Physical activity levels during pregnancy and gestational weight gain among women who are overweight or obese
Zhixian Sui A C , Lisa J. Moran A and Jodie M. Dodd A B
+ Author Affiliations
- Author Affiliations
A The Robinson Institute, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Women’s and Children’s Hospital, 72 King William Road, North Adelaide, SA 5006, Australia.
B Department of Perinatal Medicine, Women’s and Babies Division, Women’s and Children’s Hospital, 72 King William Road, North Adelaide, SA 5006, Australia.
C Corresponding author. Email: zhixian.sui@adelaide.edu.au
Health Promotion Journal of Australia 24(3) 206-213 https://doi.org/10.1071/HE13054
Submitted: 5 July 2013 Accepted: 9 October 2013 Published: 9 December 2013
Journal Compilation © Australian Health Promotion Association 2013
Abstract
Issue addressed: There is contradictory research assessing physical activity patterns during pregnancy and postpartum among women who are overweight or obese. The aim of this study was to evaluate physical activity among overweight and obese women over the course of pregnancy and the initial postpartum period.
Methods: Three hundred and five overweight or obese pregnant women completed physical-activity questionnaires at three time points during pregnancy and at 4-months postpartum.
Results: Physical activity declined between early pregnancy and 28-weeks gestation (P < 0.001) and declined further at 36-weeks gestation (P < 0.001) before increasing significantly at 4-months postpartum (P < 0.001). However, reported activity at 4-months postpartum remained significantly lower than that reported in early pregnancy (P < 0.001). There was no significant difference either cross-sectionally or for changes over pregnancy and postpartum for total levels or categories of physical activity for women with different body mass index (BMI) or gestational weight gain (GWG). BMI was the only independent predictor of the change in total physical activity over the study and GWG, with women with higher BMI having larger decline of physical activity (β = 0.114, s.e. = 0.750, P = 0.032) and less GWG (β = −0.253, s.e. = 0.063, P < 0.001).
Conclusions: Physical activity declined significantly between early pregnancy and 28-weeks gestation, with a further decline to 36-weeks gestation. At 4-months postpartum, physical activity significantly increased but not to the level of that reported at early pregnancy.
So what?: The promotion of appropriate physical activity should be implemented early in pregnancy and postpartum to prevent the decline in activity we have observed in overweight and obese women. Future research should also explore the barriers and enablers to women engaging in exercise during pregnancy and the postpartum period.
References
[1] Kramer MS, McDonald SW (2006) Aerobic exercise for women during pregnancy. Cochrane Database Syst Rev 3, CD000180[2] Tobias DK, Zhang C, van Dam RM, Bowers K, Hu FB (2010) Physical activity before and during pregnancy and risk of gestational diabetes mellitus: a meta-analysis. Diabetes Care 34, 223–39.
[3] American College of Obstetricians and Gynecologists (2002) ACOG committee opinion. Exercise during pregnancy and the postpartum period. Number 267, January 2002. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet 77, 79–81.
| ACOG committee opinion. Exercise during pregnancy and the postpartum period. Number 267, January 2002. American College of Obstetricians and Gynecologists.Crossref | GoogleScholarGoogle Scholar | 12053898PubMed |
[4] Zavorsky GS, Longo LD (2011) Adding strength training, exercise intensity, and caloric expenditure to exercise guidelines in pregnancy. Obstet Gynecol 117, 1399–402.
| Adding strength training, exercise intensity, and caloric expenditure to exercise guidelines in pregnancy.Crossref | GoogleScholarGoogle Scholar | 21606752PubMed |
[5] Chan A, Scott J, Nguyen A-M, Sage L. Pregnancy Outcome in South Australia 2008. Adelaide: Pregnancy Outcome Unit, SA Health, Government of South Australia; 2009.
[6] Institute of Medicine, National Research Council. Weight gain during pregnancy: reexamining the guidelines. Washington, DC: Institute of Medicine; 2009.
[7] Dodd JM, Grivell RM, Nguyen AM, Chan A, Robinson JS (2011) Maternal and perinatal health outcomes by body mass index category. Aust N Z J Obstet Gynaecol 51, 136–40.
| Maternal and perinatal health outcomes by body mass index category.Crossref | GoogleScholarGoogle Scholar | 21466515PubMed |
[8] Sui Z, Grivell RM, Dodd JM (2012) Antenatal exercise to improve outcomes in overweight or obese women: a systematic review. Acta Obstet Gynecol Scand 91, 538–45.
| Antenatal exercise to improve outcomes in overweight or obese women: a systematic review.Crossref | GoogleScholarGoogle Scholar | 22229625PubMed |
[9] Amorim AR, Linne YM, Lourenco PM (2007) Diet or exercise, or both, for weight reduction in women after childbirth. Cochrane Database Syst Rev CD005627
[10] Schmidt MD, Pekow P, Freedson PS, Markenson G, Chasan-Taber L (2006) Physical activity patterns during pregnancy in a diverse population of women. J Womens Health 15, 909–18.
| Physical activity patterns during pregnancy in a diverse population of women.Crossref | GoogleScholarGoogle Scholar |
[11] Watson PE, McDonald BW (2007) Activity levels in pregnant New Zealand women: relationship with socioeconomic factors, well-being, anthropometric measures, and birth outcome. Appl Physiol Nutr Metab 32, 733–42.
| Activity levels in pregnant New Zealand women: relationship with socioeconomic factors, well-being, anthropometric measures, and birth outcome.Crossref | GoogleScholarGoogle Scholar | 17622288PubMed |
[12] Mottola MF, Campbell MK (2003) Activity patterns during pregnancy. Can J Appl Physiol 28, 642–53.
| Activity patterns during pregnancy.Crossref | GoogleScholarGoogle Scholar | 12904639PubMed |
[13] Fell DB, Joseph KS, Armson BA, Dodds L (2009) The impact of pregnancy on physical activity level. Matern Child Health J 13, 597–603.
| The impact of pregnancy on physical activity level.Crossref | GoogleScholarGoogle Scholar | 18719984PubMed |
[14] Chasan-Taber L, Schmidt MD, Pekow P, Sternfeld B, Manson J, Markenson G (2007) Correlates of physical activity in pregnancy among Latina women. Matern Child Health J 11, 353–63.
| Correlates of physical activity in pregnancy among Latina women.Crossref | GoogleScholarGoogle Scholar | 17345155PubMed |
[15] Gaston A, Cramp A (2011) Exercise during pregnancy: a review of patterns and determinants. J Sci Med Sport 14, 299–305.
| Exercise during pregnancy: a review of patterns and determinants.Crossref | GoogleScholarGoogle Scholar | 21420359PubMed |
[16] Renault K, Norgaard K, Andreasen KR, Secher NJ, Nilas L (2010) Physical activity during pregnancy in obese and normal-weight women as assessed by pedometer. Acta Obstet Gynecol Scand 89, 956–61.
| Physical activity during pregnancy in obese and normal-weight women as assessed by pedometer.Crossref | GoogleScholarGoogle Scholar | 20583938PubMed |
[17] McParlin C, Robson SC, Tennant PW, Besson H, Rankin J, Adamson AJ, Pearce MS, Bell R (2010) Objectively measured physical activity during pregnancy: a study in obese and overweight women. BMC Pregnancy Childbirth 10, 76
| Objectively measured physical activity during pregnancy: a study in obese and overweight women.Crossref | GoogleScholarGoogle Scholar | 21114834PubMed |
[18] Tavares JS, Oliveira Melo AS, Amorim MMR, Oliveira Barros V, D’Aquino Benício MH, Takito MY, Alves Cardoso MA (2009) [Association between maternal physical activity, gestational weight gain and birth weight in a cohort of 118 pregnant women in Campina Grande, Northeast of Brazil.] Rev Assoc Med Bras 55, 335–41.
| [Association between maternal physical activity, gestational weight gain and birth weight in a cohort of 118 pregnant women in Campina Grande, Northeast of Brazil.]Crossref | GoogleScholarGoogle Scholar |
[19] Stuebe AM, Oken E, Gillman MW (2009) Associations of diet and physical activity during pregnancy with risk for excessive gestational weight gain. Am J Obstet Gynecol 201, e51–8.
| Associations of diet and physical activity during pregnancy with risk for excessive gestational weight gain.Crossref | GoogleScholarGoogle Scholar |
[20] Dodd JM, Turnbull DA, McPhee AJ, Wittert G, Crowther CA, Robinson JS (2011) Limiting weight gain in overweight and obese women during pregnancy to improve health outcomes: the LIMIT randomised controlled trial. BMC Pregnancy Childbirth 11, 79
| Limiting weight gain in overweight and obese women during pregnancy to improve health outcomes: the LIMIT randomised controlled trial.Crossref | GoogleScholarGoogle Scholar | 22026403PubMed |
[21] World Health Organization. (2000) Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 894, 1–253.
[22] Wendel-Vos GC, Schuit AJ, Saris WH, Kromhout D (2003) Reproducibility and relative validity of the short questionnaire to assess health-enhancing physical activity. J Clin Epidemiol 56, 1163–9.
| Reproducibility and relative validity of the short questionnaire to assess health-enhancing physical activity.Crossref | GoogleScholarGoogle Scholar | 14680666PubMed |
[23] Wagenmakers R, van den Akker-Scheek I, Groothoff JW, Zijlstra W, Bulstra SK, Kootstra JWJ, Wendel-Vos GCW, van Raaij JJAM, Stevens M (2008) Reliability and validity of the short questionnaire to assess health-enhancing physical activity (SQUASH) in patients after total hip arthroplasty. BMC Musculoskelet Disord 9, 141
| Reliability and validity of the short questionnaire to assess health-enhancing physical activity (SQUASH) in patients after total hip arthroplasty.Crossref | GoogleScholarGoogle Scholar | 18928545PubMed |
[24] Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, O’Brien WL, Bassett DR, Schmitz KH, Emplaincourt PO, Jacobs DR, Leon AS (2000) Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 32, S498–504.
| Compendium of physical activities: an update of activity codes and MET intensities.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3cvktlegsg%3D%3D&md5=e72aedfb4701854253d634197d73c304CAS | 10993420PubMed |
[25] Chan A, Scheil W, Scott J, Nguyen AM, Sage L. Pregnancy outcome in South Australia 2009. Adelaide: Pregnancy Outcome Unit, SA Health, Government of South Australia; 2011.
[26] Borodulin K, Evenson KR, Herring AH (2009) Physical activity patterns during pregnancy through postpartum. BMC Womens Health 9, 32
| Physical activity patterns during pregnancy through postpartum.Crossref | GoogleScholarGoogle Scholar | 19925650PubMed |
[27] Pereira MA, Rifas-Shiman SL, Kleinman KP, Rich-Edwards JW, Peterson KE, Gillman MW (2007) Predictors of change in physical activity during and after pregnancy: Project Viva. Am J Prev Med 32, 312–9.
| Predictors of change in physical activity during and after pregnancy: Project Viva.Crossref | GoogleScholarGoogle Scholar | 17383562PubMed |
[28] Evenson KR, Herring AH, Wen F (2012) Self-reported and objectively measured physical activity among a cohort of postpartum women: the PIN postpartum study. J Phys Act Health 9, 5–20.
[29] Durham HA, Morey MC, Lovelady CA, Namenek Brouwer RJ, Krause KM, Ostbye T (2011) Postpartum physical activity in overweight and obese women. J Phys Act Health 8, 988–93.
[30] Ostbye T, Peterson BL, Krause KM, Swamy GK, Lovelady CA (2012) Predictors of postpartum weight change among overweight and obese women: results from the Active Mothers Postpartum study. J Womens Health 21, 215–22.
| Predictors of postpartum weight change among overweight and obese women: results from the Active Mothers Postpartum study.Crossref | GoogleScholarGoogle Scholar |
[31] Lipsky LM, Strawderman MS, Olson CM (2012) Maternal weight change between 1 and 2 years postpartum: the importance of 1 year weight retention. Obesity 20, 1496–502.
[32] Evenson KR, Aytur SA, Borodulin K (2009) Physical activity beliefs, barriers, and enablers among postpartum women. J Womens Health 18, 1925–34.
| Physical activity beliefs, barriers, and enablers among postpartum women.Crossref | GoogleScholarGoogle Scholar |
[33] Doran F, Davis K (2011) Factors that influence physical activity for pregnant and postpartum women and implications for primary care. Aust J Primary Health 17, 79–85.
| Factors that influence physical activity for pregnant and postpartum women and implications for primary care.Crossref | GoogleScholarGoogle Scholar |
[34] Scheers T, Philippaerts R, Lefevre J (2012) Patterns of physical activity and sedentary behavior in normal-weight, overweight and obese adults, as measured with a portable armband device and an electronic diary. Clin Nutr 11, 756–64.
[35] Thangaratinam S, Rogozińska E, Jolly K, Glinkowski S, Roseboom T, Tomlinson JW, Kunz R, Mol BW, Coomarasamy A, Khan KS (2012) Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence. BMJ 344, e2088
| Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC38nktFGjtA%3D%3D&md5=d648d9a3daedbf904e2fcde7c4bb2602CAS | 22596383PubMed |
[36] Duncombe D, Wertheim EH, Skouteris H, Paxton SJ, Kelly L (2009) Factors related to exercise over the course of pregnancy including women’s beliefs about the safety of exercise during pregnancy. Midwifery 25, 430–8.
| Factors related to exercise over the course of pregnancy including women’s beliefs about the safety of exercise during pregnancy.Crossref | GoogleScholarGoogle Scholar | 18063253PubMed |
[37] Mudd LM, Nechuta S, Pivarnik JM, Paneth N (2009) Factors associated with women’s perceptions of physical activity safety during pregnancy. Prev Med 49, 194–9.
| Factors associated with women’s perceptions of physical activity safety during pregnancy.Crossref | GoogleScholarGoogle Scholar | 19540874PubMed |
[38] Tudor-Locke C, Williams JE, Reis JP, Pluto D (2002) Utility of pedometers for assessing physical activity: convergent validity. Sports Med 32, 795–808.
| Utility of pedometers for assessing physical activity: convergent validity.Crossref | GoogleScholarGoogle Scholar | 12238942PubMed |
[39] ter Bogt NC, Milder IE, Bemelmans WJ, Beltman FW, Broer J, Smit AJ, van der Meer K (2011) Changes in lifestyle habits after counselling by nurse practitioners: 1-year results of the Groningen Overweight and Lifestyle study. Public Health Nutr 14, 995–1000.
| Changes in lifestyle habits after counselling by nurse practitioners: 1-year results of the Groningen Overweight and Lifestyle study.Crossref | GoogleScholarGoogle Scholar | 21272417PubMed |
[40] Admiraal WM, van Valkengoed IG, de Munter JSL, Stronks K, Hoekstra JB, Holleman F (2011) The association of physical inactivity with Type 2 diabetes among different ethnic groups. Diabet Med 28, 668–72.
| The association of physical inactivity with Type 2 diabetes among different ethnic groups.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3Mrht1SjtA%3D%3D&md5=b85eed2b0921194dc85aac4efcabe6e7CAS | 21569087PubMed |
