|Year : 2020 | Volume
| Issue : 3 | Page : 221-225
How physically active are women in the third trimester of pregnancy? A cross-sectional study of physical activity in pregnancy and its outcomes among women delivering at a rural maternity hospital in South India
Madonne Rufina Dishani, Avita Rose Johnson, Merlyn Joseph, Manisha James, Preeti Lakra, Naveen Ramesh
Department of Community Health, St. John's Medical College, Bengaluru, Karnataka, India
|Date of Submission||14-May-2020|
|Date of Acceptance||29-Jul-2020|
|Date of Web Publication||05-Oct-2020|
Dr. Avita Rose Johnson
Department of Community Health, St. John's Medical College, Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Physical activity influences perinatal outcomes. Moderate-intensity aerobic activity of 150 min/week during pregnancy is recommended.
Objective: This study aimed at assessing the physical activity levels during pregnancy and determining the factors associated with physical activity among rural women.
Methods: This was a cross-sectional study conducted in a rural maternity hospital, in a village in Ramanagara district located in the south of Karnataka among pregnant women >29 weeks of gestation and newly delivered mothers availing obstetric services at the hospital. A structured questionnaire with sociodemographic characteristics, pregnancy details, and neonate details was used. International Physical Activity Questionnaire Short Form was used for measuring physical activity. Physical activity was classified as low, moderate, and high intensity by calculating metabolic equivalent minutes per week based on the Compendium of Physical Activities.
Results: Among the 158 study participants, 113 were antenatal women and 45 had just delivered. The mean age of the study participants was 23.31 ± 3.14 years and the mean weight gain per week was 0.35 ± 0.11 kg. About 96% of the subjects had high-intensity physical activity while 4% had moderate-intensity physical activity. Women from nuclear families and older mothers had significantly high physical activity. Women with high-intensity physical activity were significantly more likely to deliver a low birth weight baby in the early neonatal period.
Conclusion: Being a rural area, majority of the pregnant mothers had high-intensity level of physical activity, which was significantly associated with lower birth weight among neonates. It is recommended to avoid high-intensity physical activity during pregnancy and focus advice on moderate physical activity for pregnant women.
Keywords: Obstetric outcomes, physical activity, pregnancy
|How to cite this article:|
Dishani MR, Johnson AR, Joseph M, James M, Lakra P, Ramesh N. How physically active are women in the third trimester of pregnancy? A cross-sectional study of physical activity in pregnancy and its outcomes among women delivering at a rural maternity hospital in South India. Indian J Health Sci Biomed Res 2020;13:221-5
|How to cite this URL:|
Dishani MR, Johnson AR, Joseph M, James M, Lakra P, Ramesh N. How physically active are women in the third trimester of pregnancy? A cross-sectional study of physical activity in pregnancy and its outcomes among women delivering at a rural maternity hospital in South India. Indian J Health Sci Biomed Res [serial online] 2020 [cited 2020 Oct 23];13:221-5. Available from: https://www.ijournalhs.org/text.asp?2020/13/3/221/297186
| Introduction|| |
According to the World Health Organization, physical activity is defined as any bodily movement produced by the skeletal muscles that requires energy expenditure. Physical activities such as walking, swimming, stationary cycling, and low-impact aerobics have been considered safe during pregnancy by the American College of Obstetricians and Gynecologists (ACOG).
Physical activity has both positive and negative influences on perinatal outcomes.,,, Physical activity is recommended during pregnancy because of benefits such as lower necessity of cesarean delivery, lower incidence of obstetrical complications, lower risk of gestational diabetes, preterm delivery, preeclampsia, and neonatal complications., However, excessive and vigorous physical activity during pregnancy might result in decreased birth weight or preterm birth.
There is limited literature available regarding physical activity during pregnancy,,, especially among rural women. This study was therefore conducted with the objective of estimating the physical activity levels during pregnancy among women in a rural area of Karnataka and determining the associated factors.
Aim and objective(s)
- To determine the physical activity levels during pregnancy among women availing obstetric care from a rural maternity hospital, Solur, Karnataka
- To determine the sociodemographic factors associated with physical activity in the study subjects
- To assess the relationship between physical activity and neonatal outcomes among the study subjects.
| Methods|| |
Institutional ethics approval was obtained from the institutional ethics committee of St. John's Medical College Ref. no. IEC #155/2019, as well as permission from the hospital authorities. The study population included pregnant women in their third trimester, beyond 29 weeks. Seriously ill subjects or subjects with conditions that prevented them from understanding and answering the questionnaire were excluded.
Based on a study conducted by Rêgo et al. in Brazil, where 60.3% of the pregnant women had adequate physical activity, the sample size was estimated to be 92. However, all women who fulfilled the inclusion criteria during the 2-month study period and were willing to participate in the study were included, after obtaining written informed consent. Among the 158 study participants, 45 were women who were admitted for delivery. Birth outcomes were documented among these 45 women.
International Physical Activity Questionnaire (IPAQ)-Short Form was used to measure the physical activity in the study participants. IPAQ-Short Form is a 7-item questionnaire which measures physical activity in the last 7 days. It contains questions listing various activities such as walking, various household chores, cycling, gardening, and other outdoor activities, including sedentary activities such as reading, watching TV, resting, and sleeping, the time spent on each activity per day, and number of days per week of that activity. Based on the Compendium of Physical Activities, each physical activity was classified as vigorous, moderate, walking, or sitting.
Each of the four types of activity has a metabolic equivalent (MET) value (where 1 MET is considered a resting metabolic rate obtained during quiet sitting), which was then multiplied by the duration of the activity per day and the number of days of that activity in the week to compute the MET minutes per week.
Based on the total MET min/week, each subject was classified as having:
- Low physical activity – <600 MET min/week
- Moderate physical activity – 600 to < 1500 MET min/week
- High physical activity – >1500 min/week.
Sociodemographic and obstetric details of the study population and birth outcomes (where possible) were also noted.
The data collected were entered in Microsoft Excel and analyzed using standard statistical package SPSS (IBM, New York, USA). Data were described using proportions, mean, and standard deviation. Chi-square test and independent t-test were the tests of significance used to associate physical activity with the sociodemographic and obstetric factors and outcomes of pregnancy. A P < 0.05 was considered statistically significant.
| Results|| |
Sociodemographic details of the study population
A total of 158 antenatal women beyond the 29th week of gestation participated in the study, 45 (28.50%) of whom were admitted for delivery. The mean age of the study population was 23.31 ± 3.14 years. Most of the women, 151 (95.60%), belonged to Hindu religion and 147 (93%) of them were home makers. About 83% of the subjects were in possession of a below poverty line card. Majority of the subjects, 95 (60.20%), belonged to socioeconomic class 1 and class 2 according to the modified BG Prasad scale.
Pregnancy and delivery details among the study population
The mean weight gain per week was calculated by dividing total weight gain during pregnancy by the number of weeks of gestation. Among the study subjects, the mean weight gain per week was 0.35 ± 0.11 kg. About 25% of the subjects had at least one complication during pregnancy, and the most common complication among them was anemia (8.90%), followed by preeclampsia (2.50%), pregnancy-induced hypertension (1.90%), gestational diabetes mellitus (1.30%), and multiple gestation (1.30%). Approximately 52% of the women had received physical activity advice in some form during their pregnancy.
Among the 158 subjects, 70 (44.30%) had no previous pregnancies, and 87 (55.10%) had at least one child. Among the subjects, 27 (17.10%) had previous history of abortions, 2 (1.30%) had still births, and 2 (1.30%) had neonatal deaths.
Among the 45 women who had delivered, the duration of labor was found to be 6.12 ± 3.50 h in primiparas and 6.23 ± 3.40 h for multiparas. Among the subjects, 40% of them delivered through spontaneous labor and 53.30% of them had induced labor. About 64% of the women had a normal vaginal delivery, 26% of them underwent lower segment cesarean section, and 9% of them had assisted delivery.
The mean birth weight of the babies born was 3.03 ± 0.42 kg. The mean gestational age at birth was 38.70 ± 1.30 weeks. Among the babies, 3 (6.70%) of them had complications during delivery and only one baby required intervention at the time of birth.
Physical activity pattern in the study population
In this study, we identified that 5 (3.20%) had moderate-intensity physical activity and 153 (96.80%) had high-intensity physical activity.
The mean age of the mothers and family type were significantly associated with physical activity. As the age increases, physical activity was found to increase and high-intensity physical activity was found among the women in nuclear families, with a P < 0.05 [Table 1].
|Table 1: Association between sociodemographic details and the physical activity: n=158|
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Parity, presence or absence of complications in pregnancy, receiving physical activity advice, and previous bad obstetric history were not significantly associated with physical activity [Table 2].
|Table 2: Association between pregnancy factors and physical activity (n=158)|
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There was no significant association between physical activity during pregnancy and intranatal factors [Table 3].
|Table 3: Association between intra natal factors and physical activity (n=45)|
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The mean birth weight was lower among women with high-intensity physical activity. We also found that there was a strong correlation between the physical activity and the mean birth weight with Spearman's correlation coefficient, r = 1 [Table 4].
|Table 4: Association between neonatal factors and physical activity (n=45)|
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| Discussion|| |
The mean total MET min/week in the study subjects was 5761. Our study found that there were no women with low-intensity physical activity, while 5 (3.20%) women had moderate-intensity physical activity. Majority of the women, i.e., 96.80%, performed high-intensity physical activity. According to a study done in Australia, among pregnant women of gestational age 26–28 weeks, the total MET min/week was found to be 285. This could be due to the fact that majority of the study participants had body mass index >25 kg/m 2 and also increased mechanization for household chores, such as washing clothes and dishes. In our study, majority of the women were from rural areas, where women are very active during pregnancy and tend to do all the household chores, taking care of the children and elderly, and so on. This could be the possible reason for majority of the women in high intensity physical activity.
According to a study done in Brazil on women within first 24 h postpartum, 39.70% of the women were doing low-intensity physical activity, 42.80% of the women were doing moderate-intensity physical activity, and 17.50% were doing high-intensity physical activity. In our study, 96.80% of the women were doing high-intensity physical activity and 3.20% were doing moderate-intensity physical activity. The large group in high-intensity physical activity in our study could be due to the fact that women being more active in rural areas of India, and also, majority of the study participants were of the gestational age >29 weeks when compared to the above study where the women who had just delivered would not do much of physical activity in that previous week.
The Japan Environment and Children's study, a birth cohort study assessing physical activity during second and third trimester of pregnancy and its effects on preterm delivery and mode of delivery, found association between the factors: gestational age at delivery, mode of delivery, and age of mother with the physical activity. In our study, we found that physical activity was significantly associated with higher maternal age, with a P = 0.006. This could be due to the fact that, as age increases, the gravidity increases and the pregnant women tend to take care of their older children, which results in increased physical activity.
A community-based cohort study in Brazil done on pregnant mothers with singleton pregnancy found that there was no association between physical activity during pregnancy and birth weight of the baby. Our study found that the mean birth weight was lower among women with high-intensity physical activity when compared to women doing moderate-intensity physical activity, with a P = 0.028. We also found strong correlation between lower birth weight and high-intensity physical activity with Spearman's correlation coefficient, r = 1. This indicates that pregnant women should avoid vigorous-intensity physical activity during pregnancy.
The nutritional status of the pregnant mothers, which may affect the physical activity, and the outcomes of pregnancy were not assessed as a part of this study. This may be the possible confounding factor in our study.
| Conclusion|| |
In our study, majority of the pregnant mothers had high intensity of physical activity. High level of physical activity was found to be significantly associated with lower birth weight.
Pregnant women are advised to not engage in high-intensity or vigorous physical activity such as jogging, aerobics, bicycling, and carrying heavy weights, since it affects the birth weight of the neonate. As per the ACOG guidelines, we would recommend moderate-intensity physical activities such as household chores and brisk walking for 150 min/week.
IPAQ is a tool which subjectively measures physical activity levels in pregnancy. Physical activity measurement using pedometer or accelerometer would give the accurate measure of physical activity. The nutritional status of the study subjects, intake of micronutrient supplements, and antenatal care during pregnancy which may affect the outcomes of pregnancy were not assessed in this study. Since the questionnaire was interviewer administered, there are chances of social desirability bias in the participants' response regarding physical activity.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Rêgo AS, Alves MT, Batista RF, Ribeiro CC, Bettiol H, Cardoso VC, et al
. Physical activity in pregnancy and adverse birth outcomes. Cad Saude Publica 2016;32:e00086915.
Ele Bisson M, Croteau J, Guinhouya BC, Bujold E, Ois Audibert F, Fraser WD, et al
. Physical activity during pregnancy and infant's birth weight: Results from the 3D Birth Cohort. BMJ Open Sport Exerc Med 2017;3:e000242.
Moyer C, Livingston J, Fang X, May LE. Influence of exercise mode on pregnancy outcomes: ENHANCED by Mom project. BMC Pregnancy Childbirth 2015;15:133.
Mishra S, Kishore S. Effect of physical activity during pregnancy on gestational diabetes mellitus. Indian J Endocrinol Metab 2018;22:661-71.
Rao S, Kanade A, Margetts BM, Yajnik CS, Lubree H, Rege S, et al
. Maternal activity in relation to birth size in rural India. The Pune Maternal Nutrition Study. Europe PMC Funders Group. Eur J Clin Nutr 2003;57:531-42.
Kanade AN, Rao S, Yajnik CS, Margetts BM, Fall CH. Rapid assessment of maternal activity among rural Indian mothers (Pune Maternal Nutrition Study). Public Health Nutr 2005;8:588-95.
Lee PH, Macfarlane DJ, Lam TH, Stewart SM. Validity of the international physical activity questionnaire short form (IPAQ-SF): A systematic review. Int J Behav Nutr Phys Act 2011;8:115.
Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, et al
. Compendium of physical activities: An update of activity codes and MET intensities. Med Sci Sports Exerc 2000;32:S498-504.
Harrison CL, Thompson RG, Teede HJ, Lombard CB. Measuring physical activity during pregnancy. Int J Behav Nutr Phys Act 2011;8:19.
Id MT, Tsuchida A, Takamori A, Aoki S, Ito M, Kigawa Id M, et al
. Effects of physical activity during pregnancy on preterm delivery and mode of delivery: The Japan environment and children's study, birth cohort study. PLoS One 2018;13:1-15.
[Table 1], [Table 2], [Table 3], [Table 4]