Influence of a virtual exercise program throughout pregnancy during the covid-19 pandemic on perineal tears and episiotomy rates: A randomized clinical trial

The complications associated with COVID-19 confinement (impossibility of grouping, reduced mobility, distance between people, etc.) influence the lifestyle of pregnant women with important associated complications regarding pregnancy outcomes. Therefore, perineal traumas are the most common obstetric complications during childbirth. The aim of the present study was to examine the influence of a supervised virtual exercise program throughout pregnancy on perineal injury and episiotomy rates during childbirth. A randomized clinical trial design (NCT04563065) was used. Data were collected from 98 pregnant women without obstetric contraindications who attended their prenatal medical consultations. Women were randomly assigned to the intervention (IG, N = 48) or the control group (CG, N = 50). A virtual and supervised exercise program was conducted from 8–10 to 38–39 weeks of pregnancy. Significant differences were found between the study groups in the percentage of episiotomies, showing a lower episiotomy rate in the IG (N = 9/12%) compared to the CG (N = 18/38%) (χ2 (3) = 4.665; p = 0.031) and tears (IG, N = 25/52% vs. CG, N = 36/73%) (χ2 (3) = 4.559; p = 0.033). A virtual program of supervised exercise throughout pregnancy during the current COVID-19 pandemic may help reduce rates of episiotomy and perineal tears during delivery in healthy pregnant women

Embarazo físicamente activo, cuidado de la salud mental y emocional de la mujer gestante durante y después del COVID-19 = Active pregnancy: Emotional and mental health, and health care delivery for pregnant women during and after COVID-19

Introducción: La Pandemia de COVID-19 supuso un gran incremento en la prevalencia de patologías mentales, cambiando rutinas y hábitos y restringiendo el contacto social. Durante el embarazo, la salud mental de la mujer embarazada se puede ver fuertemente alterada debido a los naturales cambios hormonales sucedidos en su organismo. Sin embargo, estas enfermedades mentales durante el embarazo, han sido relacionadas con derivadas complicaciones tanto en el organismo materno como en el fetal. La medicación para combatir estas enfermedades está cuestionada dados los posibles efectos secundarios en ambos organismos, por lo que estrategias eficaces para afrontar estas alteraciones sin efectos nocivos para la salud, son necesarias. Objetivo: Examinar la influencia de un programa de ejercicio físico controlado y supervisado durante el embarazo en variables maternas y fetales que se obtienen durante la gestación. Material y Métodos: Un Ensayo Clínico Aleatorizado (ECA) fue llevado a cabo en colaboración con 5 centros sanitarios de España. Mujeres gestantes sanas, mayores de 18 años y con una edad gestacional comprendida entre 12 y 16 semanas fueron aleatorizadas al Grupo de Ejercicio (GE) o al Grupo de Control (GC). En el GE, las participantes llevaron a cabo un programa de ejercicio de intensidad moderada, supervisado por profesionales de las Ciencias de la Actividad Física y del Deporte, de carácter virtual durante el embarazo, realizando 3 sesiones semanales de 55-60 minutos de duración. Las participantes del GC recibieron un seguimiento obstétrico regular en los centros de referencia (colaboradores), así como información para desarrollar hábitos saludables durante el embarazo. Para medir la presencia de sintomatología en relación a enfermedades de carácter mental-psicológico (variables principales) se utilizaron diversos cuestionarios validados, en las semanas 12-16, 37 de embarazo y 6 de postparto. Otras variables maternas y neonatales fueron observadas durante la intervención para evaluar los efectos del programa sobre las mismas. Resultados: 228 mujeres gestantes sin contraindicaciones obstétricas fueron aleatoriamente asignadas al Grupo de Ejercicio (n = 106) y al Grupo de Control (n = 122). El porcentaje medio de adherencia al programa de ejercicio de las participantes en el GE fue de 86,33 ± 7,34. Tras el análisis de las variables principales, se encontraron diferencias significativas en la sintomatología depresiva al final del embarazo (9 (9,75) vs. 10 (9), p = 0,042). Así mismo, se identificó una correlación negativa (indicando menos síntomas conforme aumentaba la adherencia) entre la depresión al final del embarazo y el porcentaje de adherencia obtenido (r = -0,147; p = 0,031), y una correlación positiva indicando un aumento de los parámetros que valoran la percepción del estado de salud mental al final del embarazo conforme aumentaba la adherencia (r = 0,189; p = 0,037). Por otro lado, el porcentaje de mujeres que fumaron durante el embarazo fue significativamente menor en el GE en comparación con el GC (3,77% vs. 11,48%; χ2 (1) = 4,627; p = 0,031; Vc = 0,142) y hubo diferencias significativas en la semana de gestación en el instante del parto entre grupos (t222 = 2,27; p = 0,024; d = 0,30). Conclusiones: Un programa de ejercicio supervisado, virtual y de una intensidad moderada durante el embarazo puede actuar como una herramienta preventiva de complicaciones y alteraciones mentales y emocionales durante y después de la gestación. Gestantes participantes en un programa de ejercicio físico, durante el embarazo y de carácter virtual pueden tener una adherencia similar a la práctica de actividad física en comparación con un programa presencial. ABSTRACT Introduction: The COVID-19 Pandemic caused a great increase in the prevalence of mental pathologies, changing routines and restricting social contact. During pregnancy, the mental health of pregnant woman can be strongly altered due to the normal hormonal changes occurred in her body. However, these mental illnesses during pregnancy have been related to derived complications in both maternal and fetal organisms. The drugs intake to combat these diseases is questioned given the possible side effects in both organisms, so effective strategies to deal with these alterations without harmful effects on health are necessary. Objective: To examine the influence of a controlled and supervised physical exercise program during pregnancy on maternal and fetal variables obtained during pregnancy. Material and Methods: A Randomized Clinical Trial (RCT) was carried out in collaboration with 5 health centers in Spain. Healthy pregnant women, over 18 years old and with a gestational age between 12 and 16 weeks, were randomized to the Exercise Group (EG) or the Control Group (CG). In the EG, the participants carried out a moderate-intensity exercise program, supervised by Physical Activity and Sports Sciences professionals, via electronic devices (virtually), during pregnancy and carrying out 3 weekly sessions of 55-60 minutes duration. The CG participants received regular obstetric follow-up at the reference centers (collaborators) as well as information to develop healthy habits during pregnancy. To measure the symptomatology of mental-psychological illnesses (main variables), several validated questionnaires were used at weeks 12-16, 37 of pregnancy and 6 of postpartum. Other maternal and neonatal variables were observer during the intervention to evaluate the effects of the program on them. Results: 228 pregnant women without obstetric contraindications were randomly assigned to the Exercise Group (n = 106) and the Control Group (n = 122). The mean percentage of adherence to the exercise program of the participant in the EG was 86,33 ± 7,34. After the analysis of the main variables, significant differences were found in depressive symptomatology at the end of pregnancy (9 (9,75) vs. 10 (9), p = 0,042). Likewise, a negative correlation (indicating less symptoms as adherence increased) was identified between depression at the end of pregnancy and the percentage of adherence obtained (r = -0,147; p = 0,031), and a positive correlation observing an increase in the parameters that assess the mental health self-perception at the end of pregnancy as adherence increased (r = 0,189; p = 0,037). On the other hand, the percentage of women who smoked during pregnancy was significantly lower in the EG versus the CG (3,77% vs. 11,48%; χ2 (1) = 4,627; p = 0,031; Vc = 0,142) and there were significant differences in the week of gestation at the time of delivery between groups (t222 = 2,27; p = 0,024; d = 0,30). Conclusions: A supervised, virtual and moderate intensity exercise program during pregnancy can act as a preventive tool for mental and emotional disorders and complications during and after pregnancy. Pregnant women participating in a virtual physical exercise program during pregnancy may have a similar adherence to the practice of physical activity compared to a face-to-face program

Prenatal Anxiety and Exercise. Systematic Review and Meta-Analysis

The prevalence of prenatal anxiety has increased during the COVID-19 pandemic. Anxiety is associated with other cardiovascular, physiological, and mental illnesses, resulting in adverse health effects for the mother and foetus. The purpose of this study was to evaluate the effects of physical activity (PA) during pregnancy on the prevalence of prenatal anxiety or symptoms of anxiety. A systematic review and two meta-analyses were performed (Registration No. CRD42021275333). Peer-reviewed articles reporting the effect of a PA intervention on anxiety during pregnancy were included. The first meta-analysis (MA) included 10 studies reporting final scores of prenatal anxiety. A negative association between moderate PA during pregnancy and prenatal anxiety was found in this analysis (z = −2.62, p < 0.01; ES = −0.46, 95% CI = −0.80, −12, I2 = 84%, Pheterogeneity = 0.001). The second MA included eight studies in which measures both before and after a PA intervention were reported. The findings of this analysis revealed a positive association between exercise practice during pregnancy and a decrease in prenatal anxiety scores (z = −3.39, p < 0.001; ES = −0.48, 95% CI = −0.76, −0.20, I2 = 71%, Pheterogeneity = 0.001). Supervised PA during pregnancy could prevent and reduce prenatal anxiety and anxiety symptoms

A scoping review exploring stigma associated with postpartum urinary incontinence

Background: Postpartum urinary incontinence (PUI) occurs in 30–33% of individuals after their pregnancy, and has a detrimental impact on quality of life. Although common, PUI carries social stigma and this can affect patient behaviors, including not revealing symptoms and seeking appropriate care. Purpose: To summarize the causes of PUI stigma and its implications on health behaviors and outcomes. Methods: A scoping review was performed. The search was carried out on multiple search engines focusing on the postpartum period, urinary incontinence, and stigma. Data were extracted and mapped to identify causal factors of postpartum UI stigma and implications on outcomes and behaviors. Results: Twelve studies were included in this review. The main sources of PUI stigma were community values that negatively perceive urinary leakages as unclean and as lacking bodily control, along with self-stigma where participants seemed to be directing stereotypes and misconceptions surrounding PUI towards themselves. All studies emphasized that PUI was associated with feelings of embarrassment and shame, and this decreased the likelihood of discussing care options with healthcare providers. Conclusions: Moving forward, it is necessary to further understand PUI stigma from lived experience, including applying an intersectional approach to capture potential cultural nuances. Healthcare providers should be aware that PUI stigma could reduce patient communication, and therefore, the provider may need to initiate an effective and sensitive dialogue.info:eu-repo/semantics/publishedVersio

A scoping review exploring stigma associated with postpartum urinary incontinence

Introduction and hypothesis: Postpartum urinary incontinence (UI) is prevalent, yet health-seeking behaviours for prevention and treatment are markedly low. Health-related stigma refers to conditions that may be socially devalued and considered deviating from "expected norms" and is a barrier to equitable health care. It may be plausible that stigma is associated with postpartum UI and leads to avoiding health-seeking behaviours, which this scoping review sought to examine and summarize. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews were followed. The following keywords were used to develop a search strategy: Postpartum, Urinary Incontinence, and Stigma. The search was carried out on PubMed, PsycINFO, Scopus, CINAHL, Web of Science, ProQuest Dissertation, and Theses Global. All study designs (clinical trials, observational studies, qualitative studies) were eligible for inclusion. Data were extracted and mapped to identify causal factors of postpartum UI stigma and implications for outcomes and behaviours. Results: Twelve studies were included. Most studies utilized questionnaires assessing constructs related to the quality of life that also captured potential stigma or interviews. Sources of postpartum UI stigma included community values surrounding UI and self-stigma, whereby participants directed stereotypes associated with urinary leakage toward themselves. Implications of postpartum UI stigma included negative mental emotions such as shame and embarrassment, which led to avoiding situations where they needed to disclose symptoms, including in healthcare environments. Conclusions: Future research requires a purposeful assessment of postpartum UI stigma to learn from lived experience how to mitigate stigma and improve the quality of care.info:eu-repo/semantics/publishedVersio

A Virtual Exercise Program throughout Pregnancy during the COVID-19 Pandemic Modifies Maternal Weight Gain, Smoking Habits and Birth Weight—Randomized Clinical Trial

The intrauterine environment is key to health from a short- and long-term perspective. Birth weight is an important indicator that may influence the fetal environment due to epigenetics. Considering physical inactivity, in parallel with higher levels of stress, affecting smoking patterns and the physical and emotional health of the pregnant population, maintaining the health of future generations is crucial. A randomized clinical trial (NCT04563065) was conducted. One-hundred and ninety-two healthy pregnant individuals were assigned to the intervention (IG) or control (CG) group. Overall, significant differences were found between groups when stratified by birth weight (χ2 (1) = 6.610; p = 0.037) with low birth weight and macrosomia found more often in the CG (4% vs. 14% and 3% vs. 9%, respectively) and higher admissions to the neonatal intensive care unit (χ2 (1) = 5.075; p = 0.024) in the CG (20/28.6%) compared to the IG (9/13.0). Smoking during pregnancy was also found more often in the CG (12/17.1%) compared to the IG (3/4.4%) (p = 0.016). A virtual program of supervised exercise throughout pregnancy during the ongoing pandemic could help to maintain adequate birth weights, modify maternal smoking habits, and lower admissions to the neonatal intensive care unit

Prenatal Anxiety and Exercise. Systematic Review and Meta-Analysis

The prevalence of prenatal anxiety has increased during the COVID-19 pandemic. Anxiety is associated with other cardiovascular, physiological, and mental illnesses, resulting in adverse health effects for the mother and foetus. The purpose of this study was to evaluate the effects of physical activity (PA) during pregnancy on the prevalence of prenatal anxiety or symptoms of anxiety. A systematic review and two meta-analyses were performed (Registration No. CRD42021275333). Peer-reviewed articles reporting the effect of a PA intervention on anxiety during pregnancy were included. The first meta-analysis (MA) included 10 studies reporting final scores of prenatal anxiety. A negative association between moderate PA during pregnancy and prenatal anxiety was found in this analysis (z = −2.62, p p < 0.001; ES = −0.48, 95% CI = −0.76, −0.20, I2 = 71%, Pheterogeneity = 0.001). Supervised PA during pregnancy could prevent and reduce prenatal anxiety and anxiety symptoms

Effects of Physical Activity Interventions on Self-Perceived Health Status among Lung Cancer Patients: Systematic Review and Meta-Analysis

Patients with lung cancer may experience deterioration in quality of life due to adverse effects caused by their disease and its treatment. Although exercise programs have been shown to improve quality of life in certain stages of the disease, the overall impact on this population is unknown. The objective of this research was to evaluate the effect of physical activity on the self-perception of quality of life, physical wellbeing and dyspnea in lung cancer patients. Thirteen articles were included. Five meta-analyses were performed using the standardized mean difference (SMD) with 95% confidence intervals (CI) to evaluate the target outcomes. Results showed significant differences in quality of life (p = 0.01; SMD = 0.43, 95% CI = 0.10, 0.75), physical functioning (p = 0.01; SMD = 0.27, 95% CI = 0.06, 0.49) and physical wellbeing (p = 0.01; SMD = 0.37, 95% CI = 0.08, 0.67) in favour of participants who have undergone the programme compared to those who have not, without significant differences between the two groups in dyspnea. This study shows how physical activity interventions could have positive effects on physical functioning and physical wellbeing but could also be effective for improving quality of life in patients with lung cancer

Effectiveness of a Virtual Exercise Program During COVID-19 Confinement on Blood Pressure Control in Healthy Pregnant Women

Background: The situation caused by COVID-19 has led to movement restrictions for the majority of the population due to the confinement established by the health authorities. This new situation has changed people’s habits and significantly affected the pregnant population. Decreased exercise and increased psychophysical stress are associated with excessive weight gain, diabetes, and gestational cardiovascular complications that affect the mother, fetus, and newborn. Recent research shows that the dynamics of maternal blood pressure is one of the most important control factors during pregnancy. Thus, prevention of these type of pathologies through interventions without maternal-fetal risks is important. Objectives: To examine the influence of a virtual exercise program on maternal blood pressure during pregnancy. Materials and Methods: A randomized clinical trial design was used (NCT04563065). Data from 72 pregnant women without obstetric contraindications under confinement conditions in the Madrid area were collected. Women were randomly assigned to the intervention (IG) or control group (CG). They previously signed informed consent forms. A moderate exercise program was performed as an intervention from 8–10 to 38–39 weeks of pregnancy. Systolic (SBP) and diastolic (DBP) maternal blood pressure were measured during the first, second and third trimesters of pregnancy, as well as before and immediately after delivery in both study groups. Results: No differences in systolic and diastolic blood pressure during the first, second and third trimesters were found between groups. Significant differences in SBP were found immediately before delivery (IG = 119.83 ± 10.16 vs. CG = 125.6 ± 10.91; p = 0.047) and immediately after delivery (IG = 115.00 ± 11.18 vs. CG = 122.24 ± 15.71; p = 0.045). Conclusions: Results show lower SBP values for the IG during delivery than CG. A virtual exercise program throughout pregnancy during COVID-19 confinement can help to control systolic blood pressure before and immediately after delivery in healthy pregnant women

The Effect of Online Supervised Exercise throughout Pregnancy on the Prevention of Gestational Diabetes in Healthy Pregnant Women during COVID-19 Pandemic: A Randomized Clinical Trial

(1) Background: to examine the effect of an online supervised exercise program during pregnancy on the prevention of GDM, and on maternal and childbirth outcomes. (2) Methods: we conducted a randomized clinical trial (NCT04563065) in 260 pregnant women without obstetric contraindications who were randomized into two study groups: intervention group (IG, N = 130) or control group (CG, N = 130). An online supervised exercise program was conducted from 8&ndash;10 to 38&ndash;39 weeks of pregnancy. (3) Results: no significant differences were found at baseline in maternal characteristics; nevertheless, certain outcomes showed a favorable trend towards the IG. A lower number and percentage of GDM cases were found in the IG compared to the CG (N = 5/4.9% vs. N = 17/16.8%, p = 0.006). Similarly, fewer cases of excessive maternal weight gain (N = 12/11.8% vs. N = 31/30.7%, p = 0.001) were found in the IG, and a lower percentage of instrumental deliveries (N = 8/11.3% vs. N = 13/15.1%) and c-sections (N = 7/9.9% vs. N = 20/23.3%, p = 0.046). (4) Conclusions: an online supervised exercise program can be a preventative tool for GDM in healthy pregnant women