Current ACOG guidelines recommend exercise during a low-risk pregnancy for 30 minutes on most, if not all days of the week. However, little is known about how the volume of exercise performed during pregnancy affects fetoplacental size. In addition, the confounding effects of maternal nutrient intake and weight gain, and how they interact with exercise volume to influence fetoplacental size have not been appropriately addressed. Therefore, the purpose of this study was to examine the effects of varying maternal exercise volumes on neonatal birthweight and placental volume, while addressing the influence of maternal nutrient intake and weight gain. Subjects evaluated for this study included pregnant women who walked during gestation (n=26), performed non-walking aerobic exercise during gestation (n=30), or remained as sedentary controls (n=32). At 16, 20, 24, 28, 32, 36 weeks gestation, women recorded their nutrient intake for 3 consecutive days. Additionally, they kept monthly exercise logs indicating the type and duration of their exercise. Nutrient variables calculated included average daily Calorie intake, average daily carbohydrate intake, average daily protein intake, average daily fat intake, and average daily fiber intake. Exercise volume was calculated as the average number of minutes per week spent performing exercise. Latent growth modeling was the statistical procedure used to analyze how change in maternal exercise volume and nutrient intake throughout gestation affects neonatal outcomes. Neonatal outcomes measured were birthweight, corrected birthweight for gestational age, sex, race, and socioeconomic status, and placental volume at delivery. Maternal walking volume had no effect on newborn birthweight or corrected birthweight, while it was inversely related to placental size at birth. Maternal non-walking aerobic exercise volume was inversely related with newborn birthweight, while there was a trend toward an inverse relationship with corrected birthweight and placental volume. Controlling for Calorie intake strengthened the relationship between any form of exercise volume and infant birthweight. Calorie intake, carbohydrate intake, and protein intake were all positively related to infant birthweight. Fiber intake was significantly inversely related to placental volume. Finally, maternal exercise volume and nutrient intake were not related to maternal weight gain. This data suggests that neonatal outcome will be affected by variations in exercise protocol. In addition, nutrient intake is a potentially confounding variable that should be examined when undertaking studies addressing the role of maternal exercise on neonatal outcome.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 6 uppsatser.

Objective: The purpose of this study was to assess the feasibility of conducting a prospective cohort study during early pregnancy (<24 weeks gestation) examining the psychological factors associated with excessive pregnancy weight gain. Study Design: Women who had at least 1 prenatal care visit, had a live singleton gestation and were able to read English were eligible to enroll in the study. Women completed the self-administered survey at their prenatal clinics in Hamilton and Brantford, Ontario, Canada. Final pregnancy weight was obtained from women’s clinical charts. Results: All approached clinics agreed to participate in the study (100% clinic agreement). Five hundred thirty women completed the enrolment survey, which was a 90.0% uptake rate. An average of 6 women enrolled each week at less than 24 weeks gestation. Less than 10% of data were missing for all survey questions and outcome data (final pregnancy weight) was available for all but one participant (97.3%). Final pregnancy weights were obtained a median of 1.0 days (interquartile 0.0-3.5 days) prior to delivery. No psychological factors were significantly associated with the odds of gaining above the 2009 IOM/Health Canada guidelines in the exploratory univariate analysis. Conclusion: All feasibility outcomes demonstrated that conducting a full-scale study in Southwestern Ontario would be feasible. Conducting a full-scale study may identify associations between psychological factors and excessive pregnancy weight gain. / Thesis / Master of Science (MSc)

Objectives: The purpose of the present study was to examine background and modifiable pregnancy health behavior factors predicting infant birthweight in an economically and educationally disadvantaged sample with low medical risk. Methods: Participants were recruited from a family practice center in rural Appalachia. Participants: Over 220, predominantly Caucasian and lower SES women with low risk pregnancies were included in the sample. Data were collected through systematic chart review. Half of the women smoked during pregnancy and over 10% gave birth to low birth weight (LBW; < 2500 g) babies. Results: Compared with those who gave birth to normal weight newborns, women with LBW babies had more miscarriages, but did not differ significantly on other background factors. Women who delivered LBW babies gained less weight during pregnancy and were more likely to smoke than remaining women. After control for background factors, modifiable pregnancy health behavior factors (weight gain, prenatal care, smoking, alcohol and substance use) accounted for over 11% of birth weight variance, with nearly 7% attributable solely to smoking. Conclusions: Pregnancy smoking was the strongest behavioral predictor of LBW in this economically and educationally disadvantaged rural sample, suggesting that efforts to reduce LBW in similar populations should include targeting pregnancy smoking.

One of the primary purposes of the investigation was to examine the impact of a number of variables on the incidence of low birth weight in two states, Utah and Nevada, that have divergent low birth weight incidences. The sample size obtained from birth certificate data for this purpose was 51,147 (1969-1974) for Nevada and 26,464 (1970) and 29,422 (1974) for Utah. Additionally, separate analyses were made for Utah and Nevada data available for the year 1974. The respective sample sizes for this year were 29,422 (Utah) and 8,256 (Nevada). Least squares analysis indicated sex of the infant, race of the mother, age of the mother, parity, and county of residence were al l significantly related ( P.O:: 0 . 01) to birth weight of the infant . Examination of the birth certificate data indicated, the unmarried, black adolescent is most apt to bear a low birth weight infant in both Utah and Nevada , but the incidence of young, black, unmarried adolescents is higher in Nevada accounting in part for the divergent overall incidence of l ow birth weight be tween the two states. To supplement birth certificate information, additional questionnaire sampling was conducted in Utah and Nevada. Information on pregravid weight, pregnancy weight gain, protein intake , energy intake, smoking habits, socio -economic status, exercise patterns and over-the -counter drug use was obtained from 184 women (Utah 88, Nevada= 96). Student's t-test, stepwise regress i on and least squares analysis indicated pregravid weight and pregnancy weight gain "ere the on l y variables significantly related (P 1!.. 0.01) to birth weight .

Introdução: O ganho de peso gestacional é um indicador de saúde materno-fetal, estando associado com duração da gestação, tipo de parto, peso do bebê ao nascer e retenção de peso materno pós-parto, cujos determinantes podem ser o estado nutricional prégestacional, o consumo alimentar e os fatores sociais. Objetivos: Descrever o ganho de peso total de gestantes atendidas em unidades básicas de saúde e sua associação com o estado nutricional pré-gestacional, com fatores sóciodemográficos e relacionados à gestação. Delineamento: Estudo de coorte prospectivo de gestantes arroladas consecutivamente entre a 16a e 36a semanas e seguidas até o parto. Cenário: Serviços de pré-natal na rede básica de saúde em duas cidades do Rio Grande do Sul, Brasil. Método: Na linha de base, foram realizadas entrevistas padronizadas incluindo questionários de freqüência alimentar, de características sócio-demográficas e de dados clínicos das gestantes. O seguimento ocorreu até o pós-parto imediato, sendo coletado o peso da gestante registrado em cada consulta de pré-natal. O ganho de peso foi classificado em “adequado”, “insuficiente” e “excessivo” conforme recomendação do Institute of Medicine (1990). Regressão logística polinomial foi utilizada para estimar a associação entre categorias de ganho de peso e estado nutricional pré-gestacional e fatores sóciodemográficos e gestacionais. Resultados: As incidências de ganho de peso insuficiente e excessivo das 667 gestantes amostradas foram de 29,1% e 42,7%, respectivamente. As gestantes com sobrepeso e obesidade pré-gestacional apresentaram maior ganho ponderal excessivo (OR: 3,43 IC 95%: 1,72 – 6,84 & OR: 10,78 IC 95%: 4,15 – 27,97) em relação às que iniciaram eutróficas e que ganharam peso dentro das recomendações. Dentre aquelas que iniciaram a gravidez com obesidade, apenas 5,2% obtiveram ganho adequado de peso. Das gestantes que iniciaram a gravidez com baixo peso, 40,2% tiveram ganho ponderal insuficiente. Conclusões: A incidência de ganho ponderal excessivo é elevada. Embora o ganho insuficiente de peso persista como um problema de saúde pública, o ganho excessivo está se configurando como um problema que precisa de atenção imediata nos serviços de prénatal. / Background: Pregnancy weight gain is an index of maternal and fetal health, being associated to number of weeks at delivery, mode of delivery, newborn weight at delivery, and maternal weight retention after-birth. Pre-pregnancy nutritional status, food intake, and social factors are its determinants. Objective: Describe pregnant women weight gain in primary care services and its association to pre-pregnancy nutritional status and other pregnancy related factors. Design: Longitudinal cohort of pregnant women enrolled at 16-36 weeks of gestation and followed up until delivery. Setting: Prenatal care in primary attention services in two cities in Rio Grande do Sul, Brazil. Method: At baseline, socio-demographic and food frequency questionnaires were applied. Clinical features were also evaluated. Maternal weight was collected at each prenatal care visit, and follow up was held until early puerperium. According to Institute of Medicine (1990), weight gain was classified as “adequate”, “insufficient” or “excessive”. Polinomial logistic regression was used to measure association among weight gain categories and prepregnancy nutritional status and socio-demographic and pregnancy features. Results: 667 women compose sample, and insufficient and excessive weight gain incidences were 29.1%, and 42.7%, respectively. Women classified as overweight and obese before pregnancy had a significant excessive weight gain in pregnancy (OR: 3.43 CI 95%: 1.72 – 6.84 & OR: 10.78 CI 95%: 4.15 – 27.97) comparing to normal-weighted women that gained adequate weight during pregnancy. Only 5.2% of women who began pregnancy as obese had a normal weight gain. Among those classified as underweight at pregnancy beginning, 40.2% gained less weight than recommended during pregnancy. Conclusions: Excessive weight gain incidence is high. Although insufficient weight gain is still a public health problem, excessive gain is becoming a problem that needs immediate attention in prenatal care.

Introdução: O ganho de peso gestacional é um indicador de saúde materno-fetal, estando associado com duração da gestação, tipo de parto, peso do bebê ao nascer e retenção de peso materno pós-parto, cujos determinantes podem ser o estado nutricional prégestacional, o consumo alimentar e os fatores sociais. Objetivos: Descrever o ganho de peso total de gestantes atendidas em unidades básicas de saúde e sua associação com o estado nutricional pré-gestacional, com fatores sóciodemográficos e relacionados à gestação. Delineamento: Estudo de coorte prospectivo de gestantes arroladas consecutivamente entre a 16a e 36a semanas e seguidas até o parto. Cenário: Serviços de pré-natal na rede básica de saúde em duas cidades do Rio Grande do Sul, Brasil. Método: Na linha de base, foram realizadas entrevistas padronizadas incluindo questionários de freqüência alimentar, de características sócio-demográficas e de dados clínicos das gestantes. O seguimento ocorreu até o pós-parto imediato, sendo coletado o peso da gestante registrado em cada consulta de pré-natal. O ganho de peso foi classificado em “adequado”, “insuficiente” e “excessivo” conforme recomendação do Institute of Medicine (1990). Regressão logística polinomial foi utilizada para estimar a associação entre categorias de ganho de peso e estado nutricional pré-gestacional e fatores sóciodemográficos e gestacionais. Resultados: As incidências de ganho de peso insuficiente e excessivo das 667 gestantes amostradas foram de 29,1% e 42,7%, respectivamente. As gestantes com sobrepeso e obesidade pré-gestacional apresentaram maior ganho ponderal excessivo (OR: 3,43 IC 95%: 1,72 – 6,84 & OR: 10,78 IC 95%: 4,15 – 27,97) em relação às que iniciaram eutróficas e que ganharam peso dentro das recomendações. Dentre aquelas que iniciaram a gravidez com obesidade, apenas 5,2% obtiveram ganho adequado de peso. Das gestantes que iniciaram a gravidez com baixo peso, 40,2% tiveram ganho ponderal insuficiente. Conclusões: A incidência de ganho ponderal excessivo é elevada. Embora o ganho insuficiente de peso persista como um problema de saúde pública, o ganho excessivo está se configurando como um problema que precisa de atenção imediata nos serviços de prénatal. / Background: Pregnancy weight gain is an index of maternal and fetal health, being associated to number of weeks at delivery, mode of delivery, newborn weight at delivery, and maternal weight retention after-birth. Pre-pregnancy nutritional status, food intake, and social factors are its determinants. Objective: Describe pregnant women weight gain in primary care services and its association to pre-pregnancy nutritional status and other pregnancy related factors. Design: Longitudinal cohort of pregnant women enrolled at 16-36 weeks of gestation and followed up until delivery. Setting: Prenatal care in primary attention services in two cities in Rio Grande do Sul, Brazil. Method: At baseline, socio-demographic and food frequency questionnaires were applied. Clinical features were also evaluated. Maternal weight was collected at each prenatal care visit, and follow up was held until early puerperium. According to Institute of Medicine (1990), weight gain was classified as “adequate”, “insufficient” or “excessive”. Polinomial logistic regression was used to measure association among weight gain categories and prepregnancy nutritional status and socio-demographic and pregnancy features. Results: 667 women compose sample, and insufficient and excessive weight gain incidences were 29.1%, and 42.7%, respectively. Women classified as overweight and obese before pregnancy had a significant excessive weight gain in pregnancy (OR: 3.43 CI 95%: 1.72 – 6.84 & OR: 10.78 CI 95%: 4.15 – 27.97) comparing to normal-weighted women that gained adequate weight during pregnancy. Only 5.2% of women who began pregnancy as obese had a normal weight gain. Among those classified as underweight at pregnancy beginning, 40.2% gained less weight than recommended during pregnancy. Conclusions: Excessive weight gain incidence is high. Although insufficient weight gain is still a public health problem, excessive gain is becoming a problem that needs immediate attention in prenatal care.

Introdução: O ganho de peso gestacional é um indicador de saúde materno-fetal, estando associado com duração da gestação, tipo de parto, peso do bebê ao nascer e retenção de peso materno pós-parto, cujos determinantes podem ser o estado nutricional prégestacional, o consumo alimentar e os fatores sociais. Objetivos: Descrever o ganho de peso total de gestantes atendidas em unidades básicas de saúde e sua associação com o estado nutricional pré-gestacional, com fatores sóciodemográficos e relacionados à gestação. Delineamento: Estudo de coorte prospectivo de gestantes arroladas consecutivamente entre a 16a e 36a semanas e seguidas até o parto. Cenário: Serviços de pré-natal na rede básica de saúde em duas cidades do Rio Grande do Sul, Brasil. Método: Na linha de base, foram realizadas entrevistas padronizadas incluindo questionários de freqüência alimentar, de características sócio-demográficas e de dados clínicos das gestantes. O seguimento ocorreu até o pós-parto imediato, sendo coletado o peso da gestante registrado em cada consulta de pré-natal. O ganho de peso foi classificado em “adequado”, “insuficiente” e “excessivo” conforme recomendação do Institute of Medicine (1990). Regressão logística polinomial foi utilizada para estimar a associação entre categorias de ganho de peso e estado nutricional pré-gestacional e fatores sóciodemográficos e gestacionais. Resultados: As incidências de ganho de peso insuficiente e excessivo das 667 gestantes amostradas foram de 29,1% e 42,7%, respectivamente. As gestantes com sobrepeso e obesidade pré-gestacional apresentaram maior ganho ponderal excessivo (OR: 3,43 IC 95%: 1,72 – 6,84 & OR: 10,78 IC 95%: 4,15 – 27,97) em relação às que iniciaram eutróficas e que ganharam peso dentro das recomendações. Dentre aquelas que iniciaram a gravidez com obesidade, apenas 5,2% obtiveram ganho adequado de peso. Das gestantes que iniciaram a gravidez com baixo peso, 40,2% tiveram ganho ponderal insuficiente. Conclusões: A incidência de ganho ponderal excessivo é elevada. Embora o ganho insuficiente de peso persista como um problema de saúde pública, o ganho excessivo está se configurando como um problema que precisa de atenção imediata nos serviços de prénatal. / Background: Pregnancy weight gain is an index of maternal and fetal health, being associated to number of weeks at delivery, mode of delivery, newborn weight at delivery, and maternal weight retention after-birth. Pre-pregnancy nutritional status, food intake, and social factors are its determinants. Objective: Describe pregnant women weight gain in primary care services and its association to pre-pregnancy nutritional status and other pregnancy related factors. Design: Longitudinal cohort of pregnant women enrolled at 16-36 weeks of gestation and followed up until delivery. Setting: Prenatal care in primary attention services in two cities in Rio Grande do Sul, Brazil. Method: At baseline, socio-demographic and food frequency questionnaires were applied. Clinical features were also evaluated. Maternal weight was collected at each prenatal care visit, and follow up was held until early puerperium. According to Institute of Medicine (1990), weight gain was classified as “adequate”, “insufficient” or “excessive”. Polinomial logistic regression was used to measure association among weight gain categories and prepregnancy nutritional status and socio-demographic and pregnancy features. Results: 667 women compose sample, and insufficient and excessive weight gain incidences were 29.1%, and 42.7%, respectively. Women classified as overweight and obese before pregnancy had a significant excessive weight gain in pregnancy (OR: 3.43 CI 95%: 1.72 – 6.84 & OR: 10.78 CI 95%: 4.15 – 27.97) comparing to normal-weighted women that gained adequate weight during pregnancy. Only 5.2% of women who began pregnancy as obese had a normal weight gain. Among those classified as underweight at pregnancy beginning, 40.2% gained less weight than recommended during pregnancy. Conclusions: Excessive weight gain incidence is high. Although insufficient weight gain is still a public health problem, excessive gain is becoming a problem that needs immediate attention in prenatal care.