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Purpose: The objective of this study is to assess the effects of supervised, recommended levels of prenatal aerobic exercise on 1-month-old infant cardiac function., Methods: Eligible pregnant women were randomly assigned to either an aerobic exercise group that participated in 150 min of supervised, moderate-intensity (40% to 59% V̇O 2peak , 12 to 14 on Borg rating of perceived exertion) aerobic exercise per week for 24 wk or more or a nonexercising group that consisted of 150 min·wk -1 of relaxation techniques. One-month-old infant echocardiogram was performed to assess infant cardiac function , including heart rate (HR), left-ventricular stroke volume, cardiac output, cardiac index, ejection fraction, fractional shortening, and velocity time integral at the aortic valve. Pearson correlation analyses and linear regression models were performed., Results: Prenatal aerobic exercise was negatively correlated with infant resting HR ( r = -0.311, P = 0.02). Similarly, when controlling for infant sex and activity state, exercise level/volume ( β = -0.316; 95% CI, -0.029 to -0.002; P = 0.02) predicted resting infant HR ( R2 = 0.18, P = 0.02). In infants of overweight/obese women, infants of aerobic exercisers had increased fractional shortening ( P = 0.03). In addition, infant ventricular ejection fraction was correlated with maternal exercise attendance ( r = 0.418, P = 0.03) as well as a trend for exercise level ( r = 0.351, P = 0.08). Similarly, the only significant regression model for infants of overweight/obese women controls infant activity state ( β = -0.444; 95% CI, -0.05 to -0.01; P = 0.006) and maternal exercise level ( β = 0.492; 95% CI, 5.46-28.74; P = 0.01) predicting infant resting HR ( F = 5.79, R2 = 0.40, P = 0.003)., Conclusions: The findings of this study demonstrate that women participating in exercise in the second and third trimesters of their pregnancy may have infants with increased cardiac function at 1 month of age. Importantly, the cardiac function effects were further augmented for infants born to overweight/obese women., (Copyright © 2023 by the American College of Sports Medicine.)

The aim of this study was to update and validate the Pregnancy Physical Activity Questionnaire (PPAQ), using novel and innovative accelerometer and wearable camera measures in a free-living setting, to improve the measurement performance of this method for self-reporting physical activity. A prospective cohort of 50 eligible pregnant women were enrolled in early pregnancy (mean = 14.9 weeks' gestation). In early, middle, and late pregnancy, participants completed the updated PPAQ and, for 7 days, wore an accelerometer (GT3X-BT; ActiGraph, Pensacola, Florida) on the nondominant wrist and a wearable camera (Autographer; OMG Life (defunct)). At the end of the 7-day period, participants repeated the PPAQ. Spearman correlations between the PPAQ and accelerometer data ranged from 0.37 to 0.44 for total activity, 0.17 to 0.53 for moderate- to vigorous-intensity activity, 0.19 to 0.42 for light-intensity activity, and 0.23 to 0.45 for sedentary behavior. Spearman correlations between the PPAQ and wearable camera data ranged from 0.52 to 0.70 for sports/exercise and from 0.26 to 0.30 for transportation activity. Reproducibility scores ranged from 0.70 to 0.92 for moderate- to vigorous-intensity activity and from 0.79 to 0.91 for sports/exercise, and were comparable across other domains of physical activity. The PPAQ is a reliable instrument and a valid measure of a broad range of physical activities during pregnancy., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: Assess the effects of supervised, prenatal aerobic exercise intervention on 1-month-old neonatal morphometry., Methods: Secondary data analyses of a 24+ week, randomized controlled exercise intervention trial in pregnant women between 2015 and 2018 were performed. Eligibility criteria included pregnant women: <16 weeks of gestation, singleton pregnancy, aged 18-40 years, and body mass index of 18.5-35.00 kg∙m 2 . Eligible pregnant women (n = 128) were randomly assigned a moderate-intensity aerobic exercise group (n = 68) or a nonexercising group (n = 60) consisting of light stretching and breathing techniques. Neonatal weight, skinfold thickness, circumferences, and fat-free mass were measured at 1-month of age. Covariates included weight gain, gestational diabetes mellitus, and neonatal sex. ANCOVAs for intention-to-treat (ITT) and per protocol were performed., Results: ITT and per protocol analyses included 74 and 56 participants, respectively. Adjusted regression results showed significant between-group differences for neonatal skinfold thickness (ITT: 20.0 mm vs. 22.2 mm; p = .04; per protocol: 19.8 mm vs. 22.3 mm; p = .03) and body fat (per protocol 13.2% vs. 15.1%; p = .05). No between-group differences for weight (p = .36, .25), abdominal (p = .08, .35) and mid-upper arm circumferences (p = .30, .26), or fat-free mass (p = .83, .69)., Conclusion: The study findings suggest that aerobic exercise has a beneficial impact on neonatal skinfold thickness and percent body fat at 1 month of age. Participation in the recommended levels of aerobic exercise (150 min, moderate-intensity per week) throughout the prenatal period may serve as an effective strategy to reduce the risk of overweight or obesity in the early postnatal period., (© 2020 Wiley Periodicals, Inc.)

Objective: The purpose of this study was to determine the effects of supervised prenatal aerobic exercise on fetal morphometrics at 36 weeks of gestation., Methods: This study used data from a, 24-week, two-arm randomized controlled trial: aerobic exercise (EX) and stretching/breathing comparison group (CON). Singleton pregnancies (< 16 weeks pregnant) and women aged 18 to 40 years, BMI between 18.5 and 34.99 kg/m 2 , and no preexisting chronic health conditions were eligible. The EX group participated in 150 min of moderate-intensity weekly exercise while CON group participated in low-intensity stretching/breathing. Fetal morphometric outcomes included estimated fetal weight (EFW), ponderal index (PI), abdominal circumference (AC), anterior abdominal wall thickness (AAWT), fat mass, percent body fat, fat-free mass, assessed at 36 weeks gestation. Partial spearman rank correlations were performed, adjusting for 3 rd trimester weight gain., Results: Of the 128 pregnant women randomized, 83 (EX [n = 46] and CON [n = 37]) were eligible for analyses. Intention-to-treat analysis showed no differences in EFW (rho s  = - 0.13; p = 0.28), PI (rho s  = 0.03; p = 0.81), AC (rho s  = - 0.22; p = 0.09), AAWT (rho s  = - 0.11; p = 0.40), fat mass (rho s  = - 0.16; p = 0.23), percent body fat (rho s  = - 0.10; p = 0.43), and fat-free mass (rho s  = - 0.22; p = 0.08), after adjusting for 3rd trimester weight gain. Similar results were observed in the per protocol analyses., Conclusions: For Practice Moderate-intensity aerobic exercise during pregnancy was not associated with select fetal morphometrics at 36 weeks gestation. Potential differences in offspring morphometrics may only appear in the postnatal period, as previously documented. Further research into offspring tissue composition after birth is encouraged, specifically studies investigating differences in cellular signaling pathways related to adipose and skeletal muscle tissue development.

Aims: To assess the impact of a culturally modified, motivationally targeted, individually-tailored intervention on postpartum physical activity (PA) and PA self-efficacy among Hispanic women., Methods: Estudio PARTO was a randomized controlled trial conducted in Western Massachusetts from 2013-17. Hispanic women who screened positive for gestational diabetes mellitus were randomized to a Lifestyle Intervention (LI, n = 100) or to a comparison Health and Wellness (HW, n = 104) group during late pregnancy. Exercise goals in LI were to meet American College of Obstetrician & Gynecologists guidelines for postpartum PA. The Pregnancy Physical Activity Questionnaire (PPAQ) and the Self-Efficacy for Physical Activity Questionnaire were administered at 6 weeks, 6 months, and 1 year postpartum., Results: Compared to baseline levels, both groups had significant increases in moderate-to-vigorous PA at 6 months and one year postpartum (i.e., LI: mean change = 30.9 MET-hrs/wk, p = 0.05; HW: 27.6 MET-hrs/wk, p = 0.01), with only LI group experiencing significant increases in vigorous PA (mean change = 1.3 MET-hrs/wk, p = 0.03). Based on an intent-to-treat analysis using mixed effects models, we observed no differences in pattern of change in PA intensity and type over time between intervention groups (all p > 0.10). However, there was the suggestion of a greater decrease in sedentary activity in the LI group compared to the HW group (β = -3.56, p = 0.09)., Conclusions: In this randomized trial among high-risk Hispanic women, both groups benefitted from participation in a postpartum intervention., Competing Interests: The authors have declared that no competing interests exist.

Aims: The purpose of the study was to assess the effect of leisure and occupational physical activity on the risk of diagnosed and undiagnosed prediabetes among females and males., Methods: A sample of 17,871 non-pregnant adults was drawn from the 2007-2014 National Health and Nutrition Examination Survey. Multinomial logistic regression tested associations between moderate-to-vigorous physical activity (MVPA) and risk of diagnosed prediabetes and undiagnosed prediabetes, compared to no prediabetes., Results: Females and males who met guidelines for total MVPA (i.e., ≥10 MET-hrs/week) had a statistically significant lower risk of undiagnosed prediabetes (OR range: 0.50-0.65) as compared to those with no MVPA, however findings were no longer statistically significant after adjustment for diabetes risk factors. In terms of diagnosed prediabetes, females meeting guidelines had lower risk (OR range: 0.65-0.76), while only males engaging in the most MVPA had lower risk; findings were no longer significant after adjustment. Patterns were similar for leisure-time MVPA, but conflicting for occupational PA; females with 10-20 MET-hrs/week had a higher risk of diagnosed prediabetes (OR =1.71, 95% CI 1.11-2.61) and males with >20 MET-hrs/week had a higher risk for undiagnosed prediabetes (OR =1.17, 95% CI 1.02-1.35) after adjustment., Conclusions: This study adds to the sparse body of literature on physical activity and prediabetes, particularly with its inclusion of occupational MVPA., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Mabeline Velez et al.)

Objective/Background : Poor sleep during pregnancy is common and is associated with pregnancy complications. Physical activity (PA) is associated with better sleep in nonpregnant populations. However, studies among pregnant women are sparse, conflicting, and none have been conducted among Hispanic women, who face a disproportionate burden of poor sleep and pregnancy complications. Therefore, our objective was to examine the relationship between intensity- and domain-specific PA, respectively, on sleep quality and duration among Hispanic pregnant women. Participants : We evaluated these associations among participants ( n  = 251) in Estudio PARTO, an ongoing randomized controlled trial aimed at reducing type 2 diabetes among women at high risk. Methods : We assessed the cross-sectional relationship between PA (via Pregnancy PA Questionnaire) and sleep quality and duration (via Pittsburgh Sleep Quality Index) using baseline data (26.5 ± 6.9 weeks gestation). Results : In multivariable logistic models, household and caregiving activities were associated with higher odds of very poor sleep quality (OR = 2.69; 95% CI = 1.04 to 7.04) and with short (vs. medium) sleep duration (OR = 2.85; 95% CI = 1.07 to 7.56). In contrast, occupational PA was associated with lower odds of very poor sleep quality (OR = 0.39; 95% CI = 0.17 to 0.89). Light-intensity PA was associated with lower odds of long (vs. medium) sleep duration (OR = 0.13; 95% CI = 0.03 to 0.52). There were no statistically significant relationships between PA in any other domain and sleep. Conclusions : Prospective studies will be critical in evaluating the potential adverse impact of household and caregiving activities on poor sleep quality.

Objectives: Poor sleep among postpartum women is associated with adverse maternal outcomes. Physical activity (PA) is associated with better sleep. However, few studies have been conducted among postpartum Hispanic women. The objective of this study was to examine the association between PA and sleep quality and duration among postpartum Hispanic women., Design: A cross-sectional analysis using baseline data from Estudio PARTO, an ongoing randomized controlled trial aimed at reducing type 2 diabetes risk among Hispanic women., Setting: Baystate Medical Center, in Western Massachusetts, which serves an ethnically and socioeconomically diverse population., Participants: Hispanic women, at elevated risk for type 2 diabetes, at a mean of 11 weeks (SD = 4.5) postpartum., Measurements: PA was measured with the Pregnancy Physical Activity Questionnaire (PPAQ), and sleep was measured with the Pittsburgh Sleep Quality Index (PSQI)., Results: Mean sleep duration was 5.9 hour/night (SD = 1.7) and PSQI score was 6.5 (SD = 3.9). In multivariable logistic models, sports/exercise was associated with lower odds of very poor sleep quality (PSQI >10) (OR = 0.18, 95% CI = 0.05 to 0.69). Sports/exercise (OR = 0.05, 95% CI = 0.01 to 0.26) and vigorous intensity PA (OR = 0.13, 95% CI = 0.04 to 0.42) were associated with lower odds of short (vs normal) sleep duration. There were no statistically significant relationships between PA in any other domain or intensity and sleep quality or duration CONCLUSIONS: Findings can inform interventions designed to improve postpartum sleep via increasing opportunities for exercise among postpartum women., (Copyright © 2019 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Rates of cesarean delivery continue to increase among Hispanics, the largest minority group in the United States. Prior studies of the relationship between physical activity and cesarean delivery have been conflicting, limited by questionnaires not validated for pregnancy, and conducted primarily among non-Hispanic whites., Methods: We evaluated this association among participants (n = 1313) in Proyecto Buena Salud, a prospective cohort of Hispanic women conducted from 2006 to 2011. Physical activity was measured via the Pregnancy Physical Activity Questionnaire., Results: In total, 320 (24.4%) participants delivered via cesarean. In multivariable analyses, increasing levels of sedentary activity in mid/late pregnancy were associated with higher odds of cesarean delivery (odds ratio = 1.54; 95% confidence interval, 1.02-3.33; P trend  = .05); however, there were no clear patterns between physical activity and cesarean delivery. When we repeated the analysis excluding planned cesarean deliveries (n = 126), high levels of prepregnancy moderate-intensity physical activity (odds ratio = 0.61; 95% confidence interval, 0.38-0.99) and increasing moderate-intensity physical activity in mid/late pregnancy (P trend  = .03) were associated with reduction in odds. Increasing levels of household/caregiving physical activity in pre and mid/late pregnancy were associated with a 50% reduction in odds (P trend  < .05)., Conclusions: In this prospective cohort of Hispanics, sedentary activity increased odds of cesarean delivery, and moderate-intensity and household/caregiving physical activity reduced odds of unplanned cesarean deliveries.

Background: Latina women are at increased risk for antenatal depressive disorders, which are common during pregnancy and are associated with elevated risk for poor maternal health and birth outcomes. Physical activity is a potential mechanism to reduce the likelihood of depressive symptoms. The purpose of the study was to assess whether total and domain-specific physical activity in early pregnancy reduced risk for elevated antenatal depressive symptoms in mid-late pregnancy in a population of Latina women at high-risk for depression., Methods: Data from 820 Latina participants in the prospective cohort study Proyecto Buena Salud was examined using multivariable logistic regression. Total, moderate/vigorous, and domain-specific physical activity (household/caregiving, occupational, sports/exercise, transportation) were assessed using the Pregnancy Physical Activity Questionnaire. The Edinburgh Postnatal Depression Scale was used to assess depressive symptoms and identify women with elevated symptoms indicative of at least probable minor depression and probable major depression., Results: A total of 25.9% of participants experienced at least probable minor depression and 19.1% probable major depression in mid-late pregnancy. After adjusting for important risk factors, no significant associations were observed between total physical activity (4th Quartile vs.1st Quartile OR = 1.02, 95% CI = 0.61, 1.71; p-trend = 0.62) or meeting exercise guidelines in pregnancy (OR = 0.96, 95% CI = 0.65, 1.41) and at least probable minor depression; similarly, associations were not observed between these measures and probable major depression. There was a suggestion of increased risk of probable major depression with high levels of household/caregiving activity (4th Quartile vs 1st Quartile OR = 1.51, 95% CI = 0.93, 2.46), but this was attenuated and remained not statistically significant after adjustment. When we repeated the analysis among women who did not have elevated depressive symptoms in early pregnancy (n = 596), findings were unchanged, though a nonsignificant protective effect was observed for sport/exercise activity and probable major depression in fully adjusted analysis (OR = 0.63, 95% CI = 0.30, 1.33)., Conclusion: Among Latina women at high-risk for antenatal depression, early pregnancy physical activity was not associated with elevated depressive symptoms in mid-to-late pregnancy.

Objectives Cigarette smoking, low physical activity, and sedentary behavior are modifiable risk factors for adverse pregnancy outcomes. However, only one study has evaluated predictors of these health risk behaviors among women at high risk for gestational diabetes mellitus (GDM). Therefore, our goal was to examine predictors of smoking, low physical activity, and sedentary behavior during pregnancy in an ethnically diverse high risk cohort. Methods This cross-sectional analysis utilized baseline data from the Behaviors Affecting Baby and You (B.A.B.Y.) study conducted among prenatal care patients at high risk for GDM (personal history of GDM or family history of diabetes and body mass index [BMI] ≥ 25 kg/m 2 ). Smoking was assessed using questions from the Pregnancy Risk Assessment Monitoring System questionnaire and sedentary behavior (top vs. lower quartiles) and moderate/vigorous physical activity (bottom vs. upper quartile) via the Pregnancy Physical Activity Questionnaire. Results Participants (n = 400) enrolled at a mean of 12.4 (SD 3.6) weeks gestation. A total of 150 (44.1%) engaged in one, 37 (10.9%) in two, and 4 (1.2%) in three risk behaviors. Lower household income and not having children at home were each associated with a 2-6 fold increased odds of smoking, high sedentary behavior, and engaging in at least one risk behavior. Being married, Hispanic or of younger age was associated with a 2-6 fold reduced odds of smoking. BMI and personal history of GDM were not associated with risk behaviors. Conclusions for Practice Findings help characterize high risk groups and inform prenatal interventions targeting these health risk behaviors.

Purpose: To examine the effect of a prenatal exercise intervention on gestational weight gain (GWG) and to update meta-analyses., Design: Randomized controlled trial and meta-analysis., Setting: Obstetrical practices in a Western Massachusetts hospital., Patients: We analyzed 241 ethnically diverse pregnant participants at high risk for gestational diabetes in the Behaviors Affecting Baby and You (B.A.B.Y.) study. A total of 118 participants were randomized to an exercise intervention group and 123 to a comparison health and wellness intervention group., Intervention: A 12-week individually tailored, motivationally matched program designed to increase the compliance with guidelines for exercise during pregnancy (30 min/day)., Measures: The GWG and compliance with 2009 Institute of Medicine (IOM) guidelines for GWG abstracted from medical records., Analysis: Unadjusted logistic regression, intent-to-treat. Results were added to the existing meta-analyses using a random effects model., Results: Women randomized to the exercise group had a lower mean GWG than the comparison group (-0.97 kg, P value = .39) and were less likely to exceed IOM guidelines (odds ratio = 0.69, 95% confidence interval [CI] 0.34-1.40), but results were not statistically significant. Meta-analyses yielded a -0.63 kg (95% CI -1.17 to -0.08, P = .02) reduction in GWG and a 20% reduction in odds of exceeding IOM guidelines (95% CI 0.73 to 0.89) for the exercise intervention., Conclusion: Findings from this randomized trial among ethnically diverse women contribute to the results of meta-analyses supporting exercise as a means of attenuating GWG.

Objectives To estimate the associations of moderate and vigorous intensity exercise during pregnancy with the rate of gestational weight gain (GWG) from gestational diabetes (GDM) diagnosis to delivery, overall and stratified by prepregnancy overweight/obesity. Methods Prospective cohort study with physical activity reported shortly after the GDM diagnosis and prepregnancy weight and post-diagnosis GWG obtained from electronic health records (n = 1055). Multinomial logistic regression models in the full cohort and stratified by prepregnancy overweight/obesity estimated associations of moderate and vigorous intensity exercise with GWG below and above the Institute of Medicine's (IOM) prepregnancy BMI-specific recommended ranges for weekly rate of GWG in the second and third trimesters. Results In the full cohort, any participation in vigorous intensity exercise was associated with decreased odds of GWG above recommended ranges as compared to no participation [odds ratio (95 % confidence interval): 0.63 (0.40, 0.99)], with a significant trend for decreasing odds of excess GWG with increasing level of vigorous intensity exercise. Upon stratification by prepregnancy overweight/obesity, significant associations were only observed for BMI ≥ 25.0 kg/m(2): any vigorous intensity exercise, as compared to none, was associated with 54 % decreased odds of excess GWG [0.46 (0.27, 0.79)] and significant trends were detected for decreasing odds of GWG both below and above the IOM's recommended ranges with increasing level of vigorous exercise (both P ≤ 0.03). No associations were observed for moderate intensity exercise. Conclusions for Practice In women with GDM, particularly overweight and obese women, vigorous intensity exercise during pregnancy may reduce the odds of excess GWG., Competing Interests: The authors have no relevant conflict of interest to disclose.

Background: The proportion of women entering pregnancy overweight or obese has been rising and, in turn, is associated with adverse maternal and fetal outcomes. Gestational weight gain (GWG) exceeding Institute of Medicine (IOM) guidelines further increases health risks and has been independently associated with postpartum weight retention. Hispanic women are disproportionately affected by overweight and obesity, but have had limited access to interventions that promote healthy lifestyles due to cultural, socioeconomic, and language barriers. Therefore, the overall goal of this randomized controlled trial is to test the efficacy of a culturally and linguistically modified, individually-tailored lifestyle intervention to reduce excess GWG, increase postpartum weight loss, and improve maternal metabolic status among overweight/obese Hispanic women., Methods/design: Overweight/obese Hispanic women are recruited in early pregnancy and randomly assigned to a Lifestyle Intervention (n = 150) or a Comparison Health and Wellness (control) intervention (n = 150). Multimodal contacts (i.e., in-person, telephone counseling, and mailed print-based materials) are used to deliver the intervention from early pregnancy (12 weeks gestation) to 6 months postpartum, with follow-up to 1 year postpartum. Targets of the intervention are to achieve IOM Guidelines for GWG and postpartum weight loss; American Congress of Obstetrician and Gynecologist guidelines for physical activity; and American Diabetes Association guidelines for diet. The intervention draws from Social Cognitive Theory and the Transtheoretical Model and includes strategies to address the specific social, cultural, and economic challenges faced by low-income Hispanic women. Assessments are conducted at baseline (~10 weeks gestation), mid pregnancy (24-28 weeks gestation), late pregnancy (32-34 weeks gestation) and postpartum at 6-weeks, 6-months, and 12-months by bicultural and bilingual personnel blinded to the intervention arm. Efficacy is assessed via GWG, postpartum weight loss, and biomarkers of glycemic control, insulin resistance, and cardiovascular disease risk factors. Changes in physical activity and diet are measured via 7-day accelerometer data and 24-h dietary recalls at each assessment time period., Discussion: Hispanic women are the fastest growing minority group in the U.S. and are disproportionately affected by overweight and obesity. This randomised trial uses a high-reach, low-cost strategy that can readily be translated into clinical practice in underserved and minority populations., Trial Registration: NCT01868230 May 29, 2013.

Background: C-reactive protein (CRP) during pregnancy has been associated with adverse maternal outcomes such as preeclampsia and gestational diabetes mellitus. Randomized trials suggest that exercise programs may be associated with reductions in CRP in non-pregnant populations; however, such studies have not been conducted among pregnant women. The purpose of this study was to evaluate the impact of an individually-tailored motivationally-matched exercise intervention on CRP in pregnant women., Methods: The Behaviors Affecting Baby and You study was a randomized controlled trial of prenatal physical activity to prevent the development of gestational diabetes mellitus in women at increased risk. Women were randomized to either a 12-week exercise intervention (n = 84) or a comparison health and wellness intervention (n = 87). High sensitivity CRP (mg/dL) was measured using a commercial immunoassay kit. Physical activity was measured using the Pregnancy Physical Activity Questionnaire. Mixed model analyses were used to evaluate the impact of the intervention on change in CRP using an intent-to-treat approach., Results: CRP decreased (-0.09 mg/dL, 95 % CI: -0.25, 0.07) from pre- to post-intervention in the exercise arm (p = 0.14) and increased (0.08 mg/dL, 95 % CI: -0.07, 0.24) (p = 0.64) in the health and wellness arm; however the between group difference was not statistically significant (p = 0.14). Findings did not differ according to ethnic group or pre-pregnancy body mass index. In a secondary analysis based on self-reported physical activity, women who decreased their time spent in sports/exercise experienced a mean increase in CRP (0.09 mg/dL, 95 % CI: -0.14, 0.33), whereas women who maintained or increased their sports/ exercise experienced a mean decrease in CRP (-0.08 mg/dL, 95 % CI: -0.23, 0.08) (p = 0.046)., Conclusions: Findings from this randomized trial in an ethnically and socio-economically diverse population of pregnant women were consistent with a positive impact of the exercise intervention on CRP levels, but not of statistical significance., Clinical Trial Registration: ClinicalTrials.gov: NCT00728377 . Registered 2 August 2008.

Objective: Gestational diabetes mellitus (GDM) is a common complication of pregnancy associated with an increased incidence of pregnancy complications, adverse pregnancy outcomes, and maternal and fetal risks of chronic health conditions later in life. Physical activity has been proposed to reduce the risk of GDM and is supported by observational studies, but experimental research assessing its effectiveness is limited and conflicting. We aimed to use meta-analysis to synthesize existing randomized controlled studies of physical activity and GDM., Data Sources: We searched MEDLINE, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov for eligible studies., Methods of Study Selection: The following combination of keywords was used: (pregnant or pregnancy or gestation or gestate or gestational or maternity or maternal or prenatal) AND (exercise or locomotion or activity or training or sports) AND (diabetes or insulin sensitivity or glucose tolerance) AND (random* or trial). Eligibility was restricted to studies that randomized participants to an exercise-only-based intervention (ie, separate from dietary interventions) and presented data regarding GDM risk. Two authors performed the database search, assessment of eligibility, and abstraction of data from included studies, and a third resolved any discrepancies. A total of 469 studies was retrieved, of which 10 met inclusion criteria and could be used for analysis (3,401 participants)., Tabulation, Integration, and Results: Fixed-effects models were used to estimate summary relative risk (RR) and 95% confidence interval (CI) and I to assess heterogeneity. There was a 28% reduced risk (95% CI 9-42%) in the intervention group compared with the control group (RR 0.72, P=.005). Heterogeneity was low (I=12%) and nonsignificant (P=.33)., Conclusion: The results from this meta-analysis suggest that physical activity in pregnancy provides a slight protective effect against the development of GDM. Studies evaluating type, timing, duration, and compliance of physical activity regimens are warranted to best inform obstetric guidelines.

Objectives: We examined the impact of a prenatal exercise intervention on physical activity in 260 women at risk for gestational diabetes mellitus., Methods: We randomized participants in the Behaviors Affecting Baby and You (BABY) Study, which took place from 2007 to 2012, to either a 12-week individually tailored, motivationally matched exercise intervention (n=132) or to a comparison health and wellness intervention (n=128). We assessed physical activity with the Pregnancy Physical Activity Questionnaire. We used linear mixed models to evaluate the impact of the interventions on change in physical activity according to intensity and type, total walking, and sedentary behavior., Results: Compared with the health and wellness arm, the exercise arm had significantly greater increases in sports or exercise activity (0.3 vs 5.3 metabolic equivalent of task [MET] hours/week; P<.001), and smaller declines in total activity (-42.7 vs -2.1 MET hours/week; P=.02) and activities of moderate to vigorous intensity (-30.6 vs -10.6 MET hours/week; P=.05), and was more likely to achieve recommended guidelines for physical activity (odds ratio=2.12; 95% confidence interval=1.45, 3.10)., Conclusions: These findings extend the previous literature by demonstrating the benefits of a clinically feasible exercise intervention in an ethnically and socio-economically diverse population. Given the increased risk of adverse maternal health outcomes in ethnic minority groups, these findings may have important implications for reducing health disparities.

Introduction: Elevated C-reactive protein (CRP) is associated with adverse pregnancy outcomes. In nonpregnant populations, physical activity has been inversely associated with CRP, but this association has not been evaluated during pregnancy. The purpose of this study was to evaluate the association between objectively measured physical activity, sedentary behavior, and CRP by pregnancy trimester., Methods: We evaluated this association among 294 pregnant participants in the National Health and Nutrition Examination Survey (2003-2004 and 2005-2006). Physical activity (min·d(-1)) was assessed via accelerometer using established cut points. CRP (mg·L(-1)) was measured using a high sensitivity assay. Multivariable linear regression was used to determine the relationship between physical activity, sedentary behavior, and CRP by trimester of pregnancy., Results: Among women in the second trimester, after adjusting for age, body mass index, smoking status, and history of adverse pregnancy outcomes, light-intensity physical activity was associated with lower CRP (β = -0.002, P = 0.05). In unadjusted models, sedentary time and proportion of wear time spent sedentary were positively associated with CRP (β = 0.048, P = 0.02 and β = 2.36, P = 0.03, respectively); however, the relationship was no longer statistically significant in multivariable models (β = 0.33, P = 0.2 and β = 1.96, P = 0.08, respectively). Neither physical activity nor sedentary behavior was associated with CRP among women in the first or third trimester., Conclusions: Objectively measured light-intensity physical activity had a protective effect on CRP among women in the second trimester of pregnancy. Findings highlight the need for longitudinal studies of pregnancy physical activity and CRP with careful control for clinical characteristics of the current pregnancy.

Purpose: In this review, we provide researchers and practitioners with an overview of the physical activity and pregnancy literature to promote prenatal physical activity, improve measurement, further elucidate the role of activity in reducing maternal health complications, and inform future research., Method: We examined past and present physical activity and pregnancy studies and highlight key papers with a focus on maternal health outcomes to best inform physical activity promotion efforts., Results: We discuss: (a) historical overview of prenatal physical activity relative to the physical activity guidelines, how they have changed over time, and how evidence of the effect of prenatal activity on maternal/fetal health outcomes has affected clinical recommendations; (b) existing tools and challenges associated with measuring prenatal physical activity; (c) empirical evidence on multilevel determinants of prenatal activity to guide future intervention work; (d) empirical evidence of prenatal activity on adverse maternal outcomes (gestational diabetes mellitus, preeclampsia, excessive gestational weight gain) from observational and intervention studies; and (e) summary/recommendations for future research and practice., Conclusions: The physical activity and pregnancy literature has evolved over the past 50 years, and there is sufficient empirical evidence to support the promotion of moderate-to-vigorous prenatal physical activity for maternal health benefits. Future studies and interventions should be carefully designed, theoretically driven, and include validated and reliable activity measures. Researchers and practitioners should also consider the multifaceted determinants and outcomes of prenatal physical activity and intervene to promote physical activity before, during, and after pregnancy.

Background: A growing body of evidence suggests that physical activity during pregnancy can reduce risk of pregnancy complications. However, factors influencing activity in pregnant Hispanic women, who have high rates of sedentary activity as compared to non-Hispanic whites, are not well characterized., Purpose: To assess patterns and correlates of physical activity among 1355 participants in Proyecto Buena Salud, a prospective cohort of pregnant Hispanic women in Massachusetts from 2006 to 2011., Methods: Analyses were conducted in 2012. Pre-, early-, mid-, and late-pregnancy physical activity were assessed using the Pregnancy Physical Activity Questionnaire. Women reported the frequency and duration of household/caregiving, occupational, sports/exercise, and transportation activities and were classified according to compliance with American College of Obstetricians and Gynecologists guidelines for physical activity., Results: Household/caregiving activity was the primary mode of pregnancy activity ranging from 56% to 60% of total activity while sports/exercise contributed the least (<10%). Compared to nulliparous women, women with two or more children were 85% less likely to become inactive at any time during pregnancy (OR=0.15, 95% CI=0.04, 0.56, p-trend <0.01). Women with one or more children increased their total physical activity on average 9.73±2.04 MET-hours/week and 12.04±2.39 MET-hours/week, respectively, with the onset of pregnancy (p<0.01). Those with the highest levels of total physical activity prior to pregnancy were 87% less likely to become inactive with the onset of pregnancy than those who were inactive prior to pregnancy (OR=0.13, 95% CI= 0.05, 0.29)., Conclusions: Findings can inform culturally appropriate interventions designed to reduce pregnancy complications through the promotion of physical activity during pregnancy., (Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Epidemiological studies and surveillance systems of pregnant women often rely on collection of physical activity through self-report. This systematic review identified and summarised self-reported physical activity assessments with evidence for validity and reliability among pregnant women., Methods: Peer-reviewed articles published through 2011 were included if they assessed validity and/or reliability of an interviewer- or self-administered physical activity questionnaire or diary among pregnant women., Results: We identified 15 studies, including 12 studies that assessed questionnaires and 4 studies that assessed diaries, conducted in Australia, Finland, Norway, the U.K., the U.S. and Vietnam. For questionnaires, 92% (11/12) assessed mode, all assessed frequency and/or duration and 58% (7/12) collected information on perceived intensity. All but one study (92%) assessed validity of the questionnaires. Questionnaires compared with objective measures (accelerometers, pedometers) ranged from slight to fair agreement, while comparison with other self-reported measures ranged from substantial to almost perfect agreement. Five studies (42%) assessed test-retest reliability of the questionnaires, ranging from substantial to almost perfect agreement. The four studies on diaries were all assessed for validity against objective measures, ranging from slight to substantial agreement., Conclusions: Selection of valid and reliable physical activity measures that collect information on dose (type, frequency, duration, intensity) is recommended to increase precision and accuracy in detecting associations of physical activity with maternal and fetal outcomes., (© 2012 Blackwell Publishing Ltd.)

Pregnancy has been proposed as a critical period for the development of subsequent maternal overweight and/or obesity. Excessive gestational weight gain is, in turn, associated with maternal complications such as cesarean delivery, hypertension, preeclampsia, impaired glucose tolerance, and gestational diabetes mellitus. Although there is substantial evidence that targeting at-risk groups for type 2 diabetes prevention is effective if lifestyle changes are made, relatively little attention has been paid to the prevention of excessive gestational weight gain and impaired glucose tolerance during pregnancy. Latinos are the largest minority group in the United States, with the highest birth and immigration rates of any minority group and are disproportionately affected by overweight and obesity. However, due to cultural factors, socioeconomic factors, and language barriers, Latinos have had limited access to public health interventions that promote healthy lifestyles. Therefore, the objective of this article is to review the scientific evidence regarding the association between physical activity, dietary behaviors, and gestational weight gain and impaired glucose tolerance among Latinas. A second objective is to discuss how lifestyle interventions including weight management through diet and exercise could be successful in reducing the risk of excessive gestational weight gain and gestational diabetes mellitus. Finally, recommendations are provided for future lifestyle intervention programs in this population with a focus on translation and dissemination of research findings.

Background: Physical activity during pregnancy is associated with reduced risk of adverse maternal and fetal outcomes. However, the majority of pregnant women are inactive and interventions designed to increase exercise during pregnancy are sparse. We evaluated the feasibility and preliminary efficacy of an exercise intervention among a diverse sample of pregnant women., Methods: The B.A.B.Y. (Behaviors Affecting Baby and You) Study is conducted at a large tertiary care facility in Western Massachusetts. We randomized 110 prenatal care patients (60% Hispanic) to an individually tailored 12-week exercise intervention arm (n = 58) or to a health and wellness control arm (n = 52) at mean = 11.9 weeks gestation. Physical activity was assessed via the Pregnancy Physical Activity Questionnaire (PPAQ)., Results: After the 12-week intervention, the exercise arm experienced a smaller decrease (-1.0 MET-hrs/wk) in total activity vs. the control arm (-10.0 MET-hrs/wk; P = .03), and a higher increase in sports/exercise (0.9 MET-hrs/wk) vs. the control arm (-0.01 MET-hrs/wk; P = .02). Intervention participants (95%) reported being satisfied with the amount of information received and 86% reported finding the study materials interesting and useful., Conclusions: Findings support the feasibility and preliminary efficacy of a tailored exercise intervention in increasing exercise in a diverse sample of pregnant women.

Purpose: Prior studies of the association between physical activity and risk of hypertensive disorders of pregnancy have been conflicting, failed to assess total physical activity, and included few Hispanic women, the largest minority group in the United States with the highest birth rates., Methods: We examined this association among 1043 participants in the Latina Gestational Diabetes Mellitus Study, a prospective cohort of predominantly Puerto Rican prenatal care patients conducted from 2000 to 2004 in western Massachusetts. Physical activity before and in early pregnancy was assessed by bilingual interviewers using a modified version of the Kaiser Physical Activity Survey., Results: Fifty women (4.8%) were diagnosed with hypertensive disorders of pregnancy and 30 (2.9%) with preeclampsia. In multivariable analyses, there was a statistically significant trend of decreasing risk of hypertensive disorders with increasing sports/exercise in early pregnancy (P(trend) = 0.04). High levels of early pregnancy active living activity (odds ratio (OR) = 0.4, 95% confidence interval (CI) = 0.1-1.1, P(trend) = 0.07) and household/care giving activity (OR = 0.4, 95% CI = 0.1-1.3, P(trend) = 0.07) were associated with a 60% reduction in risk of hypertensive disorders relative to low levels; however, these associations were of marginal statistical significance. High levels of total physical activity (OR = 0.3, 95% CI = 0.1-1.0, P(trend) = 0.06) in early pregnancy were associated with a 70% reduction in the risk of hypertensive disorders relative to low levels; however, this association was also of marginal statistical significance. Prepregnancy physical activity was not associated with hypertensive disorders., Conclusions: These results in a Hispanic population, although based on small numbers of cases, corroborate previous studies suggesting that recreational activity in early pregnancy reduces the risk of hypertensive disorders of pregnancy.

To estimate the association between multiple domains of physical activity and risk of small-for-gestational-age (SGA) birth. We utilized data from 1,040 participants in the Latina Gestational Diabetes Mellitus Study, a prospective cohort of predominantly Puerto Rican prenatal care patients in Massachusetts. Physical activity was assessed by bilingual interviewers using a modified version of the Kaiser physical activity survey in early (mean = 15 weeks) and mid pregnancy (mean = 28 weeks). Physical activity (i.e., sports/exercise, household, occupational, and active living) in pre, early and mid pregnancy was categorized in quartiles. SGA was classified as <10th percentile of birth weight for gestational age. Pre- and early-pregnancy physical activity were not associated with SGA. In multivariable analyses, women with high total activity in mid-pregnancy had a decreased risk of SGA [risk ratio (RR) = 0.42; 95% confidence interval (CI) 0.21-0.82; p(trend) = 0.003] as compared to those with low total activity. Findings were similar for high household activity (RR = 0.69; 95% CI = 0.34-1.40; p(trend) = 0.26), active living (RR = 0.63; 95% CI = 0.35-1.13; p(trend) = 0.04), and occupational activity (RR = 0.79, 95% CI = 0.47-1.34; p(trend) = 0.26). High levels of sports/exercise were associated with an increased SGA risk without a significant dose-response association (RR = 2.14, 95% CI 1.04-4.39; p(trend) = 0.33). Results extend prior studies of physical activity and SGA to the Hispanic population.

Although physical activity (PA) is a key element in the prevention and management of type 2 diabetes mellitus (T2DM), many with this chronic disease do not become or remain regularly active. High-quality studies establishing the importance of exercise and fitness in diabetes were lacking until recently, but it is now well established that participation in regular PA improves blood glucose control and can prevent or delay T2DM, along with positively affecting lipids, blood pressure, cardiovascular events, mortality, and quality of life. Structured interventions combining PA and modest weight loss have been shown to lower T2DM risk by up to 58% in high-risk populations. Most benefits of PA on diabetes management are realized through acute and chronic improvements in insulin action, accomplished with both aerobic and resistance training. The benefits of physical training are discussed, along with recommendations for varying activities, PA-associated blood glucose management, diabetes prevention, gestational diabetes, and safe and effective practices for PA with diabetes-related complications.

Although physical activity (PA) is a key element in the prevention and management of type 2 diabetes, many with this chronic disease do not become or remain regularly active. High-quality studies establishing the importance of exercise and fitness in diabetes were lacking until recently, but it is now well established that participation in regular PA improves blood glucose control and can prevent or delay type 2 diabetes, along with positively affecting lipids, blood pressure, cardiovascular events, mortality, and quality of life. Structured interventions combining PA and modest weight loss have been shown to lower type 2 diabetes risk by up to 58% in high-risk populations. Most benefits of PA on diabetes management are realized through acute and chronic improvements in insulin action, accomplished with both aerobic and resistance training. The benefits of physical training are discussed, along with recommendations for varying activities, PA-associated blood glucose management, diabetes prevention, gestational diabetes mellitus, and safe and effective practices for PA with diabetes-related complications.

Exercise during pregnancy has been associated with reduced risk of gestational diabetes mellitus, however, twice as many women are sedentary during pregnancy as compared to when they are not pregnant. We conducted 3 focus groups among 20 pregnant Latina and non-Latina white women to identify barriers and facilitators to exercise in pregnancy to inform a gestational diabetes mellitus intervention study. Quantitative analyses of demographic data, and qualitative analyses of focus groups were conducted. Women identified physical limitations and restrictions, lack of resources, energy, and time as powerful exercise barriers. Social support, access to resources, information, proper diet, scheduling, and the weather were identified as powerful facilitators. Intervention programs designed for pregnant women should facilitate social support, provide information and resources, as well as promote short-term and long-term benefits.

Objective: To study a possible association between physical activity and the duration of second stage of labor among Hispanic women., Study Design: We evaluated this relationship in the Latina Gestational Diabetes Mellitus Study, a prospective cohort of Hispanic obstetric patients. The Kaiser Physical Activity Survey was used to collect information on physical activity in prepregnancy, early pregnancy and mid-pregnancy. Duration of labor was abstracted from medical records. A total of 725 women with a singleton pregnancy and a spontaneous vaginal delivery were included, which yielded > 80% power to detect a clinically meaningful mean difference of 30 minutes., Results: The mean duration of second-stage of labor was 34.3 min (SD 42.02). After adjusting for established risk factors, no significant differences in duration of labor were observed among women according to physical activity level in prepregnancy, early pregnancy, or midpregnancy., Conclusion: Findings confirm prior literature demonstrating the absence of an association between physical activity and duration of labor.

Background: Women diagnosed with gestational diabetes mellitus (GDM) are at substantially increased risk of developing type 2 diabetes and obesity, currently at epidemic rates in the United States. GDM, therefore, identifies a population of women at high risk of developing type 2 diabetes and provides an opportunity to intervene before the development of this disorder. It is well recognized that acute as well as chronic physical activity improves glucose tolerance in type 2 diabetes. To date, however, primary prevention trials have not been conducted to test whether an increase in physical activity reduces risk of developing GDM among women at high risk of this disorder., Methods: The aims of this study are to investigate the effects of a motivationally targeted, individually tailored 12-week physical activity intervention on (1) development of GDM, (2) serum biomarkers associated with insulin resistance, and (3) the adoption and maintenance of exercise during pregnancy. Women at high risk of GDM are recruited in early pregnancy and randomized to either an individually tailored exercise intervention or a comparison health and wellness intervention., Results: The overall goal of the exercise intervention is to encourage pregnant women to achieve the American College of Obstetricians and Gynecologists guidelines for physical activity during pregnancy through increasing walking and developing a more active lifestyle., Conclusions: The intervention takes into account the specific social, cultural, economic, and physical environmental challenges faced by pregnant women of diverse socioeconomic and ethnic backgrounds.

Background: Few studies have examined predictors of meeting health guidelines in pregnancy among Latina women., Objective: We assessed dietary behaviors, physical activity, and cigarette smoking in the Latina Gestational Diabetes Mellitus Study, a prospective cohort of 1231 prenatal care patients., Design: Self-reported information on lifestyle factors, demographics, medical history, and physical activity was collected by bilingual interviewers during pregnancy. Fruit/vegetable intake was determined by summing the reported consumption of specific fruit and vegetables on a food-frequency questionnaire designed for this population and then adjusted for reported total daily servings., Results: Approximately 13% of women met physical activity guidelines [>or=10 metabolic equivalents (MET)-h/wk], 19% met fruit/vegetable guidelines (7 servings/d), 21% of women smoked, and 1.4% consumed alcohol during pregnancy. In multivariate analyses, Spanish-language preference, an indicator of less acculturation, was associated with an approximately 40% less likelihood of both smoking [odds ratio (OR): 0.6; 95% CI: 0.4, 0.8] and meeting physical activity guidelines (OR: 0.6; 95% CI: 0.3, 1.0). College education was associated with a 2-fold greater likelihood of meeting fruit/vegetable guidelines (OR: 2.2; 95% CI: 1.1, 4.3) and a lower likelihood of smoking (OR: 0.2; 95% CI: 0.1, 0.4). A history of adverse pregnancy outcome was associated with a >4-fold greater likelihood of meeting physical activity guidelines. Smoking in pregnancy was associated with a decreased likelihood of meeting the fruit/vegetable guidelines (RR: 0.5; 95% CI: 0.3, 0.9)., Conclusion: Factors related to engagement in prenatal health behaviors should be addressed in the design of targeted intervention strategies in this underserved and rapidly growing population.

Objectives: National data indicate that Latina women are less active than non-Latina white women and are at higher risk of gestational diabetes and subsequent type 2 diabetes. Physical activity may reduce risk of maternal disorders of pregnancy, but sparse data exists on the correlates of physical activity in pregnant Latina women., Methods: We conducted a prospective cohort study from 2000 to 2004 among healthy Latina prenatal care patients in a public clinic and midwifery practice. Physical activity was assessed using a modified version of the Kaiser Physical Activity Survey (KPAS) in early and mid pregnancy., Results: A total of 1,231 women (predominantly of Puerto Rican heritage) met the eligibility criteria and were enrolled. Participation in household/caregiving, occupational, sports/exercise, and active living decreased from prepregnancy to pregnancy. Overall, women who were more active prior to pregnancy were more likely to have high levels of participation in every domain of pregnancy activity. Women with the highest level of participation in occupational activity during pregnancy (defined as the highest quartile of activity, compared with the lower three quartiles) were more likely to be older, college-educated, have higher income, and have fewer children. Women with the highest level of household/caregiving activity were more likely to be older, have more children, be U.S. born, and prefer Spanish while women with the highest levels of sports/exercise during pregnancy were less likely to prefer Spanish., Conclusions: These findings suggest that sociodemographic, acculturation, health, and behavioral correlates of physical activity vary by domain among Latina women. Programs aimed at promoting physical activity during pregnancy in this high risk ethnic group should recognize these differences.

In 2002, the American College of Obstetricians and Gynecologists revised their 1994 guidelines to recommend that pregnant women without medical or obstetric complications follow exercise guidelines for nonpregnant women. In spite of these guidelines, the optimal dose of recreational physical activity (i.e., total volume of energy expenditure, and specific frequency, duration and intensity) for a pregnant woman remains to be determined. Identification of this dose has been hampered by the complexity of assessing recreational physical activity in general, and particularly during pregnancy, a demanding period characterized by changing physiology. Therefore, we reviewed the measurement methods in the epidemiologic studies that examined the association between recreational physical activity and two specific pregnancy outcomes of primary public health importance, birthweight and length of gestation. From a review of the medical literature, we identified 20 published journal articles between 1966 and 2005. Study designs, participants, and physical activity assessment measures varied widely across studies. The majority of these studies did not consistently assess type, frequency, intensity, and duration of activity and did not measure these variables during each trimester of pregnancy. Because the effect of recreational physical activity on birth outcomes is likely to be modest, measurement must be highly accurate to minimize the possibility that an effect will not be observed because of measurement error. Recommendations are made for the future assessment of recreational physical activity in epidemiologic studies of these major birth outcomes.

Background: Participation in physical activity during pregnancy may reduce the risk of gestational diabetes mellitus and preeclampsia and help prevent excess maternal weight gain. However, studies describing patterns and correlates of activity during pregnancy are sparse. The purpose of this cross-sectional study was to describe total physical activity (household/caregiving, occupational, leisure, sports/exercise, and transportation) and correlates of total physical activity in a racially and economically diverse sample of 233 prenatal care patients., Methods: Bilingual interviewers administered three 24-hour physical activity recalls among women in the first trimester (11%), second trimester (36%), and third trimester (53%) of pregnancy., Results: Median total energy expenditure (MET-hours/day) was similar among women in the first and second trimesters (33.4 and 33.8 MET-hours/day, respectively) and was slightly, but not statistically significantly, lower among women in the third trimester (32.6 MET-hours/day). Moderate intensity activity followed a similar pattern, being statistically significantly lower among women in the third trimester; vigorous intensity activity was low among women in each trimester of pregnancy. In terms of activity type, household/ caregiving activity was the largest contributor to both total and combined moderate and vigorous intensity energy expenditure among women in each trimester, constituting 24%-40% of total energy expenditure. Overall, total energy expenditure was highest in white non-Hispanic women and positively associated with increasing education and a history of previous live births (p < 0.01)., Conclusions: Results from this study highlight the importance of including household/caregiving and occupational activities in addition to sports/exercise activities in the assessment of total energy expenditure during pregnancy.

Purpose: Participation in physical activity during pregnancy may reduce the risk of maternal and fetal disorders. However, few studies have validated physical activity questionnaires for use during pregnancy, a time characterized by different patterns of activity than nonpregnancy. Therefore, the aim of this study was to assess the validity and reliability of the Kaiser Physical Activity Survey (KPAS) for use during pregnancy., Methods: The KPAS, adapted from the Baecke physical activity survey, was designed specifically to assess physical activity in women. Unique features of the KPAS include the assessment of multiple domains of physical activity (household/caregiving, occupational, active living, and sports/exercise) as well as total activity. Summary KPAS indices were compared with objective (ActiGraph accelerometer by ActiGraph LLC) and subjective (Pregnancy Physical Activity Questionnaire (PPAQ)) measures of physical activity. Participants completed the self-administered PPAQ followed by the interviewer-administered KPAS and then wore the accelerometer for the following 7 d. At the end of the 7-d period, the questionnaires were repeated., Results: Intraclass correlation coefficients used to measure reproducibility of the KPAS were r = 0.84 for total activity and ranged from r = 0.76 for active living activities to r = 0.86 for occupational activity. Spearman correlations between the KPAS and three published cut points used to classify accelerometer data ranged from r = 0.49-0.59 for total activity, r = 0.12-0.26 for household/caregiving, r = 0.26-0.33 for occupational activity, r = 0.31-0.36 for active living, and r = 0.34-0.51 for sports/exercise. Spearman correlations between the KPAS and the PPAQ ranged from r = 0.71 for household/caregiving to r = 0.84 for sports/exercise., Conclusions: The KPAS is a reliable and reasonably accurate instrument for estimating physical activity among pregnant women.

Purpose: The effect of physical activity during pregnancy on maternal and fetal health remains controversial and studies have yet to identify the optimal dose of physical activity associated with favorable pregnancy outcomes. The aim of this study was to develop and validate a pregnancy physical activity questionnaire (PPAQ)., Methods: To ascertain the type, duration, and frequency of physical activities performed by pregnant women, three 24-h physical activity recalls were administered to 235 ethnically diverse prenatal care patients at a large tertiary care facility in western Massachusetts. The relative contribution of each activity to between-person variance in energy expenditure was used to establish the list of activities for the PPAQ. The PPAQ is self-administered and asks respondents to report the time spent participating in 32 activities including household/caregiving, occupational, sports/exercise, transportation, and inactivity. To validate the PPAQ, 54 pregnant women completed the PPAQ and then wore a Manufacturing Technology, Inc. actigraph for the following 7 d. At the end of the 7-d period, the PPAQ was repeated., Results: Intraclass correlation coefficients used to measure reproducibility of the PPAQ were 0.78 for total activity, 0.82 for moderate activity, 0.81 for vigorous activity, and ranged from 0.83 for sports/exercise to 0.93 for occupational activity. Spearman correlations between the PPAQ and three published cut points used to classify actigraph data ranged from 0.08 to 0.43 for total activity, 0.25 to 0.34 for vigorous activity, 0.20 to 0.49 for moderate activity, and -0.08 to 0.22 for light-intensity activity. Correlations were higher for sports/exercise and occupational activities as compared to household/caregiving activities., Conclusions: household/caregiving activities., Conclusions: The PPAQ is a reliable instrument of physical activities during pregnancy.

Purpose: To compare two methods for measuring time spent in physical activity of differing absolute intensities., Methods: Over a 7-d period, 59 women wore Computer Science and Applications, Inc. (CSA) accelerometers and recorded their activity in physical activity logs (PAL) at 15-min intervals. Three published cut points were used to classify CSA data into resting/light, moderate, and vigorous intensity categories. Data were analyzed using descriptive statistics, Spearman rank-order correlations, and Bland-Altman plots., Results: The CSA estimates of total (moderate plus vigorous) physical activity using the three cut points ranged from a mean (+/- SD) of 38.1 (+/-26.8) min.d-1 to 312.6 (+/- 101.1) min.d-1. Using the PAL, women self-reported a mean (+/- SD) of 75.1 (+/- 51.7) min.d-1 of total activity. There was fair to modest rank-order agreement between each of the three CSA measures and the PAL measure of total activity, with correlations ranging from r = 0.15 to 0.24. Correlations between CSA and PAL estimates of total activity were higher in women with body mass index values (BMI) below 25 kg.m-2 (r = 0.23-0.38) compared with women with BMI > or = 25 kg.m-2 (r = 0.06-0.08) but did not differ according to age. Correlations between the three CSA cut points ranged from r = 0.45 to 0.86., Conclusions: Three published cut points designed to classify CSA output by intensity level produced different estimates of physical activity participation. Correlations between CSA and PAL measures of activity intensity were fair overall but higher among leaner women.

Purpose: To determine the validity and reproducibility of a self-administered physical activity questionnaire that assesses the frequency, intensity, and duration of recreational, household, and occupational activity in women., Methods: The questionnaire was administered by mail twice to 131 participants 1 yr apart. During this interval, participants completed four 1-wk activity logs corresponding to different seasons throughout the year., Results: The intraclass correlation coefficients used to measure reproducibility were 0.82 for total activity, 0.79 for moderate activity, 0.86 for vigorous activity, 0.80 for recreational activity, and 0.73 for household activity. The distribution of activity scores was similar between the questionnaires and the average of the four logs, indicating the participants' ability to incorporate seasonal variation into their recall on a questionnaire. The correlations between the questionnaire-based activity scores and log-based activity scores, indicating validity, were 0.26 for total activity, 0.15 for moderate activity, and 0.52 for vigorous activity. Women younger than age 50 tended to have higher validity scores than women aged 50 yr and older (r = 0.31 vs r = 0.19, respectively, for total activity)., Conclusion: These data indicate that this physical activity questionnaire is reproducible and provides a useful measure of current activity, particularly vigorous activity, over a 1-yr period.

Background: Women with abnormal glucose tolerance during pregnancy are at risk for cardiovascular disease (CVD), with higher rates among Hispanics. However, studies on the impact of lifestyle interventions on postpartum CVD profiles are sparse. Methods: This is a secondary analysis of a controlled trial among a subsample of Hispanic women with abnormal glucose tolerance participating in Estudió PARTO (Project Aiming to Reduce Type twO diabetes; mean age = 28.2 y, SD: 5.8) who were randomized to a culturally modified Lifestyle intervention (n = 45) or a comparison Health and Wellness intervention (n = 55). Primary endpoints were biomarkers of cardiovascular risk (lipids, C-reactive protein, fetuin-A, and albumin-to-creatinine ratio) and insulin resistance (fasting insulin, glucose, HbA1c, homeostasis model assessment, leptin, tumor necrosis factor-alpha, and adiponectin) measured at baseline (6-wk postpartum) and 6 and 12 months. Results: In intent-to-treat analyses, there were no significant differences in changes in biomarkers of CVD risk or insulin resistance over the postpartum year. In prespecified sensitivity analyses, women adherent with the Lifestyle Intervention had more favorable improvements in insulin (intervention effect = −4.87, SE: 1.93, P =.01) and HOMA-IR (intervention effect = −1.15, SE: 0.53, P =.03) compared with the Health and Wellness arm. In pooled analyses, regardless of intervention arm, women with higher postpartum sports/exercise had greater increase in HDL-cholesterol (intervention effect = 6.99, SE: 1.72, P =.0001). Conclusions: In this randomized controlled trial among Hispanic women with abnormal glucose tolerance, we did not observe a significant effect on postpartum biomarkers of CVD risk or insulin resistance. Women adherent to the intervention had more favorable changes in insulin and HOMA-IR. [ABSTRACT FROM AUTHOR]

Background: Poor sleep is associated with adverse outcomes among postpartum women. Exercise may improve sleep, but this has not been well examined in the postpartum period.Purpose: To examine the impact of a culturally modified, individually tailored lifestyle intervention on sleep outcomes among postpartum Latina women.Methods: Estudio PARTO was a randomized controlled trial aimed at reducing Type 2 diabetes among Latina women with abnormal glucose tolerance in pregnancy. Participants were randomized to a lifestyle (i.e., diet and exercise; n = 70) or a health and wellness control intervention (n = 78) in late pregnancy (baseline). The Pittsburgh Sleep Quality Index (PSQI) was used to measure sleep quality (PSQI score), onset latency (minutes per night), duration (hours per night), efficiency (percentage of the time in bed asleep), and daytime dysfunction at baseline, 6 weeks, 6 months, and 12 months postpartum.Results: Mean PSQI score (6.56 ± 3.87), sleep duration (6.84 ± 1.75 hr/night), and sleep efficiency (79.70% ± 18.10%) did not differ between the arms at baseline. Mixed-effects models indicated a greater decrease of 1.29 in PSQI score (i.e., improved sleep quality) in the lifestyle versus health and wellness arm (95% confidence interval [CI] = -2.50 to -0.08, p = .04) over follow-up. There was the suggestion of a smaller decrease in sleep duration (mean = 0.48 hr/night, 95% CI = -0.10 to 1.06, p = .10) in the lifestyle versus health and wellness arm. There were no statistically significant differences in other sleep outcomes between arms.Conclusions: Findings suggest that lifestyle interventions improve sleep quality but not sleep duration, sleep onset latency, sleep efficiency, or daytime dysfunction in postpartum Latina women and, therefore, may hold promise for improving subsequent mental and physical health in this population.Clinical Trials Registration: NCT01679210. [ABSTRACT FROM AUTHOR]

Objective: Prior studies of the association between physical activity and hypertensive disorders of pregnancy have been conflicting; the majority focused on leisure-time activity only, did not use physical activity questionnaires validated for pregnancy, and were conducted in primarily non-Hispanic white populations. Methods: We prospectively evaluated this association among 1240 Hispanic women in Proyecto Buena Salud. The Pregnancy Physical Activity Questionnaire, validated for use in pregnancy, was used to assess pre- and early pregnancy sports/exercise, household/caregiving, occupational and transportation activity. Diagnoses of hypertensive disorders of pregnancy were based on medical record abstraction and confirmed by the study obstetrician. Results: A total of 49 women (4.0%) were diagnosed with a hypertensive disorder of pregnancy, including 32 women (2.6%) with pre-eclampsia. In age-adjusted analyses, high levels of early pregnancy household/caregiving activity were associated with reduced risk of total hypertensive disorders (OR = 0.4, 95% CI 0.1-0.9) and pre-eclampsia (OR = 0.3, 95% CI 0.1-0.9) relative to low levels; however, these findings were no longer statistically significant in multivariable models. Pre-pregnancy activity and pattern of activity from pre- to early-pregnancy were not significantly associated with risk. Finally, sedentary behavior was not significantly associated with hypertensive disorders. Conclusion: Findings from this prospective study of Hispanic women were consistent with those of prior prospective cohorts indicating that physical activity prior to and during early pregnancy does not significantly reduce risk of hypertensive disorders of pregnancy. [ABSTRACT FROM AUTHOR]