Physical Activity Patterns and Maternal Well-Being in Postpartum Women

OBJECTIVE: To examine changes in activity prepregnancy to postpartum; examine postpartum activity and sociodemographic predictors of maternal well-being; and, examine maternal well-being in subjects on the basis of sport/exercise activity prepregnancy to postpartum. METHODS: Ninety-one postpartum women completed a Kaiser Physical Activity Survey (KPAS) Ainsworth BE, Sternfeld B, Richardson MT, Jackson K. Evaluation of the Kaiser Physical Activity Survey in women. Med Sci Sports Exerc 2000; 32:1327-38. and the Lederman Postpartum Questionnaire (PPQ) Lederman RP, Weingarten CT, Lederman E. Postpartum self-evaluation questionaire: Measures of maternal adaptation. In: Raff BS, Carrol P, editors. Perinatal parental behaviour: Nursing research and implications for newborn health. New York: Alan R. Liss, 1981:201-31. Subjects recalled activity prepregnancy and postpartum for the KPAS indexes that included household/care giving (HC), active living habits (AL), occupation (0), and sports/exercise (SE). The PPQ has seven well-being subscales. RESULTS: Subjects with older infants or no other children increased HC and decreased O prepregnancy to postpartum compared to subjects with younger infants or > or =1 other child. Predictors of the variance in the PPQ subscales included SE and AL (21% in subscale one), SE (6.0% in subscale two), HC (5.3% in subscale three), socioeconomic status (19.7% in subscale four), O (5.0% in subscale five), education (5.2% in subscale seven). Subjects who maintained or increased SE showed better well-being as compared to subjects who reported no SE or decreased SE prepregnancy to postpartum. Conclusions: In this group of women, subjects with older infants or no other children reported higher HC and lower O prepregnancy to postpartum. Postpartum SE, education, and socioeconomic status were predictors of maternal well-being. In general, better maternal well-being was found among subjects maintaining or increasing SE compared to no SE or decreased SE prepregnancy to postpartum. Support from partner/husband, family, and friends were significant factors in maintaining or increasing SE.     

Baseline Results from Hawaii's Nā Mikimiki Project: A Physical Activity Intervention Tailored to Multiethnic Postpartum Women

During the postpartum period, ethnic minority women have higher rates of inactivity/under-activity than white women. The Nā Mikimiki (“the active ones”) Project is designed to increase moderate-to-vigorous physical activity over 18 months among multiethnic women with infants 2–12 months old. The study was designed to test, via a randomized controlled trial, the effectiveness of a tailored telephone counseling of moderate-to-vigorous physical activity intervention compared to a print/website materials-only condition. Healthy, underactive women (mean age = 32 ± 5.6 years) with a baby (mean age = 5.7 ± 2.8 months) were enrolled from 2008–2009 (N = 278). Of the total sample, 84% were ethnic minority women, predominantly Asian–American and Native Hawaiian. Mean self-reported baseline level of moderate-to-vigorous physical activity was 40 minutes/week with no significant differences by study condition, ethnicity, infant's age, maternal body mass index, or maternal employment. Women had high scores on perceived benefits, self-efficacy, and environmental support for exercise but low scores on social support for exercise. This multiethnic sample's demographic and psychosocial characteristics and their perceived barriers to exercise were comparable to previous physical activity studies conducted largely with white postpartum women. The Nā Mikimiki Project's innovative tailored technology-based intervention and unique population are significant contributions to the literature on moderate-to-vigorous physical activity in postpartum women.     

Maternal Body Mass Index and Self-Reported Postpartum Depressive Symptoms

Objectives: The association between extremes of body mass index (BMI) and depression in women has been documented, yet little is known about the relationship between obesity and postpartum depression (PPD). This study seeks to characterize the association between BMI and PPD. Methods: The 2000–2001 Utah data from Pregnancy Risk Assessment Monitoring System (PRAMS) were used to determine the proportion of women, stratified by prepregnancy body mass index, reporting postpartum depressed mood and stressors during pregnancy. Results: The prevalence of self-reported moderate or greater depressive symptoms was 27.7% (S.E. ±2.2) in underweight, 22.8% (±1.2) in normal weight, 24.8% (±2.9) in overweight and 30.8% (±2.5) in obese women. After controlling for marital status and income, normal BMI (19.8–25.9) was associated with the lowest rate of self-reported postpartum depressive symptoms. There was a two-fold increase in self-reported depressive symptoms requiring assistance among overweight and obese women compared to normal weight women (1.53% normal, 2.99% overweight, and 3.10% obese [p < 0.001]). Obese women were significantly more likely to report emotional and traumatic stressors during pregnancy than normal weight women. Conclusion: This population-based survey suggests a potential association between prepregnancy body mass index and self-reported postpartum depressive symptoms. Prospective studies of association between obesity and PPD, with improved diagnostic precision are warranted.     

Testing a Conceptual Model of Postpartum Depressive Symptoms in the First Year

Postpartum depressive symptoms (PPDS) are likely to have a multifactorial etiology. The relationships among identified PPDS risk factors, however, remain inconclusive. A vulnerability-stress conceptualization of PPDS was tested with a sample of 144 U.S. mothers aged 18–46 years, who had given birth in the last 12 months. The Edinburgh Postnatal Depression Scale, Dysfunctional Attitude Scale Form A-17, Parenting Sense of Competence Scale, and Quality of Relationships Inventory were completed. The conceptual model and three alternative models were tested using structural equation modeling. A variation of the conceptual model yielded the best fit, χ² (98) = 133.541, p = .0099, Standardized Root Mean Residual (SRMR) = 0.071, Root Mean Square Error of Approximation (RMSEA) = 0.050 (90% CI = 0.026–0.070), Tucker Lewis Index (TLI) = 0.953, Comparative Fix Index (CFI) = 0.961. Dependency and partner conflict were positively related to PPDS, while maternal-efficacy was negatively related to PPDS. Dependency moderated the relationship between maternal-efficacy and PPDS, so that this relationship was stronger for mothers with higher dependency than for those with lower dependency. Dependency, partner conflict, and maternal-efficacy should be considered when building interventions that target the wellbeing of mothers in the first year after birth.     

Repeated Depression Screening During the First Postpartum Year

PURPOSE

Postpartum depression (PPD) screening at 4 to 12 weeks’ postpartum can improve outcomes for women when linked to in-practice management programs. The benefit of repeated PPD screening during the first year postpartum remains unclear.

METHODS

We report a substudy of a large pragmatic trial of early PPD screening and practice management, the Translating Research into Practice for Postpartum Depression (TRIPPD) study. Outcome analyses were based on demographic information and Patient Health Questionnaire (PHQ-9) screening scores from questionnaires mailed to all enrolled women at baseline (4 to 12 weeks’ postpartum) and again at 6 and at 12 months’ postpartum. The main outcomes of this substudy were the 6- and 12-month rates of PHQ-9 scores that were 10 or greater for women whose baseline PHQ-9 scores were less than 10. Women whose scores were 10 or greater would be considered at high risk of PPD and appropriate for further evaluation.

RESULTS

At 6 months, 134 (10.9%) of the 1,235 women who did not have PHQ-9 scores greater than 10 at baseline had elevated scores appropriate for further evaluation. At 12 months, 59 (6.1%) of the 969 women who did not have PHQ-9 scores greater than 10 at baseline or at 6 months had elevated scores. Together the 6- and 12-month repeated screenings identified 193 women at high risk of depression. This finding represents 13.5% of the 1,432 women whose screening results were negative for PPD at baseline.

CONCLUSIONS

Repeated PPD screening at 6 and 12 months’ postpartum increases the percentage of women identified as being at high risk of PPD. Further work will be required to understand the impact of this repeated screening on patient outcomes.     

Neighbourhood Influences on Children's Weight-related Behaviours and Body Mass Index

IntroductionNeighbourhood contextual factors such as accessibility of food shops and green spaces are associated with adult bodyweight but not necessarily weight-related behaviours. Whether these associations are replicated amongst children is unknown.AimTo understand which aspects of childrens'' neighbourhoods are associated with unhealthy weight and weight-related behaviours.MethodsIndividual-level data for children from the 2006/7 New Zealand Health Survey (of Body Mass Index (BMI), dietary indicators and socioeconomic variables) were linked with geographic level data on neighbourhood deprivation, rural/urban status, percentage of community engaged in active travel, access to green space, food shops and sports/leisure facilities. Logistic regression models were fitted for measures of BMI and weight-related behaviours; sugar sweetened beverage (SSB) consumption; fast-food consumption; and television viewing.ResultsIncreased community engagement in active transport was, counterintuitively, the only neighbourhood contextual factor associated with unhealthy weight amongst children. After adjustment for socioeconomic and environmental variables, greater access to green space appeared to have a protective effect on SSB consumption and neighbourhood deprivation was associated with all three unhealthy weight-related behaviours (SSB and fast-food consumption and television viewing).ConclusionsAlthough further research is needed, evidence from the current study suggests that a repertoire of health promotion interventions and policies to change unhealthy weight-related behaviours in high deprivation neighbourhoods may be required to address childhood obesity.     

Characteristics of Eating Habits and Physical Activity in Relation to Body Mass Index Among Adolescents

Objective: To assess eating habits and the level of physical activity in adolescents and develop a predictive model for the body mass index (BMI) based on these variables.

Design: In this cross-sectional study, eating habits and the level of physical activity were assessed using a questionnaire validated in adolescents. Body mass and height collected during the last annual checkup were extracted from personal medical records.

Subjects: The sample included 330 boys and 377 girls (mean age 15.8 ± 0.2 years) who were first-year high school students in the city of Belgrade, Serbia.

Measures: Responses to each of the 14 questions about eating habits and 6 questions about physical activity were scored from the least (0) to the most (3) desired behaviors. These ratings were then averaged to arrive to an aggregate score for each domain. The BMI was calculated according to the standard method. A series of regression analyses was performed to derive the best model for predicting BMI in boys and girls based on individual eating habits and physical activity items, first separately and then combined.

Results: In the sample, 24.5% of boys and 9.5% of girls were overweight or obese. Girls’ eating habits were better than boys (mean aggregate score 2.3 ± 0.3 and 2.1 ± 0.3, respectively, p < 0.001), whereas the level of physical activity was greater in boys than girls (2.1 ± 0.6 vs 1.9 ± 0.6, p < 0.001). The differences between boys and girls in the BMI, eating habits, and physical activity remained significant after controlling for their knowledge about healthy eating and education level of their parents. Eating habits were a better predictor of BMI than physical activity, particularly in boys (R ² = 0.13 vs R ² = 0.02) compared to girls (R ² = 0.04 vs R ² = 0.01). Combining eating habits and physical activity in the multivariate model of BMI resulted in a better predictive accuracy in boys (R ² = 0.17) but not girls (R ² = 0.04).

Conclusions: Eating habits and physical activity differ between adolescent boys and girls and can predict BMI, particularly in boys. The results suggest the need to develop gender-specific programs for promoting healthy lifestyle among adolescents in our country.     

Mothers' Experience with Household Roles and Social Support During the First Postpartum Year

This prospective, longitudinal study was conducted to investigate the changes ig the division of household labor, and in the emotional and practical support received by new mothers during the first postpartum year. Questionnaires were completed by 436 married, recently employed mothers at l, 3, 6, 9, and 12 months after they had delivered their Fist child. Results showed that women assumed primary responsibility for the majority of household tasks studied, and that they perceived declines over time in their husbands' participation in household chores, their husbands' and others' expressions of caring, and in the frequency with which friends and relatives "helped out" during the year. Women who had had cesarean sections (versus those with vaginal deliveries) and who returned to work (versus those who stayed home) believed their husbands participated more in traditionally feminine household chores. Women's satisfaction with their husbands' contribution to household activities was significantly related to their own mental health, delivery type (cesarean section), job status (being at home vs. back at work), and family income; and to their husbands' occupation, expressions of caring, and participation in child care and certain household chores (house cleaning, grocery shopping, cooking, washing clolhes and dishes, household repairs, car maintenance, and garbage removal). Overall, these findings showed diminishing levels of emotional and practical support for women at a time when the need for support was likely greater: following the birth of their fist child.     

Marital Status and Motherhood: Implications for Physical Activity

Single motherhood has been associated with negative health consequences, such as increased risk for cardiovascular disease and depression, which might be accompanied by reduced levels of physical activity. This pilot study aimed to compare the magnitude of differences in physical activity between unmarried mothers, married mothers, and non-mothers. Participants (N = 66) in three equal-sized groups (n = 22) completed a battery of physical activity questions and wore an accelerometer for one week in March to May of 2012. Analyses of covariance controlling for group differences in demographic characteristics and Bonferroni post-hoc comparisons were conducted to detect differences in physical activity between groups. Compared to unmarried mothers, married mothers and non-mothers had significantly greater leisure time activity as measured by the Godin Leisure-Time Exercise Questionnaire (F(2,61) = 6.11, p = .004), overall activity in the previous year measured by the Modifiable Activity Questionnaire scores (F(2, 61) = 8.65, p = .001), and minutes spent in moderate-to-vigorous physical activity from the accelerometer (F(2,58) = 4.39, p = .02). No statistically significant differences were observed among groups for International Physical Activity Questionnaire scores or accelerometer activity and step counts. Overall, unmarried mothers were less physically active when compared to married mothers and non-mothers. Future studies should explore the correlates and health outcomes associated with physical activity among unmarried mothers.     

Parent Perspectives on Nutrition and Physical Activity During Out-of-School Time

ObjectiveOut-of-school time (OST) programs serve a large, diverse population of children, including those at increased obesity risk. In this study, parents' perspectives about nutrition and physical activity (PA) during OST were assessed.DesignSurvey.SettingOnline.ParticipantsSix hundred parents with a school-aged child participating in programs from selected OST organizations.Main Outcome MeasuresParent perspectives about the importance and availability of different foods, beverages, and PA opportunities during OST, and OST program and parent involvement in promoting healthful environments.AnalysisFrequencies were used to describe parents' perspectives. Wilcoxon tests and logistic regression analyses were conducted to test for significant differences.ResultsMost parents reported that it was important that their children have water (96.2%), fresh fruits and vegetables (79.0%), and PA (97.2%) during OST; fewer parents reported that these were regularly available. About two thirds of parents agreed that OST programs should promote healthy environments for children, whereas one third agreed that parents alone should be responsible for children's nutrition and PA.Conclusions and ImplicationsResults suggest that many parents would support efforts to improve OST nutrition and PA. Yet, there is a need to further understand the perceptions and motivations of different subgroups to enact successful obesity prevention efforts during OST.     

Annals Journal Club: Practical Opportunities for Healthy Diet and Physical Activity: Relationship to Intentions,Behaviors, and Body Mass Index

PURPOSE

Current strategies for improving diet and activity patterns focus on encouraging patients to make better choices, but they meet with limited success. Because the choices people make depend on the choices they have, we examined how practical opportunities for diet and physical activity shape behavioral intentions and achieved behaviors.

METHODS

Participants included 746 adults who visited 8 large primary care practices in the Residency Research Network of Texas in 2012. We used structural equation models to confirm factor structures for a previously validated measure of practical opportunities, and then modeled achieved diet (Starting the Conversation – Diet questionnaire), physical activity (International Physical Activity Questionnaire), and BMI as a function of opportunities (classified as either resources or conversion factors that influence use of resources), behavioral intentions, and demographic covariates.

RESULTS

In path models, resources (P <.001) and conversion factors (P = .005) predicted behavioral intentions for activity. Conversion factors (P <.001), but not resources, predicted diet intentions. Both activity resources (P = .01) and conversion factors (P <.001) were positively associated with weekly activity minutes. Diet conversion factors (P <.001), but not diet resources (P = .08), were positively associated with diet quality. The same patterns were observed for body mass index (BMI). Socioeconomic gradients in resources and conversion factors were evident.

CONCLUSIONS

Individuals’ feasible opportunities for healthy diet and activity have clinically meaningful associations with intentions, achieved behaviors, and BMI. Assessing opportunities as part of health behavior management could lead to more effective, efficient, and compassionate interventions.     

Associations Of Physical Activity And Body Mass Index With Activities Of Daily Living In Older Adults

Research reports about the associations of leisure-time physical activity (LPA) and Body Mass Index (BMI) with activities of daily living (ADL) - or instrumental activities of daily living (IADL)-dependent disability in older adults are inconclusive. Data were obtained from the 2000 Missouri Older Adult Needs Assessment Survey. Logistic regression was used to examine the associations of LPA and BMI with ADL-or IADL-dependent disability, while controlling for factors known to be associated with LPA, BMI, ADL and IADL. ADL-or IADL dependency decreased with LPA and increased with BMI regardless of each other’s level, presence of functional limitation, education, gender, race-ethnicity, and health care coverage. Physically active individuals were less likely than inactive ones to be ADL- or IADL-dependent. BMI was modestly associated with ADL- or IADL-dependency and this relationship was confounded by LPA. If confirmed by well designed longitudinal studies, LPA and BMI independent associations with ADL- or IADL-dependent disability lends supports to a strategy for improving older adult quality of life through improved physical activity. Etiological studies on the associations between risk factors and quality of life outcomes in older adults should consider the joint confounding effect of LPA and BMI.Eduardo J. Simoes, MD, Prevention Research Centers Program; Rosemarie Kobau, MPH and Lynda Anderson, PhD, Health Care and Aging Studies Branch; Ali Mokdad, PhD, Behavior Surveillance Branch, all at Coordinating Center for Health Promotion, NCCDPHP-DACH, Centers for Disease Control and Prevention, 4770 Buford Highway, N.E., MS-K45. Atlanta, GA 30341,USA; Julie Kapp, PhD and Brian Waterman, MPH, Waterman Research Solutions, 5145 Shaw Ave., St. Louis, MO 63110, USA.     

Validation of the Greek Maternal Adjustment and Maternal Attitudes Scale for Assessing Early Postpartum Adjustment

The Maternal Adjustment and Maternal Attitudes Scale is a self- administered scale, designed for use in primary care settings to identify postpartum maternal adjustment problems regarding body image, sex, somatic symptoms, and marital relationships. Women were recruited within four weeks of giving birth. Responses to the Maternal Adjustment and Maternal Attitudes Scale were compared for agreement with responses to the Edinburgh Postnatal Depression Scale as a gold standard. Psychometric measurements included: reliability coefficients, explanatory factor analysis, and confirmatory analysis by linear structural relations. A receiver operating characteristic analysis was carried out to evaluate the global functioning of the scale. Of 300 mothers screened, 121 (40.7%) were experiencing difficulties in maternal adjustment and maternal attitudes. Scores on the Maternal Adjustment and Maternal Attitudes Scale correlated well with those on the Edinburgh Postnatal Depression Scale. The internal consistency of the Maternal Adjustment and Maternal Attitudes Scale, Greek version—tested using Cronbach's alpha coefficient—was 0.859, and that of Guttman split-half coefficient was 0.820. Findings confirmed the multidimensionality of the Maternal Adjustment and Maternal Attitudes Scale, demonstrating a six-factor structure. The area under the receiver operating characteristic curve was 0.610, and the logistic estimate for the threshold score of 57/58 fitted the model sensitivity at 68% and model specificity at 64.6%. Data confirmed that the Greek version of the Maternal Adjustment and Maternal Attitudes Scale is a reliable and valid screening tool for both clinical practice and research purposes to detect postpartum adjustment difficulties.     

Correlations of Physical Activity,Body Mass Index,Shift Duty,and Selected Eating Habits among Nurses in Riyadh,Saudi Arabia

Nurses are the largest group of direct health providers and can serve as role models for their patients. In this cross sectional study we assessed the relationship among physical activity and barriers, shift duty, elevated BMI, and selected eating habits among 362 non-Saudi female nurses in Riyadh, Saudi Arabia. Results showed that 46.7% were either overweight or obese. Marital status, shift duty, education level, and BMI were significant predictors of physical activity. Weather was the most frequently reported barrier to physical activity (88.3%), followed by a lack of transportation (82.6%), and a lack of time (81.3%). Nurses who worked shift duty had significantly (p = 0.004) higher BMIs compared with day shift nurses. Nurses who rarely ate breakfast (p = 0.004) and meals (p = 0.001) and often eat fast food (p = 0.001) were more likely to be overweight or obese. Nurses should be encouraged for a better healthy lifestyles.     

The Profiling of Diet and Physical Activity in Reproductive Age Women and Their Association with Body Mass Index

Pre-pregnancy, pregnancy and postpartum are critical life stages associated with higher weight gain and obesity risk. Among these women, the sociodemographic groups at highest risk for suboptimal lifestyle behaviours and core lifestyle components associated with excess adiposity are unclear. This study sought to identify subgroups of women meeting diet/physical activity (PA) recommendations in relation to sociodemographics and assess diet/PA components associated with body mass index (BMI) across these life stages. Cross-sectional data (Australian National Nutrition and Physical Activity Survey 2011–2012) were analysed for pre-pregnancy, pregnant and postpartum women. The majority (63–95%) of women did not meet dietary or PA recommendations at all life stages. Core and discretionary food intake differed by sociodemographic factors. In pre-pregnant women, BMI was inversely associated with higher whole grain intake (β = −1.58, 95% CI −2.96, −0.21; p = 0.025) and energy from alcohol (β = −0.08, −0.14, −0.005; p = 0.035). In postpartum women, BMI was inversely associated with increased fibre (β = −0.06, 95% CI −0.11, −0.004; p = 0.034) and PA (β = −0.002, 95% CI −0.004, −0.001; p = 0.013). This highlights the need for targeting whole grains, fibre and PA to prevent obesity across life stages, addressing those most socioeconomically disadvantaged.     

The Association Between Physical Activity and Maternal Sleep During the Postpartum Period

Physical activity is associated with improved sleep quality and duration in the general population, but its effect on sleep in postpartum women is unknown. We examined cross-sectional and longitudinal associations between hours/week of self-reported domain-specific and overall moderate to vigorous physical activity (MVPA) and sleep quality and duration at 3- and 12-months postpartum among a cohort of 530 women in the Pregnancy, Infection, and Nutrition Postpartum Study. MVPA was not associated with sleep quality or duration at 3-months postpartum. At 12-months postpartum, a 1 h/week increase in recreational MVPA was associated with higher odds of good (vs. poor) sleep quality (odds ratio, OR 1.14; 95 % confidence interval, CI, 1.03–1.27) and a 1 h/week increase in child/adult care MVPA was associated with lower odds of good (vs. poor) sleep quality (OR = 0.93; 95 % CI 0.88–0.99). A 1 h/week increase in child/adult care MVPA (OR 1.08, 95 % CI 1.00–1.16) was associated with higher odds of long sleep duration and 1 h/week increases in indoor household (OR 1.09, 95 % CI 1.01–1.18) and overall MVPA (OR 1.04, 95 % CI 1.01–1.07) were associated with higher odds of short (vs. normal) sleep duration. Comparing 3-months postpartum to 12-months postpartum, increased work MVPA was associated with good sleep quality (OR 2.40, 95 % CI 1.12–5.15) and increased indoor household MVPA was associated with short sleep duration (OR 1.85, 95 % CI 1.05–3.27) as measured at 12-months postpartum. Selected domains of MVPA and their longitudinal increases were associated with sleep quality and duration at 12-months postpartum. Additional research is needed to elucidate whether physical activity can improve postpartum sleep.     

产妇产后不良情绪与社会经济地位的相关性研究

目的分析产妇产后不良情绪(过度压力、焦虑和抑郁)的发生与社会经济地位间的相关性,为预防和干预产妇产后不良情绪提供一定的理论支持和建议。方法采用便利抽样法抽取产妇223名进行自填问卷调查,不良情绪的测量采用"抑郁-焦虑-压力"量表中文精简版(DASS-21),社会经济地位包括职业、受教育程度和经济收入三个方面。用Epidata 3.0建立数据库,使用SPSS 23.0进行统计分析。结论产妇产后不良情绪的发生率普遍较高,且与社会经济地位具有一定相关性,但并非单一线性的"社会经济地位越高,不良情绪发生率越低",其影响因素是多元化的。对此,在社会宏观层面与地方系统层面均需进行调控和干预。