include increased efforts targeting community conditions for facilitating physical activity; ultimately, improving health among women and subsequent offspring.
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Abstract
Although the physiology of the heart and vascular system has not changed, there are many things we have learned and are still learning today. Research related to heart adaptations during pregnancy has been performed since the 1930s. Since the mid-1950s, researchers began to look at changes in the maternal cardiovascular system during exercise while pregnant. Research related to exercise during pregnancy and offspring heart development began and has continued since the 1970s. We will review the normal female cardiovascular system adaptations to pregnancy in general. Additionally, topics related to maternal cardiac adaptations to pregnancy during acute exercise, as well as the chronic conditioning response from exercise training will be explored. Since physical activity during pregnancy influences fetal development, the fetal cardiac development will be discussed in regards to acute and chronic maternal exercise. Similarly, the influence of various types of maternal exercise on acute and chronic fetal heart responses will be described. Briefly, the topics related to how and if there is maternal-fetal synchrony will be explained. Lastly, the developmental changes of the fetal cardiovascular system that persist after birth will be explored. Overall, the article will discuss maternal cardiac physiology related to changes with normal pregnancy, and exercise during pregnancy, as well as fetal cardiac physiology related to changes with normal development, and exercise during pregnancy as well as developmental changes in offspring after birth.
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Affiliation(s)
- Linda May
- Assistant Professor, Foundational Sciences and Research, East Carolina University, Greenville, NC
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Koullali B, Oudijk MA, Nijman TAJ, Mol BWJ, Pajkrt E. Risk assessment and management to prevent preterm birth. Semin Fetal Neonatal Med 2016; 21:80-8. [PMID: 26906339 DOI: 10.1016/j.siny.2016.01.005] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Preterm birth is the most important cause of neonatal mortality and morbidity worldwide. In this review, we review potential risk factors associated with preterm birth and the subsequent management to prevent preterm birth in low and high risk women with a singleton or multiple pregnancy. A history of preterm birth is considered the most important risk factor for preterm birth in subsequent pregnancy. General risk factors with a much lower impact include ethnicity, low socio-economic status, maternal weight, smoking, and periodontal status. Pregnancy-related characteristics, including bacterial vaginosis and asymptomatic bacteriuria, appear to be of limited value in the prediction of preterm birth. By contrast, a mid-pregnancy cervical length measurement is independently associated with preterm birth and could be used to identify women at risk of a premature delivery. A fetal fibronectin test may be of additional value in the prediction of preterm birth. The most effective methods to prevent preterm birth depend on the obstetric history, which makes the identification of women at risk of preterm birth an important task for clinical care providers.
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Affiliation(s)
- B Koullali
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands.
| | - M A Oudijk
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands
| | - T A J Nijman
- Department of Obstetrics and Gynaecology, University Medical Center, Utrecht, The Netherlands
| | - B W J Mol
- Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia
| | - E Pajkrt
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands
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Gustafsson MK, Stafne SN, Romundstad PR, Mørkved S, Salvesen KÅ, Helvik A. The effects of an exercise programme during pregnancy on health‐related quality of life in pregnant women: a Norwegian randomised controlled trial. BJOG 2015; 123:1152-60. [DOI: 10.1111/1471-0528.13570] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2015] [Indexed: 12/16/2022]
Affiliation(s)
- MK Gustafsson
- Department of Public Health and General Practice Norwegian University of Science and Technology Trondheim Norway
- Trondheim University Hospital (St Olavs Hospital) Trondheim Norway
| | - SN Stafne
- Department of Public Health and General Practice Norwegian University of Science and Technology Trondheim Norway
- Clinical Services St Olavs Hospital Trondheim University Hospital Trondheim Norway
| | - PR Romundstad
- Department of Public Health and General Practice Norwegian University of Science and Technology Trondheim Norway
| | - S Mørkved
- Department of Public Health and General Practice Norwegian University of Science and Technology Trondheim Norway
- Clinical Services St Olavs Hospital Trondheim University Hospital Trondheim Norway
| | - KÅ Salvesen
- Department of Laboratory Medicine Children's and Women's Health Norwegian University of Science and Technology Trondheim Norway
- National Center for Fetal Medicine Department of Obstetrics and Gynecology Trondheim University Hospital Trondheim Norway
| | - A‐S Helvik
- Department of Public Health and General Practice Norwegian University of Science and Technology Trondheim Norway
- Ageing and Health Norwegian Centre for Research Education and Service Development Vestfold Hospital Trust Tønsberg Norway
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Wang ML, Arroyo J, Druker S, Sankey HZ, Rosal MC. Knowledge, Attitudes and Provider Advice by Pre-Pregnancy Weight Status: A Qualitative Study of Pregnant Latinas With Excessive Gestational Weight Gain. Women Health 2015; 55:805-28. [DOI: 10.1080/03630242.2015.1050542] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Monica L. Wang
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Julie Arroyo
- Massachusetts Rehabilitation Commission, Malden, Massachusetts, USA
| | - Susan Druker
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | | | - Milagros C. Rosal
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Seneviratne SN, McCowan LME, Cutfield WS, Derraik JGB, Hofman PL. Exercise in pregnancies complicated by obesity: achieving benefits and overcoming barriers. Am J Obstet Gynecol 2015; 212:442-9. [PMID: 24909342 DOI: 10.1016/j.ajog.2014.06.009] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 05/08/2014] [Accepted: 06/03/2014] [Indexed: 01/21/2023]
Abstract
An increasing number of women are entering pregnancy in an overweight or obese state. Obese women and their offspring are at increased risk of adverse perinatal outcomes, which may be improved by regular moderate-intensity antenatal exercise. Current guidelines recommend that all pregnant women without contraindications engage in ≥30 minutes of moderate-intensity exercise on a daily basis. However, obese women are usually less physically active and tend to further reduce activity levels during pregnancy. This commentary summarizes the potential short- and long-term benefits of antenatal exercise in obese pregnant women, highlights the challenges they face, and discusses means of improving their exercise levels. In addition, we make recommendations on exercise prescription for pregnancies complicated by obesity.
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Affiliation(s)
- Sumudu N Seneviratne
- Liggins Institute, University of Auckland, Auckland, New Zealand; Gravida: National Centre for Growth and Development, University of Auckland, Auckland, New Zealand
| | - Lesley M E McCowan
- Gravida: National Centre for Growth and Development, University of Auckland, Auckland, New Zealand; Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
| | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand; Gravida: National Centre for Growth and Development, University of Auckland, Auckland, New Zealand
| | - José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand; Gravida: National Centre for Growth and Development, University of Auckland, Auckland, New Zealand.
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Bovbjerg ML, Siega-Riz AM, Evenson KR, Goodnight W. Exposure analysis methods impact associations between maternal physical activity and cesarean delivery. J Phys Act Health 2015; 12:37-47. [PMID: 24509873 PMCID: PMC4590730 DOI: 10.1123/jpah.2012-0498] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Previous studies report conflicting results regarding a possible association between maternal physical activity (PA) and cesarean delivery. METHODS Seven-day PA recalls were collected by telephone from pregnant women (n = 1205) from North Carolina, without prior cesarean, during 2 time windows: 17 to 22 weeks and 27 to 30 weeks completed gestation. PA was treated as a continuous, nonlinear variable in binomial regressions (log-link function); models controlled for primiparity, maternal contraindications to exercise, preeclampsia, pregravid BMI, and percent poverty. We examined both total PA and moderate-to-vigorous PA (MVPA) at each time. Outcomes data came from medical records. RESULTS The dose-response curves between PA or MVPA and cesarean risk at 17 to 22 weeks followed an inverse J-shape, but at 27 to 30 weeks the curves reversed and were J-shaped. However, only (total) PA at 27 to 30 weeks was strongly associated with cesarean risk; this association was attenuated when women reporting large volumes of PA (> 97.5 percentile) were excluded. CONCLUSION We did not find evidence of an association between physical activity and cesarean birth. We did, however, find evidence that associations between PA and risk of cesarean may be nonlinear and dependent on gestational age at time of exposure, limiting the accuracy of analyses that collapse maternal PA into categories.
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Affiliation(s)
- Marit L Bovbjerg
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR
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Lindqvist M, Mogren I, Eurenius E, Edvardsson K, Persson M. "An on-going individual adjustment": a qualitative study of midwives' experiences counselling pregnant women on physical activity in Sweden. BMC Pregnancy Childbirth 2014; 14:343. [PMID: 25269457 PMCID: PMC4190373 DOI: 10.1186/1471-2393-14-343] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 09/24/2014] [Indexed: 11/13/2022] Open
Abstract
Background In Sweden, midwives play prominent supportive role in antenatal care by counselling and promoting healthy lifestyles. This study aimed to explore how Swedish midwives experience the counselling of pregnant women on physical activity, specifically focusing on facilitators and barriers during pregnancy. Also, addressing whether the midwives perceive that their own lifestyle and body shape may influence the content of the counselling they provide. Methods Eight focus group discussions (FGD) were conducted with 41 midwives working in antenatal care clinics in different parts of Sweden between September 2013 and January 2014. Purposive sampling was applied to ensure a variation in age, work experience, and geographical location. The FGD were digitally recorded, transcribed verbatim, and analyzed using manifest and latent content analysis. Results The main theme– “An on-going individual adjustment” was built on three categories: “Counselling as a challenge”; “Counselling as walking the thin ice” and “Counselling as an opportunity” reflecting the midwives on-going need to adjust their counselling depending on each woman’s specific situation. Furthermore, counselling pregnant women on physical activity was experienced as complex and ambiguous, presenting challenges as well as opportunities. When midwives challenged barriers to physical activity, they risked being rejected by the pregnant women. Despite risking rejection, the midwives tried to promote increased physical activity based on their assessment of individual needs of the pregnant woman. Some participants felt that their own lifestyle and body shape might negatively influence the counselling; however, the majority of participants did not agree with this perspective. Conclusions Counselling on physical activity during pregnancy may be a challenging task for midwives, characterized by on-going adjustments based on a pregnant woman’s individual needs. Midwives strive to find individual solutions to encourage physical activity. However, to improve their counselling, midwives may benefit from further training, also organizational and financial barriers need to be addressed. Such efforts might result in improved opportunities to further support pregnant women’s motivation for performance of physical activity.
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Affiliation(s)
- Maria Lindqvist
- Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå, Sweden.
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Abstract
INTRODUCTION There is increasingly a double burden of under-nutrition and obesity in women of reproductive age. Preconception underweight or overweight, short stature and micronutrient deficiencies all contribute to excess maternal and fetal complications during pregnancy. METHODS A systematic review and meta-analysis of the evidence was conducted to ascertain the possible impact of preconception care for adolescents, women and couples of reproductive age on maternal, newborn and child health (MNCH) outcomes. A comprehensive strategy was used to search electronic reference libraries, and both observational and clinical controlled trials were included. Cross-referencing and a separate search strategy for each preconception risk and intervention ensured wider study capture. RESULTS Maternal pre-pregnancy weight is a significant factor in the preconception period with underweight contributing to a 32% higher risk of preterm birth, and obesity more than doubling the risk for preeclampsia, gestational diabetes. Overweight women are more likely to undergo a Cesarean delivery, and their newborns have higher chances of being born with a neural tube or congenital heart defect. Among nutrition-specific interventions, preconception folic acid supplementation has the strongest evidence of effect, preventing 69% of recurrent neural tube defects. Multiple micronutrient supplementation shows promise to reduce the rates of congenital anomalies and risk of preeclampsia. Although over 40% of women worldwide are anemic in the preconception period, only one study has shown a risk for low birth weight. CONCLUSION All women, but especially those who become pregnant in adolescence or have closely-spaced pregnancies (inter-pregnancy interval less than six months), require nutritional assessment and appropriate intervention in the preconception period with an emphasis on optimizing maternal body mass index and micronutrient reserves. Increasing coverage of nutrition-specific and nutrition-sensitive strategies (such as food fortification; integration of nutrition initiatives with other maternal and child health interventions; and community based platforms) is necessary among adolescent girls and women of reproductive age. The effectiveness of interventions will need to be simultaneously monitored, and form the basis for the development of improved delivery strategies and new nutritional interventions.
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Affiliation(s)
- Sohni V Dean
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| | - Zohra S Lassi
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| | - Ayesha M Imam
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
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Recreational Exercise Before and During Pregnancy in Relation to Plasma C-Reactive Protein Concentrations in Pregnant Women. J Phys Act Health 2014; 12:770-5. [PMID: 25111060 DOI: 10.1123/jpah.2013-0390] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Pregnant women who are physically active have a lower risk of preeclampsia and gestational diabetes than women who are less active. One possible mechanism is a reduction in low-grade inflammation, as measured by plasma concentrations of C-reactive protein (CRP). The association between exercise and CRP in pregnant women, however, has not been adequately investigated. METHODS A total of 537 pregnant women, enrolled around the 17th week of gestation in the Norwegian Mother and Child Cohort Study in 2003 to 2004, were studied. Self-reported recreational exercise was recalled for both 3 months before pregnancy and early pregnancy. The total energy expenditure from recreational exercise (total recreational exercise, metabolic equivalent of task [MET]-hr/week) was estimated, and low-, moderate- and vigorous-intensity exercise was defined. Plasma CRP concentrations were measured during pregnancy. RESULTS In adjusted linear regression models, mean CRP concentration was 1.0% lower [95% CI = -1.9% to 0.2%] with each 1 MET-hr/week of total recreational exercise before pregnancy. In addition, vigorous-intensity exercise before pregnancy was more strongly related to a reduction in CRP levels than low- or moderate-intensity exercise. However, we observed no association between recreational exercise during pregnancy and plasma CRP levels. CONCLUSIONS Recreational exercise before pregnancy, especially vigorous exercise, may reduce the risk of maternal inflammation during pregnancy.
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Nathanielsz PW, Ford SP, Long NM, Vega CC, Reyes-Castro LA, Zambrano E. Interventions to prevent adverse fetal programming due to maternal obesity during pregnancy. Nutr Rev 2014; 71 Suppl 1:S78-87. [PMID: 24147928 DOI: 10.1111/nure.12062] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Maternal obesity is a global epidemic affecting both developed and developing countries. Human and animal studies indicate that maternal obesity adversely programs the development of offspring, predisposing them to chronic diseases later in life. Several mechanisms act together to produce these adverse health effects. There is a consequent need for effective interventions that can be used in the management of human pregnancy to prevent these outcomes. The present review analyzes the dietary and exercise intervention studies performed to date in both altricial and precocial animals, rats and sheep, with the aim of preventing adverse offspring outcomes. The results of these interventions present exciting opportunities to prevent, at least in part, adverse metabolic and other outcomes in obese mothers and their offspring.
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Affiliation(s)
- Peter W Nathanielsz
- Center for Pregnancy and Newborn Research, Department of Obstetrics, University of Texas Health Sciences Center San Antonio, San Antonio, Texas, USA
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Antenatal exercise in overweight and obese women and its effects on offspring and maternal health: design and rationale of the IMPROVE (Improving Maternal and Progeny Obesity Via Exercise) randomised controlled trial. BMC Pregnancy Childbirth 2014; 14:148. [PMID: 24767604 PMCID: PMC4002538 DOI: 10.1186/1471-2393-14-148] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 04/14/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Obesity during pregnancy is associated with adverse outcomes for the offspring and mother. Lifestyle interventions in pregnancy such as antenatal exercise, are proposed to improve both short- and long-term health of mother and child. We hypothesise that regular moderate-intensity exercise during the second half of pregnancy will result in improved maternal and offspring outcomes, including a reduction in birth weight and adiposity in the offspring, which may be protective against obesity in later life. METHODS/DESIGN The IMPROVE (Improving Maternal and Progeny Risks of Obesity Via Exercise) study is a two-arm parallel randomised controlled clinical trial being conducted in Auckland, New Zealand. Overweight and obese women (BMI ≥25 kg/m2) aged 18-40 years, with a singleton pregnancy of <20 weeks of gestation, from the Auckland region, are eligible for the trial. Exclusion criteria are ongoing smoking or medical contra-indications to antenatal exercise.Participants are randomised with 1:1 allocation ratio to either intervention or control group, using computer-generated randomisation sequences in variable block sizes, stratified on ethnicity and parity, after completion of baseline assessments. The intervention consists of a 16-week structured home-based moderate-intensity exercise programme utilising stationary cycles and heart rate monitors, commencing at 20 weeks of gestation. The control group do not receive any exercise intervention. Both groups undergo regular fetal ultrasonography and receive standard antenatal care. Due to the nature of the intervention, participants are un-blinded to group assignment during the trial.The primary outcome is offspring birth weight. Secondary offspring outcomes include fetal and neonatal body composition and anthropometry, neonatal complications and cord blood metabolic markers. Maternal outcomes include weight gain, pregnancy and delivery complications, aerobic fitness, quality of life, metabolic markers and post-partum body composition. DISCUSSION The results of this trial will provide valuable insights on the effects of antenatal exercise on health outcomes in overweight and obese mothers and their offspring. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12612000932864.
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Tinloy J, Chuang CH, Zhu J, Pauli J, Kraschnewski JL, Kjerulff KH. Exercise during pregnancy and risk of late preterm birth, cesarean delivery, and hospitalizations. Womens Health Issues 2014; 24:e99-e104. [PMID: 24439953 DOI: 10.1016/j.whi.2013.11.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 11/08/2013] [Accepted: 11/08/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Federal physical activity guidelines recommend at least 150 minutes of moderate-intensity exercise per week during pregnancy. We studied whether regular exercise during pregnancy is associated with preterm birth, cesarean delivery, and hospitalization during pregnancy. METHODS Self-reported weekly exercise was ascertained in 3,006 women during the third trimester of pregnancy. Using multivariable logistic regression, we report the relationship between regular exercise (≥150 min/wk) and late preterm birth, cesarean delivery, and hospitalization during pregnancy, controlling for age, race, marital status, education, poverty status, prepregnancy body mass index weight category, gestational weight gain, and prepregnancy diabetes or hypertension. RESULTS Nearly one third of women reported meeting current federal physical activity recommendations during pregnancy. Five percent had late preterm birth, 29% had cesarean deliveries, and 20% reported hospitalization during pregnancy. In multivariable analysis, regular exercise during pregnancy was not associated with late preterm birth or hospitalization during pregnancy. Physical activity of 150 or more minutes per week was associated with reduced odds of cesarean delivery compared with less than 60 minutes per week, but the finding was not significant (adjusted odds ratio, 0.86; 95% confidence interval, 0.69-1.07). CONCLUSION In the First Baby Study, physical activity was not associated with late preterm birth or hospitalizations, and may be associated with decreased odds of cesarean delivery.
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Affiliation(s)
- Jennifer Tinloy
- Department of Medicine, MidState Medical Center, Meriden, Connecticut
| | - Cynthia H Chuang
- Division of General Internal Medicine, Penn State College of Medicine, Hershey, Pennsylvania.
| | - Junjia Zhu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Jaimey Pauli
- Department of Obstetrics and Gynecology, Penn State University College of Medicine, Hershey, Pennsylvania
| | - Jennifer L Kraschnewski
- Division of General Internal Medicine, H034, Penn State College of Medicine, Hershey, Pennsylvania
| | - Kristen H Kjerulff
- Departments of Public Health Sciences & Obstetrics and Gynecology, Penn State College of Medicine, Hershey, Pennsylvania
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Avni-Barron O, Hoagland K, Ford C, Miller LJ. Preconception planning to reduce the risk of perinatal depression and anxiety disorders. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.10.27] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lassi ZS, Bhutta ZA. Risk factors and interventions related to maternal and pre-pregnancy obesity, pre-diabetes and diabetes for maternal, fetal and neonatal outcomes: a systematic review. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17474108.2013.841453] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Abstract
Medical authorities advise US adults to perform a minimum of 30 minutes of moderate-intensity aerobic physical activity on most days of the week to improve health and reduce risk for many chronic conditions. New findings from epidemiologic studies suggest that physical activity not only reduces the risk of developing coronary heart disease, stroke, and type 2 diabetes but also may prevent certain cancers (including colon and breast cancer), osteoporotic fracture, falls, cognitive decline, mood disturbances, and adverse pregnancy outcomes. Physical activity is important for regulating body weight, but many cardiometabolic benefits of exercise are independent of such regulation. This article reviews recent epidemiologic evidence on physical activity with respect to a variety of health outcomes in women and concludes with guidance for clinicians seeking to boost activity levels in sedentary patients. However, additional research is needed on features of individual- and community-based interventions and policies that successfully promote healthful levels of physical activity.
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Affiliation(s)
- Shari S. Bassuk
- Division of Preventive Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts
| | - JoAnn E. Manson
- Division of Preventive Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts
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Tomić V, Sporiš G, Tomić J, Milanović Z, Zigmundovac-Klaić D, Pantelić S. The effect of maternal exercise during pregnancy on abnormal fetal growth. Croat Med J 2013; 54:362-8. [PMID: 23986277 PMCID: PMC3760660 DOI: 10.3325/cmj.2013.54.362] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aim To assess the effect of maternal physical activity during pregnancy on abnormal fetal growth. Methods The study group of 166 women in gestational week 6-8 exercised regularly three days per week at submaximal intensity during their entire pregnancy and the control group of 168 women received standard antenatal care. The main outcomes were macrosomia and intrauterine growth restriction. Results The study group had a lower frequency of macrosomia in newborns (6.0% vs 12.5%, P = 0.048) and gestational diabetes (1.8% vs 8.3%, P = 0.008) than the control-group, but there was no significant difference in intrauterine growth restriction (7.2% vs 6.5%). There was also no significant differences in other perinatal outcomes. Conclusions The beneficial effect of maternal physical activity on fetal growth may be caused the impact of aerobic exercise on glucose tolerance. Fitness trainers and kinesiologists, as well as health care providers, should be educated on the benefits of regular exercise during pregnancy and safe physical exercise for pregnant women.
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Affiliation(s)
- Vlatka Tomić
- Zoran Milanovic, Faculty of Sport and Physical Education, Carnojeviceva 10a,
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Dean SV, Mason EM, Howson CP, Lassi ZS, Imam AM, Bhutta ZA. Born too soon: care before and between pregnancy to prevent preterm births: from evidence to action. Reprod Health 2013; 10 Suppl 1:S3. [PMID: 24625189 PMCID: PMC3828587 DOI: 10.1186/1742-4755-10-s1-s3] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Providing care to adolescent girls and women before and between pregnancies improves their own health and wellbeing, as well as pregnancy and newborn outcomes, and can also reduce the rates of preterm birth. This paper has reviewed the evidence-based interventions and services for preventing preterm births, reported the findings from research priority exercise, and prescribed actions for taking this call further. Certain factors in the preconception period have been shown to increase the risk for prematurity and, therefore, preconception care services for all women of reproductive age should address these risk factors through preventing adolescent pregnancy, preventing unintended pregnancies, promoting optimal birth spacing, optimizing pre-pregnancy weight and nutritional status (including a folic acid-containing multivitamin supplement) and ensuring that all adolescent girls have received complete vaccination. Preconception care must also address risk factors that may be applicable to only some women. These include screening for and management of chronic diseases, especially diabetes; sexually-transmitted infections; tobacco and smoke exposure; mental health disorders, notably depression; and intimate partner violence. The approach to research in preconception care to prevent preterm births should include a cycle of development and delivery research that evaluates how best to scale up coverage of existing evidence-based interventions, epidemiologic research that assesses the impact of implementing these interventions and discovery science that better elucidates the complex causal pathway of preterm birth and helps to develop new screening and intervention tools. In addition to research, policy and financial investment is crucial to increasing opportunities to implement preconception care, and rates of prematurity should be included as a tracking indicator in global and national maternal child health assessments.
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Affiliation(s)
- Sohni V Dean
- Albert Einstein Medical Center, Philadelphia, USA
| | | | | | | | | | - Zulfiqar A Bhutta
- Aga Khan University, Karachi 74800, Pakistan
- The Hospital for Sick Children, Toronto, Canada
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Booth FW, Roberts CK, Laye MJ. Lack of exercise is a major cause of chronic diseases. Compr Physiol 2013; 2:1143-211. [PMID: 23798298 DOI: 10.1002/cphy.c110025] [Citation(s) in RCA: 1367] [Impact Index Per Article: 113.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Chronic diseases are major killers in the modern era. Physical inactivity is a primary cause of most chronic diseases. The initial third of the article considers: activity and prevention definitions; historical evidence showing physical inactivity is detrimental to health and normal organ functional capacities; cause versus treatment; physical activity and inactivity mechanisms differ; gene-environment interaction (including aerobic training adaptations, personalized medicine, and co-twin physical activity); and specificity of adaptations to type of training. Next, physical activity/exercise is examined as primary prevention against 35 chronic conditions [accelerated biological aging/premature death, low cardiorespiratory fitness (VO2max), sarcopenia, metabolic syndrome, obesity, insulin resistance, prediabetes, type 2 diabetes, nonalcoholic fatty liver disease, coronary heart disease, peripheral artery disease, hypertension, stroke, congestive heart failure, endothelial dysfunction, arterial dyslipidemia, hemostasis, deep vein thrombosis, cognitive dysfunction, depression and anxiety, osteoporosis, osteoarthritis, balance, bone fracture/falls, rheumatoid arthritis, colon cancer, breast cancer, endometrial cancer, gestational diabetes, pre-eclampsia, polycystic ovary syndrome, erectile dysfunction, pain, diverticulitis, constipation, and gallbladder diseases]. The article ends with consideration of deterioration of risk factors in longer-term sedentary groups; clinical consequences of inactive childhood/adolescence; and public policy. In summary, the body rapidly maladapts to insufficient physical activity, and if continued, results in substantial decreases in both total and quality years of life. Taken together, conclusive evidence exists that physical inactivity is one important cause of most chronic diseases. In addition, physical activity primarily prevents, or delays, chronic diseases, implying that chronic disease need not be an inevitable outcome during life.
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Affiliation(s)
- Frank W Booth
- Departments of Biomedical Sciences, Medical Pharmacology and Physiology, and Nutrition and Exercise Physiology, Dalton Cardiovascular Institute, University of Missouri, Columbia, Missouri, USA.
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