Glenn Markenson

Development and Validation of a Pregnancy Physical Activity Questionnaire

PURPOSE The effect of physical activity during pregnancy on maternal and fetal health remains controversial and studies have yet to identify the optimal dose of physical activity associated with favorable pregnancy outcomes. The aim of this study was to develop and validate a pregnancy physical activity questionnaire (PPAQ). METHODS To ascertain the type, duration, and frequency of physical activities performed by pregnant women, three 24-h physical activity recalls were administered to 235 ethnically diverse prenatal care patients at a large tertiary care facility in western Massachusetts. The relative contribution of each activity to between-person variance in energy expenditure was used to establish the list of activities for the PPAQ. The PPAQ is self-administered and asks respondents to report the time spent participating in 32 activities including household/caregiving, occupational, sports/exercise, transportation, and inactivity. To validate the PPAQ, 54 pregnant women completed the PPAQ and then wore a Manufacturing Technology, Inc. actigraph for the following 7 d. At the end of the 7-d period, the PPAQ was repeated. RESULTS Intraclass correlation coefficients used to measure reproducibility of the PPAQ were 0.78 for total activity, 0.82 for moderate activity, 0.81 for vigorous activity, and ranged from 0.83 for sports/exercise to 0.93 for occupational activity. Spearman correlations between the PPAQ and three published cut points used to classify actigraph data ranged from 0.08 to 0.43 for total activity, 0.25 to 0.34 for vigorous activity, 0.20 to 0.49 for moderate activity, and -0.08 to 0.22 for light-intensity activity. Correlations were higher for sports/exercise and occupational activities as compared to household/caregiving activities. CONCLUSIONS household/caregiving activities. CONCLUSIONS The PPAQ is a reliable instrument of physical activities during pregnancy.

Postpartum diabetes screening in women with a history of gestational diabetes.

OBJECTIVE: Women with a history of gestational diabetes mellitus (GDM) are at high risk for developing type 2 diabetes (diabetes mellitus, DM). The American Diabetes Association recommends regular postpartum diabetes screening for women with a history of GDM, but the American College of Obstetricians and Gynecologists (ACOG) is not as directive. We sought to examine postpartum glycemic testing in women diagnosed with GDM. METHODS: We conducted an observational cohort study of women diagnosed with GDM at one of two large academic medical centers between 2000 and 2001. Kaplan-Meier estimates of the time from delivery to the first postpartum DM screening tests were determined, and predictors of postpartum DM screening were examined using Cox proportional hazards testing. RESULTS: Only 37% of eligible women underwent the postpartum diabetes screening tests recommended by the American Diabetes Association (fasting glucose or oral glucose tolerance test [OGTT]), with a median time from delivery to the first such testing of 428 days. By comparison, 94% of women underwent postpartum cervical cancer screening using a Papanicolaou (Pap) test, with a median time from delivery to Pap testing of 49 days. Even when random glucose testing was included in a broad definition of postpartum DM screening (random or fasting glucose, glycosylated hemoglobin, or OGTT), only two thirds of women (67%) received a postpartum glycemic assessment. CONCLUSION: In the population studied, only 37% of women with a history of GDM were screened for postpartum DM according to guidelines published by the American Diabetes Association. Efforts to improve postpartum DM screening in this high-risk group are warranted. LEVEL OF EVIDENCE: II-2

Predictors of excessive and inadequate gestational weight gain in Hispanic women.

Factors influencing gestational weight gain are incompletely understood, particularly among Hispanic women. We assessed medical, sociodemographic, behavioral, and psychosocial predictors of overall gestational weight gain, as well as gains below, within, or above the range recommended by the Institute of Medicine (IOM) within a prospective study of 770 Hispanic (predominantly Puerto Rican) prenatal care patients at a large tertiary care facility in Western Massachusetts. One third of women gained within the recommended range, 22% gained below, and 45% gained above the range. In multivariate analysis, women in the highest category of BMI (Ptrend < 0.001) and parity (Ptrend < 0.001) gained on average 9 lbs less than those in the lowest category. Increasing time in residence in the continental United States (Ptrend < 0.01) as well as a number of prenatal care visits (Ptrend = 0.03) were positively associated with weight gain. Overweight women (odds ratio (OR) = 2.2, 95% confidence interval (CI) 1.3, 3.8) and those over age 30 years (OR = 2.5, 95% CI 1.2, 5.0) were more likely to gain above the IOM range as compared to normal‐weight women and those aged 20–24, respectively. Women with <10 years of residence in the United States were 50% less likely to gain above the IOM range as compared to third‐generation women (95% CI 0.3, 0.9). Findings identify determinants of gestational weight gain which can form the basis of targeted interventions in this rapidly growing ethnic group.

Correlates of physical activity in pregnancy among Latina women

Objectives: National data indicate that Latina women are less active than non-Latina white women and are at higher risk of gestational diabetes and subsequent type 2 diabetes. Physical activity may reduce risk of maternal disorders of pregnancy, but sparse data exists on the correlates of physical activity in pregnant Latina women. Methods: We conducted a prospective cohort study from 2000 to 2004 among healthy Latina prenatal care patients in a public clinic and midwifery practice. Physical activity was assessed using a modified version of the Kaiser Physical Activity Survey (KPAS) in early and mid pregnancy. Results: A total of 1,231 women (predominantly of Puerto Rican heritage) met the eligibility criteria and were enrolled. Participation in household/caregiving, occupational, sports/exercise, and active living decreased from prepregnancy to pregnancy. Overall, women who were more active prior to pregnancy were more likely to have high levels of participation in every domain of pregnancy activity. Women with the highest level of participation in occupational activity during pregnancy (defined as the highest quartile of activity, compared with the lower three quartiles) were more likely to be older, college-educated, have higher income, and have fewer children. Women with the highest level of household/caregiving activity were more likely to be older, have more children, be U.S. born, and prefer Spanish while women with the highest levels of sports/exercise during pregnancy were less likely to prefer Spanish. Conclusions: These findings suggest that sociodemographic, acculturation, health, and behavioral correlates of physical activity vary by domain among Latina women. Programs aimed at promoting physical activity during pregnancy in this high risk ethnic group should recognize these differences.

Prepregnancy body mass index, gestational weight gain, and risk of hypertensive pregnancy among Latina women

OBJECTIVE Prepregnancy body mass index (BMI) and gestational weight gain have been associated with hypertensive disorders of pregnancy, but previous studies have included few Latinas, a group at increased risk. STUDY DESIGN We examined these associations in the Latina Gestational Diabetes Mellitus Study, a prospective cohort of 1231 women conducted from 2000 to 2004. RESULTS In multivariable analysis, obese women (BMI > 29.0 kg/m(2)) had 2.5 times the risk of hypertensive pregnancy (95% confidence interval [CI], 1.3-4.8) and 2.7 times the risk of preeclampsia (95% CI, 1.2-5.8), compared with women whose BMI was 19.8 to 26.0 kg/m(2). Women with excessive gestational weight gain had a 3-fold increased risk of a hypertensive disorder of pregnancy (95% CI, 1.1-7.2) and a 4-fold risk of preeclampsia (95% CI, 1.2-14.5), compared with women achieving weight gain guidelines. CONCLUSION These findings suggest prepregnancy obesity and excessive weight gain are associated with hypertension in pregnancy in a Latina population and could be potentially modifiable risk factors.

The use of the polymerase chain reaction to detect bacteria in amniotic fluid in pregnancies complicated by preterm labor

OBJECTIVES The purpose of this investigation was to determine the feasibility of using the polymerase chain reaction to detect bacteria in amniotic fluid and to compare pregnancy outcomes in subsets of women categorized by amniotic fluid culture, polymerase chain reaction, and interleukin-6 findings. STUDY DESIGN Amniotic fluid from 54 pregnancies with preterm labor and no clinical evidence of intraamniotic infection was evaluated with use of the polymerase chain reaction, interleukin-6, and bacterial culture. Gestational age, newborn weight, and time between amniocentesis and delivery were compared between subsets of women categorized by these tests. RESULTS With use of the polymerase chain reaction <100 bacteria per milliliter could be detected in amniotic fluid. A total of 55.5% of the amniotic fluid samples were polymerase chain reaction positive, whereas 9.2% of culture results were positive. Birth weights and gestational age at delivery were less and time from amniocentesis to delivery was shorter in the polymerase chain reaction-positive group (p < 0.05). Nine samples (15%) had elevated interleukin-6 concentrations; of these, six were polymerase chain reaction positive. CONCLUSIONS The polymerase chain reaction is a sensitive means of detecting bacteria in amniotic fluid. These results provide further evidence of an association between preterm delivery and intraamniotic infection. Not all amniotic fluid samples with elevated interleukin-6 levels have bacteria detectable by the polymerase chain reaction. We anticipate that the polymerase chain reaction will provide another avenue for the detection of bacteria in amniotic fluid.

Physical activity and gestational diabetes mellitus among hispanic women

OBJECTIVE Studies in predominantly non-Hispanic white populations have suggested that physical activity during pregnancy is associated with a reduced risk of gestational diabetes mellitus (GDM). There are few such studies in Hispanic women, a group at increased risk for GDM. METHODS We conducted a prospective cohort study of household/caregiving, occupational, sports/exercise, and active living habits and the risk of GDM among 1006 Hispanic (predominantly Puerto Rican) prenatal care patients in western Massachusetts from 2000 to 2004. Prepregnancy, early pregnancy, and midpregnancy physical activity was assessed using the Kaiser Physical Activity Survey. RESULTS A total of 33 women (3.3%) were diagnosed with GDM, and 119 women (11.8%) were diagnosed with abnormal glucose tolerance. There were no significant associations between GDM risk and occupational and active living activities in prepregnancy, early pregnancy, and midpregnancy or with a change in levels of household/caregiving, occupational, and active living activities from prepregnancy to during pregnancy. However, after controlling for age and prepregnancy body mass index (BMI), women in the highest quartile of prepregnancy (OR = 0.2, 95% CI 0.1-0.8, p(trend) = 0.03) and midpregnancy (OR = 0.2, 95% CI 0.1-0.8, p(trend) = 0.004) household/caregiving activities as well as midpregnancy sports/exercise (0.1, 95% CI 0.0-0.7, p(trend) = 0.12) had a reduced risk of GDM compared with women in the lowest quartile. CONCLUSIONS Findings in this Hispanic population, although based on small numbers of cases, are consistent with prior research among predominantly non-Hispanic white populations.

Perspectives of Latina and non-Latina white women on barriers and facilitators to exercise in pregnancy

Exercise during pregnancy has been associated with reduced risk of gestational diabetes mellitus, however, twice as many women are sedentary during pregnancy as compared to when they are not pregnant. We conducted 3 focus groups among 20 pregnant Latina and non-Latina white women to identify barriers and facilitators to exercise in pregnancy to inform a gestational diabetes mellitus intervention study. Quantitative analyses of demographic data, and qualitative analyses of focus groups were conducted. Women identified physical limitations and restrictions, lack of resources, energy, and time as powerful exercise barriers. Social support, access to resources, information, proper diet, scheduling, and the weather were identified as powerful facilitators. Intervention programs designed for pregnant women should facilitate social support, provide information and resources, as well as promote short-term and long-term benefits.

Parvovirus B19 infections in pregnancy

Parvovirus B19 is the viral agent that causes the childhood exanthum erythema infectiosum, or fifth disease. Approximately 50% of pregnant women are seropositive for this agent and thus immune to primary infection. However, acute infection may develop in seronegative pregnant women exposed to B19. Acute B19 infections during pregnancy have been associated with miscarriage and hydrops fetalis. This latter condition is amenable to fetal therapy via intrauterine transfusion.

A Randomized Controlled Trial of Prenatal Physical Activity to Prevent Gestational Diabetes: Design and Methods

BACKGROUND Women diagnosed with gestational diabetes mellitus (GDM) are at substantially increased risk of developing type 2 diabetes and obesity, currently at epidemic rates in the United States. GDM, therefore, identifies a population of women at high risk of developing type 2 diabetes and provides an opportunity to intervene before the development of this disorder. It is well recognized that acute as well as chronic physical activity improves glucose tolerance in type 2 diabetes. To date, however, primary prevention trials have not been conducted to test whether an increase in physical activity reduces risk of developing GDM among women at high risk of this disorder. METHODS The aims of this study are to investigate the effects of a motivationally targeted, individually tailored 12-week physical activity intervention on (1) development of GDM, (2) serum biomarkers associated with insulin resistance, and (3) the adoption and maintenance of exercise during pregnancy. Women at high risk of GDM are recruited in early pregnancy and randomized to either an individually tailored exercise intervention or a comparison health and wellness intervention. RESULTS The overall goal of the exercise intervention is to encourage pregnant women to achieve the American College of Obstetricians and Gynecologists guidelines for physical activity during pregnancy through increasing walking and developing a more active lifestyle. CONCLUSIONS The intervention takes into account the specific social, cultural, economic, and physical environmental challenges faced by pregnant women of diverse socioeconomic and ethnic backgrounds.