Watkins Virginia Y, Zhao Peinan, Frolova Antonina I, Carter Ebony B, Kelly Jeannie C, Odibo Anthony O, England Sarah K, Raghuraman Nandini
Department of Obstetrics and Gynecology, Duke University Health System, Durham, NC (Watkins).
Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO (Zhao, Frolova, Odibo, England, Raghuraman, and Kelly).
Am J Obstet Gynecol MFM. 2024 Dec;6(12):101534. doi: 10.1016/j.ajogmf.2024.101534. Epub 2024 Oct 28.
Physical activity in pregnancy decreases the risk of adverse maternal and neonatal outcomes. This study evaluates the association between first trimester physical activity, assessed by Kaiser Physical Activity Survey (KPAS) scores, and adverse perinatal outcomes.
This is a secondary analysis of a prospective cohort study in which patients were administered the KPAS in each trimester. The primary outcomes were birthweight, large for gestational age (LGA), and small for gestational age (SGA) neonates. Secondary outcomes were composite neonatal morbidity (neonatal acidemia with pH<7.1, hypoxic ischemic encephalopathy, mechanical ventilation, hypoglycemia, and suspected sepsis), gestational diabetes, gestational hypertension, preeclampsia, inadequate and excess gestational weight gain. Outcomes were compared between patients with and without high physical activity levels during early pregnancy, defined as 1st trimester KPAS scores ≥75th percentile and <75th percentile, respectively. Multivariable logistic regression was used to adjust for confounders.
A total of 1,045 patients with a complete 1st trimester KPAS were included in this analysis and 262 patients were in the top quartile of physical activity levels in early pregnancy. Higher physical activity levels in the 1st trimester were associated with numerically but not clinically significantly higher birthweights (3191.3±696.1 vs 3076.3±719.8 g, P=.03) with no difference in rates of SGA (10.3% vs 13.3%, P=.25, aRR 0.79; 95% CI 0.52, 1.16) or LGA neonates (8.0% vs 7.3%, P=.80, aRR 1.14; 95% CI 0.68, 1.81). Higher physical activity levels were associated with decreased rates of composite neonatal morbidity (8.4% vs 15%, P<.01, aRR 0.59; 95% CI 0.37, 0.89) and gestational hypertension (6.5% vs 12.9%, P<.01, aRR 0.56; 95% CI 0.33, 0.89). Gestational weight gain and the incidence of gestational diabetes and preeclampsia were similar between groups.
Higher levels of physical activity in the first trimester are associated with higher birth weights and lower rates of composite neonatal morbidity and gestational hypertension.
孕期进行体育活动可降低孕产妇和新生儿不良结局的风险。本研究评估了通过凯泽体育活动调查（KPAS）评分评估的孕早期体育活动与围产期不良结局之间的关联。
这是一项前瞻性队列研究的二次分析，研究中在每个孕期对患者进行KPAS评估。主要结局为出生体重、大于胎龄（LGA）和小于胎龄（SGA）新生儿。次要结局为复合新生儿发病率（pH<7.1的新生儿酸血症、缺氧缺血性脑病、机械通气、低血糖和疑似败血症）、妊娠期糖尿病、妊娠期高血压、先兆子痫、孕期体重增加不足和过多。分别比较孕早期体育活动水平高（定义为孕早期KPAS评分≥第75百分位数）和体育活动水平低（定义为孕早期KPAS评分<第75百分位数）的患者的结局。采用多变量逻辑回归对混杂因素进行校正。
本分析共纳入1045例孕早期KPAS完整的患者，262例患者处于孕早期体育活动水平的前四分位数。孕早期体育活动水平较高与出生体重在数值上较高但无临床显著差异相关（3191.3±696.1 vs 3076.3±719.8 g，P = 0.03），SGA新生儿发生率无差异（10.3% vs 13.3%，P = 0.25，调整后相对危险度[aRR] 0.79；95%置信区间[CI] 0.52，1.16）或LGA新生儿发生率无差异（8.0% vs 7.3%，P = 0.80，aRR 1.14；95% CI 0.68，1.81）。体育活动水平较高与复合新生儿发病率降低相关（8.4% vs 15%，P<0.01，aRR 0.59；95% CI 0.37，0.89）以及妊娠期高血压降低相关（6.5% vs 12.9%，P<0.01，aRR 0.56；95% CI 0.33，0.89）。两组间孕期体重增加以及妊娠期糖尿病和先兆子痫的发生率相似。
孕早期较高水平的体育活动与较高的出生体重以及较低的复合新生儿发病率和妊娠期高血压发生率相关。
