Barriers to physical activity in pregnant women: a cross-sectional study

Abstract

Background

Despite the American College of Obstetricians and Gynecologists’ (ACOG) recommendations on the benefits of physical activity during pregnancy, low levels of physical activity are reported worldwide. This research aims to identify the barriers to physical activity (PA) and their predictors among pregnant women.

Methods

In this cross-sectional study, data were collected from 351 pregnant women aged 18–45 with gestational ages of 10–37 weeks through convenience sampling. These women took part in the study from May 2022 to August 2024 and completed a demographic-obstetric scale and the Barriers to Physical Activity during Pregnancy Scale (BPAPS). Data were analyzed using univariate and multivariate linear regression.

Results

The total BPAPS score was 78.07 ± 16.25(range 29 to 145). The highest and lowest scores among the subscales were related to environmental barriers (43.67 ± 17.80) and interpersonal barriers (38.74 ± 17.93). The most commonly reported environmental barriers were limited access to sports facilities and the difficulty of exercising in hot or cold weather. In multivariate analysis, educational level (B = 4.39), employment status(B = 9.54), regular physical activity before pregnancy (B = 7.34), and maternal age (B = 0.91) were identified as strong independent predictors of physical activity barriers.

Conclusions

This study found that environmental barriers were the most prominent obstacles to physical activity among pregnant women, while interpersonal barriers were perceived as less influential. Higher education, employment, regular physical activity before pregnancy, and younger maternal age were associated with fewer perceived barriers during pregnancy. These findings suggest that addressing physical inactivity in pregnancy may require multilevel approaches that extend beyond individual counseling and consider environmental conditions. The results highlight modifiable factors that may inform future interventions and support healthcare providers in identifying women who are more likely to experience greater barriers to physical activity during pregnancy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-026-09034-z.

Background

Pregnancy involves significant physiological and psychological changes to prepare the body and uterus for the growth and development of the fetus [1]. These changes can lead to discomforts and complications in some women, such as back pain, gestational diabetes, obesity, hypertension, and psychological disorders [1, 2]. Engaging in physical activity (PA) during pregnancy reduces the likelihood of physical and psychological complications [1, 3] and lowers the risk of gestational diabetes, hypertension, cesarean delivery, obesity, postpartum depression, and other pregnancy-related complications [4, 5]. Moreover, regular PA is associated with reduced musculoskeletal complaints, improved body image, and enhanced psychological well-being [6]. It also benefits the fetus by improving placental function, increasing the newborn’s Apgar score, and potentially preventing excessive birth weight [7]. Additionally, studies suggest that infants born to mothers who exercised during pregnancy show better neurodevelopment [8].

The American College of Obstetricians and Gynecologists (ACOG) has stated that pregnant women who do not engage in at least 150 min of moderate-intensity PA per week are classified as inactive [9]. It is recommended that pregnant women perform 30 min of moderate-intensity PA daily [10]. Despite recommendations, pregnant women often face multiple barriers and insufficient support to engage in regular PA [11]. Studies from various countries have demonstrated low levels of PA among pregnant women [12, 13]. A recent study in Sweden, which assessed PA and inactivity in 2,203 pregnant women, reported that only 27% followed the recommended guidelines for PA during pregnancy [13]. Similarly, a study by Zhou T. et al. (2022) found that among a population of 1,636 pregnant Chinese women, only 2.8% met ACOG’s recommendation of at least 150 min of moderate-intensity PA per week [14]. In an Iranian study, it was also reported that in a group of 165 pregnant women, only 26.7% engaged in high levels of PA during pregnancy [15].

Various individual, interpersonal, social, and environmental factors may influence the level of PA among pregnant women. These include low educational attainment [16], employment status [17], pregnancy-related discomforts [7], fatigue [18], lack of access to facilities [12], and insufficient social support [19]. Findings across studies, however, are inconsistent. For instance, while some research suggests that higher education is associated with greater PA during pregnancy [20, 21], others have reported no such link [22, 23]. Similar discrepancies exist regarding employment status [24, 25], number of children [26, 27], and age [12, 28]. Moreover, few studies have focused specifically on the barriers to PA during pregnancy [29], with most assessing general activity levels [16].

Recent studies have relied on researcher-developed tools to assess PA during pregnancy; however, this study focuses on using a validated and psychometrically tested instrument (BPAPS) to explore barriers and their predictors among Iranian pregnant women [1, 16, 30, 31]. For example, many studies have used the Pregnancy PA Questionnaire (PPAQ) to assess PA levels. However, it has been reported that the PPAQ lacks sufficient structural validity in evaluating total and high-intensity PA [32]. As a result, certain aspects of the predictors of PA barriers in pregnant women may have been overlooked. Understanding these barriers is not only important for explaining low levels of PA but also for informing clinically relevant and context-sensitive interventions during prenatal care. Given the lack of relevant data on Iranian pregnant women and the cultural, attitudinal, and climatic variations across provinces that influence lifestyle choices, this study uniquely used a validated and psychometrically tested tool (BPAPS) to identify barriers to PA and their independent predictors among Iranian pregnant women, providing context-specific insights that extend previous research.

Methods

Participants

Iranian pregnant women aged 18–45, at 10–37 weeks of gestation, who could read and write in Persian, were included in the study ( They were chosen to represent low-risk women of reproductive age, excluding very early and late stages of pregnancy where medical restrictions on PA are more common), had no medical restrictions on PA during pregnancy as determined by a physician or midwife (Medical restrictions were determined through self-report by asking participants whether their physician or midwife had advised them to avoid PA. Women with any contraindications, including signs of threatened preterm labor (regular painful contractions, vaginal bleeding, or amniotic fluid leakage), were excluded from the study), and did not exhibit conditions such as severe disability or symptoms like excessive shortness of breath, severe chest pain, dizziness or fainting that did not improve with rest. Additionally, participants were excluded if they showed signs of preterm labor (regular painful uterine contractions, vaginal bleeding, or continuous fluid leakage from the vagina). Eligible women were required to provide informed written consent to participate. Samples who left more than 10% of the questionnaire items unanswered were excluded from the study [33].

Study design

This cross-sectional study is the quantitative part of a sequential explanatory mixed-methods study conducted at all women’s clinics and prenatal care facilities under Babol University of Medical Sciences. These educational treatment centers provide prenatal services by obstetricians and midwives. Sampling was carried out from May 2022 to August 2024 using a convenience sampling method among eligible pregnant women. Participants completed the self-reported surveys in person at the women’s clinics. All quantitative data were de-identified and treated confidentially. The protocol for this sequential explanatory mixed-methods study has been published in the Journal of Client-Centered Nursing Care [34].

Instruments

We invited pregnant women to voluntarily complete a demographic-obstetric questionnaire. Additionally, we used the Barriers to PA During Pregnancy Scale (BPAPS) to assess barriers to PA. Both questionnaires were self-reported by eligible pregnant women.

Demographic-obstetric scale

This scale included questions about participants’ age, spouse’s age, education, occupation, pre-pregnancy/early pregnancy BMI, place of residence, gestational age, number of children, engagement in regular PA before pregnancy (Pre-pregnancy PA was defined as engaging in regular exercise (≥ 3 times per week of moderate-intensity activity) before conception), and participation in childbirth preparation classes.

BPAPS Scale

This questionnaire was created and psychometrically validated among 320 pregnant women attending perinatal clinics at health centers in Ilam, Iran, by Amiri Farahani, a co-author of this study, in 2021 and contains 29 items with four subscales: pregnancy-related intrapersonal barriers, non-pregnancy-related intrapersonal barriers, interpersonal barriers, and environmental barriers. It uses a five-point Likert scale, ranging from Strongly Disagree = 1 to Strongly Agree = 5. The total BPAPS score ranges from 29 to 145, with higher scores indicating greater barriers to PA during pregnancy. The internal consistency of the 29-item BPAPS scale was reported with a Cronbach’s alpha of 0.824. The intraclass correlation coefficient (ICC) between test and retest was 0.87, confirming the high reliability of the scale. Cronbach’s alpha values for the overall scale and its subscales were 0.82, 0.81, 0.73, 0.73, and 0.72, respectively. The construct validity of BPAPS was confirmed through known-group validity and exploratory factor analysis [35]. Additionally, for the present study sample (n = 351), we calculated the internal consistency, which yielded a Cronbach’s alpha of 0.899, indicating good reliability.

Statistical analysis

For statistical analysis, after collecting the data and verifying its accuracy, descriptive statistics were reported using measures of central tendency (mean) and dispersion (standard deviation), or as frequencies and percentages. For the BPAPS subscales, higher scores were interpreted as greater barriers. To standardize the subscale scores and make them comparable, each score was adjusted by subtracting the minimum possible score for that subscale. This difference was then divided by the range of possible scores for the subscale (i.e., the difference between the maximum and minimum possible scores). Finally, the result was multiplied by 100 to express the standardized score as a percentage, making it easier to interpret and compare across subscales.

To predict PA barriers scores, both univariate and multivariate linear regression analyses were conducted. Multivariate analysis was employed to control for confounding variables, with both standardized and unstandardized regression coefficients, along with their 95% confidence intervals, reported. All analyses were performed using SPSS software version 23, with the significance level set at P < 0.05. In the absence of established clinical cut-off points for BPAPS, clinical relevance was interpreted based on relative differences between subscales and the identification of modifiable predictors associated with higher barrier scores.

Sample size

The sample size was calculated based on the study’s objectives, with the largest required sample size taken into account. To achieve this, the sample size was calculated using data from previous studies on the mean total score of PA barriers [27], applying the formula for estimating a population mean. The calculation was based on the reported mean of 88.55 and a standard deviation of 19.28. With a 95% confidence level, a standard deviation of 19.28, and a margin of error of 1.5, the initial required sample size was 325 participants. Considering a 10% dropout rate, the final sample size was set at 358 participants.

Results

A total of 351 pregnant women responded to all the questionnaire items and were included in the analysis. The mean ± SD age of the participating women and their spouses was 29.06 ± 5.99 years and 33.55 ± 5.21 years, respectively. Most participants (74.4%, n = 261) were in the second half of their pregnancy (21 weeks or more), with a mean gestational age of 27.43 ± 8.45. Additionally, 72.1% of participants were either first-time mothers or had only one child. The mean pre-pregnancy/early pregnancy BMI was 26.08 ± 4.70, and about one-third of the participants reported having a university-level education (Table 1).

Table 1.

Examples of the most commonly reported barriers in each subscale

Subscale	most commonly reported barriers in each subscale	Number of questions	Mean ± SD
Pregnancy-related intrapersonal barriers	“I cannot be physically active because of pain (such as back pain, hip pain, and/or headache)”	Q13	3.09 ± 1.14
Non-pregnancy-related intrapersonal barriers	“Physical activity is too hard for me”	Q1	3.06 ± 1.12
Interpersonal barriers	“I do not engage in physical activity because I lack access to complete information about physical activity during pregnancy”	Q20	2.80 ± 1.09
Environmental barriers	“There is too great a distance from my home to facilities designed for physical activity”	Q28	3.05 ± 1.17

As shown in Table 2, the total score for barriers to PA during pregnancy was 78.07 ± 16.25. Subscale scores were standardized on a 0-100 scale, with higher scores indicating greater barriers. The most significant barriers were related to environmental factors. The environmental barrier subscale had the highest mean score (43.67 ± 17.80), indicating that environmental factors represented the most prominent perceived barrier to PA during pregnancy. While interpersonal barriers were the least prominent (38.74 ± 17.93). To facilitate interpretation, standardized scores above 40 on the 0–100 scale were considered indicative of moderate to high perceived barriers. Based on this threshold, environmental barriers represented a clinically relevant obstacle to PA during pregnancy in this population. Examples of the most commonly reported barriers in each subscale included in Table 3. All barriers mentioned in Supplementary file 1.

Table 2.

Demographic and obstetric characteristics of pregnant women

Variables	Items	Mean ± SD
Age		29.06 ± 5.99
Spouse’s age		33.55 ± 5.21
GA (in weeks)		27.43 ± 8.45
BMI		26.08 ± 4.70
		Number (%)
Education	High school completion at most	234 (66.7)
	University education	117 (33.3)
Employment	Unemployed Employed	316 (90.0) 35 (10.0)
Place of Residence	Village City	186 (53.0) 165 (47.0)
Number of Children	One child at most Two children At least three children	253 (72.1) 73 (20.8) 25 (7.1)
Preparation Class for Childbirth***	No Yes	211 (78.7) 57 (21.3)
Regular PA before pregnancy	No Yes	247 (70.4) 104 (29.6)

*Body mass index

**gestational age

*** Childbirth preparation classes are conducted after the 20th week of pregnancy. Therefore, 83 women who were less than 20 weeks pregnant were excluded from the analysis

Table 3.

Total score of barriers to physical activity and subscale scores

Variables	Total Mean (SD)	Median (IQR)	Minimum-Maximum
Intrapersonal barriers related to pregnancy	27.26(6.56) 43.16(16.40) a	27.00(22.00_31.00) 52.50(30.00-52.50)	10.00_49.00 0-100
Intrapersonal barriers non-related to pregnancy	13.33(3.76) 41.68(18.80) a	13.00(11.00_16.00) 40.00(30.00–55.00)	5.00_25.00 0-100
Interpersonal barriers	12.74(3.58) 38.74(17.93) a	12.00(10.00_15.00) 35.00(25.00–50.00)	5.00_25.00 0-100
Environmental barriers	24.72(6.40) 43.67(17.80) a	24.00(20.00_28.00) 41.66(30.55–52.77)	9.00_44.00 0-100
Total score	78.07(16.25)	78.00(67.00_87.00)	29.00_142.00

^aScores were standardized to a 0-100 scale for comparability across subscales. Scoresare based on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). Higher scores indicate greater perceived barriers to physicalactivity

In the univariate and multivariate linear regression analyses aimed at investigating the relationship between barriers to PA and several demographic-obstetric factors, four key variables emerged as strong independent predictors: education, employment, pre-pregnancy PA, and age. These predictors significantly influenced the barriers experienced by pregnant women in engaging in PA. Higher education was associated with fewer barriers to PA. In the univariate regression, each additional level of education was associated with an average reduction of 6.35 points in the barriers score. In the multivariate regression analysis, a one-unit increase in education level was linked to a reduction of 4.39 points in the barriers score. These findings were statistically significant (P < 0.05).

Also, Pregnant women who were employed reported better PA status. The barriers score for employed women was 7.85 points lower than that of non-employed women in the univariate analysis and 9.54 points lower in the multivariate analysis (P < 0.05). Women who engaged in regular PA prior to pregnancy experienced fewer barriers during pregnancy. The univariate regression analysis revealed that women who participated in regular PA before pregnancy faced barriers that were approximately 9 points lower. In the multivariate analysis, those who were physically active prior to pregnancy showed a barriers’ score reduction of 7.34 points compared to their inactive counterparts (P < 0.05). Younger pregnant women reported fewer barriers to PA compared to older participants. In both the univariate and multivariate regression analyses, for each additional year of maternal age, the barriers score increased by 0.41 points and 0.91 points, respectively (P < 0.05) (Tables 4 and 5).

Table 4.

Relationship between total score of barriers to physical activity and demographic and obstetric characteristics based on univariate linear regression analysis

Variables	β (SE)	Beta	95% (CI)	P *
Education (High school completion at most/ University education)	-6.35 (1.81)	-0.18	-9.91 To -2.79	0.001
Employment (unemployed/employed)	-7.85 (2.86)	-0.14	-13.50 To -2.21	0.006
Number of Children (One child at most/ Two children/ At least three children)	4.87 (1.40)	0.18	2.11 To 7.63	0.001
Residence (Village/City)	4.23 (1.72)	0.13	0.84 To 7.62	0.015
Preparation Class for Childbirth (no-yes)	-5.49 (2.45)	-0.13	-10.33 To -0.66	0.026
Pre-pregnancy PA (no/yes)	-8.97 (1.84)	-0.25	-12.59 To -5.35	0.000
Age	0.41 (0.14)	0.15	0.13 To 0.69	0.004
Spouse’s Age	0.23 (0.16)	0.07	-0.09 To 0.55	0.167
BMI	0.29 (0.18)	0.08	-0.07 To 0.65	0.116
GA (in weeks)	-0.13 (0.10)	-0.06	-0.33 To 0.07	0.204

*p < 0.05

Bold values indicate statistically significant results (p< 0.05)

Table 5.

Relationship between barriers to physical activity score and demographic and obstetric characteristics based on multivariate linear regression analysis

Variables	β (SE)	Beta	95% (CI)	P *
Education (High school completion at most/ University education)	-4.39 (2.20)	-0.12	-8.73 To -0.5	0.047
Employment (unemployed/employed)	-9.54 (3.46)	-0.16	-16.37 To -2.71	0.006
Number of children (One child at most/ Two children/ At least three children)	2.66 (1.72)	0.09	-0.73 To 6.06	0.124
Residence (Village/City)	0.31 (2.01)	0.009	-3.64 To 4.26	0.877
Preparation Class for Childbirth (no-yes)	-1.54 (2.50)	-0.03	-6.45 To 3.38	0.538
Pre-pregnancy PA (no/yes)	-7.34 (2.07)	-0.20	-11.43 To -3.25	< 0.001
Age	0.91 (0.24)	0.32	0.43 To 1.38	< 0.001
Spouse’s Age	-0.59 (0.27)	-0.18	-1.14 To -0.04	0.035
BMI	0.38 (0.21)	0.10	-0.04 To 0.80	0.075
GA (in weeks)	-0.18 (0.19)	-0.05	-0.57 To 0.20	0.357

*p < 0.05

Adjusted for women’s education, women’s job, number of children, place of residence, preparation class for childbirth, pre-pregnancy physical activity, women’s age, spouse’s age, women’s BMI, GA

*R square = 0.19 and adjusted R square = 0.16

Bold values indicate statistically significant results (p< 0.05)

Discussion

The present study aimed to identify the barriers to PA and their predictors among pregnant Iranian women. By quantifying the relative contribution of different types of barriers, the present study provides clinically meaningful insights into which factors may be most amenable to intervention during pregnancy. Unlike previous studies that primarily described general barriers to PA, our study uniquely applied a validated tool to quantify specific types of barriers and their predictors within a culturally distinct population. This study focused on identifying and quantifying perceived barriers to PA, providing a foundation for future research to examine how these barriers translate into actual PA behaviors. The results revealed that the most significant barriers to PA were environmental factors, whereas interpersonal barriers were the least significant. Women with higher education levels, those who were employed, those who engaged in regular PA before pregnancy, and younger women reported fewer barriers to PA during pregnancy.

The most significant environmental barriers included limited access to exercise facilities (such as being far from home, unsuitable conditions, and a lack of available locations) and difficulties in engaging in PA during extreme cold or hot weather. Koleilat et al. [36] also reported that extreme temperatures were among the most important barriers to exercising during pregnancy [36]. A recent qualitative study conducted in Iran with 40 participants found that urban congestion and the prevalence of numerous residential buildings limited the availability of suitable walking spaces for pregnant women [37]. Similarly, Dolatabadi et al. [27] identified these factors as environmental barriers affecting pregnant Iranian women; however, their research indicated that environmental barriers received the lowest overall scores [27]. This discrepancy in results may be attributed to the differing geographical contexts of the studies, particularly between northern and southwestern Iran. Furthermore, the current study had a larger representation of participants from rural areas, where lower socio-economic status and geographic location may lead to reduced access to essential facilities for PA compared to those in urban settings. From a clinical and public health perspective, the prominence of environmental barriers suggests that individual-level counseling alone may be insufficient, and structural interventions are required to meaningfully reduce PA barriers during pregnancy.

Regarding intrapersonal barriers related to pregnancy, the most significant obstacles were related to pain (such as back pain, pelvic pain, or headaches) and pregnancy-related changes, such as a growing abdomen and changes in appearance. This finding is likely due to the physiological changes associated with pregnancy that are necessary for the growth and maintenance of the pregnancy. Additionally, many pregnant women reported viewing pregnancy as a time for rest, which made PA difficult due to lack of energy and fatigue. The belief that pregnancy is a time for rest may be because there is still no culture of exercise for pregnant women in developing countries like Iran, and such beliefs have persisted over time [27]. Similarly, previous studies identified intrapersonal barriers related to pregnancy, including lack of energy, pain, and swelling [27, 36]. In a population of Saudi Arabian women, 25% identified fatigue as a barrier to engaging in PA during pregnancy [38]. Additionally, back pain and pelvic discomfort are prevalent, with nearly half of pregnant women reporting these issues, which can further hinder PA participation [39]. Pregnancy-related pain may be an important predictor of reduced PA during pregnancy. Addressing this factor through pain management education and physiotherapy support could help improve activity levels among pregnant women.

In terms of intrapersonal barriers unrelated to pregnancy, participants most frequently reported that “PA is too hard” and a lack of motivation. Additionally, many women cited multiple responsibilities such as childcare, and time constraints as reasons for their reduced PA. Given the rising trend of sedentary lifestyles outside of pregnancy, it is not surprising that many women find it difficult to engage in PA during pregnancy [9, 36], particularly in the current study, where approximately 70% reported no history of PA prior to pregnancy. Furthermore, in Iranian culture, the responsibility for raising and caring for children predominantly falls on women, which significantly impacts their personal time. It should be noted that in this study, PA refers to structured exercise rather than daily movement. Although caring for young children involves physical effort, it typically limits the time and opportunity mothers have for planned exercise. These findings highlight the importance of educating and encouraging spouses to share household responsibilities and parenting duties, allowing mothers to have more personal time and engage more effectively with their children. Supporting evidence from previous studies reinforces these findings [27, 40], indicating that shared responsibilities can lead to improved maternal well-being and increased opportunities for PA, ultimately benefiting both mothers and their children.

In the context of interpersonal barriers, the highest scores were related to the lack of access to sufficient information about PA and discouragement from friends and relatives. Similarly, previous studies have noted that women often have limited knowledge about PA [27, 41] and that discouragement from peers [27, 37] serves as a barrier to engaging in PA during pregnancy. The lack of awareness may result from incomplete information transfer and the limited time that healthcare providers allocate for delivering prenatal care during pregnancy. Additionally, many healthcare providers lack the necessary skills to educate patients about PA [42]. Therefore, empowering healthcare providers, such as midwives and obstetric specialists responsible for prenatal care, could improve the quality of services and enhance the health outcomes of pregnant women. In a qualitative study by Kianfard et al. [37], some pregnant women identified their spouses as a significant barrier to maintaining PA [37]. This discouragement may arise from concerns about potential harm to both the mother and fetus, underscoring the need for interventions such as counseling sessions for couples and childbirth preparation classes that involve spouses.

In the present study, regular PA before pregnancy, education level, employment status, and maternal age were identified as the most significant predictors of barriers to PA. The results indicated a significant association between regular pre-pregnancy PA and barriers to engaging in PA. Similarly, previous studies have shown that pregnant women who did not have a routine exercise habit before pregnancy were less likely to adhere to PA recommendations during pregnancy [43, 44]. Coll et al. [45] found that women who engaged in regular PA before pregnancy encountered similar barriers to PA during pregnancy as those who were inactive beforehand; however, they typically made an effort to uphold their pre-pregnancy exercise routines [45]. Additionally, it has been reported that if women are inactive before pregnancy, this inactivity can become habitual, making it difficult to modify their behavior later on [46]. For instance, Haakstad et al. [26] found that only 3.4% of women who were inactive before pregnancy started exercising during pregnancy [26]. Such findings emphasize the importance of PA among women of childbearing age. Educating women before pregnancy can lead to a reduction in the consequences of inactivity during pregnancy; however, such educational approaches should be supported by broader systemic and environmental measures that facilitate equitable access to PA opportunities.

Educating women before pregnancy can lead to a reduction in the consequences of inactivity during pregnancy.

In relation to education level, the present study found that women with a university education reported significantly fewer barriers to PA on average. Similarly, previous studies have also reported this association [13, 28]. These findings may be attributed to the fact that educated women are generally more aware of the benefits of PA. Therefore, it is crucial to ensure that women with lower educational levels receive comprehensive information regarding how to participate in PA and the associated benefits during pregnancy. To achieve this, prenatal care centers could create and distribute brochures on this topic to women or provide in-person or telephone counseling services conducted by trained professionals to encourage PA [26, 27, 30] In contrast to the current study, Haakstad et al. [26] reported no significant relationship between exercise in the third trimester and education level [26]. This contradictory finding may be attributed to the fact that most pregnant women participating in their study were at a favorable educational and socio-economic status.

Women’s employment emerged as one of the strongest predictors of barriers to PA in the current study. Pregnant women who were employed reported fewer barriers to PA. Similarly, a previous study indicated that unemployment led to reduced adherence to the recommendations from ACOG and American College of Sports Medicine (ACSM) among pregnant women [24]. However, two studies conducted in the Netherlands and Africa found that unemployed women were more physically active during pregnancy than their employed counterparts [17, 28]. Additionally, Evenson et al. [47] found no significant relationship between employment and PA levels among pregnant women [47]. This discrepancy in results may stem from cultural variations and differences in how PA is defined across various studies.

Our study indicated that older women reported more barriers to PA during pregnancy. Similarly, Hailemariam et al. [1] found that pregnant women aged 26 to 35 were significantly more likely to be inactive compared to their counterparts aged 16 to 25 [1]. However, the study by Okafor et al. [12] showed that pregnant women under the age of 19 were less compliant with PA recommendations than those aged 19 to 34 [12]. Other studies have indicated that the relationship between the age of pregnant women and PA during pregnancy is ambiguous [19, 27]. Consequently, additional research is necessary to explore PA and its barriers across various age groups of pregnant women to provide more comprehensive insights.

The univariate analysis of the present study revealed a significant relationship between the number of children, place of residence (urban/rural), and participation in childbirth preparation classes with the overall barriers to PA among pregnant women. Women who were first-time mothers or had at most one child reported fewer barriers to PA compared to those with multiple children. Similarly, Meander et al. [13] reported that not having children was associated with higher levels of PA [13]. However, a recent study conducted in Iran found no significant relationship between the number of children and barriers to PA [27]. On the other hand, the results of a study by Mendinueta et al. [48] indicated that the number of previous children had a positive correlation with light to moderate PA during pregnancy [48]. Such findings necessitate further investigations into the role of parity and the number of children on PA, as previous children may be perceived as barriers to women’s PA during pregnancy in societies where caregiving and household responsibilities predominantly fall on women [27, 40]. Conversely, women with higher socio-economic status who may not be solely responsible for caring for their previous children, as well as those receiving social support from spouses and peers, may have greater motivation and more time to dedicate to PA [48].

Our study results indicated that rural pregnant women reported higher scores of barriers to PA. This finding may be attributed to a lack of facilities and limited access to parks and recreational venues. Urban women might utilize parks and streets for light to moderate physical activities such as walking. Similarly, a study by Szubert et al. [49] in Poland reported that women living in rural areas were less physically active during pregnancy compared to those living in urban areas [49]. However, Evenson et al. [47] did not report such a relationship [47]. Future research aimed at examining factors influencing PA during pregnancy and the role of place of residence may provide insights for implementing interventions to promote PA during pregnancy, addressing residence-related factors.

The current results indicated that participation in childbirth preparation classes was linked to fewer barriers to PA among pregnant women. Prior research has also demonstrated that attending these classes enhances pregnant women’s understanding of the benefits of PA, which can lead to increased levels of activity and improved quality of life [50, 51]. Consequently, childbirth preparation classes may serve as an effective and accessible strategy for addressing physical inactivity during pregnancy.

Strengths and limitations

Among the limitations of this study are the lack of objective tools (such as accelerometers or pedometers) for assessing PA and the reliance on self-reported, closed-ended questions. Furthermore, although a validated and reliable instrument was used, there are no established clinical cut-off points for the BPAPS, which limits the interpretation of absolute barrier scores. In addition, due to the cross-sectional design of the study, causal relationships between the identified predictors and PA barriers cannot be inferred. Moreover, we did not explore the influence of socio-economic status on the barriers to PA among pregnant women, as establishing rapport with participants to accurately disclose their economic information through household income questionnaires proved to be challenging. Future research is recommended to investigate the impact of socio-economic characteristics and other factors, such as personality traits and social support, that may influence PA in pregnant women. Although gestational age (10–37 weeks) was adjusted in the multivariate analysis, the inclusion of participants from all trimesters remains a design limitation, as trimester-specific variations in perceived barriers could not be explored.

We included only healthy women without pregnancy complications in this study, so the findings do not be representative of all pregnant women in diverse regions and communities. Therefore, future studies should involve a more diverse sample of pregnant women, including those with underlying health conditions or from different ethnic backgrounds. Also, the convenience sampling limits the study’s generalizability. Despite these limitations, we collected valuable background information that aids in addressing barriers to PA among pregnant women, thereby complementing prior research. Additionally, we utilized a specific scale designed to assess barriers to PA for pregnant women, which has seen limited application in earlier studies.

Conclusions

The results of our study indicated that environmental barriers constituted the most prominent obstacles to PA among pregnant women, whereas interpersonal barriers were perceived as less influential. Higher educational attainment, employment, engagement in regular PA prior to pregnancy, and younger maternal age were associated with lower perceived barriers to PA during pregnancy. From a clinical and public health perspective, these findings suggest that individual-level counseling alone may be insufficient to address PA during pregnancy. Instead, multilevel approaches that combine education with improvements in environmental conditions, such as access to safe and suitable spaces for PA, may be required. Healthcare providers involved in prenatal care may benefit from using these findings to identify women who are more likely to experience higher barriers and to tailor counseling accordingly. While this study does not establish causal relationships, it highlights modifiable factors that may inform the design of future interventions aimed at reducing PA barriers during pregnancy. Further longitudinal and interventional research is warranted to examine how addressing these barriers may influence PA behaviors and maternal health outcomes.

Abbreviations

PA

Physical Activity

ACOG

American College of Obstetricians and Gynecologists

BPAPS

Barriers to Physical Activity in Pregnant Scale

PPAQ

Pregnancy Physical Activity Questionnaire

BMI

Body Mass Index

GA

Gestational Age

Authors’ contributions

F.B. & R.F. Conceptualization, Methodology, Software. HA.N. Validity tests, Data curation, R.F. & F.B. Writing- Original draft preparation. F.B. Supervision, Visualization, Investigation. R.F., F.B., A.O., L.A.F., S.N., & HA.N. Writing- Reviewing and Editing.

Funding

This study was financially supported by Babol University of Medical Sciences. Grant Number: 724134896.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

The present cross-sectional study was part of a mixed-methods research project approved by the Ethics Committee of Babol University of Medical Sciences (IR.MUBABOL.HRI.REC.1401.238). Participation was voluntary, and only women who provided informed written consent completed the questionnaires. Participants were assured that their choice not to participate or to withdraw from the study would not affect the quality of their prenatal care. Additionally, confidentiality and the privacy of the participants were strictly upheld. Research conducted in accordance with the Helsinki Declaration.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.