Pregnancy Leisure-time Physical Activity Research Articles

Leisure Time Physical Activity, Sedentary Time in Pregnancy, and Infant Weight at Approximately 12 Months.

Background: Maternal leisure time physical activity (LTPA) and sedentary time during pregnancy may influence programming of infant growth in a sex-specific manner.Materials and Methods: Participants (N = 35,212) from the Danish National Birth Cohort reported moderate/vigorous LTPA (hours/week) in early (conception to mean 16 weeks of gestation) and late pregnancy (mean 31 weeks of gestation to delivery) during interviews at 16 weeks of gestation and 6 months postpartum. Participants reported screen time at work and time spent watching television/videos (hours/day) in early pregnancy. Infant weight at 12 months of age was reported by mothers. Weight-for-length was categorized using sex-specific international standards.Results: Participants reported on average 1 hour per week of early pregnancy moderate/vigorous LTPA, 0.5 hour per week of late pregnancy LTPA, and 3 hours per day of early pregnancy sedentary time. Early pregnancy LTPA category was not associated with infant weight (p for trend = 0.62). There were suggested associations of early pregnancy sedentary time above the first quartile with greater odds of infant underweight (odds ratio = 1.15–1.27; p for trend = 0.27). Associations were similar in male and female infants.Conclusions: There is no clear relationship between early or late pregnancy LTPA and infant weight at 12 months in our study. Maternal early pregnancy sedentary time may be associated with infant underweight at 12 months.

Early Pregnancy Leisure Time Physical Activity and Circulating MicroRNAs

Leisure time physical activity (LTPA) during pregnancy is associated with pregnancy complications and fetal outcomes. Epigenetic mechanisms potentially play key roles in these associations. Few studies have investigated epigenetic biomarkers in relation to LTPA. PURPOSE: To determine if maternal LTPA in early pregnancy is associated with candidate circulating microRNAs (miRNAs), epigenetic biomarkers with post-transcription regulatory roles. METHODS: This was a cross-sectional study conducted among participants (N=74) of the Omega study, a pregnancy cohort study. Participants self-reported LTPA duration (hours/week) and energy expenditure (MET-hours/week) during an interview in early pregnancy (16 weeks gestation, on average). LTPA was considered both as a continuous variable and categorized according to current American College of Sports Medicine recommendations for physical activity (not active, active<150 minutes/week, active≥150 minutes/week). Levels of circulating microRNAs (miR-126-3p, 146b-5p, miR-155-5p, miR-21-3p, miR-210-3p, miR-222-3p, miR-223-3p, miR-517-5p, miR-518a-3p, miR-29a-3p), selected based on their role in pathophysiologic pathways (e.g. inflammation, oxidative stress, and placental function) related to pregnancy complications and outcomes, were measured using qRT-PCR. Linear regression adjusted for maternal age and gestational age at blood draw was used to determine beta estimates and 95% confidence intervals. RESULTS: Each additional hour or MET-hour/week of LTPA was not associated with levels of circulating miRNAs (all P>0.05). Compared to women who were not active, women who were active but did not meet recommendations had higher levels of circulating miR-517-5p (β=0.24; 95% CI: 0.06, 1.0; P=0.05). Compared to women who were active below recommended levels, meeting or exceeding recommendations was associated with higher levels of circulating miR-517-5p (β=3.7; 95% CI: 0.99, 14; P=0.05). Early pregnancy LTPA was not associated with levels of other circulating miRNAs. CONCLUSION: Maternal LTPA in early pregnancy may be associated with circulating levels of miR-517-5p, a placenta-specific miRNA related to placental growth, development, and function.

Leisure Time Physical Activity and Gestational Diabetes Mellitus in the Omega Study

Findings of studies investigating associations of leisure time physical activity (LTPA) with gestational diabetes mellitus (GDM) risk have been inconsistent. We investigated associations of LTPA with GDM and whether these associations differ by prepregnancy overweight/obese status or gestational weight gain category. Participants (N = 3209) of the Omega study, a pregnancy cohort study in Washington State (1996-2008), reported LTPA duration (h·wk) and energy expenditure (MET·h·wk) in the year before pregnancy and in early pregnancy. Diagnoses of GDM were abstracted from medical records. Poisson regression models were used to determine relative risks of GDM across tertiles of prepregnancy or early pregnancy LTPA duration and energy expenditure. Stratified analyses and interaction terms were used to assess effect modification by prepregnancy overweight/obese status (BMI ≥25 kg·m) or gestational weight gain category (adequate or excessive). Each tertile increase in prepregnancy LTPA duration or energy expenditure was associated with 15% (95% CI = 0.72-1.00) and 19% (95% CI = 0.69-0.96) lower risk of GDM, respectively. Each tertile increase in early pregnancy LTPA duration or energy expenditure was associated with 16% (95% CI = 0.72-0.97) and 17% (95% CI = 0.72-0.95) lower risk of GDM, respectively. LTPA during both prepregnancy and early pregnancy was associated with a 46% reduced risk of GDM (95% CI = 0.32-0.89) compared with inactivity during both periods. LTPA-GDM associations were similar by prepregnancy BMI and gestational weight gain. Our results support a role for the promotion of physical activity before and during pregnancy in the prevention of GDM.

MEASURING PHYSICAL ACTIVITY IN PREGNANCY USING QUESTIONNAIRES: A META-ANALYSIS

Physical activity (PA) during normal pregnancy has various positive effects on pregnant women’s health. Determination of the relationship between PA and health outcomes requires accurate measurement of PA in pregnant women. The purpose of this review is to provide a summary of valid and reliable PA questionnaires for pregnant women. During 2013, Pubmed, OvidSP and Web of Science databases were searched for trials on measurement properties of PA questionnaires for pregnant population. Six studies and four questionnaires met the inclusion criteria: Pregnancy Physical Activity Questionnaire, Modified Kaiser Physical Activity Survey, Short Pregnancy Leisure Time Physical Activity Questionnaire and Third Pregnancy Infection and Nutrition Study Physical Activity Questionnaire. Assessment of validity and reliability was performed using correlations of the scores in these questionnaires with objective measures and subjective measures (self-report) of PA, as well as test-retest reliability coefficients. Sample sizes included in analysis varied from 45 to 177 subjects. The best validity and reliability characteristics (together with effect sizes) were identified for the Modified Kaiser Physical Activity Survey and Pregnancy Physical Activity Questionnaire (French, Vietnamese, standard). In conclusion, assessment of PA during pregnancy remains a challenging and complex task. Questionnaires are a simple and effective, yet limited tool for assessing PA.

The Influence of Risk Perceptions and Efficacy Beliefs on Leisure-Time Physical Activity During Pregnancy.

Pregnancy risk perceptions and physical activity efficacy beliefs may facilitate or impede pregnancy leisure-time physical activity (LTPA). We examined the separate and joint influence of these variables on LTPA behavior among pregnant women. Pregnant women (n = 302) completed a survey containing questions on LTPA efficacy beliefs and behavior, as well as pregnancy risk perceptions with respect to the health of the unborn baby. As stipulated by the Risk Perception Attitude (RPA) Framework, 4 attitudinal groups were created: Responsive (High Risk+High Efficacy), Proactive (Low+High), Avoidant (High+Low), and Indifferent (Low+Low). Moderate LTPA and vigorous LTPA were dichotomized for study analyses. A total of 82 women (27.2%) met the moderate physical activity guideline and 90 women (30.1%) performed any vigorous LTPA. Responsive and proactive pregnant women (those with high efficacy) were most likely to meet the moderate guideline and participate in vigorous LTPA. Hierarchical logistic regression did not reveal an interactive effect of pregnancy risk perceptions and LTPA efficacy beliefs for meeting the moderate guideline (OR = 0.94, 95% CI = 0.66-1.36) or any vigorous LTPA participation (OR = 1.41, 95% CI = 0.86-2.29). LTPA efficacy beliefs appear important in facilitating greater levels of pregnancy LTPA. Significant interactive effects between pregnancy risk perceptions and LTPA efficacy beliefs were not found.

The Influence of Risk Perceptions and Efficacy Beliefs on Leisure-Time Physical Activity during Pregnancy

Pregnancy risk perceptions and physical activity efficacy beliefs may facilitate or impede pregnancy leisure-time physical activity (LTPA). According to the Risk Perception Attitude Framework (RPA), these psychosocial factors may have an interactive effect on behavior. PURPOSE: To determine the separate and joint influence of pregnancy risk perceptions and LTPA efficacy beliefs on LTPA behavior among pregnant women. METHODS: Pregnant women (n=302) completed a survey which contained questions on LTPA beliefs and behavior, as well as pregnancy risk perceptions with respect to the health of the unborn baby. Median splits were used to categorize women as high/low for their pregnancy risk perceptions and LTPA efficacy beliefs for both moderate and vigorous LTPA. These variables were then combined to create four RPA attitudinal groups: Responsive (High Risk+High Efficacy), Proactive (Low+High), Avoidant (High+Low), and Indifferent (Low+Low). Moderate LTPA was dichotomized as meeting guidelines [moderate LTPA ≥150 min/week] or not. Vigorous LTPA was dichotomized as performing any [vigorous LTPA >0 min/week] or not. Chi-square and logistic regression analyses were used to examine relations between RPA attitudinal groups and LTPA participation. Hierarchical logistic regression was used to examine the joint influence of pregnancy risk perceptions and LTPA efficacy beliefs on pregnancy LTPA. RESULTS: A total of 82 women (27.2%) met the moderate LTPA guidelines and 90 women (30.1%) performed any vigorous LTPA. Responsive and proactive pregnant women (those with high efficacy) were most likely to meet the moderate LTPA guidelines and participate in any vigorous LTPA. Hierarchical logistic regression did not reveal an interactive effect of pregnancy risk perceptions and LTPA efficacy beliefs for meeting moderate LTPA guidelines (β=0.94, CI=0.66-1.36) or any vigorous LTPA participation (β=1.41, CI=0.86-2.29). CONCLUSIONS: LTPA efficacy beliefs are important in facilitating greater levels of pregnancy LTPA. Significant interactive effects between pregnancy risk perceptions (with respect to the health of the baby) and LTPA efficacy beliefs on LTPA participation were not found. Health promotion efforts should focus on increasing LTPA self-efficacy to increase rates of participation among pregnant women.

Maternal Leisure Time Physical Activity and Pregnancy Complications

PURPOSE: To investigate associations of pre-pregnancy and early pregnancy leisure time physical activity with pregnancy complications, and to examine whether these associations are modified by pre-pregnancy overweight/obese status. METHODS: Participants (N=3310) of the Omega study, a pregnancy cohort study, reported LTPA duration (hours/week) and energy expenditure (MET-hours/week) in the year before pregnancy (ppLTPA) and in early pregnancy (epLTPA) at 15 weeks gestation. Diagnoses of gestational diabetes mellitus (GDM) and pregnancy induced hypertension or preeclampsia (PIH/PE) were abstracted from medical records. Poisson regression models were used to determine relative risks of pregnancy complications across quartiles of duration and energy expenditure of ppLTPA or epLTPA. Stratified analysis and interaction terms were used to assess effect modification by pre-pregnancy body mass index (BMI, normal: 18.5-24.9 kg/m2 or overweight/obese: ≥25 kg/m2). RESULTS: The 25th, 50th, 75th percentiles for ppLTPA duration were 1.94, 3.98, 6.63 hours/week and 0, 2.63, 5.50 hours/week for epLTPA duration. ppLTPA was associated with decreased risk of GDM overall and among women with normal pre-pregnancy BMI. Each quartile increase in ppLTPA duration was associated with 14% (RR=0.86; 95% CI: 0.75-0.99) and 18% (RR=0.82; 95% CI: 0.67-0.99) lower risk of GDM overall and among women with normal pre-pregnancy BMI, respectively. epLTPA was associated with decreased risk of GDM overall and among women with overweight/obese pre-pregnancy BMI. Each quartile increase in epLTPA duration was associated with 13% (RR=0.87; 95% CI: 0.75-1.00) and 18% (RR=0.82; 95% CI: 0.65-1.03) lower risk of GDM overall and among overweight/obese women, respectively. Interaction terms for LTPA and pre-pregnancy overweight/obesity status were not statistically significant. LTPA was not associated with risk of PIH/PE. CONCLUSION: ppLTPA was associated with decreased risk of GDM among women with normal pre-pregnancy BMI while an inverse association of epLTPA with GDM appeared to be present only among overweight/obese women. Pre-pregnancy BMI may need to be considered when recommending interventions to prevent GDM. Future studies to replicate these results are warranted.

Physical Activity-Related Discussion between Pregnant Women and Prenatal Healthcare Providers

Prenatal healthcare providers (HCP) are in an influential position to advocate for leisure-time physical activity (LTPA) among pregnant women. Previous research suggests when such discussions occur, they may lack accurate or complete information and may be perceived negatively by pregnant women. PURPOSE: To 1) assess pregnant women’s perceptions of physical activity discussion with their prenatal HCPs and 2) determine the relationship between these discussions and meeting current LTPA guidelines included in the Physical Activity Guidelines for Americans. METHODS: A survey (paper or online) was completed by 302 pregnant women. Participants answered questions regarding physical activity discussions with prenatal HCPs and their pregnancy LTPA behavior. Moderate LTPA was dichotomized as meeting guidelines [moderate LTPA ≥150 min/week] or not. Vigorous LTPA was dichotomized as performing any [vigorous LTPA >0 min/week) or not. Relative frequencies were calculated for all categorical responses. Logistic regression analyses were conducted to examine relationships among physical activity guideline discussions, meeting moderate LTPA guidelines, and participating in any vigorous LTPA. These analyses adjusted for prepregnancy LTPA and LTPA efficacy beliefs. RESULTS: Nearly two-thirds of participants (n=199) reported having discussed physical activity with their prenatal HCP. However, current physical activity guidelines for pregnant women were addressed in less than half of those discussions (n=96). Pregnant women who discussed the current guidelines with prenatal HCPs had increased odds of participating in any vigorous LTPA (aOR=2.48, 95% CI: 1.28-4.81), but not for meeting the moderate LTPA guidelines (aOR=0.83, 95% CI: 0.45-1.55). Of those who did not report having physical activity discussions, 44.9% (n=48) reported the desire to discuss physical activity with their HCPs. Nearly 60% of the total analytic sample (n=180) reported their prenatal HCP as the source from whom they would most like to receive physical activity information. CONCLUSIONS: Physical activity discussion between pregnant women and prenatal HCPs is related to vigorous LTPA participation. Prenatal HCPs are perceived by pregnant women to be an important and desirable source of physical activity information.

Body mass index is associated with appropriateness of weight gain but not leisure-time physical activity during pregnancy.

Little is known about how leisure-time physical activity (LTPA) influences gestational weight gain (GWG) among body mass index (BMI) categories. The purpose of this study was to examine the relationship between pregnancy LTPA and the proportion of normal, overweight, and obese women who meet GWG recommendations. Participants included 449 subcohort women from the Pregnancy Outcomes and Community Health (POUCH) study. LTPA was collapsed into 3 categories [(None, < 7.5 kcal/kg/wk (low), ≥ 7.5 kcal/kg/wk (recommended)]. GWG was categorized according to IOM recommendations (low, recommended, or excess). Chi-square and logistic regression analyses were used to evaluate relationships among LTPA, BMI, and GWG. Overweight women were more likely to have high GWG vs. normal weight women (OR = 2.3, 95% CI 1.3-4.0). Obese women were more likely to experience low GWG (OR = 7.3, 95% CI 3.6-15.1; vs. normal and overweight women) or excess GWG (OR = 3.5, 95% CI 1.9-6.5; vs. normal weight women). LTPA did not vary by prepregnancy BMI category (P = .55) and was not related to GWG in any prepregnancy BMI category (P = .78). Regardless of prepregnancy BMI, LTPA did not affect a woman's GWG according to IOM recommendations. Results may be due to LTPA not differing among BMI categories.

Associations among gestational weight gain, physical activity, and pre-pregnancy body size with varying estimates of pre-pregnancy weight

Objectivesthe purpose of this study was to examine associations among gestational weight gain (GWG) and pregnancy leisure-time physical activity (LTPA), within pre-pregnancy body mass index (BMI) categories, while utilising two different estimates of pre-pregnancy weight. Designa cohort study. Data were collected via questionnaire and abstraction from birth certificate as a part of a larger study. Settingthree antenatal clinics in Lansing, Michigan, USA. Participantsa subset of women who participated in the Archive for Research on Child Health (ARCH) study and delivered a singleton, term infant (n=135). Participants were enroled prior to 14 weeks׳ gestation. Measurementspre-pregnancy BMI was categorised as normal, overweight and obese (excluded underweight). GWG was calculated by subtracting pre-pregnancy weight from weight at childbirth (obtained from birth certificate) and classified as ‘excess’ or ‘not excess’ using the upper limit of the 2009 IOM recommended range. These two variables were constructed twice, first by using pre-pregnancy weight self-reported at enrolment and second, by using pre-pregnancy weight recorded on birth certificates. LTPA, also self-reported at enrolment, was modelled using two thresholds, moderate LTPA, and vigorous LPTA. Findingsoverall, 56–60% of our sample experienced excess GWG, depending on the source used for pre-pregnancy weight. Overweight and obese women had significantly higher odds of excess GWG (compared to normal weight women; Odds Ratio (OR)=2.48–5.34). LTPA level did not differ among pre-pregnancy BMI categories and was not related to appropriateness of GWG. Key conclusionsregardless of the source of pre-pregnancy weight, overweight and obese women were more likely to experience excess GWG (compared to normal weight women) and LTPA was not significantly related to the appropriateness of GWG. Implications for practicefindings highlight the need for practitioners to effectively communicate GWG recommendations and counsel women about the importance of achieving appropriate GWG. Although GWG counselling has traditionally been focused on obese women, these results suggest overweight women are in need of GWG counselling as well.

Relationship of Past-Pregnancy Physical Activity and Self-efficacy With Current Physical Activity and Postpartum Weight Retention

Life events unique to the perinatal period may place a woman at greater risk for decreased physical activity and increased postpartum weight retention (PPWR). Study purposes were to determine a) the relationship between women’s postpartum self-efficacy (SE) to overcome perceived barriers to exercise with current and past pregnancy leisure-time physical activity (LTPA), and b) the relationship between LTPA and PPWR. A Modifiable Activity Questionnaire was used to assess current and past pregnancy LTPA (Met*h/wk) at 20 and 32 weeks gestation and 12 weeks postpartum. Current barriers to LTPA and SE were assessed via the Perceived Barriers Efficacy Questionnaire. Top three barrier values were averaged to obtain an overall SE score for participants (N=30). Pearson correlations were run between LTPA, PPWR and SE scores. ANOVA was used to compare PPWR between women who did and did not meet LTPA guidelines of 7.5 MET*h/wk. The top three barriers to LTPA were time, motivation, and childcare. Positive correlations (p≤0.01) were found between SE levels and LTPA at all time periods of interest. LTPA was inversely related to PPWR. Relationships between SE, LTPA, and PPWR helped validate the need to promote perinatal PA, to aid long term weight management.

Health Benefits of Physical Activity during Pregnancy

While early studies on the effects of leisure time physical activity (LTPA) during pregnancy were concerned about possible harm to the mother or fetus, these fears have not been substantiated. Instead, a growing body of literature has documented several health benefits related to pregnancy LTPA. The purpose of this article was to synthesize evidence from epidemiological studies conducted in the United States, Canada, and Scandinavia on the benefits of LTPA and exercise during pregnancy with regard to maternal health, pregnancy outcomes, and child health. We focused on studies evaluating relations between pregnancy LTPA and gestational diabetes, hypertensive disorders, excessive gestational weight gain, birth weight, timing of delivery, and child body composition. The bulk of evidence supports beneficial effects of pregnancy LTPA on each outcome; however, most previous studies have been observational and used self-reported LTPA at only one or two time points in pregnancy. Limitations of the current knowledge base and suggestions for future research on the health benefits of LTPA during pregnancy are provided.

Leisure-Time Physical Activity in Pregnancy and the Birth Weight Distribution: Where Is the Effect?

Leisure-time physical activity (LTPA) is recommended during pregnancy and has been associated with lower risk of delivering a large infant. We sought to characterize the effect of LTPA across the entire birth weight distribution. Women enrolled in the Pregnancy Outcomes and Community Health (POUCH) Study (1998-2004) were followed-up in 2007. Follow-up efforts were extensive for a subcohort and minimal for the remainder (nonsubcohort). Thus, 596 subcohort and 418 nonsubcohort women who delivered at term participated. Offspring were categorized as small-, appropriate-, or large-for-gestational-age (SGA, AGA, and LGA, respectively) based on gender and gestational age-specific birth weight z-scores (BWz). At follow-up, women recalled pregnancy LTPA and were classified as inactive, insufficiently active or meeting LTPA recommendations. Linear, logistic, and quantile regression analyses were conducted separately by subcohort status. Meeting LTPA recommendations decreased odds of LGA significantly among the nonsubcohort (aOR = 0.30, 95% CI: 0.14-0.64) and nonsignificantly among the subcohort (aOR = 0.68, 95% CI: 0.34-1.34). In quantile regression, meeting LTPA recommendations reduced BWz among the upper quantiles in the nonsubcohort. LTPA during pregnancy lowered odds of LGA and reduced BWz among the upper quantiles, without shifting the entire distribution. LTPA during pregnancy may be useful for reducing risks of large fetal size.

Leisure-time Physical Activity During Pregnancy And The Birth Weight Distribution: Where Is The Effect?

Previous reports have shown leisure-time physical activity (LTPA) during pregnancy to be related to small decreases in mean birth weight and/or decreased risk of giving birth to a large for gestational age infant. However, the effect of LTPA across the entire birth weight distribution has not been examined. PURPOSE: To characterize the relationship between pregnancy LTPA and birth weight. METHODS: Women enrolled in the Pregnancy Outcomes and Community Health Study (1998-2004) were followed-up in 2007. Follow-up efforts were extensive for a subcohort and minimal for the remainder, or non-subcohort. As a result, 596 (67% of eligible) subcohort and 418 (26% of eligible) non-subcohort women who delivered at term were included in this investigation. Original data collection provided maternal demographics. Medical records provided child gender, gestational age, and birth weight. Gender and gestational age-specific birth weight z-scores (BWz) were calculated and offspring were categorized as small-, appropriate-, or large-for-gestational-age (SGA, AGA, and LGA, respectively). At follow-up, women recalled pregnancy LTPA and were classified as inactive, insufficiently active (> 0 but < 7.5 kcal/kg/wk), and meeting LTPA recommendations (≥ 7.5 kcal/kg/wk). Linear, logistic, and quantile regression analyses were conducted separately by subcohort status. RESULTS: The subcohort had greater racial and socioeconomic diversity than the non-subcohort. In multivariate linear regressions, LTPA was not associated with changes in mean birth weight among either group. Among the non-subcohort, meeting LTPA recommendations significantly decreased odds of LGA (aOR=0.30, 95%CI: 0.14-0.64) without affecting odds of SGA. Quantile regression analyses showed that meeting LTPA recommendations was unrelated to BWz until the 0.65 quantile, after which it significantly reduced BWz among the non-subcohort. Results for the subcohort were similar but not statistically significant. CONCLUSIONS: LPTA during pregnancy appears to lower odds of LGA and reduce BWz among the upper quantiles without causing a mean shift in the entire distribution. Due to adverse maternal and child health effects associated with high birth weight, our results may indicate a substantial health benefit for LTPA during pregnancy.