Hanne Kristine Hegaard

Leisure time physical activity during pregnancy and impact on gestational diabetes mellitus, pre-eclampsia, preterm delivery and birth weight: a review

Background. It has been questioned whether leisure time physical activity (LTPA) during pregnancy is beneficial or deleterious to pregnancy outcome, and whether a sedentary lifestyle during pregnancy has a negative impact on pregnancy. Answers to these questions are of general interest, since some young women are very physically active during leisure time, while others have a sedentary lifestyle. Method. In this review, we analysed the association between LTPA and the selected pregnancy outcomes, gestational diabetes mellitus (GDM), pre‐eclampsia, preterm delivery, and birth weight. Results. The prevailing literature clearly indicates that LTPA before and/or during pregnancy has a protective effect on the development of GDM and pre‐eclampsia. Furthermore, LTPA does not seem to have a negative impact on the rate of preterm delivery or on birth weight. Conclusion. Thus, it seems relevant that health authorities recommend 30 min of daily physical activity to healthy pregnant women.

Association between maternal weight gain and birth weight

OBJECTIVE: To investigate the association between maternal weight gain and birth weight less than 3,000 g and greater than or equal to 4,000 g in underweight (body mass index [BMI] less than 19.8 kg/m2), normal weight (BMI 19.8–26.0 kg/m2), overweight (BMI 26.1–29.0 kg/m2), and obese (BMI greater than 29.0 kg/m2) women, with emphasis on the use of the American Institute of Medicine (IOM) recommendations in Denmark. METHODS: We analyzed data from 2,248 women with singleton, term pregnancies. The relationship between weight gain and risk of birth weight less than 3,000 g and greater than or equal to 4,000 g was examined in the four BMI groups, and use of IOM recommendations was tested by logistic regression analyses. RESULTS: We found an inverse relationship between maternal weight gain and the proportion of infants with a birth weight less than 3,000 g. Birth weight greater than or equal to 4,000 g increased with an increasing weight gain in underweight and normal-weight women, but the association was less apparent in overweight and obese women. Underweight women seemed to benefit from gaining more weight than recommended by the IOM, because the odds ratio (OR) of birth weight less than 3,000 g was 0.3 (95% confidence interval [CI] 0.1–0.9) and the OR was 1.7 for birthweight greater than or equal to 4,000 g (95% CI 0.8–3.6). The normal-weight women had an increased risk of birth weight less than 3,000 g (OR 2.4, 95% CI 1.5–3.7) if weight gain was below the recommended range, and the OR of birth weight greater than or equal to 4,000 g was 1.9 (95% CI 1.5–2.5) when the women gained more than recommended. CONCLUSION: The IOM recommendations may provide a basis for Danish recommendations to pregnant women, although the upper recommended limit for underweight women may have to be increased. LEVEL OF EVIDENCE: II

Multimodal intervention raises smoking cessation rate during pregnancy.

Background.  The aim was to study the effect of a multimodal smoking cessation intervention regimen on a number of pregnant smokers.

Leisure time physical activity is associated with a reduced risk of preterm delivery

OBJECTIVE This study was undertaken to study the association between the times spent on sports activities and leisure time physical activity in the first and early second trimester of pregnancy and the risk of preterm delivery. STUDY DESIGN Population-based follow-up study of 5749 healthy pregnant women who delivered in Aarhus University Hospital, Denmark. RESULTS Women who practiced more than 1 type of sports had a significantly reduced adjusted risk (odds ratio = 0.09 95% CI, 0.01-0.66) of preterm delivery compared with women with no sports activity. Compared with sedentary pregnant women, women engaged in light leisure time physical activity had a 24% nonsignificantly reduced adjusted risk (odds ratio = 0.76, 95% CI, 0.60-1.02) of preterm delivery and those engaged in moderate-to-heavy leisure time activity had a 66% reduced adjusted risk (odds ratio = 0.34, 95% CI, 0.14-0.85). CONCLUSION Moderate-to-heavy leisure time physical activity during pregnancy is associated with a significantly reduced risk of preterm delivery.

The effect of environmental tobacco smoke during pregnancy on birth weight.

Background. This study explores whether pregnant nonsmokers’ exposure to environmental tobacco smoke (ETS) affects the average birth weight at term.

Sports and Leisure Time Physical Activity During Pregnancy in Nulliparous Women.

To describe patterns of leisure time physical activity during pregnancy in relation to pre-pregnancy leisure time physical activity, socio-demographic characteristics, fertility history, and lifestyle factors. 4,718 nulliparous with singleton pregnancy and intended spontaneous vaginal delivery were included in the study at gestational week 33 from May 2004 to July 2005. Information was provided by self-administered questionnaires. Leisure time physical activity was categorised into four categories: competitive sport, moderate-to-heavy, light or sedentary. In this population of nulliparous women, 4% participated in competitive sport, 25% in moderate-to-heavy activities, 66% in light activities, and 5% in sedentary activities in the year prior to pregnancy. Physical activity before pregnancy was statistically significantly associated with age, pre-pregnancy BMI, chronic diseases, number of years at school, and smoking habits. The proportion of women who took part in competitive sports, and moderate-to-heavy activities decreased over the three trimesters of pregnancy. The proportion of women with light physical activity was stable during pregnancy while the proportion of women with sedentary activity increased from 6% to 29%. During the third trimester women performing competitive sports or moderate-to-heavy activities before pregnancy continued to have a higher level of physical activity than women with light activities or sedentary activities before pregnancy. In general the intensity and time spent on exercise decreased during pregnancy. Women with the highest level of exercise prior to pregnancy continued to be the most active during pregnancy. Among women with sedentary activities before pregnancy one-fourth changed to light activity during pregnancy.

Preconception care policy, guidelines, recommendations and services across six European countries: Belgium (Flanders), Denmark, Italy, the Netherlands, Sweden and the United Kingdom

Abstract Objectives Preconception care is important for the screening, prevention and management of risk factors that affect pregnancy outcomes. We aimed to investigate pre-pregnancy care policies, guidelines, recommendations and services in six European countries. Methods In 2013, an electronic search and investigation was undertaken of preconception policy, guidelines, recommendations and services available to healthcare professionals and the general public in six European countries: Belgium (Flanders), Denmark, Italy, the Netherlands, Sweden and the United Kingdom. Findings were compared within five categories: Governmental policy and legislation; Professional bodies and organisations; Healthcare providers; Charitable organisations; Web-based public information and internet sites. Results All countries had preconception recommendations for women with chronic diseases, such as diabetes and epilepsy. Recommendations for healthy women and men were fragmented and inconsistent. Preconception guidance was often included in antenatal and pregnancy guidelines. Differences between countries were seen with regard to nutritional and lifestyle advice particularly in relation to fish, caffeine and alcohol consumption, and vitamin supplementation. Conclusions Current guidelines are heterogeneous. Collaborative research across Europe is required in order to develop evidence-based guidelines for preconception health and care. There is a need to establish a clear strategy for promoting advice and guidance within the European childbearing population. Chinese Abstract 摘要 目的 孕前保健对于那些影响妊娠结局的风险因素的筛查、预防和管理是非常重要的。我们旨在调查六个欧洲国家的孕前保健政策、指南、推荐规范和服务项目 方法 2013年，一项服务于医疗专家和公众的电子搜索和调查项目在六个欧洲国家：比利时（弗兰德斯）、丹麦、意大利、荷兰、瑞典和英国展开。其结果从以下五个方面进行比较：政府政策和立法；专业团队和机构；医务人员；慈善组织；基于网络的公共信息和互联网站。 结果 所有国家对于患有慢性病的女性（如糖尿病和癫痫）均有相应的孕前推荐规范。而对于健康男女的推荐规范则比较分散且不一致。孕前指南常包括在产前和妊娠指南中。各个国家关于营养和生活方式的建议，尤其涉及鱼类、咖啡因、饮酒和维生素补充方面是不同的。 结论 现行的指南多种多样，需要整个欧洲进行合作研究，从而为孕前卫生保健制定循证指南。因此有必要为促进建议和指南在欧洲生育年龄人群中的实施建立清晰的方法。

Sports and leisure‐time physical activity in pregnancy and birth weight: a population‐based study

We examined the association between sports and other leisure‐time physical activities during pregnancy and birth weight of babies born after 37 completed weeks of gestation. All Danish‐speaking pregnant women attending routine antenatal care at the Department of Obstetrics, Aarhus University Hospital, Denmark, from August 1989 to September 1991 were invited to participate in the study. A total of 4458 healthy women who delivered after 37 completed gestational weeks participated in this study. The associations between sports (0, 1–2, 3+ h/week) or leisure‐time physical activity (sedentary, light, and moderate to heavy) and birth weight were examined by linear and logistic regression and adjusted for potential confounding factors such as smoking, parity, schooling, pre‐pregnancy body mass index and gestational age. The results showed that pregnant women who practiced sports or were moderate to heavy leisure‐time physical active during the early second or the early third trimester gave birth to infants with a similar birth weight as inactive women. The proportion of newborns with a low (<2500 g) or a high birth weight (≥4500 g) was also unchanged. In conclusion, in this large population‐based study, we found no association between sports and leisure‐time physical activity and low‐birth weight, high‐birth weight, or average‐birth weight.

Experiences of physical activity during pregnancy in Danish nulliparous women with a physically active life before pregnancy. A qualitative study

BackgroundNational guidelines recommend that healthy pregnant women take 30 minutes or more of moderate exercise a day. Most women reduce the level of physical activity during pregnancy but only a few studies of womens experiences of physical activity during pregnancy exist. The aim of the present study was to elucidate experiences and views of leisure time physical activity during pregnancy in nulliparous women who were physically active prior to their pregnancy.MethodsA qualitative study was conducted by means of personal interviews. Nineteen women, all with a moderate pre-pregnancy level of physical activity but with different levels of physical activity during pregnancy, participated in the study. Content analysis was applied.ResultsIn the analyses of experiences and views of physical activities during pregnancy, four categories and nine sub-categories were developed: Physical activity as a lifestyle (Habit and Desire to continue), Body awareness (Pregnancy-related discomfort, Having a complicated pregnancy and A growing body), Carefulness (Feelings of worry and Balancing worry and sense of security) and Sense of benefit (Feelings of happiness and Physical well-being).ConclusionAs other studies have also shown, women find that the discomfort and complications associated with pregnancy, the growing body, and a sense of insecurity with physical activity are barriers to maintaining former levels of physical activity. This study adds a new perspective by describing womens perceptions of these barriers and of overcoming them - thus, when pregnant, the majority of the women do not cease to be physically active but continue to be so. Barriers are overcome by applying ones own experience, looking to role models, mirroring the activities of other pregnant women and following the advice of experts (midwives/physiotherapists). Women then continue to be physically active during pregnancy, most often to a lesser extent or in alternative activities, and derive considerable enjoyment and physical well-being from this.

Pregnancy planning and lifestyle prior to conception and during early pregnancy among Danish women

Abstract Objective To investigate the extent to which Danish women attending antenatal care plan their pregnancies and to determine the association between pregnancy planning and the intake of folic acid, alcohol consumption and smoking habits prior to conception and before the 16th week of gestation. Methods A cross-sectional survey of 258 women. Main outcome measures: intake of folic acid, alcohol consumption and smoking. Pregnancy planning was assessed by the London Measure of Unplanned Pregnancy (LMUP) and the five graded Swedish Pregnancy Planning Scale. Results Most (77%) of the participants reported that their pregnancies were very or fairly well planned. Higher median LMUP scores were observed in women taking folic acid (p < 0.001), in those consuming less alcohol, and in women who stopped smoking prior to pregnancy (p = 0.043). However, 43% of the respondents with a high degree of pregnancy planning and 98% of those with a low degree of planning had not taken folic acid prior to pregnancy. Binge drinking during early pregnancy was reported by 20% of women with a high degree of planned pregnancy and 31% of those with a low degree (p = 0.1). Conclusion Pregnancy planning was associated with a healthier lifestyle but still many women could improve their lifestyle in connection to pregnancy. Their level of alcohol consumption is higher than that recommended for best pregnancy outcome. Chinese abstract 目的。探讨在何种程度上参加产前保健计划的丹麦妇女怀孕，并确定妊娠规划和叶酸的摄入量，饮酒和吸烟习惯受孕前和怀孕第16周前之间的关联。 方法。采用横断面调查的258名妇女。主要观察指标：摄取叶酸，饮酒和吸烟。怀孕计划是由伦敦的的意外怀孕（ LMUP ）和五个梯度瑞典妊娠规划规模测量评估。 的结果。大多数（77％ ）的参与者报道，怀孕非常或相当精心策划。较高的平均LMUP分数，观察妇女服用叶酸（ P < 0.001 ） ，在那些消耗少饮酒，在妇女怀孕前戒烟（ P = 0.043） 。然而，具有高度的怀孕计划， 98％的那些低度的规划有43％的受访者并没有采取叶酸，怀孕前。具有高度的计划怀孕的程度低（ P = 0.1 ）和31％ ， 20％的女性在怀孕早期报道暴饮。 结论。健康的生活方式是与怀孕计划，但仍有许多连接到怀孕妇女可以改善他们的生活方式。他们的酒精消费水平高于建议最佳妊娠结局。.