Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, 204 Craft Avenue, Suite A208, Pittsburgh, PA, 15213, USA.
RTI International, Research Triangle Park, NC, USA.
Int J Behav Nutr Phys Act. 2018 Jul 11;15(1):68. doi: 10.1186/s12966-018-0701-5.
Although leisure-time physical activity (PA) contributes to overall health, including pregnancy health, patterns across pregnancy have not been related to birth outcomes. We hypothesized that women with sustained low leisure-time PA would have excess risk of adverse pregnancy outcomes, and that changing patterns across pregnancy (high to low and low to high) may also be related to risk of adverse pregnancy outcomes.
Nulliparous women (n = 10,038) were enrolled at 8 centers early in pregnancy (mean gestational age in weeks [SD] = 12.05 [1.51]. Frequency, duration, and intensity (metabolic equivalents) of up to three leisure activities reported in the first, second and third trimesters were analyzed. Growth mixture modeling was used to identify leisure-time PA patterns across pregnancy. Adverse pregnancy outcomes (preterm birth, [PTB, overall and spontaneous], hypertensive disorders of pregnancy [HDP], gestational diabetes [GDM] and small-for-gestational-age births [SGA]) were assessed via chart abstraction.
Five patterns of leisure-time PA across pregnancy were identified: High (35%), low (18%), late decreasing (24%), early decreasing (10%), and early increasing (13%). Women with sustained low leisure-time PA were younger and more likely to be black or Hispanic, obese, or to have smoked prior to pregnancy. Women with low vs. high leisure-time PA patterns had higher rates of PTB (10.4 vs. 7.5), HDP (13.9 vs. 11.4), and GDM (5.7 vs. 3.1, all p < 0.05). After adjusting for maternal factors (age, race/ethnicity, BMI and smoking), the risk of GDM (Odds ratio 2.00 [95% CI 1.47, 2.73]) remained higher in women with low compared to high patterns. Early and late decreasing leisure-time PA patterns were also associated with higher rates of GDM. In contrast, women with early increasing patterns had rates of GDM similar to the group with high leisure-time PA (3.8% vs. 3.1%, adjusted OR 1.16 [0.81, 1.68]). Adjusted risk of overall PTB (1.31 [1.05, 1.63]) was higher in the low pattern group, but spontaneous PTB, HDP and SGA were not associated with leisure-time PA patterns.
Sustained low leisure-time PA across pregnancy is associated with excess risk of GDM and overall PTB compared to high patterns in nulliparous women. Women with increased leisure-time PA early in pregnancy had low rates of GDM that were similar to women with high patterns, raising the possibility that early pregnancy increases in activity may be associated with improved pregnancy health.
Registration number NCT02231398 .
尽管休闲时间的身体活动（PA）有助于整体健康，包括怀孕健康，但整个怀孕期间的模式与出生结果并没有关联。我们假设，持续低休闲时间 PA 的女性发生不良妊娠结局的风险会增加，而整个怀孕期间（高到低和低到高）模式的变化也可能与不良妊娠结局的风险相关。
10038 名初产妇（平均孕周 [SD] 为 12.05 [1.51] 周）在 8 个中心入组。分析了在第一个、第二个和第三个三个月中报告的最多三种休闲活动的频率、持续时间和强度（代谢当量）。采用增长混合物模型来识别整个孕期的休闲时间 PA 模式。通过图表分析评估不良妊娠结局（早产，[PTB，总体和自发性]、妊娠高血压疾病 [HDP]、妊娠期糖尿病 [GDM] 和小于胎龄儿 [SGA]）。
共确定了五种孕期休闲时间 PA 模式：高（35%）、低（18%）、晚期下降（24%）、早期下降（10%）和早期增加（13%）。持续低休闲时间 PA 的女性更年轻，更有可能是黑人或西班牙裔，肥胖，或在怀孕前吸烟。与高休闲时间 PA 模式相比，低休闲时间 PA 模式的女性 PTB 发生率更高（10.4%比 7.5%），HDP 发生率更高（13.9%比 11.4%），GDM 发生率更高（5.7%比 3.1%，均 P<0.05）。调整了产妇因素（年龄、种族/民族、BMI 和吸烟）后，与高 PA 模式相比，低 PA 模式的 GDM 风险（比值比 2.00 [95%CI 1.47, 2.73]）仍然更高。早期和晚期下降的休闲时间 PA 模式也与 GDM 发生率升高相关。相比之下，早期增加 PA 模式的女性 GDM 发生率与高休闲时间 PA 模式相似（3.8%比 3.1%，调整后的比值比 1.16 [0.81, 1.68]）。低模式组整体 PTB 的调整风险（1.31 [1.05, 1.63]）较高，但自发性 PTB、HDP 和 SGA 与休闲时间 PA 模式无关。
与高 PA 模式相比，整个孕期持续低休闲时间 PA 与 GDM 和整体 PTB 的风险增加相关。在妊娠早期增加休闲时间 PA 的女性发生 GDM 的风险较低，与高 PA 模式相似，这可能表明妊娠早期增加活动与改善妊娠健康有关。
注册号 NCT02231398。
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