Patterns of leisure-time physical activity across pregnancy and adverse pregnancy outcomes

Janet M Catov, Corette B Parker, Bethany Barone Gibbs, Carla M Bann, Benjamin Carper, Robert M Silver, Hyagriv N Simhan, Samuel Parry, Judith H Chung, David M Haas, Ronald J Wapner, George R Saade, Brian M Mercer, C Noel Bairey-Merz, Philip Greenland, Deborah B Ehrenthal, Shannon E Barnes, Anthony L Shanks, Uma M Reddy, William A Grobman, NICHD NuMoM2b and NHLBI NuMoM2b Heart Health Study Network, Janet M Catov, Corette B Parker, Bethany Barone Gibbs, Carla M Bann, Benjamin Carper, Robert M Silver, Hyagriv N Simhan, Samuel Parry, Judith H Chung, David M Haas, Ronald J Wapner, George R Saade, Brian M Mercer, C Noel Bairey-Merz, Philip Greenland, Deborah B Ehrenthal, Shannon E Barnes, Anthony L Shanks, Uma M Reddy, William A Grobman, NICHD NuMoM2b and NHLBI NuMoM2b Heart Health Study Network

Abstract

Background: Although leisure-time physical activity (PA) contributes to overall health, including pregnancy health, patterns across pregnancy have not been related to birth outcomes. We hypothesized that women with sustained low leisure-time PA would have excess risk of adverse pregnancy outcomes, and that changing patterns across pregnancy (high to low and low to high) may also be related to risk of adverse pregnancy outcomes.

Methods: Nulliparous women (n = 10,038) were enrolled at 8 centers early in pregnancy (mean gestational age in weeks [SD] = 12.05 [1.51]. Frequency, duration, and intensity (metabolic equivalents) of up to three leisure activities reported in the first, second and third trimesters were analyzed. Growth mixture modeling was used to identify leisure-time PA patterns across pregnancy. Adverse pregnancy outcomes (preterm birth, [PTB, overall and spontaneous], hypertensive disorders of pregnancy [HDP], gestational diabetes [GDM] and small-for-gestational-age births [SGA]) were assessed via chart abstraction.

Results: Five patterns of leisure-time PA across pregnancy were identified: High (35%), low (18%), late decreasing (24%), early decreasing (10%), and early increasing (13%). Women with sustained low leisure-time PA were younger and more likely to be black or Hispanic, obese, or to have smoked prior to pregnancy. Women with low vs. high leisure-time PA patterns had higher rates of PTB (10.4 vs. 7.5), HDP (13.9 vs. 11.4), and GDM (5.7 vs. 3.1, all p < 0.05). After adjusting for maternal factors (age, race/ethnicity, BMI and smoking), the risk of GDM (Odds ratio 2.00 [95% CI 1.47, 2.73]) remained higher in women with low compared to high patterns. Early and late decreasing leisure-time PA patterns were also associated with higher rates of GDM. In contrast, women with early increasing patterns had rates of GDM similar to the group with high leisure-time PA (3.8% vs. 3.1%, adjusted OR 1.16 [0.81, 1.68]). Adjusted risk of overall PTB (1.31 [1.05, 1.63]) was higher in the low pattern group, but spontaneous PTB, HDP and SGA were not associated with leisure-time PA patterns.

Conclusions: Sustained low leisure-time PA across pregnancy is associated with excess risk of GDM and overall PTB compared to high patterns in nulliparous women. Women with increased leisure-time PA early in pregnancy had low rates of GDM that were similar to women with high patterns, raising the possibility that early pregnancy increases in activity may be associated with improved pregnancy health.

Trial registration: Registration number NCT02231398 .

Keywords: Gestational diabetes; Physical activity; Pregnancy; Preterm birth.

Conflict of interest statement

Ethics approval and consent to participate

All local institutional review boards approved the study protocol, and participants provided written informed consent prior to enrollment.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Leisure-time physical activity per week for nuMoM2b study visits

References

    1. Physical Activity Guidelines Advisory Committee . 2018 Physical activity guidelines advisory committee scientific report. Washington, DC: U.S. Department of Health and Human Services; 2018.
    1. ACOG Committee Opinion No. 650: physical activity and exercise during pregnancy and the postpartum period. Obstet Gynecol. 2015;126(6):e135–e142. doi: 10.1097/AOG.0000000000001214.
    1. Evenson KR, Wen F. National trends in self-reported physical activity and sedentary behaviors among pregnant women: NHANES 1999-2006. Prev Med. 2010;50:123–128. doi: 10.1016/j.ypmed.2009.12.015.
    1. Borodulin KM, Evenson KR, Wen F, Herring AH, Benson AM. Physical activity patterns during pregnancy. Med Sci Sports Exerc. 2008;40:1901–1908. doi: 10.1249/MSS.0b013e31817f1957.
    1. Borodulin K, Evenson KR, Monda K, Wen F, Herring AH, Dole N. Physical activity and sleep among pregnant women. Paediatr Perinat Epidemiol. 2010;24:45–52. doi: 10.1111/j.1365-3016.2009.01081.x.
    1. Chappell LC, Seed PT, Myers J, et al. Exploration and confirmation of factors associated with uncomplicated pregnancy in nulliparous women: prospective cohort study. BMJ. 2013;347:f6398. doi: 10.1136/bmj.f6398.
    1. Romero R, Espinoza J, Gonçalves L, Kusanovic J, Friel L, Hassan S. The role of inflammation and infection in preterm birth. Semin Reprod Med. 2007;25:21–39. doi: 10.1055/s-2006-956773.
    1. Labarrere CA, DiCarlo HL, Bammerlin E, et al. Failure of physiologic transformation of spiral arteries, endothelial and trophoblast cell activation, and acute atherosis in the basal plate of the placenta. Am J Obstet Gynecol. 2017;216:287. doi: 10.1016/j.ajog.2016.12.029.
    1. Bo S, Valpreda S, Menato G, et al. Should we consider gestational diabetes a vascular risk factor? Atherosclerosis. 2007;194:e72–e79. doi: 10.1016/j.atherosclerosis.2006.09.017.
    1. Catalano PM, McIntyre HD, Cruickshank JK, et al. The hyperglycemia and adverse pregnancy outcome study: associations of GDM and obesity with pregnancy outcomes. Diabetes Care. 2012;35:780–786. doi: 10.2337/dc11-1790.
    1. Barakat R, Pelaez M, Cordero Y, et al. Exercise during pregnancy protects against hypertension and macrosomia: randomized clinical trial. Am J Obstet Gynecol. 2016;214:649. doi: 10.1016/j.ajog.2015.11.039.
    1. Garcia-Patterson A, Martin E, Ubeda J, Maria MA, de Leiva A, Corcoy R. Evaluation of light exercise in the treatment of gestational diabetes. Diabetes Care. 2001;24:2006–2007. doi: 10.2337/diacare.24.11.2006.
    1. North RA, McCowan LM, Dekker GA, et al. Clinical risk prediction for pre-eclampsia in nulliparous women: development of model in international prospective cohort. BMJ. 2011;342:d1875. doi: 10.1136/bmj.d1875.
    1. Conde-Agudelo A, Papageorghiou AT, Kennedy SH, Villar J. Novel biomarkers for the prediction of the spontaneous preterm birth phenotype: a systematic review and meta-analysis. BJOG. 2011;118:1042–1054. doi: 10.1111/j.1471-0528.2011.02923.x.
    1. Haas DM, Parker CB, Wing DA, et al. A description of the methods of the nulliparous pregnancy outcomes study: monitoring mothers-to-be (nuMoM2b) Am J Obstet Gynecol. 2015;212:539. doi: 10.1016/j.ajog.2015.01.019.
    1. Shea S, Stein AD, Lantigua R, Basch CE. Reliability of the behavioral risk factor survey in a triethnic population. Am J Epidemiol. 1991;133:489–500. doi: 10.1093/oxfordjournals.aje.a115916.
    1. Centers for Disease Control and Prevention. Division of Nutrition, Physical Activity, and Obesity . A Data Users Guide to the BRFSS Physical Activity Questions. 2011.
    1. Pharr JR, Coughenour CA, Bungum TJ. An assessment of the relationship of physical activity, obesity, and chronic diseases/conditions between active/obese and sedentary/ normal weight American women in a national sample. Public Health. 2018;156:117–123. doi: 10.1016/j.puhe.2017.12.013.
    1. Robbins C, Boulet SL, Morgan I, et al. Disparities in preconception health indicators - behavioral risk factor surveillance system, 2013-2015, and pregnancy risk assessment monitoring system, 2013-2014. MMWR Surveill Summ. 2018;67:1–16. doi: 10.15585/mmwr.ss6701a1.
    1. Ainsworth BE, Haskell WL, Herrmann SD, et al. 2011 compendium of physical activities: a second update of codes and MET values. Med Sci Sports Exerc. 2011;43:1575–1581. doi: 10.1249/MSS.0b013e31821ece12.
    1. Facco FL, Parker CB, Reddy UM, et al. NuMoM2b sleep-disordered breathing study: objectives and methods. Am J Obstet Gynecol. 2015;212(4):542. doi: 10.1016/j.ajog.2015.01.021.
    1. Facco FL, Parker CB, Reddy UM, et al. Association between sleep-disordered breathing and hypertensive disorders of pregnancy and gestational diabetes mellitus. Obstet Gynecol. 2017;129:31–41. doi: 10.1097/AOG.0000000000001805.
    1. Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M. A United States national reference for fetal growth. Obstet Gynecol. 1996;87:163–168. doi: 10.1016/0029-7844(95)00386-X.
    1. Koren G, Boskovic R, Hard M, Maltepe C, Navioz Y, Einarson A. Motherisk-PUQE (Pregnancy-unique quantification of emesis and nausea) scoring system for nausea and vomiting of pregnancy. Am J Obstet Gynecol. 2002;186:S228–S231. doi: 10.1067/mob.2002.123054.
    1. Ram N, Grimm KJ. Growth mixture modeling: a method for identifying differences in longitudinal change among unobserved groups. Int J Behav Dev. 2009;33:565–576. doi: 10.1177/0165025409343765.
    1. Muthén LK, Muthén BO. Mplus user’s guide 1998-2017. 8. Los Angeles, CA: Muthén & Muthén; 2017.
    1. Santo EC, Forbes PW, Oken E, Belfort MB. Determinants of physical activity frequency and provider advice during pregnancy. BMC Pregnancy Childbirth. 2017;17:286. doi: 10.1186/s12884-017-1460-z.
    1. Hesketh KR, Evenson KR. Prevalence of U.S. pregnant women meeting 2015 ACOG physical activity guidelines. Am J Prev Med. 2016;51:e87–e89. doi: 10.1016/j.amepre.2016.05.023.
    1. Cordero Y, Mottola MF, Vargas J, Blanco M, Barakat R. Exercise is associated with a reduction in gestational diabetes mellitus. Med Sci Sports Exerc. 2015;47:1328–1333. doi: 10.1249/MSS.0000000000000547.
    1. Aune D, Sen A, Henriksen T, Saugstad OD, Tonstad S. Physical activity and the risk of gestational diabetes mellitus: a systematic review and dose-response meta-analysis of epidemiological studies. Eur J Epidemiol. 2016;31:967–997. doi: 10.1007/s10654-016-0176-0.
    1. Coe DP, Conger SA, Kendrick JM, et al. Postprandial walking reduces glucose levels in women with gestational diabetes mellitus. Appl Physiol Nutr Metab. 2018;43(5):531–534. doi: 10.1139/apnm-2017-0494.
    1. Norris T, McCarthy FP, Khashan AS, et al. Do changing levels of maternal exercise during pregnancy affect neonatal adiposity? Secondary analysis of the babies after SCOPE: evaluating the longitudinal impact using neurological and nutritional endpoints (BASELINE) birth cohort (Cork, Ireland) BMJ Open. 2017;7(11):e017987. doi: 10.1136/bmjopen-2017-017987.
    1. Bisson M, Croteau J, Guinhouya BC, et al. Physical activity during pregnancy and infant's birth weight: results from the 3D birth cohort. BMJ Open Sport Exerc Med. 2017;3:e000242. doi: 10.1136/bmjsem-2017-000242.
    1. Haas DM, Ehrenthal DB, Koch MA, et al. Pregnancy as a window to future cardiovascular health: design and implementation of the nuMoM2b heart health study. Am J Epidemiol. 2016;183:519–530. doi: 10.1093/aje/kwv309.
    1. Evenson KR, Huston SL, Wood JL, Bors P. Change in the prevalence of leisure activity with the number of activities recalled. Med Sci Sports Exerc. 2003;35:1882–1886. doi: 10.1249/01.MSS.0000093800.64675.56.
    1. McCarty-Singleton S, Sciscione AC. Maternal activity restriction in pregnancy and the prevention of preterm birth: an evidence-based review. Clin Obstet Gynecol. 2014;57:616–627. doi: 10.1097/GRF.0000000000000048.
    1. Sciscione AC. Maternal activity restriction and the prevention of preterm birth. Am J Obstet Gynecol. 2010;202:232.e1. doi: 10.1016/j.ajog.2009.07.005.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi