Does Physical Activity During Pregnancy Reduce the Risk of Gestational Diabetes among Previously Inactive Women?

ABSTRACT: Background: Gestational diabetes affects approximately 7 percent of all pregnancies in the United States; its prevalence may have increased among all ethnic groups since the early 1990s. Our study examined whether physical activity during pregnancy reduced the risk of gestational diabetes among women who were physically inactive before pregnancy. Methods: We used data from the 1988 National Maternal and Infant Health Survey (NMIHS), a nationally representative sample of mothers with live births. The NMIHS obtained mothers’ gestational diabetes diagnoses from care providers and mothers reported their physical activity before and during pregnancy, including the number of months with physical activity and types of physical activity. We developed a physical activity index, the product of the number of months with physical activity, and average metabolic equivalents for specific activities. The analysis included 4,813 women who reported being physically inactive before pregnancy, with singleton births and no previous diabetes diagnosis. Results: Gestational diabetes was diagnosed in 3.5 percent of the weighted sample in 1988. About 11.8 percent of these previously inactive women began physical activity during pregnancy. Women who became physically active had 57 percent lower adjusted odds of developing gestational diabetes than those who remained inactive (OR 0.43, 95% CI 0.20–0.93). Women who had done brisk walking during pregnancy had a lower adjusted risk of gestational diabetes (OR 0.44, CI 0.19–1.02) and women with a physical activity index score above the median had 62 percent lower odds of developing gestational diabetes than the inactive women (CI 0.15–0.96). Conclusions: Results suggest that physical activity during pregnancy is associated with lower risk for gestational diabetes among previously inactive women. (BIRTH 35:3 September 2008)     

Exercise During Pregnancy and Cesarean Delivery: North Carolina PRAMS, 2004–2005

Background: The current rate of cesarean delivery in the United States is 31 percent. Previous studies have suggested that exercise during pregnancy may be associated with a lower risk of cesarean delivery, but sample sizes were small and methods often inadequate. This study examined whether or not an association exists between prenatal exercise and delivery mode using data from the 2004 and 2005 North Carolina Pregnancy Risk Assessment Monitoring System (PRAMS) survey. Methods: PRAMS postpartum questionnaire responses about frequency of exercise during the last 3 months of pregnancy for 1,955 women without a prior cesarean delivery were linked to birth certificates. Results: Among 1,342 women delivering at term, exercise was not associated with delivery mode in this data set: compared with women exercising less than once a week, neither women exercising one to four times per week nor those exercising five times or more per week had an altered risk of cesarean (risk ratio [RR] [95% confidence limit] [CL] 0.89 [0.69–1.15], 1.04 [0.66–1.64], respectively, adjusted for parity, gestational age, hypertension). Among 613 women delivering preterm, the results were also not statistically significant, but a compelling trend toward a protective effect could be seen (RR [95% CL] 0.65 [0.38–1.13], 0.62 [0.29–1.33]). Conclusions: Maternal self‐reported frequency of exercise during pregnancy was not associated with a reduced risk of cesarean delivery. Larger studies with better exposure ascertainment may provide a more definitive answer.     

Physical Activity Counselling Received Throughout Pregnancy and Effect on Behaviours: A Quasi-Experimental Study

ObjectivesThe objective was to examine the frequency of physical activity (PA) counselling for pregnant women over the course of their pregnancies and the effect on the women’s PA behaviour.MethodsA quasi-experimental study was conducted in the maternity unit of a hospital. In total, 72 pregnant women were randomized into a control or intervention group. Counselling about PA was dispensed to the women in the intervention group throughout pregnancy by health professionals who had been sensitized to its importance and the recommendations. The women in the control group received the usual consultation content. The PA behaviour of pregnant women in the intervention group who reported receiving PA counselling was evaluated. The counselling and PA levels were evaluated by chi-square tests and repeated measures analysis of variance, respectively.ResultsOverall, the women received little counselling in accordance with the recommendations, although the intervention group women received this counselling more frequently (P = 0.049). All women in the intervention group who reported receiving counselling throughout pregnancy limited their decline in PA compared with those in the control group. The decline in total PA among normal-weight and overweight pregnant women was reduced in the intervention group (respectively, P = 0.043 and P = 0.044).ConclusionOur intervention showed the effectiveness of counselling on PA behaviour, although the effect was observed at the end of pregnancy. Training and sensitizing for professionals should be strengthened to ensure that counselling in line with the recommendations to maintain or increase PA levels throughout pregnancy is provided.     

Smoking Status and Symptoms of Depression During and After Pregnancy Among Low-Income Women

ObjectiveTo describe the point prevalence rates, relapse rates, smoking status, and symptoms of depression and to examine the relationship between smoking status and symptoms of depression from early pregnancy to 12 months after childbirth among low-income women.DesignSecondary data analysis.SettingData from the national Nurse-Family Partnership program.ParticipantsWomen who were enrolled in the national Nurse-Family Partnership program between 2011 and 2016 with histories of smoking 3 months before pregnancy (N = 1,554).MethodsWe used smoking status and Edinburgh Postnatal Depression Scale scores in early pregnancy, late pregnancy, and 12 months after childbirth to identify point prevalence rates, relapse rates, smoking status, and symptoms of depression. We used chi-square and additional analyses to examine the relationship between smoking status and symptoms of depression.ResultsThe prevalence of smoking was 30.12% (n = 468) in early pregnancy, 24.39% (n = 379) in late pregnancy, and 50.58% (n = 786) 12 months after childbirth. Prevalence rates of a positive depression screening result were 30.31% (n = 471), 20.46% (n = 318), and 18.08% (n = 281), respectively. Smoking relapse rates were 2.45% (n = 38) during the third trimester and 27.86% (n = 433) at 12 months after childbirth. Eight distinct patterns of smoking and depression were identified. Women who smoked were significantly more likely to also have positive depression screening results during the third trimester and at 12 months after childbirth compared with nonsmoking women (OR = 1.37, 95% confidence interval [1.04, 1.81] and OR = 1.93, 95% confidence interval [1.47, 2.51], respectively).ConclusionPrevalence rates of smoking, relapse, and positive depression screening results were great in this sample of low-income women during and after pregnancy. Pivotal time points exist where the trajectory of smoking and depression screening patterns may change. It is important for smoking cessation interventions to incorporate mental health assessment and treatment.     

妊娠期开展“孕妇学校”课程对新生儿结局影响的研究

目的:分析妊娠期开展“孕妇学校”课程对于新生儿结局的影响。方法:回顾性分析2018年10月—2019年8月在中国人民武装警察部队特色医学中心（我院）产科住院的单胎孕足月且妊娠期规律产检的孕妇资料,根据其妊娠期参加“孕妇学校”课程次数分为观察组高组（≥7次课程）、中组（4~6次课程）、低组（≤3次课程）及对照组（未参加课程）,各组分别有53例、56例、48例和69例孕妇纳入研究。观察各组新生儿结局指标,包括新生儿体质量、脐动脉血pH值、脐动脉血乳酸水平、出生后Apgar评分、胎粪吸入综合征（meconium aspiration syndrome,MAS）发生率、缺血缺氧性脑病（hypoxic ischemic encephalopathy,HIE）发生率、坏死性小肠炎（necrotizing enteritis,NEC）发生率及转入新生儿科率。结果:观察组高、中、低组在新生儿体质量、新生儿脐动脉血乳酸水平方面均低于对照组,差异均有统计学意义（P<0.05）;观察组高、中组在新生儿脐动脉血pH值、出生后1 min Apgar评分方面均高于对照组,差异有统计学意义（P<0.05）。观察组高、中、低组在新生儿出生后5 min Apgar评分、出生后10 min Apgar评分、新生儿发生MAS、HIE、NEC率及转入新生儿科率方面与对照组差异无统计学意义（P>0.05）。结论:妊娠期开展“孕妇学校”课程在一定程度上可以改善新生儿体质量、脐动脉血pH值、脐动脉乳酸水平及出生后1 min Apgar评分,值得孕期广泛开展。     

Exploring Dental Care Misconceptions and Barriers in Pregnancy

Abstract: Background: Poor oral health is increasingly linked to adverse pregnancy outcomes, including preterm birth and low‐birthweight infants. Little is known about childbearing women’s experiences in obtaining dental care. The objective of this study was to explore Florida women’s experience of barriers in obtaining dental care before and during their pregnancies. Methods: Study data were derived from a larger data set of a study that examined barriers to prenatal care. One month after giving birth face‐to‐face interviews were conducted with 253 African American women, 18 to 35 years old, who were residents of one of three Florida counties. Interview questions about women’s experiences on obtaining oral health care before and during pregnancy, and recall of guidance about oral health care during prenatal visits were transcribed and analyzed qualitatively. Through subject‐level content analysis, key themes were assessed about the participants’ perspectives on obtaining oral health care before and during pregnancy. Results: Most participants did not obtain dental care and did not recall receiving dental information during prenatal visits. Barriers to dental care included lack of insurance, difficulty in finding a dentist, low priority given to dental care, misconceptions about the safety and appropriateness of dental care during pregnancy, and sporadic anticipatory guidance during prenatal care. Conclusions: Misconceptions about the appropriateness of oral health care during pregnancy may affect women’s access to and use of this care. Given the implications of poor oral health on possible adverse birth outcomes and its larger connection with the general health of mothers and babies, attention to oral health misconceptions and barriers is warranted. (BIRTH 37:4 December 2010)     

Physical Activity Prior to and During Pregnancy and Risk of Postpartum Depressive Symptoms

Objective: To examine the relationship between physical activity before and during the last trimester of pregnancy and postpartum depressive symptoms.
Design: Secondary analysis of data from the 2004 and 2005 Pregnancy Risk Assessment Monitoring System.
Settings: Mailed questionnaire or telephone interview of new mothers in North Carolina.
Patients/Participants: Female residents of North Carolina, ages 18 to 45 ( n =2,169), who had given birth to a live infant in the past 2 to 6 months.
Methods: Information on physical activity and depressive symptoms was self-reported. Logistic regression was used to examine the physical activity-depressive symptom associations while controlling for confounding variables.
Results: After adjustment for confounders, there were no statistically significant associations between being physically active before and/or during pregnancy and feeling depressed or "down." However, participants who were physically active both prepregnancy and during the last trimester had decreased odds of having little interest or pleasure compared with participants who were not physically active, after adjustment for age and marital status (odds ratio =0.66, 95% confidence interval: 0.49, 0.87).
Conclusion: Although regular physical activity is recommended for healthy women during pregnancy, additional studies are needed to investigate the physical activity-depressive symptoms association. If confirmed in other studies, physical activity may be an additional option for women who want to ease postpartum depressive symptoms.     

Frequency,Severity, and Effect on Life of Physical Symptoms Experienced During Pregnancy

This study aimed to: 1) describe the number, frequency, severity of discomfort and effect of symptoms on life of 29 physical symptoms women experienced at 15 to 25 weeks of gestation; 2) explore whether experiencing this group of physical symptoms more frequently and intensely was associated with a higher score of depressive symptoms and lower self‐esteem; (3) examine whether discomfort and effect ratings aided prediction of well being over and above symptom frequency; and (4) investigate which individual physical symptoms contributed most to predicting depressive symptoms and self‐esteem. Pregnant women (n = 215) completed the Beck Depression Inventory, Rosenberg Self‐Esteem Scale, and a physical symptoms questionnaire. Frequency, discomfort, and the effect of physical symptoms all consistently correlated with higher scores for depressive symptoms, but less consistently with lower self‐esteem. Discomfort and the effect of symptoms predicted variance in depressive symptoms after accounting for symptom frequency. Higher frequency, more discomfort, and the effect of fatigue and effect of flatulence were related to depressive symptoms. Relationships between pregnancy‐related physical symptoms, depressive symptoms, and low self‐esteem suggest that when women report any of these constellation of factors, further screening is indicated. A comprehensive assessment of physical symptoms includes frequency, discomfort, and effect on life.     

Recent Trends in Clinicians Providing Care to Pregnant Women in the United States

Introduction: Health care needs of pregnant women are met by a variety of clinicians in a changing policy and practice environment. This study documents recent trends in types of clinicians providing care to pregnant women in the United States. Methods: We used a repeat cross‐sectional design and data from the Integrated Health Interview Series (2000‐2009), a nationally representative data set, for respondents who reported being pregnant at the time of the survey (N = 3204). Using longitudinal logistic regression models, we analyzed changes over time in pregnant women's reported use of care from 1) obstetrician‐gynecologists; 2) midwives, nurse practitioners (NPs), or physician assistants (PAs); or 3) both an obstetrician‐gynecologist and a midwife, NP, or PA. Results: The percentage of pregnant women who reported seeing an obstetrician‐gynecologist (87%) remained steady from 2000 through 2009. After controlling for demographic and clinical variables, the percentage who reported receiving care from a midwife, NP, or PA increased 4% annually (yearly adjusted odds ratio [AOR] 1.04; P < .001), indicating a cumulative increase of 48% over the decade. The percentage of pregnant women who received care from both an obstetrician‐gynecologist and a midwife, NP, or PA also increased (AOR 1.027; P < .001), for a cumulative increase of 30%. Discussion: The increasing role of midwives, NPs, and PAs in the provision of maternity care suggests changes in the perinatal workforce and practice models that may promote collaborative care and quality improvement. However, better data collection is required to gather detailed information on specific provider types, these trends, and their implications.     

Randomized Clinical Trial of an Aquatic Physical Exercise Program During Pregnancy

ObjectiveTo determine the effect of an aquatic physical exercise program performed during pregnancy on rate of intact perineum after childbirth.DesignRandomized clinical trial.SettingHealth centers in the metropolitan health district of Granada, Spain.ParticipantsA total of 129 pregnant women (control group [CG] = 64; aquatic exercise group [EG] = 65).MethodsThe intervention was an aquatic physical exercise program specifically designed for pregnant women (Study of Water Exercise During Pregnancy [SWEP] method). Participants were randomly assigned to the CG or EG by simple random sampling. Participants in the EG performed three sessions per week of physical exercises, which were led by the principal investigator. All participants received routine prenatal care. We evaluated status of the perineum after birth, including laceration and episiotomy rates. We also evaluated participants’ weight, body mass index (BMI) in the first and third trimesters, parity, the administration of anesthesia, and birth weight of the neonate as potential confounding variables.ResultsThe women in the EG had a greater rate of intact perineum than those in the CG (odds ratio [OR] = 13.54, 95% confidence interval [CI] [2.75, 66.56]). After adjusting for infant birth weight, the effect of the intervention on intact perineum was an OR of 8.57 (95% CI [1.85, 39.68]. Maternal weight gain did not influence the odds of intact perineum (OR = 1.072, 95% CI [0.896, 1.283]). Women who previously gave birth and followed the SWEP method had an OR of 10.197 (95% CI [2.190, 47.476] for an intact perineum. The administration of anesthesia and previous pregnancy also were associated with intact perineum (OR = 6.68, 95% CI [1.21, 36.84] and OR = 5.42, 95% CI [1.64, 17.89] respectively.ConclusionThe women who followed the SWEP method were significantly more likely to have intact perinea after childbirth.     

Mixed-Methods Study of the Experience of Pregnancy During the COVID-19 Pandemic

ObjectiveTo understand the experiences of women who were pregnant during the initial stage of the COVID-19 pandemic, March 2020 to May 2020, and how they coped with stress.DesignA convergent mixed-methods design.SettingOnline survey that launched in April 2020.ParticipantsA total of 185 pregnant women.MethodsFor the quantitative strand, we measured adaptation to coping with stress using the Brief Resilient Coping Scale. For the qualitative strand, we asked participants to describe the experience of being pregnant during the pandemic.ResultsThe mean score on the Brief Resilient Coping Scale was 14.7, which indicated a medium-level resilient coper. Using Krippendorff’s content analysis, we identified four themes: Robbed of Enjoying the Expected Pregnancy Experiences, Anxiety and Fear in the Face of a Pandemic Pregnancy, Heightened Source of Worry With Birth on the Horizon, and Choosing Hope.ConclusionTo meet the needs of pregnant women, perinatal nurses and other maternity care providers must understand the experience of pregnancy during times of upheaval, such as the onset of a global pandemic. Health care providers and nurses can help ensure ideal outcomes for pregnant women by recognizing the loss of the expected pregnancy experience, providing support through creative social outlets, and fostering hopeful optimism.     

Impact of physical activity and traumatic exposure on occurrence of gestational hypertension: a survey of pregnant women in an armed-conflict region in Nigeria

ABSTRACT

Objective

To compare physical activity level and traumatic exposure between normotensive and hypertensive pregnant women in an armed conflict region of Nigeria.