Preventing long-term risk of obesity for two generations: Prenatal physical activity is part of the puzzle

Background. The period surrounding pregnancy has been identified as a risk period for overweight/obesity in both mother and child because of excessive gestational weight gain (GWG). The promotion of a healthy GWG is therefore of paramount importance in the context of the prevention of obesity in the current and next generations. Objective. To provide a comprehensive overview of the effect of prenatal physical activity interventions, alone or in combination with nutritional counselling, on GWG and to address whether preventing excessive GWG decreases the incidence of infant high birth weight and/or postpartum weight retention. Method. A search of the PubMed database was conducted to identify all relevant studies. Nineteen studies were included in this review: 13 interventions combining physical activity, nutrition, and GWG counselling and 6 interventions including physical activity alone. Results. Prenatal lifestyle interventions promoting healthy eating and physical activity habits appear to be the most effective approach to prevent excessive GWG. Achievement of appropriate GWG may also decrease the incidence of high infant birth weight and postpartum weight retention. Conclusion. Healthy eating habits during pregnancy, combined with an active lifestyle, may be important elements in the prevention of long-term risk of obesity for two generations. © 2012 Stephanie-May Ruchat and Michelle F. Mottola

Cross-cultural adaptation of the Cardiff Fertility Knowledge Scale and the Fertility Status Awareness Tool for the French-Canadian population

OBJECTIVE: The Cardiff Fertility Knowledge Scale (CFKS) and the Fertility Status Awareness Tool (FertiSTAT) are validated tools allowing the evaluation of fertility knowledge and raising awareness about risk indicators for reduced fertility. Their use by health care professionals practicing in the field of reproductive health might optimize fertility of the Canadian population. However, there currently is no version of these questionnaires for the French-Canadian population. The objective of this study was to translate and culturally adapt the CFKS and FertiSTAT to the French-Canadian population. METHODS: The translation and adaptation of the questionnaires was completed following a 4- stage approach: 1) forward translation, 2) synthesis, 3) expert committee review, and 4) testing of the prefinal version of the questionnaires. The testing stage was conducted with a sample of 30 women and 10 men. RESULTS: During the translation process, linguistic difficulties were met for some items of both questionnaires but were resolved by consensus of the expert committee. Thirty women and 10 men tested the prefinal version of the CFKS-F and FertiSTAT-F. On a 5-point Likert scale, the global comprehension was 4.8±0.5 and 4.6±0.6, respectively. Based on the comments of the participants, the expert committee made minor modifications in the final version of the questionnaires to clarify the formulation of questions and adapt to one medical term. CONCLUSION: Tools to assess fertility knowledge and the presence of risk indicators for reduced fertility are now available for health care professionals practicing in the field of reproductive health

Lumbopelvic pain, anxiety, physical activity and mode of conception: a prospective cohort study of pregnant women

Objectives Pregnancy-related lumbopelvic pain (LPP) is a frequent condition known to significantly affect women in their daily life. The aetiology of pregnancy-related LPP pain is still not clearly established but the mode of conception has been suggested to contribute to LPP. Anxiety related to fertility treatments may be one of the contributing factors. The primary objectives of this study were to determine the evolution of LPP prevalence and severity, and anxiety throughout pregnancy in women who conceived spontaneously (SP) or after fertility treatments (FT). A further aim was to examine the relationship between pregnancy-related LPP severity and anxiety. The secondary objective was to determine the evolution of physical activity and their correlation with the severity of pregnancy-related LPP. Design Prospective cohort study. Setting Pregnant women were recruited through physicians’ referrals, posters and newspaper advertisements in the local and surrounding communities (hospital, maternity care clinic, prenatal centres, sports centres, local university) in the city of Trois-Rivières, Canada. Participants 59 pregnant women (33 SP and 26 FT) were assessed during the first, second and third trimester of pregnancy.Primary and secondary outcome measures Pregnancy-related LPP prevalence and severity (primary), trait and state anxiety, and physical activity levels (secondary).Results There was no relationship between the mode of conception and the outcome measures. The prevalence and severity of LPP increased over the course of pregnancy (time effect, p<0.0001) whereas trait anxiety decreased from early to mid-pregnancy (time effect, p=0.03). Activity limitations increased throughout pregnancy (time effect, p<0.0001) and physical activity levels decreased (time effect, p<0.0001). The severity of LPP was positively correlated with activity limitations (r=0.51 to 0.55) but negatively with physical activity levels (r=−0.39 to −0.41).Conclusions Maternal health-related factors, such as LPP, anxiety and physical activity, are not different in women who conceived spontaneously or after fertility treatments. The more LPP was severe, the more the women were physically limited and inactive

Effects of prenatal exercise on fetal heart rate, umbilical and uterine blood flow: a systematic review and meta-analysis

Objective To perform a systematic review and meta-analysis examining the influence of acute and chronic prenatal exercise on fetal heart rate (FHR) and umbilical and uterine blood flow metrics. Design Systematic review with random-effects meta-analysis and meta-regression. Data sources Online databases were searched up to 6 January 2017. Study eligibility criteria Studies of all designs were included (except case studies) if published in English, Spanish or French, and contained information on the population (pregnant women without contraindication to exercise), intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise, alone [“exercise-only”] or in combination with other intervention components [eg, dietary; “exercise + co-intervention”]), comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and outcomes (FHR, beats per minute (bpm); uterine and umbilical blood flow metrics (systolic:diastolic (S/D) ratio; Pulsatility Index (PI); Resistance Index (RI); blood flow, mL/min; and blood velocity, cm/s)). Results ‘Very low’ to ‘moderate’ quality evidence from 91 unique studies (n=4641 women) were included. Overall, FHR increased during (mean difference (MD)=6.35bpm; 95% CI 2.30 to 10.41, I2=95%, p=0.002) and following acute exercise (MD=4.05; 95% CI 2.98 to 5.12, I2=83%, p\u3c0.00001). The incidence of fetal bradycardia was low at rest and unchanged with acute exercise. There were no significant changes in umbilical or uterine S/D, PI, RI, blood flow or blood velocity during or following acute exercise sessions. Chronic exercise decreased resting FHR and the umbilical artery S/D, PI and RI at rest. Conclusion Acute and chronic prenatal exercise do not adversely impact FHR or uteroplacental blood flow metrics

Effectiveness of exercise interventions in the prevention of excessive gestational weight gain and postpartum weight retention: a systematic review and meta-analysis

Objective Gestational weight gain (GWG) has been identified as a critical modifier of maternal and fetal health. This systematic review and meta-analysis aimed to examine the relationship between prenatal exercise, GWG and postpartum weight retention (PPWR). Design Systematic review with random effects meta-analysis and meta-regression. Online databases were searched up to 6 January 2017. Study eligibility criteria Studies of all designs in English, Spanish or French were eligible (except case studies and reviews) if they contained information on the population (pregnant women without contraindication to exercise), intervention (frequency, intensity, duration, volume or type of exercise, alone [ exercise-only ] or in combination with other intervention components [eg, dietary; exercise + co-intervention]), comparator (no exercise or different frequency, intensity, duration, volume or type of exercise) and outcomes (GWG, excessive GWG (EGWG), inadequate GWG (IGWG) or PPWR). Results Eighty-four unique studies (n=21530) were included. Low\u27 to moderate\u27 quality evidence from randomised controlled trials (RCTs) showed that exercise-only interventions decreased total GWG (n=5819; -0.9kg, 95%CI -1.23 to -0.57kg, I-2=52%) and PPWR (n=420; -0.92kg, 95%CI -1.84 to 0.00kg, I-2=0%) and reduced the odds of EGWG (n=3519; OR 0.68, 95%CI 0.57 to 0.80, I-2=12%) compared with no exercise. High\u27 quality evidence indicated higher odds of IGWG with prenatal exercise-only (n=1628; OR 1.32, 95%CI 1.04 to 1.67, I-2=0%) compared with no exercise. Conclusions Prenatal exercise reduced the odds of EGWG and PPWR but increased the risk of IGWG. However, the latter result should be interpreted with caution because it was based on a limited number of studies (five RCTs)

Is supine exercise associated with adverse maternal and fetal outcomes? A systematic review

Objective Theoretical concerns regarding the supine position at rest due to the gravid uterus obstructing aorta and vena caval flow may impinge uterine blood flow (UBF) to the fetus and maternal venous return. Design Systematic review. Data sources Online databases up to 11 December 2017. Study criteria Eligible population (pregnant without contraindication to exercise), intervention (frequency, intensity, duration, volume or type of supine exercise), comparator (no exercise or exercise in left lateral rest position, upright posture or other supine exercise), outcomes (potentially adverse effects on maternal blood pressure, cardiac output, heart rate, oxygen saturation, fetal movements, UBF, fetal heart rate (FHR) patterns; adverse events such as bradycardia, low birth weight, intrauterine growth restriction, perinatal mortality and other adverse events as documented by study authors), and study design (except case studies and reviews) published in English, Spanish, French or Portuguese. Results Seven studies (n=1759) were included. \u27Very low\u27 to \u27low\u27 quality evidence from three randomised controlled trials indicated no association between supervised exercise interventions that included supine exercise and low birth weight compared with no exercise. There was \u27very low\u27 to \u27low\u27 quality evidence from four observational studies that showed no adverse events in the mother; however, there were abnormal FHR patterns (as defined by study authors) in 20 of 65 (31%) fetuses during an acute bout of supine exercise. UBF decreased (13%) when women moved from left lateral rest to acute dynamic supine exercise. Conclusion There was insufficient evidence to ascertain whether maternal exercise in the supine position is safe or should be avoided during pregnancy

2019 Canadian guideline for physical activity throughout pregnancy

The objective is to provide guidance for pregnant women and obstetric care and exercise professionals on prenatal physical activity. The outcomes evaluated were maternal, fetal or neonatal morbidity, or fetal mortality during and following pregnancy. Literature was retrieved through searches of MEDLINE, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Scopus and Web of Science Core Collection, CINAHL Plus with Full Text, Child Development & Adolescent Studies, Education Resources Information Center, SPORTDiscus, ClinicalTrials.gov and the Trip Database from inception up to 6 January 2017. Primary studies of any design were eligible, except case studies. Results were limited to English-language, Spanish-language or French-language materials. Articles related to maternal physical activity during pregnancy reporting on maternal, fetal or neonatal morbidity, or fetal mortality were eligible for inclusion. The quality of evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation methodology. The Guidelines Consensus Panel solicited feedback from end users (obstetric care providers, exercise professionals, researchers, policy organisations, and pregnant and postpartum women). The development of these guidelines followed the Appraisal of Guidelines for Research and Evaluation II instrument. The benefits of prenatal physical activity are moderate and no harms were identified; therefore, the difference between desirable and undesirable consequences (net benefit) is expected to be moderate. The majority of stakeholders and end users indicated that following these recommendations would be feasible, acceptable and equitable. Following these recommendations is likely to require minimal resources from both individual and health systems perspectives