Effects of supervised aerobic and strength training in overweight and grade I obese pregnant women on maternal and foetal health markers: the GESTAFIT randomized controlled trial

Virginia A Aparicio, Olga Ocón, Carmen Padilla-Vinuesa, Alberto Soriano-Maldonado, Lidia Romero-Gallardo, Milkana Borges-Cósic, Irene Coll-Risco, Pilar Ruiz-Cabello, Pedro Acosta-Manzano, Fernando Estévez-López, Inmaculada C Álvarez-Gallardo, Manuel Delgado-Fernández, Jonatan R Ruiz, Mireille N Van Poppel, Julio J Ochoa-Herrera, Virginia A Aparicio, Olga Ocón, Carmen Padilla-Vinuesa, Alberto Soriano-Maldonado, Lidia Romero-Gallardo, Milkana Borges-Cósic, Irene Coll-Risco, Pilar Ruiz-Cabello, Pedro Acosta-Manzano, Fernando Estévez-López, Inmaculada C Álvarez-Gallardo, Manuel Delgado-Fernández, Jonatan R Ruiz, Mireille N Van Poppel, Julio J Ochoa-Herrera

Abstract

Background: During pregnancy, a sedentary lifestyle may have negative consequences on maternal and foetal health status. The main objective of this project is to assess the effects of an exercise intervention in overweight and grade I obese pregnant on maternal and foetal health markers.

Methods/design: The present study aims to recruit 60 overweight and grade I obese women interested in participating in an exercise intervention program from the 17th gestational week until delivery. Women will be randomized to either an exercise (three 60-min sessions/week of combined aerobic and strength training and pelvic floor exercises), or usual care (control) group (30 women per group). The primary outcome measures are maternal weight gain, and maternal and neonatal glycaemic profile. Secondary outcome measures are: i) perinatal obstetric records; i) body composition; iii) dietary patterns; iv) physical fitness; v) low-back pain; vi) objectively measured physical activity and sedentary behaviour; vii) haematology and biochemical analyses; viii) oxidative stress; ix) pro- and anti-inflammatory markers; x) bone health biomarkers; xi) sleep quality; xii) mental health, quality of life and positive health.

Discussion: The findings of this project will help to identify strategies for primary prevention and health promotion based on this exercise-based intervention program among overweight and grade I obese pregnant women.

Trial registration: NCT02582567 ; Date of registration: 20/10/2015.

Keywords: Glycaemic profile; Lipid profile; Newborn; Nutrition; Oxidative stress; Physical activity; Physical fitness; Quality of life; Sleep quality.

Figures

Fig. 1
Fig. 1
Organizational and participants flow

References

    1. Barouki R, Gluckman PD, Grandjean P, Hanson M, Heindel JJ. Developmental origins of non-communicable disease: implications for research and public health. Environ Health. 2012;11:42. doi: 10.1186/1476-069X-11-42.
    1. Hanson MA, Gluckman PD. Developmental origins of health and disease--global public health implications. Best pract res Clin obstetrics gynaecol. 2015;29(1):24–31. doi: 10.1016/j.bpobgyn.2014.06.007.
    1. Hure AJ, Collins CE, Giles WB, Wright IM, Smith R. Protocol for the Women And Their Children’s Health (WATCH) study: a cohort of pregnancy and beyond. J epidemiol. 2012;22(3):267–275. doi: 10.2188/jea.JE20110079.
    1. Loprinzi PD, Fitzgerald EM, Woekel E, Cardinal BJ. Association of physical activity and sedentary behavior with biological markers among U.S. pregnant women. J women’s health (2002) 2013;22(11):953–958. doi: 10.1089/jwh.2013.4394.
    1. de Groot CJ, van Poppel MN, van Poppel MN, Ruchat SM, Mottola MF. Physical activity and gestational diabetes mellitus. J pregnancy. 2014;60:104–112.
    1. Mudd LM, Evenson KR. Review of impacts of physical activity on maternal metabolic health during pregnancy. Curr diabetes reports. 2015;15(2):572. doi: 10.1007/s11892-014-0572-3.
    1. Melzer K, Schutz Y, Boulvain M, Kayser B. Physical activity and pregnancy: cardiovascular adaptations, recommendations and pregnancy outcomes. Sports med (Auckland, NZ) 2010;40(6):493–507. doi: 10.2165/11532290-000000000-00000.
    1. Dempsey JC, Butler CL, Williams MA. No need for a pregnant pause: physical activity may reduce the occurrence of gestational diabetes mellitus and preeclampsia. Exerc Sport Sci Rev. 2005;33(3):141–149. doi: 10.1097/00003677-200507000-00007.
    1. Boghossian NS, Yeung E, Albert PS, Mendola P, Laughon SK, Hinkle SN, Zhang C. Changes in diabetes status between pregnancies and impact on subsequent newborn outcomes. Am J Obstet Gynecol. 2014;210(5):431. doi: 10.1016/j.ajog.2013.12.026.
    1. Cnattingius S, Villamor E, Johansson S, Edstedt Bonamy AK, Persson M, Wikstrom AK, Granath F. Maternal obesity and risk of preterm delivery. Jama. 2013;309(22):2362–2370. doi: 10.1001/jama.2013.6295.
    1. Persson M, Johansson S, Villamor E, Cnattingius S. Maternal overweight and obesity and risks of severe birth-asphyxia-related complications in term infants: a population-based cohort study in Sweden. PLoS Med. 2014;11(5):e1001648. doi: 10.1371/journal.pmed.1001648.
    1. Lee KK, Raja EA, Lee AJ, Bhattacharya S, Bhattacharya S, Norman JE, Reynolds RM. Maternal Obesity During Pregnancy Associates With Premature Mortality and Major Cardiovascular Events in Later Life. Hypertension. 2015;66(5):938–944. doi: 10.1161/HYPERTENSIONAHA.115.05920.
    1. Pacce S, Saure C, Mazza CS, Garcia S, Tomzig RG, Lopez AP, Ribarola L, Krochick GA. Impact of maternal nutritional status before and during pregnancy on neonatal body composition: A cross-sectional study. Diabetes metabolic syndr. 2015;10:S7–S12. doi: 10.1016/j.dsx.2015.08.015.
    1. Carty D, Akehurst C, Savage R, Sungatullina L, Robinson S, McBride M, McClure J, Freeman D, Delles C. Differential gene expression in obese pregnancy. Pregnancy hypertension. 2014;4(3):232–233.
    1. Awan S, Bibi S, Makhdoom A, Farooq S, Sm T, Qazi RA. Adverse fetomaternal outcome among pregnant overweight women. Pakistan j med sci. 2015;31(2):383–387.
    1. Johansson S, Villamor E, Altman M, Bonamy AK, Granath F, Cnattingius S. Maternal overweight and obesity in early pregnancy and risk of infant mortality: a population based cohort study in Sweden. BMJ. 2014;349:g6572. doi: 10.1136/bmj.g6572.
    1. Nascimento SL, Surita FG, Godoy AC, Kasawara KT, Morais SS. Physical Activity Patterns and Factors Related to Exercise during Pregnancy: A Cross Sectional Study. PLoS One. 2015;10(6):e0128953. doi: 10.1371/journal.pone.0128953.
    1. Clarke PE, Gross H. Women’s behaviour, beliefs and information sources about physical exercise in pregnancy. Midwifery. 2004;20(2):133–141. doi: 10.1016/j.midw.2003.11.003.
    1. Ruifrok AE, Althuizen E, Oostdam N, van Mechelen W, Mol BW. The relationship of objectively measured physical activity and sedentary behaviour with gestational weight gain and birth weight. J Pregnancy. 2014;2014:567379. doi:10.1155/2014/567379.
    1. Ruiz JR, Perales M, Pelaez M, Lopez C, Lucia A, Barakat R. Supervised exercise-based intervention to prevent excessive gestational weight gain: a randomized controlled trial. Mayo Clin Proc. 2013;88(12):1388–1397. doi: 10.1016/j.mayocp.2013.07.020.
    1. Petrov Fieril K, Glantz A, Fagevik Olsen M. The efficacy of moderate-to-vigorous resistance exercise during pregnancy: a randomized controlled trial. Acta Obstet Gynecol Scand. 2015;94(1):35–42. doi: 10.1111/aogs.12525.
    1. O’Connor PJ, Poudevigne MS, Cress ME, Motl RW, Clapp JF., 3rd Safety and efficacy of supervised strength training adopted in pregnancy. J Phys Act Health. 2011;8(3):309–320. doi: 10.1123/jpah.8.3.309.
    1. Benjamin DR, van de Water AT, Peiris CL. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy. 2014;100(1):1–8. doi: 10.1016/j.physio.2013.08.005.
    1. Hall DC, Kaufmann DA. Effects of aerobic and strength conditioning on pregnancy outcomes. Am J Obstet Gynecol. 1987;157(5):1199–1203. doi: 10.1016/S0002-9378(87)80294-6.
    1. Brankston GN, Mitchell BF, Ryan EA, Okun NB. Resistance exercise decreases the need for insulin in overweight women with gestational diabetes mellitus. Am J Obstet Gynecol. 2004;190(1):188–193. doi: 10.1016/S0002-9378(03)00951-7.
    1. Hazeldean D. Being fit in pregnancy. pract midwife. 2014;17(2):11–12.
    1. Bisson M, Almeras N, Plaisance J, Rheaume C, Bujold E, Tremblay A, Marc I. Maternal fitness at the onset of the second trimester of pregnancy: correlates and relationship with infant birth weight. Pediatr obesity. 2013;8(6):464–474. doi: 10.1111/j.2047-6310.2012.00129.x.
    1. Clapp JF., 3rd Morphometric and neurodevelopmental outcome at age five years of the offspring of women who continued to exercise regularly throughout pregnancy. J Pediatr. 1996;129(6):856–863. doi: 10.1016/S0022-3476(96)70029-X.
    1. Park JW, Kim MH, Eo SJ, Lee EH, Kang JS, Chang HK, Leem YH. Maternal exercise during pregnancy affects mitochondrial enzymatic activity and biogenesis in offspring brain. Int j neurosci. 2013;123(4):253–264. doi: 10.3109/00207454.2012.755969.
    1. May LE, Scholtz SA, Suminski R, Gustafson KM. Aerobic exercise during pregnancy influences infant heart rate variability at one month of age. Early Hum Dev. 2014;90(1):33–38. doi: 10.1016/j.earlhumdev.2013.11.001.
    1. Keshavarzi F, Farnia V, Yazdchi K, Najafi F, Brand S, Bajoghli H, Nankali A, Salmanzadeh H. Effect of maternal anxiety on maternal serum and fetal cord blood cortisol. Asia-Pacific psychiatry. 2014;6(4):435–439.
    1. Tapia Collados C, Gil Guillen V, Orozco Beltran D. [Influence of maternal anxiety on the frequency of paediatric primary care visits. Atencion primaria/Sociedad Espanola de Medicina de Familia y Comunitaria. 2005;36(2):64–8.
    1. Kolu P, Raitanen J, Luoto R. Physical activity and health-related quality of life during pregnancy: a secondary analysis of a cluster-randomised trial. Matern Child Health J. 2014;18(9):2098–2105. doi: 10.1007/s10995-014-1457-4.
    1. Gaston A, Prapavessis H. Tired, moody and pregnant? Exercise may be the answer. Psychol Health. 2013;28(12):1353–1369. doi: 10.1080/08870446.2013.809084.
    1. Poudevigne MS, O’Connor PJ. A review of physical activity patterns in pregnant women and their relationship to psychological health. Sports med (Auckland, NZ) 2006;36(1):19–38. doi: 10.2165/00007256-200636010-00003.
    1. Shivakumar G, Brandon AR, Snell PG, Santiago-Munoz P, Johnson NL, Trivedi MH, Freeman MP. Antenatal depression: a rationale for studying exercise. Depression anxiety. 2011;28(3):234–242. doi: 10.1002/da.20777.
    1. Rezaei E, Moghadam ZB, Saraylu K. Quality of life in pregnant women with sleep disorder. J family reproduct health. 2013;7(2):87–93.
    1. Wu M, Li X, Feng B, Wu H, Qiu C, Zhang W. Correlation between sleep quality of third-trimester pregnancy and postpartum depression. Med Sci Monit. 2014;20:2740–2745. doi: 10.12659/MSM.891222.
    1. Okun ML, Kline CE, Roberts JM, Wettlaufer B, Glover K, Hall M. Prevalence of sleep deficiency in early gestation and its associations with stress and depressive symptoms. J women’s health (2002) 2013;22(12):1028–1037. doi: 10.1089/jwh.2013.4331.
    1. Pires GN, Andersen ML, Giovenardi M, Tufik S. Sleep impairment during pregnancy: possible implications on mother-infant relationship. Med Hypotheses. 2010;75(6):578–582. doi: 10.1016/j.mehy.2010.07.036.
    1. Hayase M, Shimada M, Seki H. Sleep quality and stress in women with pregnancy-induced hypertension and gestational diabetes mellitus. Women birth. 2014;27(3):190–195. doi: 10.1016/j.wombi.2014.04.002.
    1. Izci Balserak B, Jackson N, Ratcliffe SA, Pack AI, Pien GW. Sleep-disordered breathing and daytime napping are associated with maternal hyperglycemia. Sleep breathing. 2013;17(3):1093–1102. doi: 10.1007/s11325-013-0809-4.
    1. Okun ML, Luther JF, Wisniewski SR, Wisner KL. Disturbed sleep and inflammatory cytokines in depressed and nondepressed pregnant women: an exploratory analysis of pregnancy outcomes. Psychosom Med. 2013;75(7):670–681. doi: 10.1097/PSY.0b013e31829cc3e7.
    1. Okun ML, Schetter CD, Glynn LM. Poor sleep quality is associated with preterm birth. Sleep. 2011;34(11):1493–1498.
    1. Owusu JT, Anderson FJ, Coleman J, Oppong S, Seffah JD, Aikins A, O’Brien LM. Association of maternal sleep practices with pre-eclampsia, low birth weight, and stillbirth among Ghanaian women. Int j gynaecol obstetrics. 2013;121(3):261–265. doi: 10.1016/j.ijgo.2013.01.013.
    1. Ko YL, Lin PC, Chen SC. Stress, sleep quality and unplanned Caesarean section in pregnant women. Int j nurs pract. Int J Nurs Pract. 2015;21(5):454-61. doi:10.1111/ijn.12267.
    1. Hung HM, Ko SH, Chen CH. The association between prenatal sleep quality and obstetric outcome. j nurs res. 2014;22(3):147–154. doi: 10.1097/jnr.0000000000000039.
    1. Madaeva IM, Kolesnikova LI, Protopopova NV, Sakh’ianova NL, Berdina ON. [Features of the sleep pattern during pregnancy] Vestn Ross Akad Med Nauk. 2014;1–2:93–97. doi: 10.15690/vramn.v69i1-2.949.
    1. Lara-Carrasco J, Simard V, Saint-Onge K, Lamoureux-Tremblay V, Nielsen T. Disturbed dreaming during the third trimester of pregnancy. Sleep Med. 2014;15(6):694–700. doi: 10.1016/j.sleep.2014.01.026.
    1. Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Obstet Gynecol. 2010;115(5):1063–1070. doi: 10.1097/AOG.0b013e3181d9d421.
    1. Kanagasabai T, Thakkar NA, Kuk JL, Churilla JR, Ardern CI. Differences in physical activity domains, guideline adherence, and weight history between metabolically healthy and metabolically abnormal obese adults: a cross-sectional study. int j behav nutr phys act. 2015;12:64. doi: 10.1186/s12966-015-0227-z.
    1. Kalisiak B, Spitznagle T. What effect does an exercise program for healthy pregnant women have on the mother, fetus, and child? PM R: j injury, function, rehabilitation. 2009;1(3):261–266. doi: 10.1016/j.pmrj.2008.12.006.
    1. ACOG committee opinion Exercise during pregnancy and the postpartum period. Number 267, January 2002. American College of Obstetricians and Gynecologist. Int J Gynaecol Obstet. 2002;77(1):79–81. doi: 10.1016/S0020-7292(02)80004-2.
    1. Evenson KR, Barakat R, Brown WJ, Dargent-Molina P, Haruna M, Mikkelsen EM, Mottola MF, Owe KM, Rousham EK, Yeo S. Guidelines for Physical Activity during Pregnancy: Comparisons From Around the World. Am J Lifestyle Med. 2014;8(2):102–121. doi: 10.1177/1559827613498204.
    1. Zavorsky GS, Longo LD. Exercise guidelines in pregnancy: new perspectives. Sports med(Auckland, NZ) 2011;41(5):345–360. doi: 10.2165/11583930-000000000-00000.
    1. Barakat R, Pelaez M, Lopez C, Lucia A, Ruiz JR. Exercise during pregnancy and gestational diabetes-related adverse effects: a randomised controlled trial. Br J Sports Med. 2013;47(10):630–636. doi: 10.1136/bjsports-2012-091788.
    1. White E, Pivarnik J, Pfeiffer K. Resistance training during pregnancy and perinatal outcomes. J Phys Act Health. 2014;11(6):1141–1148. doi: 10.1123/jpah.2012-0350.
    1. Pelaez M, Gonzalez-Cerron S, Montejo R, Barakat R. Pelvic floor muscle training included in a pregnancy exercise program is effective in primary prevention of urinary incontinence: a randomized controlled trial. Neurourol Urodyn. 2014;33(1):67–71. doi: 10.1002/nau.22381.
    1. Medicine ACoS . ACSM’s Guidelines for Exercise Testing and Prescription. ninth edition. Philadelphia: Lippincott Williams and Wilkins; 2013.
    1. Bozkurt M, Yumru AE, Sahin L. Pelvic floor dysfunction, and effects of pregnancy and mode of delivery on pelvic floor. Taiwanese j obstetr gynecol. 2014;53(4):452–458. doi: 10.1016/j.tjog.2014.08.001.
    1. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377–381. doi: 10.1249/00005768-198205000-00012.
    1. Okamoto T, Masuhara M, Ikuta K. Acute effects of self-myofascial release using a foam roller on arterial function. J strength condition res. 2014;28(1):69–73. doi: 10.1519/JSC.0b013e31829480f5.
    1. Ana Carbonell Baeza VAAGM, Jonatan Ruz Ruiz, Francisco B. Ortega Porcel, Manuel Delgado Fernández. Guía de promoción para la actividad física. Junta de Andalucía, Consejería de Salud Depósito Legal: SE-8656-2010 2012.
    1. Hui AL, Ludwig S, Gardiner P, Sevenhuysen G, Dean HJ, Sellers E, McGavock J, Morris M, Shen GX, Jiang D. Effects of lifestyle intervention on dietary intake, physical activity level, and gestational weight gain in pregnant women with different pre-pregnancy Body Mass Index in a randomized control trial. BMC pregnancy childbirth. 2014;14(1):331. doi: 10.1186/1471-2393-14-331.
    1. de Onis M, Habicht JP. Anthropometric reference data for international use: recommendations from a World Health Organization Expert Committee. Am J Clin Nutr. 1996;64(4):650-8. .
    1. Perin F, Pittet JC, Schnebert S, Perrier P, Tranquart F, Beau P. Ultrasonic assessment of variations in thickness of subcutaneous fat during the normal menstrual cycle. European j ultrasound. 2000;11(1):7–14. doi: 10.1016/S0929-8266(99)00070-1.
    1. Panagiotakos DB, Pitsavos C, Stefanadis C. Dietary patterns: a Mediterranean diet score and its relation to clinical and biological markers of cardiovascular disease risk. Nutr Metab Cardiovasc Dis. 2006;16(8):559–568. doi: 10.1016/j.numecd.2005.08.006.
    1. Mariscal-Arcas M, Rivas A, Monteagudo C, Granada A, Cerrillo I, Olea-Serrano F. Proposal of a Mediterranean diet index for pregnant women. Br J Nutr. 2009;102(5):744–749. doi: 10.1017/S0007114509274769.
    1. Mataix J L, Martinez de Victoria E. et al. Valoración del estado nutricional de la Comunidad Autónoma de Andalucía; 2000.
    1. Astrand PO, Ryhming I. A nomogram for calculation of aerobic capacity (physical fitness) from pulse rate during sub-maximal work. J Appl Physiol. 1954;7(2):218–221.
    1. Rikli RE, Jones J. Development and validation of a functional fitness test for community residing older adults. J Aging Phys Act. 1999;7:129–161. doi: 10.1123/japa.7.2.129.
    1. Ruiz-Ruiz J, Mesa JL, Gutierrez A, Castillo MJ. Hand size influences optimal grip span in women but not in men. J Hand Surg [Am] 2002;27(5):897–901. doi: 10.1053/jhsu.2002.34315.
    1. Ortega FB, Ruiz JR, Espana-Romero V, Vicente-Rodriguez G, Martinez-Gomez D, Manios Y, Beghin L, Molnar D, Widhalm K, Moreno LA, et al. The International Fitness Scale (IFIS): usefulness of self-reported fitness in youth. Int J Epidemiol. 2011;40(3):701–711. doi: 10.1093/ije/dyr039.
    1. Payares K, Lugo LH, Morales V, Londono A. Validation in Colombia of the Oswestry disability questionnaire in patients with low back pain. Spine. 2011;36(26):E1730–E1735. doi: 10.1097/BRS.0b013e318219d184.
    1. Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med. 2001;8(12):1153–1157. doi: 10.1111/j.1553-2712.2001.tb01132.x.
    1. Buysse DJ, Reynolds CF, 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213. doi: 10.1016/0165-1781(89)90047-4.
    1. Herring SJ, Foster GD, Pien GW, Massa K, Nelson DB, Gehrman PR, Davey A. Do pregnant women accurately report sleep time? A comparison between self-reported and objective measures of sleep duration in pregnancy among a sample of urban mothers. Sleep breathing. 2013;17(4):1323–1327. doi: 10.1007/s11325-013-0835-2.
    1. Alonso J, Prieto L, Anto JM. [The Spanish version of the SF-36 Health Survey (the SF-36 health questionnaire): an instrument for measuring clinical results] Med Clin (Barc) 1995;104(20):771–776.
    1. Ruiz-Grosso P, Loret de Mola C, Vega-Dienstmaier JM, Arevalo JM, Chavez K, Vilela A, Lazo M, Huapaya J. Validation of the Spanish Center for Epidemiological Studies Depression and Zung Self-Rating Depression Scales: a comparative validation study. PLoS One. 2012;7(10):e45413. doi: 10.1371/journal.pone.0045413.
    1. Garcia-Esteve L, Ascaso C, Ojuel J, Navarro P. Validation of the Edinburgh Postnatal Depression Scale (EPDS) in Spanish mothers. J Affect Disord. 2003;75(1):71–76. doi: 10.1016/S0165-0327(02)00020-4.
    1. Spielberger CD, Gorsuch RL, RE. L (eds.). STAI: Manual del Cuestionario de Ansiedad Estado-Rasgo. Madrid: TEA Ediciones; 2002.
    1. Wesstrom J, Skalkidou A, Manconi M, Fulda S, Sundstrom-Poromaa I. Pre-pregnancy restless legs syndrome (Willis-Ekbom Disease) is associated with perinatal depression. J Clin Sleep Med. 2014;10(5):527–533.
    1. Perez-Romero T, Comas-Fuentes A, Deban-Fernandez M, Gonzalez-Nuevo Quinones JP, Maujo-Fernandez J. [Prevalence of restless legs syndrome at the office in primary health care] Rev Neurol. 2007;44(11):647–651.
    1. Isidori AM, Pozza C, Esposito K, Giugliano D, Morano S, Vignozzi L, Corona G, Lenzi A, Jannini EA. Development and validation of a 6-item version of the female sexual function index (FSFI) as a diagnostic tool for female sexual dysfunction. J Sex Med. 2010;7(3):1139–1146. doi: 10.1111/j.1743-6109.2009.01635.x.
    1. Fernandez-Berrocal P, Extremera N, Ramos N. Validity and reliability of the Spanish modified version of the Trait Meta-Mood Scale. Psychol Rep. 2004;94(3 Pt 1):751–755. doi: 10.2466/pr0.94.3.751-755.
    1. Watson D, Clark LA, Tellegen A. Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol. 1988;54(6):1063–1070. doi: 10.1037/0022-3514.54.6.1063.
    1. Campbell-Sills L, Stein MB. Psychometric analysis and refinement of the Connor-davidson Resilience Scale (CD-RISC): Validation of a 10-item measure of resilience. J Trauma Stress. 2007;20(6):1019–1028. doi: 10.1002/jts.20271.
    1. Notario-Pacheco B, Solera-Martinez M, Serrano-Parra MD, Bartolome-Gutierrez R, Garcia-Campayo J, Martinez-Vizcaino V. Reliability and validity of the Spanish version of the 10-item Connor-Davidson Resilience Scale (10-item CD-RISC) in young adults. Health qual life outcomes. 2011;9:63. doi: 10.1186/1477-7525-9-63.
    1. Junien C. Early determinants of health and disease: epigenetics and environment. Bull Acad Natl Med. 2011;195(3):511–526.
    1. Gaudet L, Wen SW, Walker M. The combined effect of maternal obesity and fetal macrosomia on pregnancy outcomes. J Obstet Gynaecol Can. 2014;36(9):776–784. doi: 10.1016/S1701-2163(15)30479-5.
    1. Sebert SP, Hyatt MA, Chan LL, Yiallourides M, Fainberg HP, Patel N, Sharkey D, Stephenson T, Rhind SM, Bell RC, et al. Influence of prenatal nutrition and obesity on tissue specific fat mass and obesity-associated (FTO) gene expression. Repro (Cambridge, England) 2010;139(1):265–274. doi: 10.1530/REP-09-0173.
    1. Russo LM, Nobles C, Ertel KA, Chasan-Taber L, Whitcomb BW. Physical Activity Interventions in Pregnancy and Risk of Gestational Diabetes Mellitus: A Systematic Review and Meta-analysis. Obstet Gynecol. 2015;125(3):576–582. doi: 10.1097/AOG.0000000000000691.
    1. Blehar MC, Spong C, Grady C, Goldkind SF, Sahin L, Clayton JA. Enrolling pregnant women: issues in clinical research. Women’s health issues. 2013;23(1):e39–e45. doi: 10.1016/j.whi.2012.10.003.
    1. Salvesen KÅ, Hem E, Sundgot-Borgen J. Fetal wellbeing may be compromised during strenuous exercise among pregnant elite athletes. Br J Sports Med. 2012;46(4):279–283. doi: 10.1136/bjsm.2010.080259.
    1. Davenport MH, Charlesworth S, Vanderspank D, Sopper MM, Mottola MF. Development and validation of exercise target heart rate zones for overweight and obese pregnant women. Appl physiol nutr metabol. 2008;33(5):984–989. doi: 10.1139/H08-086.
    1. Rallis S, Skouteris H, McCabe M, Milgrom J. A prospective examination of depression, anxiety and stress throughout pregnancy. Women birth. 2014;27(4):e36–e42. doi: 10.1016/j.wombi.2014.08.002.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться