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Several studies have suggested that maternal lifestyle during pregnancy may influence long-term health of offspring by altering the offspring epigenome. Whether maternal leisure-time physical activity (LTPA) during pregnancy might have this effect is unknown. The purpose of this study was to determine the relationship between maternal LTPA during pregnancy and offspring DNA methylation. Participants were recruited from the Archive for Research on Child Health study. At enrollment, participants’ demographic information and self-reported LTPA during pregnancy were determined. High active participants (averaged 637.5 min per week of LTPA; n=14) were matched by age and race to low active participants (averaged 59.5 min per week LTPA; n=28). Blood spots were obtained at birth. Pyrosequencing was used to determine methylation levels of long interspersed nucleotide elements (LINE-1) (global methylation) and peroxisome proliferator-activated receptor-gamma (PPARγ), peroxisome proliferator-activated receptor-gamma coactivator (PGC1-α), insulin-like growth factor 2 (IGF2), pyruvate dehydrogenase kinase, isozyme 4 (PDK4) and transcription factor 7-like 2 (TCF7L2). We found no differences between offspring of high active and low active groups for LINE-1 methylation. The only differences in candidate gene methylation between groups were at two CpG sites in the P2 promoter of IGF2; the offspring of low active group had significantly higher DNA methylation (74.70±2.25% methylation for low active v. 72.83±2.85% methylation for high active; P=0.045). Our results suggest no effect of maternal LTPA on offspring global and candidate gene methylation, with the exception of IGF2. IGF2 has been previously associated with regulation of physical activity, suggesting a possible role of maternal LTPA on regulation of offspring physical activity.

(1) Develop artificial neural network (ANN) models for wrist accelerometer data which can predict energy expenditure (EE) using data collected from either wrist. (2) Develop ANNs for detecting the wrist on which the accelerometer was worn. Forty-four adults wore GENEActiv accelerometers on the left and right wrists and a portable metabolic analyzer while participating in a 90 min semi-structured activity protocol. Participants performed 14 sedentary, lifestyle, exercise, and ambulatory activities and were allowed to choose activity order, duration, and intensity. ANNs were created to predict EE and wrist detection using a leave-one-out cross-validation. In total, 12 combinations of feature sets (mean and variance of raw, vector magnitude, and absolute value data), training methods (left- and right- wrist), and testing methods (left- and right-wrist data) were used to develop EE prediction ANNs. Accuracy of the ANNs was evaluated using correlations, root mean square error (RMSE), and bias, using metabolic analyzer data as the criterion for EE. ANNs using raw data from the same wrist (e.g. EE predicted from right wrist ANNs using accelerometer data from right wrist) had the highest accuracy for EE prediction (r = 0.84, RMSE = 1.25-1.26 METs); conversely, opposite-wrist prediction accuracy (e.g. EE predicted from right wrist ANNs using accelerometer data from left wrist) was lower (r = 0.60-0.64, RMSE = 1.93-2.01 METs). Preprocessing into absolute values prior to ANN development allowed for, high EE prediction accuracy, with no difference in accuracy for same- versus opposite-wrist prediction (r = 0.80-0.83, RMSE = 1.30-1.49 METs). Wrist detection ANNs correctly determined wrist placement 100% of the time. Highly accurate, wrist-independent EE prediction ANNs were developed by computing absolute values of raw acceleration data prior to ANN development. This method provides a potential approach for advancing predictive accuracy of wrist-worn accelerometers.

The purpose of this article is to compare accuracy of activity type prediction models for accelerometers worn on the hip, wrists, and thigh. Forty-four adults performed sedentary, ambulatory, lifestyle, and exercise activities (14 total, 10 categories) for 3–10 minutes each in a 90-minute semi-structured laboratory protocol. Artificial neural networks (ANNs) were developed for four accelerometers (right hip, both wrists, and right thigh,) to predict individual activities and activity categories, with direct observation (DO) as criterion. The wrist-mounted accelerometers achieved the highest accuracy for individual activities (80.9%–81.1%) and activity categories (86.6%–86.7%); accuracy was not different between wrists. The hip-mounted accelerometer had the lowest accuracy (66.2% individual activities, 72.5% activity categories); thigh-mounted accelerometer accuracy (71.4% individual activities, 84.0% activity categories) fell between the wrist- and hip-mounted accelerometers. ANNs developed for ac...

Background:Pregnancy risk perceptions and physical activity efficacy beliefs may facilitate or impede pregnancy leisure-time physical activity (LTPA). We examined the separate and joint influence of these variables on LTPA behavior among pregnant women.Methods:Pregnant women (n = 302) completed a survey containing questions on LTPA efficacy beliefs and behavior, as well as pregnancy risk perceptions with respect to the health of the unborn baby. As stipulated by the Risk Perception Attitude (RPA) Framework, 4 attitudinal groups were created: Responsive (High Risk+High Efficacy), Proactive (Low+High), Avoidant (High+Low), and Indifferent (Low+Low). Moderate LTPA and vigorous LTPA were dichotomized for study analyses.Results:A total of 82 women (27.2%) met the moderate physical activity guideline and 90 women (30.1%) performed any vigorous LTPA. Responsive and proactive pregnant women (those with high efficacy) were most likely to meet the moderate guideline and participate in vigorous LTPA. Hierarchical logistic regression did not reveal an interactive effect of pregnancy risk perceptions and LTPA efficacy beliefs for meeting the moderate guideline (OR = 0.94, 95% CI = 0.66–1.36) or any vigorous LTPA participation (OR = 1.41, 95% CI = 0.86–2.29).Conclusions:LTPA efficacy beliefs appear important in facilitating greater levels of pregnancy LTPA. Significant interactive effects between pregnancy risk perceptions and LTPA efficacy beliefs were not found.

AB Purpose: The purpose of this study was to develop, validate, and compare energy expenditure (EE) prediction models for accelerometers placed on the hip, thigh, and wrists using simple accelerometer features as input variables in EE prediction models. Methods: Forty-four healthy adults participated in a 90-min, semistructured, simulated free-living activity protocol. During the protocol, participants engaged in 14 different sedentary, ambulatory, lifestyle, and exercise activities for 3-10 min each. Participants chose the order, duration, and intensity of activities. Four accelerometers were worn (right hip, right thigh, as well as right and left wrists) to predict EE compared with that measured by the criterion measure (portable metabolic analyzer). Artificial neural networks (ANNs) were created to predict EE from each accelerometer using a leave-one-out cross-validation approach. Accuracy of the ANN was evaluated using Pearson correlations, root mean square error, and bias. Several ANNs were developed using different input features to determine those most relevant for use in the models. Results: The ANNs for all four accelerometers achieved high measurement accuracy, with correlations of r > 0.80 for predicting EE. The thigh accelerometer provided the highest overall accuracy (r = 0.90) and lowest root mean square error (1.04 METs), and the differences between the thigh and the other monitors were more pronounced when fewer input variables were used in the predictive models. None of the predictive models had an overall bias for prediction of EE. Conclusions: A single accelerometer placed on the thigh provided the highest accuracy for EE prediction, although monitors worn on the wrists or hip can also be used with high measurement accuracy.

Objective To describe associations between maternal lipids and birthweight and to determine whether pre-pregnancy body mass index (BMI) modifies these associations. Design Cohort study. Setting Multiple communities in Michigan, USA. Population Participants were a sub-cohort of women from the multi-community Pregnancy Outcomes and Community Health (POUCH) study (1998–2004). Methods Maternal total cholesterol, high-density lipoprotein (HDLc), and low-density lipoprotein (LDLc) cholesterol, and triglycerides were assessed at 16–27 weeks' gestation. Women were classified as having normal (

OBJECTIVES: To provide an updated US birth weight for gestational age reference corrected for likely errors in last menstrual period (LMP)-based gestational age dating, as well as means and SDs, to enable calculation of continuous and categorical measures of birth weight for gestational age. METHODS: From the 2009–2010 US live birth files, we abstracted singleton births between 22 and 44 weeks of gestation with at least 1 nonmissing estimate of gestational age (ie, LMP or obstetric/clinical) and birth weight. Using an algorithm based on birth weight and the concordance between these gestational age estimates, implausible LMP-based gestational age estimates were either excluded or corrected by using the obstetric/clinical estimate. Gestational age– and sex-specific birth weight means, SDs, and smoothed percentiles (3rd, 5th, 10th, 90th, 95th, 97th) were calculated, and the 10th and 90th percentiles were compared with published population-based references. RESULTS: A total of 7 818 201 (99% of eligible) births were included. The LMP-based estimate of gestational age comprised 85% of the dataset, and the obstetric/clinical estimate comprised the remaining 15%. Cut points derived from the current reference identified ∼10% of births as ≤10th and ≥90th percentiles at all gestational weeks, whereas cut points derived from previous US-based references captured variable proportions of infants at these thresholds within the preterm and postterm gestational age ranges. CONCLUSIONS: This updated US-based birth weight for gestational age reference corrects for likely errors in gestational age dating and allows for the calculation of categorical and continuous measures of birth size.

Objectives Evaluate accuracy of the activPAL and its proprietary software for prediction of time spent in physical activity (PA) intensities (sedentary, light, and moderate-to-vigorous) and energy expenditure (EE) and compare its accuracy to that of a machine learning model (ANN) developed from raw activPAL data. Design Semi-structured accelerometer validation in a laboratory setting. Methods Participants (n = 41 [20 male]; age = 22.0 ± 4.2) completed a 90-min protocol performing 13 activities for 3–10 min each and choosing activity order, duration, and intensity. Participants wore an activPAL accelerometer (right thigh) and a portable metabolic analyzer. Criterion measures of time spent in sedentary, light, and moderate-to-vigorous PA were determined using measured MET values of ≤1.5, 1.6–2.9, and ≥3.0, respectively. Estimated times in each PA intensity from the activPAL software and ANN were compared with the criterion using repeated measures ANOVA. Window-by-window EE prediction was assessed using correlations and root mean square error. Results activPAL software-estimated sedentary time was not different from the criterion, but light PA was overestimated (6.2 min) and moderate- to vigorous PA was underestimated (4.3 min). ANN-estimated sedentary time and light PA were not different from the criterion, but moderate- to vigorous PA was overestimated (1.8 min). For EE estimation, the activPAL software had lower correlations (r = 0.76 vs. r = 0.89) and higher error (1.74 vs. 1.07 METs) than the ANN. Conclusions The ANN had higher accuracy for estimation of EE and PA than the activPAL software in this semi-structured laboratory setting, indicating potential for the ANN to be used in PA assessment.

Objective. This study examined associations between maternal lipid levels at mid-pregnancy and preterm delivery, medically indicated or spontaneous. Design: Prospective cohort study. Setting. Women were recruited from 52 clinics in five Michigan, USA communities (1998–2004). Population. Pregnant women were enrolled at 15–27 weeks’ gestation and followed to delivery (n=3019). Methods. A single blood sample was obtained at study enrollment. Blood lipids, i.e. total cholesterol (TC), high-density lipoprotein (HDLc), low-density lipoprotein (LDLc) cholesterol, and triglycerides (TG), were measured on a sub-cohort (n=1309). Main outcome measures. There were 221 spontaneous, 100 medically indicated preterm deliveries and 988 term deliveries. Polytomous logistic regression models examined relationships among cholesterol levels (Low

Summary Nechuta S, Mudd LM, Elliott MR, Lepkowski JM, Paneth N, the Michigan Alliance for the National Children's Study. Attitudes of pregnant women towards collection of biological specimens during pregnancy and at birth. Paediatric and Perinatal Epidemiology 2012; 26: 272–275. Epidemiological investigations of maternal and child health may involve the collection of biological specimens, including cord blood and the placenta; however, the attitudes of pregnant women towards participation in the collection of biological specimens have been studied rarely. We evaluated attitudes towards collection and storage of biological specimens, and determined whether attitudes differed by maternal characteristics, in a cross-sectional study of pregnant women residing in Kent County, Michigan. Women were interviewed at their first visit for prenatal care between April and October 2006 (n = 311). Willingness to participate was highest for maternal blood collection (72%), followed by storage of biological specimens (68%), placenta collection (64%), and cord blood collection (63%). About one-quarter of women (25–28% by procedure) would not participate even if compensated. Hispanic ethnicity was associated with unwillingness to participate in maternal blood collection (OR = 2.16 [95% CI 1.15, 4.04]). Primiparity was associated with unwillingness to participate in cord blood collection (OR = 1.72 [95% CI 1.23, 2.42]). Among women willing to participate, Hispanic women were less likely to require compensation; while higher educated, married and primiparous women were more likely to require compensation. In conclusion, while many pregnant women were willing to participate in biological specimen collection, some women were more resistant, in particular Hispanic and primiparous women. Targeting these groups of women for enhanced recruitment efforts may improve overall participation rates and the representativeness of participants in future studies of maternal and child health.

This study investigates associations between gene expressions of aromatase (CYP19), 17α hydroxylase (CYP17), and estrogen receptors α and β and anthropometric measurements in offspring of the Michigan fish eater cohort. Leg and trunk length, height, weight, and BMI and gene expression in peripheral blood cells were measured in offspring of the Michigan fish eater cohort. The parental generation was followed between 1973 and 1991, and maternal age, height, and weight data were collected. Female offspring were contacted in 2001/2002 and followed up in 2006/2007; offspring information included age, education, reproductive history, smoking, and exercise. Gene expression was standardized against 18S ribosomal ribonucleic acid (18SrRNA) and RNA polymerase II (RNA PolII) expressions. Mixed models assessed the statistical effect of gene expression on anthropometric outcomes, accounting for multiple offspring from one mother. Anthropometric measurements and gene expression were measured in 139 female offspring. The two length and the height measurements were correlated, as were BMI and weight. CYP19 expression was correlated with the other gene expressions and both estrogen receptor expressions were associated. For every 1 unit of ΔC(t) (18SrRNA - CYP19) or ΔC(t) (RNA PolII - CYP19), BMI was increased by 0.9 (P = 0.03) and 0.87 kg/m(2) (P = 0.04), respectively, and weight by 2.35 kg (P = 0.03) and 2.1 kg (P = 0.03), respectively. For every 1 unit of ΔC(t) (18SrRNA - CYP17), leg length was increased by 0.84 cm (P = 0.04). The results suggest that CYP17 gene expression may influence growth during childhood and adolescence while CYP19 may be associated with the concurrent measures of weight and BMI.

Health benefits of physical activity (PA) during pregnancy have been noted, but women's perceptions of PA safety have been little studied. Objectives To examine associations among PA participation, safety perceptions, and demographic characteristics. Methods Pregnant women were recruited from nine clinics in Grand Rapids, MI (USA) from April to October, 2006. Demographics, participation in moderate and vigorous PA, and perceived safety of both intensities (5-pt Likert scales) were reported. Logistic regression analyses were used to estimate associations. Results Of 342 eligible women, 296 provided complete PA information. Most (88%) participated in some PA and felt moderate PA was safe (89%), but only 36% felt vigorous PA was safe. Feeling unsafe/unsure about moderate PA was associated with non-White race/ethnicity, low education, low income, not participating in moderate PA, and/or not intending to be active during pregnancy. Hispanic ethnicity, low education, nulliparity, and not participating in moderate or vigorous PA were associated with feeling unsafe/unsure about vigorous PA. Conclusions Pregnant women generally feel that moderate PA is safe, but are less certain about vigorous PA. More work is needed to inform pregnant women about the benefits of moderate PA, especially among non-White and low education/income populations.

To investigate the effect of prenatal exposure to polychlorinated biphenyls (PCBs) and dichlorodiphenyl-dichloroethylene (DDE) on weight, height and body mass index (BMI) in adult female offspring of the Michigan fisheater cohort examined between 1973 and 1991.259 mothers from the Michigan fisheater cohort were studied. Prenatal exposure to PCBs and DDE was estimated by extrapolating maternal measurements to the time that the women gave birth. 213 daughters aged 20-50 years in 2000 were identified and 83% of them participated in at least one of two repeated investigations in 2001/02 (n = 151) and 2006/07 (n = 129). To assess the effect of prenatal PCB and DDE exposure on anthropometric measurements, generalised estimating equations nested for repeated measurements (2001/02 and 2006/07) and for sharing the same mother were used. We controlled for maternal height and BMI and for daughters' age, birth weight, having been breastfed and number of pregnancies.Maternal height and BMI were significant predictors of the daughters' height, weight and BMI. Low birth weight (2500 g) was significantly associated with reduced adult offspring weight and BMI. The weight and BMI of adult offspring were statistically significantly associated with the extrapolated prenatal DDE levels of their mothers. Controlling for confounders and compared to maternal DDE levels of1.503 microg/l, offspring BMI was increased by 1.65 when prenatal DDE levels were 1.503-2.9 microg/l and by 2.88 if levels were2.9 microg/l. Prenatal PCB levels showed no effect.Prenatal exposure to the oestrogenic endocrine-disrupting chemical DDE may contribute to the obesity epidemic in women.

Objectives The cooperation of healthcare personnel is essential for implementing clinical research, yet little is known about the willingness of staff to facilitate research. This study assessed attitudes of prenatal clinic and delivery room (DR) staff toward facilitation of research, with a particular focus on the National Children’s Study (NCS). Methods Staff from seven sampled prenatal clinics (N = 82) and all three DRs in Kent County, MI (N = 169) completed anonymous surveys assessing willingness to recruit patients (clinic) or collect biological specimens (DR), desired incentives, and barriers to research in general and the NCS specifically. Results Clinic staff included 36 office workers, 29 nurses, 11 medical assistants and 6 physicians/physician assistants. DR staff included 127 nurses, 19 support staff, 11 physicians and 10 technicians. Clinic staff would hand out brochures (72%) and describe studies (65%), but only 44% wanted outside research staff to recruit patients. Non-White staff were 4.1 times more likely (95% CI. 1.2–14.1) to permit outside staff to recruit. DR staff would collect placentas (84%) and cord blood (77%), and preferred DR staff to perform the collections. In both settings, financial incentives were not required or were modest. Lack of time was the most reported research barrier, followed by patient flow and lack of space. A small fraction of healthcare workers reported refusal to facilitate research tasks. Conclusions Careful planning of research with all clinic and DR staff will be necessary for successful execution of the NCS or other large-scale clinical research studies.

Preeclampsia is diagnosed in women presenting with new onset hypertension accompanied by proteinuria or other signs of severe organ dysfunction in the second half of pregnancy. Preeclampsia risk is increased 2- to 4-fold among women with type 1 or type 2 diabetes. The limited number of pregnant women with preexisting diabetes and the difficulties associated with diagnosing preeclampsia in women with proteinuria prior to pregnancy are significant barriers to research in this high-risk population. Gestational diabetes mellitus (GDM) also increases preeclampsia risk, although it is unclear whether these two conditions share a common pathophysiological pathway. Nondiabetic women who have had preeclampsia are more likely to develop type 2 diabetes later in life. Among women with type 1 diabetes, a history of preeclampsia is associated with an increased risk of retinopathy and nephropathy. More research examining the pathophysiology, treatment, and the long-term health implications of preeclampsia among women with preexisting and gestational diabetes is needed.

Our purpose was to review relations between physical activity during pregnancy, gestational diabetes, and other maternal metabolic markers (i.e., lipids, tumor necrosis factor alpha (TNFα), interleukin six (IL-6), leptin, and adiponectin). While observational studies indicate a protective effect of physical activity on gestational diabetes, interventions that promote recommended levels of physical activity during pregnancy (i.e., 150+ min/week) have failed to show significant effects. However, interventions have been often underpowered and with low protocol adherence. Maternal lipids, TNFα, IL-6, and leptin all increase and adiponectin decreases with a healthy pregnancy. Although the evidence base is small, preliminary results indicate a beneficial effect of physical activity on lowering triglycerides, TNFα, and leptin levels while increasing muscle-derived IL-6 levels during pregnancy. Future studies are needed to examine relationships among prospectively measured physical activity and metabolic markers throughout pregnancy, as well as theoretically based physical activity interventions to prevent gestational diabetes.

Background:We sought to evaluate the effects of maternal leisure-time physical activity (LTPA) during pregnancy and current child LTPA on child weight status.Methods:Women with term pregnancies in the Pregnancy Outcomes and Community Health Study (1998–2004) were followed-up. A race-stratified subset of participants (cohort A) received extensive follow-up efforts leading to better response rates (592/926 = 64%) and diversity. The remainder (Cohort B) had a lower response rate (418/1629 = 26%). Women reported child height, weight and LTPA at 3 to 9 years (inactive vs. active), and recalled pregnancy LTPA (inactive vs. active). A 4-category maternal/child LTPA variable was created (reference: active pregnancy + active child). Children were classified as healthy weight, overweight, or obese using age- and sex-specific Body Mass Index percentiles. Logistic regression was used to assess the odds of child obesity (reference: healthy weight).Results:In unadjusted analyses, pregnancy inactivity increased odds for obesity when the child was active (1.6 [95% CI, 1.0−2.6] in Cohort A; 2.1 [95% CI, 1.1−4.0] in Cohort B), and more so when the child was inactive (2.4 [95% CI, 1.2−4.9] in Cohort A; 3.0 [95% CI, 1.0−8.8] in Cohort B). Adjustment for covariates attenuated results to statistical nonsignificance but the direction of relations remained.Conclusions:Maternal inactivity during pregnancy may contribute to child obesity risk.

Background:Little is known about how leisure-time physical activity (LTPA) influences gestational weight gain (GWG) among body mass index (BMI) categories. The purpose of this study was to examine the relationship between pregnancy LTPA and the proportion of normal, overweight, and obese women who meet GWG recommendations.Methods:Participants included 449 subcohort women from the Pregnancy Outcomes and Community Health (POUCH) study. LTPA was collapsed into 3 categories [(None, < 7.5 kcal/kg/wk (low), ≥ 7.5 kcal/kg/wk (recommended)]. GWG was categorized according to IOM recommendations (low, recommended, or excess). Chi-square and logistic regression analyses were used to evaluate relationships among LTPA, BMI, and GWG.Results:Overweight women were more likely to have high GWG vs. normal weight women (OR = 2.3, 95% CI 1.3–4.0). Obese women were more likely to experience low GWG (OR = 7.3, 95% CI 3.6–15.1; vs. normal and overweight women) or excess GWG (OR = 3.5, 95% CI 1.9–6.5; vs. normal weight women). LTPA did not vary by prepregnancy BMI category (P = .55) and was not related to GWG in any prepregnancy BMI category (P = .78).Conclusions:Regardless of prepregnancy BMI, LTPA did not affect a woman’s GWG according to IOM recommendations. Results may be due to LTPA not differing among BMI categories.

MUDD, L. M., K. M. OWE, M. F. MOTTOLA, and J. M. PIVARNIK. Health Benefits of Physical Activity during Pregnancy: An International Perspective. Med. Sci. Sports Exerc., Vol. 45, No. 2, pp. 268–277, 2013. While early studies on the effects of leisure time physical activity (LTPA) during pregnancy were concerned about possible harm to the mother or fetus, these fears have not been substantiated. Instead, a growing body of literature has documented several health benefits related to pregnancy LTPA. The purpose of this article was to synthesize evidence from epidemiological studies conducted in the United States, Canada, and Scandinavia on the benefits of LTPA and exercise during pregnancy with regard to maternal health, pregnancy outcomes, and child health. We focused on studies evaluating relations between pregnancy LTPA and gestational diabetes, hypertensive disorders, excessive gestational weight gain, birth weight, timing of delivery, and child body composition. The bulk of evidence supports beneficial effects of pregnancy LTPA on each outcome; however, most previous studies have been observational and used self-reported LTPA at only one or two time points in pregnancy. Limitations of the current knowledge base and suggestions for future research on the health benefits of LTPA during

To examine associations between the densities of available parkland, parkland provided per capita, and levels of physical activity (PA) and overweight in urban United States.Cross-sectional correlation research using data drawn from the Trust for Public Land's 2010 City Park Facts and The Behavioral Risk Factor Surveillance System (BRFSS). City Park Facts is a report containing "basic information on urban park systems--from acreage, to facilities, to staffing, to budgets, to usership, and more" for America's 85 largest cities. The Behavioral Risk Factor Surveillance System is a state-based surveillance system that collects information on health risk behaviors, preventive health practices, and health care access primarily related to chronic disease and injury.Sixty-seven metropolitan statistical areas in the United States that provided data for both reports.Randomly selected adults aged 18 years and older who participated in the 2009 Behavioral Risk Factor Surveillance Survey in the 67 metropolitan statistical areas.Total parkland per acre of metropolitan area was correlated to inactivity, engaging in recommended levels of moderate or vigorous PA, engaging in recommended levels of vigorous PA, and body weight. Parkland acreage per 1000 residents was correlated to these same variables. Multilevel models considered these relationships while controlling for race, family income, and age of respondents and accounting for clustering by metropolitan statistical area.There were significant, positive correlations between park density and PA (r(s) = 0.37, n = 67, P.01) and between park density and exercise (r(s) = 0.35, n = 67, P.01), and a negative correlation between park density and being above normal weight (r(s) = -0.32, n = 67, P.01). Adjusted multilevel models showed that parkland density in the highest versus lowest quartile was associated with significantly higher odds of meeting PA guidelines (aOR = 1.19, 95% CI: 1.08-1.30) and reduced odds of being overweight/obese (aOR = 0.85, 95% CI: 0.76-0.95).Each of these findings substantiates the need for providing parkland in a community. As such, this research helps to support the notion that the development of a strong park system may lead to positive PA and health outcomes for that community.

Epidemiological investigations of maternal and child health may involve the collection of biological specimens, including cord blood and the placenta; however, the attitudes of pregnant women towards participation in the collection of biological specimens have been studied rarely. We evaluated attitudes towards collection and storage of biological specimens, and determined whether attitudes differed by maternal characteristics, in a cross-sectional study of pregnant women residing in Kent County, Michigan. Women were interviewed at their first visit for prenatal care between April and October 2006 (n = 311). Willingness to participate was highest for maternal blood collection (72%), followed by storage of biological specimens (68%), placenta collection (64%), and cord blood collection (63%). About one-quarter of women (25-28% by procedure) would not participate even if compensated. Hispanic ethnicity was associated with unwillingness to participate in maternal blood collection (OR = 2.16 [95% CI 1.15, 4.04]). Primiparity was associated with unwillingness to participate in cord blood collection (OR = 1.72 [95% CI 1.23, 2.42]). Among women willing to participate, Hispanic women were less likely to require compensation; while higher educated, married and primiparous women were more likely to require compensation. In conclusion, while many pregnant women were willing to participate in biological specimen collection, some women were more resistant, in particular Hispanic and primiparous women. Targeting these groups of women for enhanced recruitment efforts may improve overall participation rates and the representativeness of participants in future studies of maternal and child health.

The 2-day meeting held in Bethesda, MD on selfreport physical activity covered a multitude of topics to understand the current scientific evidence and craft recommendations for future research. Although much has been done, more research remains to be conducted to develop the most reliable and valid self-report physical activity instruments and also to develop feasible methodologies to employ the instruments across multiple populations and settings. Once data have been collected, though, there is the ongoing challenge of disseminating such information to researchers, students and trainees, and, ultimately, practitioners. As self-report physical activity measures are being used in the field, there is additionally an ever-present need to give feedback to researchers so that these measures can be further refined. In this commentary, we suggest ways and provide an example to augment collaboration between researchers and practitioners to construct a practice-based evidence for self-report physical activity measurement.

Background:Leisure-time physical activity (LTPA) is recommended during pregnancy and has been associated with lower risk of delivering a large infant. We sought to characterize the effect of LTPA across the entire birth weight distribution.Methods:Women enrolled in the Pregnancy Outcomes and Community Health (POUCH) Study (1998–2004) were followed-up in 2007. Follow-up efforts were extensive for a subcohort and minimal for the remainder (nonsubcohort). Thus, 596 subcohort and 418 nonsubcohort women who delivered at term participated. Offspring were categorized as small-, appropriate-, or large-for-gestational-age (SGA, AGA, and LGA, respectively) based on gender and gestational age-specific birth weight z-scores (BWz). At follow-up, women recalled pregnancy LTPA and were classified as inactive, insufficiently active or meeting LTPA recommendations. Linear, logistic, and quantile regression analyses were conducted separately by subcohort status.Results:Meeting LTPA recommendations decreased odds of LGA significantly among the nonsubcohort (aOR = 0.30, 95% CI: 0.14–0.64) and nonsignificantly among the subcohort (aOR = 0.68, 95% CI: 0.34–1.34). In quantile regression, meeting LTPA recommendations reduced BWz among the upper quantiles in the nonsubcohort.Conclusions:LTPA during pregnancy lowered odds of LGA and reduced BWz among the upper quantiles, without shifting the entire distribution. LTPA during pregnancy may be useful for reducing risks of large fetal size.

Background:Leisure-time physical activity (LTPA) during pregnancy has maternal benefits, but effects on offspring have not often been considered. This study aimed to determine associations among trimester-specific LTPA during pregnancy and toddler size.Methods:Women (n = 300) were recruited while pregnant in 2006. At follow-up (2008), women reported demographics; recalled type, duration, and frequency of trimester-specific LTPA (MET·min/wk); and rated their toddler’s current LTPA level (more, same, or less than others their age). A subset (n = 23) volunteered to have maternal and toddler height, weight, and body fat measured. Maternal body mass index (BMI) and toddler weight-for-height z-scores (WHZ) were calculated.Results:Median toddler WHZ was 0.6 (range −0.5 to 2.9). In Spearman correlations, third trimester LTPA was marginally associated with lower toddler weight (rs = −0.39, P = .06) and WHZ (rs = −0.40, P = .06), but no other measures of maternal LTPA and toddler body size were related. Birth weight z-score was positively associated with toddler weight (rs = 0.51, P = .01) but negatively associated with percent body fat (rs= −0.46, P = .03). Measures of maternal size were unassociated with toddler size.Conclusions:These results provide preliminary support for LTPA during late pregnancy to have a lasting effect on offspring size.

To investigate the effects of postnatal dexamethasone treatment on aerobic fitness and physical activity levels in school-aged children born with very low birth weight (VLBW).This was a follow-up study of 65 VLBW infants who participated in a randomized controlled trial of dexamethasone (DEX) to reduce ventilator dependency. Aerobic fitness was determined from peak oxygen uptake (VO(2peak)) with a cycle ergometer. Habitual physical activity was assessed by questionnaire.A trend for a treatment with an interaction between treatment and of diagnosis of chronic lung disease (CLD) was found, with the children in the placebo group with CLD having the lowest VO(2peak) (P = .09). Reduced fitness was seen in 53% of the group treated with DEX and 48% of the group given placebo. No between-group differences in physical activity were seen. Parental reports suggested that nearly two-thirds of the children participated in1 hour per week of vigorous physical activity, which was explained in part by decreased large airway function (r = 0.30; P = .03).We found no adverse effect of postnatal DEX on aerobic fitness or habitual physical activity at school age. However, the reduced fitness and physical activity levels emphasize the need for closer follow-up and early interventions promoting physical activity to reduce the risk of chronic disease in this at-risk population.

It seems paradoxical that both increased height and earlier age at menarche (which predicts for shorter stature) are both associated with increased breast cancer risk.Retrospective data from a parental cohort coupled with prospective interviews with and anthropometric measurements from their daughters were used. Multivariable linear regression analyses were conducted using mixed regression models to account for same-family participants.Controlling for birth weight, maternal height, and birth cohort, and analyzed as a group, a 1-year increase in the age at menarche predicted an increase in standing height, leg length, and trunk height of 0.76, 0.41, and 0.35 cm, respectively. However, when stratifying by birth year (prior to 1966 vs 1966 or after), these relationships were true only for those born prior to 1966.Given the height-breast cancer risk association, the emerging evidence linking breast cell proliferation to hormones associated with growth, and the finding in this study that the relationship between age at menarche and adult height no longer exists for women born in 1966 or later, it is possible that the long-established relationship between age at menarche and breast cancer risk may also no longer exist.

We assessed attitudes of a multi-ethnic sample of pregnant women in regard to participation in five data collection procedures planned for use in the National Children's Study. A cross-sectional survey was conducted in nine prenatal clinics in Kent County, Michigan between April and October 2006. Women were approached in clinic waiting rooms at the time of their first prenatal visit and 311 (91.0%) participated. Women were asked about their willingness to participate, and the smallest amount of compensation required for participation in a 45-min in-person interview, a 15-min telephone interview, maternal and infant medical record abstraction, and an infant physical examination. Percentages for willingness to participate were highest for telephone interview (83%), followed by in-person interview (60%), infant examination (57%), and maternal (56%) and infant medical records (54%). About 34-48% of women reported that no compensation would be required for participation by data procedure. Some women reported unwillingness to participate in telephone (9%) or personal (17%) interview, record abstraction (34%) or infant examination (26%), even with compensation. Education greater than high school was associated with increased odds of refusal for infant physical examination, adjusted odds ratio 2.44 [95% confidence interval 1.41, 4.23]. In conclusion, 9-34% of pregnant women, depending on procedure, stated they would not participate in non-invasive research procedures such as medical record abstraction and infant examination, even with compensation. Resistance to these research procedures was especially noted among more highly educated women. Planning for the National Children's Study will have to address potential resistance to research among pregnant women.

Most adults do not meet the American College of Sports Medicine and Centers for Disease Control and Prevention (ACSM/CDC) physical activity recommendations. Even fewer meet the more extreme Institute of Medicine (IOM) physical activity recommendations. Compliance with either recommendation has been conventionally assessed by combining frequencies and durations of self-reported activities. Leisure-time energy expenditure is a cumulative measure of activity that offers an alternative method of defining compliance. Purposes: To calculate the leisure-time energy expenditure of adults complying with the ACSM/CDC or the IOM physical activity recommendations determined by conventional measures and to reexamine compliance with the IOM recommendation using energy expenditure criteria. Methods: National, cross-sectional data from the 2000 Behavioral Risk Factor Surveillance System determined the mode, frequency, and duration of up to two leisure-time activities performed by adults. Four mutually exclusive activity groups (Non-, Low-, ACSM/CDC-, and IOM-Active) were defined on the basis of frequencies and durations of reported activities. Leisure-time energy expenditure (kcal[middle dot]kg-1[middle dot]wk-1) was calculated per respondent. The energy expenditure threshold for meeting the IOM recommendation was calculated as 21 kcal[middle dot]kg-1[middle dot]wk-1. Results: Of the 162,669 respondents included in the analyses, 29.9% were Nonactive, whereas 42.3%, 23.3%, and 4.5% were Low-, ACSM/CDC-, and IOM-Active, respectively. Median leisure-time energy expenditure values were 9.0, 27.4, and 63.0 kcal[middle dot]kg-1[middle dot]wk-1 for Low-, ACSM/CDC-, and IOM-Active groups, respectively. When using energy expenditure criteria, compliance with the IOM recommendation rose to 27.7% of respondents. Conclusions: Compliance with the IOM physical activity recommendation dramatically increased when assessed by energy expenditure compared with conventional criteria, thereby highlighting the potential bias of conventional methods. A significant proportion of adults meet the intent but not the letter of the IOM activity recommendation.

Some female athletes may have decreased bone mineral density (BMD), which puts them at higher risk for stress fractures and future osteoporosis.To compare site-specific BMD among National Collegiate Athletic Association Division I varsity female athletes and to determine predictor variables of BMD measurements.Between-groups design.University health care system.All women varsity athletes were invited to participate in a cross-sectional study. Of 12 sports, we obtained complete data from 99 women (mean age = 20.2 +/- 1.3 years) representing gymnastics, softball, cross-country, track, field hockey, soccer, crew, and swimming/diving.Each participant was weighed, measured, and questioned about her menstrual status. Using dual-energy x-ray absorptiometry, we measured total-body BMD and region-of-interest scores for lumbar spine, pelvis, and average leg (average from right and left leg measurements) BMD. Using analyses of covariance, we compared BMD measurements among sports at each site while controlling for menstrual status and mass, and we performed a stepwise regression analysis to determine significant predictors of BMD at each site.Twenty-three athletes were oligomenorrheic or amenorrheic. Runners had the lowest total-body (1.079 +/- 0.055 g.cm (-2)) and site-specific ( P.01) BMD values for every site except average leg score when compared with gymnasts and softball players. Swimmers and divers had significantly lower average leg BMD (1.117 +/- 0.086 g.cm (-2)) than athletes in every other sport except runners and rowers ( P.01). Regression analysis revealed only mass and sport as significant predictors of total-body BMD.Runners and swimmers and divers demonstrated some deficits in site-specific BMD values when compared with athletes in other sports. When treating a female varsity athlete, athletic trainers should consider her mass and sport type with regard to her bone health.