Though physical activity (PA) is recommended during pregnancy, it remains unclear how occupational physical activity (OPA) and sedentary behavior (SB) contribute to activity patterns and health ...during pregnancy. The purpose of this secondary analysis was to determine if OPA pattern is a determinant of all-day PA and evaluate associations with pregnancy/infant health outcomes. Data was from two prospective cohorts with study visits each trimester: MoM Health (Pittsburgh, PA; n = 120) and PRAMS (Iowa City, Iowa; n = 20). Using employment status/job hours (self-reported in demographic questionnaires) and OPA from the Pregnancy Physical Activity Questionnaire, latent class analysis identified three groups: sitting (n = 61), part-time mixed (n = 9), and active (n = 29). A fourth group included non-working participants (n = 32). Device-based PA (ActiGraph GT3X), SB (activPAL3 micro), and blood pressure were measured each trimester. Glucose screening test, gestational age, gestational weight gain, adverse pregnancy outcomes (APOs: gestational hypertension, preeclampsia, eclampsia, gestational diabetes, intrauterine growth restriction, and preterm birth), and infant outcomes (length, weight, and sex) were abstracted from medical records. Associations between groups with APOs and pregnancy/infant health were calculated using linear/logistic regression with adjustment for age, pre-pregnancy BMI, education, and race. Self-reported participant characteristics were similar across groups, except education which was higher in the sitting versus other groups. All-day device-based PA differed across groups; for example, the sitting group had the highest SB across trimester (all p<0.01) while the active group had the highest steps per day across trimesters (all p<0.01). Pregnancy/infant health did not differ between groups (all p>0.09). Compared to the non-working group, the risk of any APO was non-significantly higher in the sitting (OR = 2.27, 95%CI = 0.63-8.18) and active groups (OR = 2.40, 95%CI = 0.66-9.75), though not the part-time mixed (OR = 0.86, 95%CI = 0.08-9.1). OPA pattern is a determinant of all-day PA during pregnancy. Future studies with larger samples should examine associations between pregnancy OPA patterns and pregnancy/infant health.
To examine changes in lifestyle behaviors early in the COVID-19 pandemic among pregnant women.
A cross-sectional internet-based survey was completed by 706 pregnant women (mean age 29.6 years ± 3.2) ...residing in the United States in May 2020 to assess self-reported changes in diet, physical activity, and sleep during the COVID-19 pandemic. Logistic regression analyses examined whether sociodemographic, clinical, and pandemic-related characteristics were associated with health behavior changes.
Approximately 17% of women reported their diets worsened during the COVID-19 pandemic, 42% reported improvements, and 41% reported no change. For physical activity, 22% reported they stopped being active, 2% reported they became active, and 76% reported no change. Nearly one-third of participants reported getting less sleep. The factors consistently associated with adverse lifestyle changes (worse diet, stopped being active, and reduced sleep) were experiences of pregnancy complications, loss of income due to COVID-19, and changes in social connections due to COVID-19.
A substantial proportion of pregnant women reported adverse lifestyle changes during the COVID-19 pandemic. Interventions during the pandemic to optimize health behaviors in pregnant women, especially among those with pregnancy complications, should address economic disadvantages and social support.
Abstract Objective This study investigated patient and provider perceptions of weight gain, physical activity, and nutrition counseling during prenatal care visits. Methods Individual qualitative ...interviews were conducted with 30 pregnant women between 20 and 30 weeks gestation (15 African American, 15 White) and 11 prenatal care providers (5 attending physicians, 5 residents, 1 nurse practitioner) in 2014. Results The majority of patients and providers reported receiving or giving advice on weight gain (87% and 100%, respectively), physical activity (87% and 91%), and nutrition (100% and 91%) during a prenatal visit. Discussion of counseling content was largely consistent between patients and providers. However, counseling was limited and not fully consistent with current weight gain, physical activity, or dietary guidelines during pregnancy. Most patients viewed provider advice positively, but some wanted more detailed information. Providers discussed many barriers to lifestyle counseling, including lack of time, inadequate training, concern about the sensitivity of the topic, lower education or income level of the patient, cultural differences, and lack of patient interest. Conclusions Providers discussed weight gain, physical activity, and nutrition during prenatal care visits and patients accurately recalled this advice. However, counseling was limited and not fully consistent with guidelines. Future studies are needed to develop and evaluate the efficacy of interventions to help providers overcome perceived barriers and more effectively counsel women on weight and healthy lifestyles during pregnancy.
Steps per day is a meaningful metric for physical activity promotion in clinical and population settings. To guide promotion strategies of step goals, it is important to understand the association of ...steps with clinical end points, including mortality.
To estimate the association of steps per day with premature (age 41-65 years) all-cause mortality among Black and White men and women.
This prospective cohort study was part of the Coronary Artery Risk Development in Young Adults (CARDIA) study. Participants were aged 38 to 50 years and wore an accelerometer from 2005 to 2006. Participants were followed for a mean (SD) of 10.8 (0.9) years. Data were analyzed in 2020 and 2021.
Daily steps volume, classified as low (<7000 steps/d), moderate (7000-9999 steps/d), and high (≥10 000 steps/d) and stepping intensity, classified as peak 30-minute stepping rate and time spent at 100 steps/min or more.
All-cause mortality.
A total of 2110 participants from the CARDIA study were included, with a mean (SD) age of 45.2 (3.6) years, 1205 (57.1%) women, 888 (42.1%) Black participants, and a median (interquartile range IQR) of 9146 (7307-11 162) steps/d. During 22 845 person years of follow-up, 72 participants (3.4%) died. Using multivariable adjusted Cox proportional hazards models, compared with participants in the low step group, there was significantly lower risk of mortality in the moderate (hazard ratio HR, 0.28 95% CI, 0.15-0.54; risk difference RD, 53 95% CI, 27-78 events per 1000 people) and high (HR, 0.45 95% CI, 0.25-0.81; RD, 41 95% CI, 15-68 events per 1000 people) step groups. Compared with the low step group, moderate/high step rate was associated with reduced risk of mortality in Black participants (HR, 0.30 95% CI, 0.14-0.63) and in White participants (HR, 0.37 95% CI, 0.17-0.81). Similarly, compared with the low step group, moderate/high step rate was associated with reduce risk of mortality in women (HR, 0.28 95% CI, 0.12-0.63) and men (HR, 0.42 95% CI, 0.20-0.88). There was no significant association between peak 30-minute intensity (lowest vs highest tertile: HR, 0.98 95% CI, 0.54-1.77) or time at 100 steps/min or more (lowest vs highest tertile: HR, 1.38 95% CI, 0.73-2.61) with risk of mortality.
This cohort study found that among Black and White men and women in middle adulthood, participants who took approximately 7000 steps/d or more experienced lower mortality rates compared with participants taking fewer than 7000 steps/d. There was no association of step intensity with mortality.
Inadequate and excessive gestational weight gain (GWG) is associated with adverse health outcomes for mother and child. Health care providers are well positioned to help women achieve appropriate ...GWG. This systematic review examined associations between women's report of provider advice on GWG and women's compliance with the Institute of Medicine (IOM) GWG guidelines.
In March 2019, PubMed, EMBASE, and Cochrane CENTRAL databases were searched. Observational studies were eligible if published from 1990 to 2019, described provider advice on GWG, and determined whether women's target or actual GWG was consistent with the 1990 or 2009 IOM guidelines. Heterogeneity across studies precluded the use of meta-analytic methods.
Seventeen cross-sectional and cohort studies of poor to good quality, representing 20,717 women were included. Approximately 69% of women reported provider advice on GWG during pregnancy; however, only 50% reported provider advice consistent with IOM guidelines. Eleven studies found that provider advice on GWG was significantly associated with women's compliance with IOM guidelines, and six studies found no association.
While a high percentage of women report provider advice on GWG, accuracy of reported advice is less than optimal. The evidence examining associations of provider advice and women's compliance with guidelines is mixed and limited by methodological concerns. Future studies using more robust methods in diverse populations are needed to confirm the role of provider advice in optimizing GWG. Intervention studies are also necessary to increase the proportion of providers who accurately counsel their patients on appropriate GWG to improve health outcomes.
The Institute of Medicine (IOM) has provisional gestational weight gain (GWG) guidelines for women pregnant with twins due to limited data in this population. To better inform guidelines, the ...objective of this systematic review was to build on prior work and examine recent data on the associations of GWG with maternal and child health in twin pregnancies.
In February 2021, Ovid MEDLINE, Embase, CINAHL, and Cochrane Library were searched. Observational studies were eligible if published from January 1, 2013 through February 23, 2021, and examined associations of GWG with maternal or child health outcomes after accounting for gestational age at delivery and pre-pregnancy body mass index. Heterogeneity across studies precluded the use of meta-analytic methods.
A total of 29 studies were included. For maternal outcomes, excessive GWG was associated with an increased risk of hypertensive disorders of pregnancy; whereas studies examining gestational diabetes and delivery method reported mixed findings. For child outcomes, inadequate GWG was associated with lower birthweight, small for gestational age, and preterm birth. Adequate or excessive GWG was associated with later gestational age at delivery.
This study advances an earlier review by including a more diverse array of maternal and child outcomes. Many of the limitations noted in the original review persist; for example, no studies examined the associations of GWG and outcomes beyond birth. Although it appears that GWG within the IOM guidelines is associated with more optimal outcomes, additional methodologically rigorous studies are needed to better inform evidence-based guidelines.
Maternal pregnancy nutrition influences fetal growth. Evidence is limited, however, on the relationship of maternal diet during pregnancy and lactation on infant postnatal growth and adiposity. Our ...purpose was to examine associations between maternal diet quality during pregnancy and lactation with offspring growth and body composition from birth to six months. Maternal diet quality was serially assessed in pregnancy and at one and three months postpartum, using the Healthy Eating Index⁻2015 in a cohort of 354 fully breastfeeding mother⁻infant dyads. Infant length-for-age (LAZ), weight-for-age (WAZ), and weight-for-length (WLZ) Z-scores were assessed at birth, one, three, and six months. Infant body fat percent (BF%), fat mass (FM), and fat-free mass (FFM) were measured at six months using dual-energy X-ray absorptiometry. Higher maternal diet quality from pregnancy through three months postpartum was associated with lower infant WLZ from birth to six months (
= 0.02) and BF% at six months (
≤ 0.05). Higher maternal diet quality at one and three months postpartum was also associated with lower infant FM at six months (
< 0.01). In summary, maternal diet quality during pregnancy and lactation was inversely associated with infant relative weight and adiposity in early postnatal life. Additional research is needed to explore whether associations persist across the life course.
Background
Few studies have evaluated whether pandemic‐related stressors, worries, and social distancing have affected the mental health of pregnant women during the COVID‐19 pandemic.
Methods
Data ...came from an online survey of United States pregnant women (n = 715), conducted in May 2020. The Edinburgh Postnatal Depression Scale and Generalized Anxiety Disorder Scale were used to assess depressive symptoms, thoughts of self‐harm, and moderate or severe anxiety. Multiple logistic regressions were used to examine the associations of COVID‐19 experiences with mental health outcomes.
Results
Participants were racially diverse. The prevalence of adverse mental health outcomes was 36% for probable depression, 20% for thoughts of self‐harm, and 22% for anxiety. Women who reported family members dying from COVID‐19 had four times higher odds of having thoughts of self‐harm than women who did not experience family death. Depression was more prevalent among women who canceled or reduced medical appointments. Women were more likely to have worse mental health outcomes if they expressed worry about getting financial or emotional/social support, about their pregnancy, or about family or friends. Strict social distancing was positively associated with depression. A higher proportion of adults working from home was inversely associated with depression and thoughts of self‐harm.
Conclusion
High percentages of pregnant women had symptoms of depression or anxiety, suggesting an urgent need to screen and treat mental health conditions among pregnant women during the pandemic. Pandemic‐related risks and protective factors are relevant to developing tailored interventions to address the mental health of pregnant women during pandemic circumstances.
Lifestyle modifications are the first-line treatment recommendation for elevated blood pressure (BP) or stage-1 hypertension (E/S1H) and include resistance exercise training (RET). The purpose of the ...current study was to examine the effect of a 9-wk RET intervention in line with the current exercise guidelines for individuals with E/S1H on resting peripheral and central BP, vascular endothelial function, central arterial stiffness, autonomic function, and inflammation in middle-aged and older adults (MA/O) with untreated E/S1H. Twenty-six MA/O adults (54 ± 6 yr; 16 females/10 males) with E/S1H engaged in either 9 wk of 3 days/wk RET (
= 13) or a nonexercise control (Con;
= 13). Pre- and postintervention measures included peripheral and central systolic (SBP and cSBP) and diastolic BP (DBP and cDBP), flow-mediated dilation (FMD), carotid-femoral pulse wave velocity (cfPWV), cardiovagal baroreflex sensitivity (BRS), cardiac output (CO), total peripheral resistance (TPR), heart rate variability (HRV), and C-reactive protein (CRP). RET caused significant reductions in SBP {mean change ± 95% CI = -7.9 (-12.1, -3.6) mmHg;
< 0.001}, cSBP 6.8 (-10.8, -2.7) mmHg;
< 0.001), DBP 4.8 (-10.3, -1.2) mmHg;
< 0.001, and cDBP -5.1 (-8.9, -1.3) mmHg;
< 0.001; increases in FMD +2.37 (0.61, 4.14)%;
= 0.004 and CO +1.21 (0.26, 2.15) L/min;
= 0.006; and a reduction in TPR -398 (-778, -19) mmHg·s/L;
= 0.028. RET had no effect on cfPWV, BRS, HRV, or CRP relative to Con (
≥ 0.20). These data suggest that RET reduces BP in MA/O adults with E/S1H alongside increased peripheral vascular function and decreased TPR without affecting cardiovagal function or central arterial stiffness.
This is among the first studies to investigate the effects of chronic resistance exercise training on blood pressure (BP) and putative BP regulating mechanisms in middle-aged and older adults with untreated elevated BP or stage-1 hypertension in a randomized, nonexercise-controlled trial. Nine weeks of resistance exercise training elicits 4- to 8-mmHg improvements in systolic and diastolic BP alongside improvements in vascular endothelial function and total peripheral resistance without influencing central arterial stiffness or cardiovagal function.
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