Abstract
Objective:
To assess how physical activity and sedentary behavior change from pre-pregnancy to pregnancy, and if pre-pregnancy and pregnancy physical activity and sedentary behavior are related to gestational weight gain, blood pressure, or blood glucose across pregnancy.
Design:
Secondary analysis of two prospective cohort studies
Setting:
Prenatal research centers in Pittsburgh, PA and Iowa City, IA.
Participants:
Pregnant individuals (n=131), 18-45 years old, of any BMI, with no medical condition limiting physical activity or use of hypertension/diabetes medications.
Methods:
Participants self-reported physical activity and sedentary behavior pre-pregnancy and in each trimester using validated questionnaires. Blood pressure, blood glucose, and weight were obtained from study visits and/or electronic medical records. Multivariable regression examined associations between pre-pregnancy, trimester-specific, and changes in physical activity and sedentary behavior with weight gain and blood pressure outcomes in each trimester, and blood glucose in the second trimester.
Results:
Compared to pre-pregnancy, physical activity was lower in each trimester, and sedentary behavior was higher in each trimester (p<0.05). Increasing physical activity from pre-pregnancy levels was associated with lower first trimester SBP (p<0.05). Unexpectedly, higher pre-pregnancy physical activity was associated with higher SBP in the first trimester (p=0.02) and higher weight gain in the third trimester (p=0.02). Higher and increasing sedentary behavior was associated with greater weight gain in the third trimester (p=0.03).
Conclusion:
Future research should investigate the opportune time (before or during pregnancy) to deliver behavior modification interventions that could prevent excessive gestational weight gain or elevated blood pressure to improve maternal health outcomes.
Keywords: Physical Activity, Sedentary Behavior, Gestational Weight Gain, Gestational hypertension, Gestational diabetes
Introduction
Increasing physical activity and reducing sedentary behavior are important behavioral modifications for improving health across the lifespan (Piercy et al., 2018). Particularly during pregnancy, higher physical activity levels are associated with lower risk of excessive gestational weight gain, gestational hypertension, gestational diabetes, and improved labor and birth outcomes (Davenport et al., 2018; Davenport et al., 2019; Ruchat et al., 2018). Higher levels of sedentary behavior may also be associated with adverse pregnancy outcomes, including hypertensive disorders of pregnancy and reduced gestational age and fetal growth (Barone Gibbs et al., 2021; Jones et al., 2021), in addition to higher gestational weight gain (Sun & Chien, 2021). Physical activity and sedentary behavior represent possible behavioral targets for mitigating adverse maternal and infant outcomes.
While current evidence and clinical convention suggest that physical activity levels decrease during pregnancy (Catov et al., 2018; Ferrari & Joisten, 2021), few studies include measurement of physical activity or sedentary behavior prior to pregnancy to determine how physical activity levels and sedentary behavior change across pregnancy compared to pre-pregnancy levels (Ferrari & Joisten, 2021). Understanding how both physical activity and sedentary behavior change from the pre-pregnancy period can improve the education provided during pre-conception and prenatal care (Catalano & deMouzon, 2015). Additionally, while higher physical activity levels and lower sedentary behavior have been associated with improved maternal and infant health outcomes (Barone Gibbs et al., 2021; Davenport et al., 2018; Davenport et al., 2019; Jones et al., 2021; Ruchat et al., 2018), the timing of physical activity and sedentary behavior (e.g., initiation prior to pregnancy or during pregnancy) that is most strongly related to pregnancy health outcomes has not been established. Specifically, whether changes in physical activity and sedentary behavior from pre- to during pregnancy are associated with the development of pregnancy complications is largely unknown. Understanding the timing of these health behaviors in relation to pregnancy health is a critical step toward developing interventions to improve pregnancy health.
To address these gaps, the aims of our analyses were 1) to assess how physical activity and sedentary behavior change across pregnancy compared to pre-pregnancy levels, and 2) to investigate if physical activity and sedentary behavior before pregnancy, during pregnancy, or the changes from pre-to-during pregnancy were related to gestational weight gain, blood pressure, or blood glucose across the three trimesters of pregnancy. We hypothesized that physical activity levels would decrease and sedentary behavior would increase in pregnancy from pre-pregnancy levels. We further hypothesized that higher and increasing physical activity and lower and declining sedentary behavior across pregnancy would be associated with reduced gestational weight gain, lower blood pressure, and lower blood glucose.
Methods
This study is a secondary analysis of data collected from the MOnitoring Movement and Health Study (MOM Health) conducted at the University of Pittsburgh and the PRegnancy Activity Monitoring Study (PRAMS) conducted at the University of Iowa. Study procedures have been previously reported (Barone Gibbs et al., 2021). Briefly, MOM Health and PRAMS were prospective cohort studies conducted in 2017-2019 that followed participants from the first trimester through birth. Study visits took place between 8 and 13 weeks, 22 and 24 weeks, and 32 and 34 weeks. At each study visit, participants completed questionnaires related to physical activity and sedentary behavior (described below). During the first trimester study visit, participants self-reported demographic information. Participants (n=140) were enrolled by convenience sampling. Inclusion criteria included being less than 14 weeks pregnant at the first study visit and 18-45 years old. Exclusion criteria were current health concerns that precluded participation in physical activity, current use of medications to manage diabetes or hypertension, or current participation in a research study intending to alter lifestyle behaviors. All participants provided written, informed consent, and all procedures were approved by the University of Pittsburgh and the University of Iowa Institutional Review Boards.
Measures
Though the MoM Health Study and PRAMS used gold standard actigraphy methodology to measure objective physical activity and sedentary behavior during pregnancy (Barone Gibbs et al., 2021), objective measurement of pre-pregnancy levels was not logistically possible based on study enrollment during the first trimester. As the primary goal of the current analysis was to evaluate pre-to-during pregnancy patterns of physical activity and sedentary behavior, the present analysis is restricted to self-reported physical activity and sedentary behavior using validated instruments measured at each of these time periods, described below.
Physical Activity
Physical activity was assessed by the Pregnancy Physical Activity Questionnaire (PPAQ). The PPAQ (Chronbach’s = .78) contains 32 questions that assess various types of activity and have been reported to account for up to 90% of the variance in individual physical activity (Chasan-Taber et al., 2004). The score from the PPAQ sums the number of METs (metabolic equivalents) calculated for each activity and represents the number of MET minutes per week. Higher MET values reflect more vigorous activity. Higher PPAQ scores reflect higher levels of physical activity. The PPAQ was administered during each trimesters’ study visit by a study team member. At the first trimester study visit, participants were also asked to complete the PPAQ while recalling their levels of physical activity in the three months prior to pregnancy.
Sedentary Behavior
Sedentary behavior was assessed by the validated Sedentary Behavior Two Doman Questionnaire (SB2D) (Barone Gibbs et al., 2020). The SB2D is a short questionnaire that asks how many hours per day are spent sitting on workdays and weekends. A weighted average was calculated according to not employed, full-time, or part-time employment status to estimate the total average number of hours spent sitting per day. A higher number indicates more sedentary behavior. This questionnaire was also administered during each trimester. At the first trimester study visit, participants were also asked to complete the SB2D based on their sedentary behavior in the three months prior to pregnancy.
Gestational weight gain
We selected gestational weight gain as an outcome variable because excessive gestational weight gain, especially in early pregnancy, has been associated with increased risk for hypertensive disorders of pregnancy and gestational diabetes (Goldstein et al., 2017). Gestational weight gain was calculated for each trimester and overall. Self-reported pre-pregnancy weight was subtracted from the weight measured at each study visit to assess gestational weight gain. Due to the wide range of first trimester visits (8 to 14 weeks gestation), participants’ prenatal care records were also accessed to capture weight obtained at prenatal care visits. The weight closest to 12 weeks gestation was used in analyses to reduce unintended variance. Participants were further classified as “excessive gestational weight gain,” “adequate,” or “inadequate” according to the Institute of Medicine’s gestational weight gain guidelines (Institute of Medicine, 2009). IOM guidelines have a recommended total pregnancy weight gain of 28-40 pounds for underweight women (BMI<18.5), 25-35 pounds for normal weight women (BMI 18.5-24.9), 15-25 pounds for overweight women (BMI 25-29.5), and 11-20 pounds for obese women (BMI >30).
Blood pressure
We investigated blood pressure as an outcome variable because changes in blood pressure are important clinical indicators of the development of hypertensive disorders of pregnancy. Blood pressure was obtained during study visits with slightly different methods between the two cohort studies. Both studies used the same monitor (Omron HEM-705) and measured arm circumference to select the appropriate blood pressure cuff size (Asmar et al., 2010; Muntner et al., 2019). In MoM Health (City), participants sat quietly with their arm supported and feet flat on the floor for at least ten minutes prior to obtaining two blood pressure readings, with a one-minute rest in between. A third measurement was taken if the SBP differed by ≥10 mmHg or the DBP differed by ≥6 mmHg. In PRAMS (City), participants rested for five minutes prior to obtaining three blood pressure readings (Asmar et al., 2010; Muntner et al., 2019). For the purposes of the analysis, we averaged the first two blood pressure readings for all participants. If the first two blood pressure readings differed SBP by ≥10 mmHg or DBP by ≥6 mmHg, we averaged the two closest blood pressure readings.
Blood glucose
We investigated blood glucose as an outcome variable because blood glucose is used as a diagnostic indicator of gestational diabetes, but using a continuous variable provides more statistical power in small samples than using a dichotomous variable for the infrequent diagnosis of gestational diabetes in our cohort. The one-hour blood glucose value measured from the glucose tolerance test that is part of standard prenatal care conducted between 24 and 28 weeks gestation was abstracted from the medical record. This outcome was selected because it was available in most women, regardless of gestational diabetes risk or status. Because blood glucose results are from the glucose tolerance test, statistical analyses with one-hour glucose as the outcome were only conducted in the second trimester.
Data analysis
Data analyses were conducted in SPSS 27. Descriptive summaries were calculated and normality of data were assessed. Differences in physical activity and sedentary behavior in the pre-pregnancy period and across pregnancy were assessed by repeated measures ANOVA. Multivariable linear regression was used to assess the association between pre-pregnancy and trimester-specific physical activity and sedentary behavior and changes from pre-to-trimester-specific physical activity and sedentary behavior with weight gain, systolic blood pressure, diastolic blood pressure, and glucose (second trimester only). Weight gain analyses were adjusted for pre-pregnancy BMI, age, education, and self-reported race. Blood pressure analyses were adjusted for pre-pregnancy BMI, history of gestational hypertension, and age. Blood glucose analyses were adjusted for pre-pregnancy BMI and history of gestational diabetes. Control variables were selected based on the existence of associations between the control variables and the outcomes measurement. A p-value of 0.05 was used as the threshold of statistical significance. Individuals with missing data were excluded from analyses for which they were missing data.
Results
Participants (N=131) had an average pre-pregnancy BMI of 26.80 kg/m2 and an average age of 30.9 years. Participants predominantly worked full time (57%), had a college degree (61%), and were married (70%,). The majority of the sample (71%) self-identified as White, while 16% identified as Black, and 5% identified as Other. Demographic information is presented in Table 1.
Table 1:
Participant demographic characteristics
| Variable | Mean | SD | Range |
|---|---|---|---|
|
| |||
| Pre-pregnancy BMI | 26.80 | 6.73 | 17.10-51.85 |
| Age | 30.85 | 4.86 | 19-42 |
| Number of pregnancies | 1.72 | 2.14 | 0-11 |
| Number of births | 1.01 | 1.32 | 0-8 |
|
| |||
| N | % | ||
|
| |||
| Employment status | |||
| Full time | 81 | 57 | |
| Part-time | 16 | 11.3 | |
| Unemployed/ homemaker | 27 | 19 | |
| Student | 4 | 2.8 | |
| Education | |||
| Some high school | 3 | 2.1 | |
| High school graduate/ GED | 12 | 9.2 | |
| Vocational training | 3 | 2.1 | |
| Some college/ Associate’s degree | 25 | 17.6 | |
| College (Bachelor’s) degree | 33 | 23.2 | |
| Graduate degree | 54 | 38 | |
| Marital Status | |||
| Married | 100 | 70.4 | |
| Living with partner | 13 | 9.2 | |
| Separated/ divorced | 1 | .7 | |
| Widowed | 2 | 1.4 | |
| Single/ not married | 12 | 10.6 | |
| Insurance Provider | |||
| Public | 21 | 14.8 | |
| Private | 107 | 75.4 | |
| Income | |||
| Under $50,000 | 34 | 23.9 | |
| $50,000-100,000 | 45 | 31.7 | |
| Over $100,000 | 42 | 29.6 | |
| Self-reported Race | |||
| White | 101 | 71.1 | |
| Black | 23 | 16.2 | |
| Other | 7 | 4.9 | |
As seen in Figure 1, compared to mean pre-pregnancy levels (325 ± 163 MET-minutes per week), mean physical activity levels were significantly lower in the first trimester (288 ± 140 MET-minutes per week), second trimester (294 ±163 MET-minutes per week) and third trimester (284 ± 156 MET-minutes per week; all p<0.05). Physical activity levels slightly rebounded in the second trimester compared to the first trimester, but the difference was not statistically significant. As seen in Figure 2, compared to pre-pregnancy levels (4.96 ± 2.93 hours per day), mean sedentary behavior was significantly higher in the first trimester (5.59 ± 2.45 hours per day), second trimester (5.68± 2.73 hours per day), and third trimester (5.83 ± 2.82 hours per day; all p<0.05).
Figure 1:
Physical activity levels across pregnancy. Figure 1 describes the means and 95% confidence interval of average MET minutes in each trimester of pregnancy. Dashed lines and asterisks represent the statistical significance of trimester-specific physical activity levels compared to pre-pregnancy physical activity levels ****=p<0.0001; ***=p<0.001; **=p<0.01.
Figure 2:
Sedentary time across pregnancy. Figure 2 describes the means and 95% confidence interval of average hours of sedentary time in each trimester of pregnancy. Dashed lines and asterisks represent the statistical significance of trimester-specific sedentary time compared to pre-pregnancy sedentary time. ***= p<0.001**=p<0.01; *=p<0.05
Table 2 describes participants’ weight gain and blood pressure across pregnancy and blood glucose in the second trimester. On average, participants gained weight consistent with gestational weight gain guidelines; 33% (N=43) had excessive gestational weight gain, and 10% (N=14) had inadequate gestational weight gain according to IOM guidelines. Systolic blood pressure remained consistent in the first and second trimester and increased slightly in the third trimester (p<0.01). At baseline, six (4.6%) women had a systolic blood pressure ≥130 mmHg. Diastolic blood pressure decreased in the second trimester and increased in the third trimester compared to the first trimester (p<0.01). At baseline, eight (6.1%) women had a diastolic blood pressure ≥80 mm/Hg. Overall, 19 (14.5%) women had a blood glucose level over 140mg/dL, which would have indicated a need for further screening for gestational diabetes.
Table 2:
Weight gain and blood pressure across pregnancy and blood glucose
| Outcome Variable | First Trimester Mean (SD) | Second Trimester Mean (SD) | Third Trimester Mean (SD) |
|---|---|---|---|
| Weight gain (kg)^ | 1.19 (2.53) | 4.50 (3.42) | 10.37 (4.88) |
| Systolic BP (mm/Hg) | 112.51 (12.08) | 112.70 (10.47) | 117.17 (10.76) |
| Diastolic BP (mm/Hg) | 67.55 (8.02) | 65.21 (7.08) | 69.96 (7.69) |
| Glucose* | 110.40 (29.53) |
The available weight obtained closest to 12 weeks gestation was used for weight gain analysis. The average gestational age for the first trimester weight was 12.55 weeks gestation
Blood glucose values are from glucose tolerance test that was conducted between 24 and 28 weeks as part of routine prenatal care
Abbreviations: BP= blood pressure; kg= kilograms; mm/Hg= millimeters of mercury; SD= standard deviation.
Table 3 reports multivariate associations between pre-pregnancy, trimester-specific, and changes in physical activity and sedentary behavior with weight gain and blood pressure across pregnancy and blood glucose in the second trimester. Higher pre-pregnancy physical activity (std β = .354), higher third trimester sedentary behavior (std β = .216), and an increase in sedentary behavior in the third trimester compared to pre-pregnancy levels (std β=.215) were associated with greater third trimester weight gain. Higher pre-pregnancy (std β= .318), first trimester (std β= −.260), and increasing pre-pregnancy to first trimester physical activity levels (std β =−.195) were associated with higher first trimester systolic blood pressure. No factors were significantly associated with second and third trimester systolic blood pressure, diastolic blood pressure in any trimester, nor blood glucose.
Table 3:
Multivariable associations between physical activity, sedentary behavior and weight gain, blood pressure, and blood glucose
| Weight Gain kg std β (p-value) |
Systolic BP mmHg std β (p-value) |
Diastolic BP mmHg std β (p-value) |
Glucose mg/dL std β (p-value) |
|
|---|---|---|---|---|
| First Trimester | ||||
| Pre-pregnancy PA | −.026 (.88) | .318 (.03) | .078 (.57) | |
| First Trimester PA | .219 (.21) | −.260 (.07) | −.119 (.39) | |
| Δ pre-to-first trimester PA | .013 (.89) | −.195 (.02) | −.089(.41) | |
| Pre-pregnancy SED | −.147 (.31) | .224 (.06) | −.068 (.54) | |
| First trimester SED | .150 (.31) | −.078(.53) | .085 (.48) | |
| Δ pre-to-first trimester SED | .091 (.33) | −.105 (.22) | −.020 (.81) | |
| Second Trimester | ||||
| Pre-pregnancy PA | −.090 (.53) | .038 (.75) | −.205 (.07) | −.124 (.39) |
| Second Trimester PA | .215 (.12) | −.069 (.56) | .030 (.78) | .167 (.25) |
| Δ pre-to- second trimester PA | −.023 (.79) | −.030 (.72) | −.043 (.60) | −.06 (.49) |
| Pre-pregnancy SED | −.032 (.72) | .030 (.74) | −.050 (.55) | .019 (.85) |
| Second Trimester SED | −.130 (.16) | .046 (.61) | −.086 (.30) | −.047 (.66) |
| Δ pre-to- second trimester SED | −.048 (.59) | −.009 (.91) | −.001(.99) | .009 (.92) |
| Third Trimester | ||||
| Pre-pregnancy PA | .354 (.02) | .049 (.69) | −.025 (.85) | |
| Third Trimester PA | −.237 (.12) | .100 (.42) | .014 (.91) | |
| Δ pre-to-third trimester PA | .151 (.12) | −.151 (.10) | −.102 (.27) | |
| Pre-pregnancy SED | −.132 (.18) | .075 (.45) | .001 (.99) | |
| Third Trimester SED | .216 (.03) | −.033 (.74) | −.027 (.79) | |
| Δ pre-to-third trimester SED | .215 (.03) | −.099 (.28) | −.035 (.70) |
Weight gain: adjusted for pre-pregnancy BMI, age, education, race
Systolic BP: adjusted for BMI, HTN
Diastolic BP: adjusted for age, BMI, HTN
Glucose: adjusted for BMI and history of GDM
Abbreviations: kg= kilograms; BP= blood pressure; mm/Hg= millimeters of mercury; mg/dL= milligrams per deciliter; std β= Standardized beta; PA= physical activity; SED= sedentary behavior; Δ= change from pre-pregnancy to the specific trimester
Discussion
We demonstrated that physical activity levels decrease from pre-pregnancy to the first trimester, rebound slightly (though not to pre-pregnancy levels) in the second trimester, and return to first trimester levels in the third trimester. Sedentary behavior increases by an average of 30 minutes per day in the first trimester and remains at that level for the remainder of pregnancy. We also demonstrated that some pre-pregnancy, trimester-specific, and changes from pre-pregnancy in physical activity and sedentary behavior were associated with weight gain and blood pressure outcomes during the first and third trimester.
Limited data exist that assess physical activity levels and sedentary behavior in the pre-pregnancy period to compare to activity levels across pregnancy (Ferrari & Joisten, 2021). We demonstrated that physical activity levels decline and sedentary behavior increases compared to pre-pregnancy. The rebound in physical activity levels observed in the second trimester does not appear to return to pre-pregnancy levels, suggesting that women continue to have lower physical activity across pregnancy compared to pre-pregnancy levels. While larger studies in more representative samples are needed to confirm our findings, these data suggest the potential importance of assessing both pre-pregnancy physical activity and sedentary behavior during prenatal care when providing education during pregnancy. Pregnant women may need counseling on increasing physical activity and decreasing sedentary behavior throughout pregnancy to promote optimal pregnancy outcomes.
Our results indicate that sedentary behavior both during pregnancy and the change in sedentary behavior from pre-pregnancy levels may both contribute to gestational weight gain. Most studies investigating gestational weight gain focus on moderate-to-vigorous intensity physical activity, which, while related to sedentary behavior, is a distinct concept. Available studies investigating sedentary behavior and weight gain during pregnancy report mixed associations, with some studies reporting no association (Chasan-Taber et al., 2014; Ruifrok et al., 2014) whie others report that more sedentary time is associated with higher gestational weight gain (Jiang et al. 2012; Ha et al 2020). Given the associations between excessive gestational weight gain and adverse pregnancy outcomes, sedentary behavior may be an important target for decreasing excessive gestational weight gain and the associated sequelae.
Higher pre-pregnancy levels of physical activity were associated with higher weight gain, which was unexpected. Previous reports have shown that physical activity can be used as an intervention to reduce excessive gestational weight gain (Barakat et al., 2019; Ruchat et al., 2018; Shieh et al., 2018). The unexpected association could be due to biased recall. Participants may have overestimated physical activity levels and underestimated pre-pregnancy weight, leading to a false association between weight gain and pre-pregnancy physical activity (Han et al., 2016). Additionally, individuals with an underweight or normal BMI, who may be more likely to have higher physical activity levels (Andersson-Hall et al., 2021), are instructed to gain more weight than their overweight and obese BMI counterparts (Rasmussen et al., 2009). The association between higher physical activity and more weight gain may be related to the differences in recommendations for and achieved gestational weight gain.
Previous studies have shown that higher levels of sedentary behavior in pregnancy are associated with an increased occurrence of hypertensive disorders of pregnancy (Barone Gibbs et al., 2021; Do et al., 2020; Fazzi et al., 2017), while others have shown no association between sedentary behavior and hypertensive disorders of pregnancy (Baena-García et al., 2019; Chasan-Taber et al., 2015). While we did see associations between lower physical activity, higher sedentary behavior and higher blood pressure, we did not see consistent relationships between sedentary behavior and physical activity levels and blood pressure outcomes, which limits the generalizability of our results. However, these preliminary data suggest a relationship may exist, warranting further investigation in prospective studies. Future studies should use objective measures of pre-pregnancy sedentary behavior and physical activity to determine how sedentary behavior and physical activity impact blood pressure outcomes in pregnancy.
Contrary to our hypothesis, higher levels of pre-pregnancy physical activity were associated with higher blood pressure in the first trimester. We speculate several factors may have contributed to the unexpected association. A handful of individuals did have hypertension prior to pregnancy but were not taking anti-hypertensive medications per the study inclusion criteria. Physical activity and dietary modifications are first-line treatments for hypertension, and as such, some individuals may have engaged in physical activity as part of their treatment for hypertension. Additionally, the physiologic decrease in blood pressure that occurs during early pregnancy (Sanghavi & Rutherford, 2014), combined with variations in experiences of morning sickness, which may lead to hypotension, may be preventing our ability to accurately assess associations between pre-pregnancy factors and first trimester blood pressure. Finally, individuals may have had biased recall of physical activity levels as described previously.
There were no associations between physical activity or sedentary behavior with 1-hr blood glucose levels. The lack of association was surprising given that increasing physical activity is used as an intervention, along with diet, to control gestational diabetes (Cantor et al., 2021). However, it is possible that physical activity and sedentary behavior may not influence blood glucose that is already in a therapeutic range. Only six participants (4.6%) in our sample received a diagnosis of gestational diabetes compared to an estimated prevalence of 6-8% in the general US population (Casagrande et al., 2018; Deputy et al., 2018). Given the low occurrence of GDM and relatively normal blood glucose levels in our sample, we may not have been able to observe a relationship between physical activity, sedentary behavior, and blood glucose.
Strengths and Limitations
Our analysis has strengths. Our data were longitudinal, spanning from pre-pregnancy to late pregnancy (32-34 weeks gestation). We were also able to abstract clinical data (weight, blood pressure, and blood glucose) from electronic medical records, improving the completeness and reliability of these data. Our analysis also has limitations. Physical activity and sedentary behavior were ascertained using self-report questionnaires, which are not as valid as objective measures. Participants were also asked to retrospectively recall pre-pregnancy weight, physical activity, and sedentary behavior, which may have introduced recall bias. Additionally, the participants are not representative of the general U.S. pregnant population, limiting generalizability.
Conclusions
Future research is warranted to investigate the relative importance of timing and optimal behavior for intervention on gestational weight gain, blood pressure, and pregnancy health. Such investigations should include prospective assessment of pre-pregnancy behaviors and objective measurements of physical activity and sedentary behavior prior to and across pregnancy to accurately determine the timing and type of behavioral interventions best suited to combat excessive gestational weight gain and elevated blood pressure. Such investigations may improve the timeliness and specificity of education provided to women contemplating pregnancy or presenting for prenatal care, ultimately improving pregnancy outcomes.
Highlights.
Women reported lower physical activity and higher sedentary behavior during pregnancy compared to the three months before pregnancy.
Higher pre-pregnancy physical activity and sedentary behavior and increases in sedentary behavior were associated with greater total weight gain by the third trimester.
Increasing levels of physical activity from pre-pregnancy were associated with lower first trimester blood pressure.
Acknowledgments
The authors would like to thank the participants of the MoM Health Study and PRAMS.
Funding Sources:
The MoM Health Study was funded by the American Heart Association (17GRNT3340016) with research registry, recruitment, and statistical support from the University of Pittsburgh Clinical and Translational Science Institute (NIH UL1TR000005). The PRAMS Study was funded by the University of Iowa. This project was also supported by NIH/NINR T32NR009759.
Footnotes
Conflicts of Interest: The authors have no conflicts of interest to disclose
Ethical approval: The Institutional Review Boards at the University of Pittsburgh and the University of Iowa approved all research procedures.
References
- Andersson-Hall U, de Maré H, Askeli F, Börjesson M, & Holmäng A (2021). Physical activity during pregnancy and association with changes in fat mass and adipokines in women of normal-weight or with obesity. Scientific Reports, 11(1), 12549. 10.1038/s41598-021-91980-z [DOI] [PMC free article] [PubMed] [Google Scholar]
- Asmar R, Khabouth J, Topouchian J, El Feghali R, & Mattar J (2010). Validation of three automatic devices for self-measurement of blood pressure according to the International Protocol: The Omron M3 Intellisense (HEM-7051-E), the Omron M2 Compact (HEM 7102-E), and the Omron R3-I Plus (HEM 6022-E). Blood Pressure Monitoring, 15(1), 49–54. 10.1097/MBP.0b013e3283354b11 [DOI] [PubMed] [Google Scholar]
- Baena-García L, Ocón-Hernández O, Acosta-Manzano P, Coll-Risco I, Borges-Cosic M, Romero-Gallardo L, de la Flor-Alemany M, & Aparicio VA (2019). Association of sedentary time and physical activity during pregnancy with maternal and neonatal birth outcomes. The GESTAFIT Project. Scand J Med Sci Sports, 29(3), 407–414. 10.1111/sms.13337 [DOI] [PubMed] [Google Scholar]
- Barakat R, Refoyo I, Coteron J, & Franco E (2019). Exercise during pregnancy has a preventative effect on excessive maternal weight gain and gestational diabetes. A randomized controlled trial. Braz J Phys Ther, 23(2), 148–155. 10.1016/j.bjpt.2018.11.005 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Barone Gibbs B, Jones MA, Jakicic JM, Jeyabalan A, Whitaker KM, & Catov JM (2021). Objectively Measured Sedentary Behavior and Physical Activity Across 3 Trimesters of Pregnancy: The Monitoring Movement and Health Study. J Phys Act Health, 18(3), 254–261. 10.1123/jpah.2020-0398 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Barone Gibbs B, Paley JL, Jones MA, Whitaker KM, Connolly CP, & Catov JM (2020). Validity of self-reported and objectively measured sedentary behavior in pregnancy. BMC Pregnancy and Childbirth, 20(1), 99. 10.1186/s12884-020-2771-z [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cantor AG, Jungbauer RM, McDonagh M, Blazina I, Marshall NE, Weeks C, Fu R, LeBlanc ES, & Chou R (2021). Counseling and Behavioral Interventions for Healthy Weight and Weight Gain in Pregnancy: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA, 325(20), 2094–2109. 10.1001/jama.2021.4230 [DOI] [PubMed] [Google Scholar]
- Casagrande SS, Linder B, & Cowie CC (2018). Prevalence of gestational diabetes and subsequent Type 2 diabetes among U.S. women. Diabetes Research and Clinical Practice, 141, 200–208. 10.1016/j.diabres.2018.05.010 [DOI] [PubMed] [Google Scholar]
- Catalano P, & deMouzon SH (2015). Maternal obesity and metabolic risk to the offspring: why lifestyle interventions may have not achieved the desired outcomes. International Journal of Obesity (2005), 39(4), 642–649. 10.1038/ijo.2015.15 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Catov JM, Parker CB, Gibbs BB, Bann CM, Carper B, Silver RM, Simhan HN, Parry S, Chung JH, Haas DM, Wapner RJ, Saade GR, Mercer BM, Bairey-Merz CN, Greenland P, Ehrenthal DB, Barnes SE, Shanks AL, Reddy UM, Grobman WA, NuMoM2b, N., & Network, N. N. b. H. H. S. (2018). Patterns of leisure-time physical activity across pregnancy and adverse pregnancy outcomes. The International Journal of Behavioral Nutrition and Physical Activity, 15(1), 68. 10.1186/s12966-018-0701-5 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Chasan-Taber L, Schmidt MD, Roberts DE, Hosmer D, Markenson G, & Freedson PS (2004). Development and validation of a Pregnancy Physical Activity Questionnaire. Med Sci Sports Exerc, 36(10), 1750–1760. 10.1249/01.mss.0000142303.49306.0d [DOI] [PubMed] [Google Scholar]
- Chasan-Taber L, Silveira M, Pekow P, Braun B, Manson JE, Solomon CG, & Markenson G (2015). Physical activity, sedentary behavior and risk of hypertensive disorders of pregnancy in Hispanic women. Hypertension in Pregnancy, 34(1), 1–16. 10.3109/10641955.2014.946616 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Davenport MH, Ruchat SM, Poitras VJ, Jaramillo Garcia A, Gray CE, Barrowman N, Skow RJ, Meah VL, Riske L, Sobierajski F, James M, Kathol AJ, Nuspl M, Marchand AA, Nagpal TS, Slater LG, Weeks A, Adamo KB, Davies GA, Barakat R, & Mottola MF (2018). Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: a systematic review and meta-analysis. British Journal of Sports Medicine, 52(21), 1367–1375. 10.1136/bjsports-2018-099355 [DOI] [PubMed] [Google Scholar]
- Davenport MH, Ruchat SM, Sobierajski F, Poitras VJ, Gray CE, Yoo C, Skow RJ, Jaramillo Garcia A, Barrowman N, Meah VL, Nagpal TS, Riske L, James M, Nuspl M, Weeks A, Marchand AA, Slater LG, Adamo KB, Davies GA, Barakat R, & Mottola MF (2019). Impact of prenatal exercise on maternal harms, labour and delivery outcomes: a systematic review and meta-analysis. British Journal of Sports Medicine, 53(2), 99–107. 10.1136/bjsports-2018-099821 [DOI] [PubMed] [Google Scholar]
- Deputy NP, Kim SY, Conrey EJ, & Bullard KM (2018). Prevalence and Changes in Preexisting Diabetes and Gestational Diabetes Among Women Who Had a Live Birth - United States, 2012-2016. MMWR: Morbidity and Mortality Weekly Report, 67(43), 1201–1207. 10.15585/mmwr.mm6743a2 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Do NC, Vestgaard M, Ásbjörnsdóttir B, Nichum VL, Ringholm L, Andersen LLT, Jensen DM, Damm P, & Mathiesen ER (2020). Physical activity, sedentary behavior and development of preeclampsia in women with preexisting diabetes. Acta Diabetologica, 57(5), 559–567. 10.1007/s00592-019-01459-7 [DOI] [PubMed] [Google Scholar]
- Fazzi C, Saunders DH, Linton K, Norman JE, & Reynolds RM (2017). Sedentary behaviours during pregnancy: a systematic review. The International Journal of Behavioral Nutrition and Physical Activity, 14(1), 32. 10.1186/s12966-017-0485-z [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ferrari N, & Joisten C (2021). Impact of physical activity on course and outcome of pregnancy from pre- to postnatal. European Journal of Clinical Nutrition. 10.1038/s41430-021-00904-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Goldstein RF, Abell SK, Ranasinha S, Misso M, Boyle JA, Black MH, Li N, Hu G, Corrado F, Rode L, Kim YJ, Haugen M, Song WO, Kim MH, Bogaerts A, Devlieger R, Chung JH, & Teede HJ (2017). Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis. JAMA, 317(21), 2207–2225. 10.1001/jama.2017.3635 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Han E, Abrams B, Sridhar S, Xu F, & Hedderson M (2016). Validity of Self-Reported Pre-Pregnancy Weight and Body Mass Index Classification in an Integrated Health Care Delivery System. Paediatric and Perinatal Epidemiology, 30(4), 314–319. 10.1111/ppe.12286 [DOI] [PubMed] [Google Scholar]
- Institute of Medicine. (2009). Weight Gain During Pregnancy: Reexamining the Guidelines (K. M. Rasmussen & A. L. Yaktine, Eds.). The National Academies Press. 10.17226/12584 [DOI] [PubMed] [Google Scholar]
- Jones MA, Catov JM, Jeyabalan A, Whitaker KM, & Barone Gibbs B (2021). Sedentary behaviour and physical activity across pregnancy and birth outcomes. Paediatric and Perinatal Epidemiology, 35(3), 341–349. 10.1111/ppe.12731 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Muntner P, Shimbo D, Carey RM, Charleston JB, Gaillard T, Misra S, Myers MG, Ogedegbe G, Schwartz JE, Townsend RR, Urbina EM, Viera AJ, White WB, & Wright JT Jr. (2019). Measurement of Blood Pressure in Humans: A Scientific Statement From the American Heart Association. Hypertension, 73(5), e35–e66. 10.1161/hyp.0000000000000087 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Piercy KL, Troiano RP, Ballard RM, Carlson SA, Fulton JE, Galuska DA, George SM, & Olson RD (2018). The Physical Activity Guidelines for Americans. JAMA, 320(19), 2020–2028. 10.1001/jama.2018.14854 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rasmussen KM, Catalano PM, & Yaktine AL (2009). New guidelines for weight gain during pregnancy: what obstetrician/gynecologists should know. Current Opinion in Obstetrics and Gynecology, 21(6), 521–526. 10.1097/GCO.0b013e328332d24e [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ruchat SM, Mottola MF, Skow RJ, Nagpal TS, Meah VL, James M, Riske L, Sobierajski F, Kathol AJ, Marchand AA, Nuspl M, Weeks A, Gray CE, Poitras VJ, Jaramillo Garcia A, Barrowman N, Slater LG, Adamo KB, Davies GA, Barakat R, & Davenport MH (2018). Effectiveness of exercise interventions in the prevention of excessive gestational weight gain and postpartum weight retention: a systematic review and meta-analysis. British Journal of Sports Medicine, 52(21), 1347–1356. 10.1136/bjsports-2018-099399 [DOI] [PubMed] [Google Scholar]
- Sanghavi M, & Rutherford JD (2014). Cardiovascular Physiology of Pregnancy. Circulation, 130(12), 1003–1008. 10.1161/CIRCULATIONAHA.114.009029 [DOI] [PubMed] [Google Scholar]
- Shieh C, Cullen DL, Pike C, & Pressler SJ (2018). Intervention strategies for preventing excessive gestational weight gain: systematic review and meta-analysis. Obesity Reviews, 19(8), 1093–1109. 10.1111/obr.12691 [DOI] [PubMed] [Google Scholar]
- Sun JJ, & Chien LY (2021). Decreased Physical Activity during Pregnancy Is Associated with Excessive Gestational Weight Gain. International Journal of Environmental Research and Public Health, 18(23). 10.3390/ijerph182312597 [DOI] [PMC free article] [PubMed] [Google Scholar]