Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
Deployment Health Research Department, Military Population Health Directorate, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106.
Mil Med. 2020 Feb 12;185(1-2):e227-e234. doi: 10.1093/milmed/usz168.
Active duty Navy women participate in biannual Physical Fitness Assessments (PFAs), which include height and weight measurements and a Physical Readiness Test (PRT). PFAs are waived during pregnancy and resume the cycle after 6 months following maternity leave. The purpose of this study was to compare changes in PFA results over time between women who had or did not have a live birth during the follow-up period, and identify characteristics of women with lower PFA results postpartum.
This longitudinal study included 14,142 active duty Navy women, aged 19-40 years, with PFA results during July 2011-June 2015. Multivariable logistic regression, Stuart-Maxwell tests, and mixed effects modeling were used to examine changes in PRT scores and body mass index over time between women with and without a live birth during follow-up. All data were analyzed in 2017. This study was approved by the institutional review boards at the Uniformed Services University Office of Research and the Naval Health Research Center, and informed consent was waived in accordance with 32 CFR § 219.116(d).
Postpartum women had increased odds of PRT failures (AOR = 3.88, 95% CI: 1.44-10.40) and lower PRT scores (AOR = 1.47, 95% CI: 1.12-1.92) up to 2.5 years postpartum, versus women without a live birth. Being enlisted, obese/overweight prepregnancy, and younger were risk factors for suboptimal PFA outcomes. Mean core strength and cardiovascular endurance, but not upper body strength, scores were significantly lower in postpartum women at 1 year postpartum versus women without a live birth.
Our findings show that additional interventions may be needed to assist women in returning to prepregnancy fitness up to 1 year postpartum. Future studies should examine additional factors that may improve postpartum fitness in addition to enhancing maternity leave policies.
现役海军女性每半年参加一次体能评估（PFA），其中包括身高和体重测量以及体能达标测试（PRT）。在怀孕期间可以免除 PFA，并且在产假结束后 6 个月后恢复周期。本研究的目的是比较随访期间有或没有活产的女性的 PFA 结果随时间的变化，并确定产后 PFA 结果较低的女性的特征。
这项纵向研究包括 14142 名年龄在 19-40 岁之间的现役海军女性，她们在 2011 年 7 月至 2015 年 6 月期间进行了 PFA 检查。使用多变量逻辑回归、斯图尔特-马克斯韦尔检验和混合效应模型来检查随访期间有和没有活产的女性的 PRT 评分和体重指数随时间的变化。所有数据均于 2017 年进行分析。本研究得到了统一服务大学研究办公室和海军健康研究中心机构审查委员会的批准，并根据 32 CFR§219.116(d)获得了豁免知情同意。
产后女性在产后 2.5 年内 PRT 失败的可能性增加（优势比[OR] = 3.88，95%置信区间[CI]：1.44-10.40），PRT 评分较低（OR = 1.47，95%CI：1.12-1.92），与无活产的女性相比。入伍、孕前肥胖/超重以及年龄较小是 PFA 结果不佳的危险因素。与无活产的女性相比，产后女性在产后 1 年时的核心力量和心血管耐力平均值显著降低，但上肢力量平均值没有降低。
我们的研究结果表明，可能需要额外的干预措施来帮助女性在产后 1 年内恢复到孕前的健康水平。未来的研究应该检查除了加强产假政策之外，还有哪些因素可以提高产后的健康水平。
