妊娠不同时期体力活动模式及其变化趋势纵向研究

背景妊娠期的体力活动近年来被看作是生殖健康的重要组成部分，鼓励孕妇采取积极的生活方式去取代传统的孕妇需要限制活动的观点。国外研究显示，从妊娠早期到妊娠中期，再到妊娠晚期，体力活动是逐渐降低的，国内关于妊娠不同时期体力活动模式及变化相关研究尚不足。目的探讨妊娠早期、妊娠中期和妊娠晚期体力活动模式及其变化趋势，为制定有针对性的干预措施提供参考。方法采用便利抽样法对2017年5月至2018年5月在江门市五邑中医院产科门诊初次产检建册（妊娠6~13+6周）的低危孕妇进行调查。由研究者自行设计一般资料调查表，收集一般资料；采用中文版孕期身体活动问卷（PPAQ）在妊娠早期、妊娠中期和妊娠晚期进行调查，分析在妊娠不同时期体力活动的模式及其变化轨迹。结果共纳入312例孕妇，排除48例，脱落15例，最终249例孕妇完成调查。249例孕妇在妊娠早期每周总能量消耗的平均数为201.7 MET-hours，妊娠中期为188.6 MET-hours，妊娠晚期为177.2 MET-hours；整个妊娠期静坐行为约占总能量消耗的17%，低强度活动约占总能量消耗的60%，中等强度活动占总能量消耗的21.2%~24.4%，高强度活动占总能量消耗不足1%。活动类型中，家务活动约占总能量消耗的48%，职业活动约占总能量消耗的40%，交通出行约占总能量消耗的9%，运动锻炼占总能量消耗不足3%。妊娠早期、妊娠中期、妊娠晚期静坐行为、中等强度活动、高强度活动、家务活动、运动锻炼、总能量消耗代谢当量比较，差异均有统计学意义（P<0.05）；其中妊娠晚期静坐行为、中等强度活动、家务活动、总能量消耗代谢当量低于妊娠早期，差异有统计学意义（P<0.05）。结论医务人员应鼓励孕妇减少静坐时间，并根据孕妇的个体情况制定适合其实际情况的体力活动建议和指导，以改善母婴健康。妊娠中期可能是促进体力活动的最好时机。

A Longitudinal Study of Physical Activity Patterns and Change Trajectory during Pregnancy

Background Physical activity during pregnancy has recently been considered as an essential part of reproductive health,and pregnant women are encouraged to adopt an active lifestyle instead of traditionally restricting their activities.Studies from abroad have shown that pregnancy physical activity gradually decreases with the progress of pregnancy.Domestic studies on the patterns and changes of pregnancy physical activity are still insufficient.Objective To explore the pattern of physical activity in the first,second and third trimesters of pregnancy,and its change trajectory,providing a reference for the formulation of targeted interventions.Methods Convenience sampling was used to select low-risk pregnant women from Obstetric Clinic,Jiangmen Wuyi Hospital of Traditional Chinese Medicine from May 2017 to May 2018.All had a health file created at 6-13⁺⁶ weeks'gestation at the first antenatal examination.A self-developed questionnaire was used to collect general demographic data.The Chinese version of the Pregnancy Physical Activity Questionnaire was used to investigate physical activity in the first,second and third trimesters of pregnancy.Patterns and changes of physical activity were analyzed by the stage of pregnancy.Results Among the 312 participants,except for 48 excluded cases and 15 dropouts,the other 249 who completed the survey were finally included.The average weekly metabolic equivalent of task(MET)values for the respondents in the first,second and third trimesters of pregnancy were 201.7,188.6,and 177.2 MET-hours,respectively.Sedentary activity,light-intensive activity,moderate-intensive activity,and vigorous-intensive activity accounted for 17%,60%,21.2%-24.4%,and less than 1%of the energy expenditure attributable to total activity,respectively.In terms of activity type,household/caregiving,occupational,transportation and sports/exercise accounted for 48%,40%,9%,and less than 3%of the energy expenditure attributable to total activity,respectively.The differences in MET values of sedentary activity,light-intensive activity,moderate-intensive activity,and vigorous-intensive activity,household activity,sports/exercise,and total activity across three stages of pregnancy were statistically significant(P<0.05).Among which,the MET values of sedentary activity,moderate-intensive activity,household activity,and total activity in the third trimester were much lower than those in the first trimester,with a statistically significant difference(P<0.05).Conclusion To improve maternal and infant health,healthcare workers should encourage pregnant women to reduce their sedentary time,and give them individualized physical activity recommendations and guidance.The second trimester may be the best time to promote physical activity.