Dissertation
Dissertation > Medicine, health > Preventive Medicine,Health > Maternal and child health > Women 's health and hygiene

The Influence of Physical Activity during Pregnancy on Pregnant Outcomes and Infant Growth

Author JiangZuo
Tutor QianXu;HeGengSheng;LinZuoHeng
School Fudan University
Course Epidemiology and Biostatistics,
Keywords Physical activity during pregnancy Reliability Validity Physical activity scale Odograph Pregnancy outcomes Infant growth and development Insulin gene duplication variable sequence
CLC R173
Type PhD thesis
Year 2009
Downloads 529
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Background seek effective, simple and economical way to improve health, improve the physical quality of the human is always the relentless pursuit of the goal of health workers. Through the promotion of physical activity to improve health status has been widespread concern. As the special stages in the life of women during pregnancy, affect their health status to the mother and two generations. Previous studies have shown that physical activity during pregnancy on fetal growth and development, pregnancy weight gain, pregnancy complications, maternal mental health, and even the long-term health of the mother and offspring there is a wide range of post-partum recovery. But the impact of physical activity during pregnancy pregnancy outcomes international research conclusions also inconsistent, worthy of the people to continue to explore. In our country, because of the pregnancy physical activity measurement difficulties and lack of basic data related research in our country has not been developed. Relative to international research progress of research in physical activity during pregnancy basically not start lagging behind, and affects the quality of of daily maternal health services. Therefore, this study aims to explore the appropriate physical activity during pregnancy monitoring tools, and the first systematic analysis of the impact of physical activity during pregnancy on pregnancy outcome and infant growth and development; while observing the insulin gene polymorphisms on fetal and infant growth and development , analysis of the interaction with the physical activity during pregnancy. Through this research, I hope to guide the development of appropriate tools for maternal health physical activity to explore the application of methods of clinical monitoring to guide physical activity during pregnancy, and to provide a basis for further research. The head of the research purpose of this study is the large population surveys and the laboratory genetic polymorphism analysis method to explore the physical activity during pregnancy monitoring tool suitable for pregnant women in China; analysis of physical activity during pregnancy on pregnancy outcome and infant growth and development; observed biological factors (insulin gene polymorphisms) and fetal and infant growth and development of the relationship between its interactions with physical activity during pregnancy; maternal health physical activity guide the development of appropriate tools to explore the application of clinical monitoring guidance and research. Research, to find and establish the physical activity scale in line with China's social background, physical activity scale for the test-retest reliability study in pregnant Chinese women population, to evaluate the physical activity scale reliability. For physical activity diary and odograph of the gold standard for the validity of the evaluation of physical activity in the population of pregnant women Scale validity of pregnant women in China. 2 describes the basic condition of the pregnant women, physical activity, analysis of pregnancy strength, and duration of each of the categories of physical activity, energy consumption, and physical activity status quo of the total energy consumption. 3, analysis of pregnancy dietary energy intake factors, physical activity during pregnancy on pregnancy outcomes such as pregnancy weight gain and birth weight-related indicators, the influence of the mode of delivery, as well as the growth of the relationship of the developmental level of physical activity during pregnancy and infancy . 4, to explore science, convenient clinical monitoring of physical activity during pregnancy guidance method. 5 Determination of fetal insulin gene polymorphisms and cord blood serum insulin levels. Analysis of the relationship between fetal insulin gene polymorphism and serum insulin levels and neonatal birth weight. Analysis of the impact of the growth and development of the fetal umbilical cord insulin gene polymorphism infancy. Study of physical activity during pregnancy, fetal insulin gene polymorphism on the interaction between birth weight and infant growth and development. Methods epidemiological cohort study design, combined with the analysis of the two means of on-site investigation and laboratory testing, large population studies. Create a queue of pregnant women, during pregnancy synchronous use the physical activity Scale and odograph of collection of physical activity during pregnancy. Scale evaluation of reliability and validity in a queue in a random sample of pregnant women, pregnant women need to be completed in the second trimester or third trimester of pregnancy physical activity scale, and also complete a physical activity diary and to wear odograph four days, within two weeks apart again to fill in the physical activity scale for four days. According the pregnancy odograph steps record, according to a certain standard of pregnant women divided into physical activity level of activity of different groups: the sit-group, low active group, the more active group and the active group, followed up to childbirth, to collect birth outcomes data and laboratory testing specimens, continue to follow-up newborn to 1 year of age, the growth and development of information collected within 1 year of age. Analysis of physical activity during pregnancy on pregnancy outcome and infant growth and development; analysis of insulin gene polymorphisms on fetal and infant growth and development. Research using a structured questionnaire, scale and objective instruments, laboratory testing and other methods to collect quantitative data, and combined with semi-structured qualitative interviews. Statistical analysis methods including multiple linear regression (Multiple linear regression), the two classifications of non-conditional logistic regression (Binary logistic regression), and mixed linear model (Mixed linear \The major findings were collected from November 2005 to November 2008 a total of 866 valid physical activity during pregnancy and pregnancy outcome data to complete the follow-up of 695 cases of infancy. , The reliability and validity of the scales of physical activity during pregnancy results 106 subjects participated in the study of the reliability and validity of the physical activity scale. Before and after the two test-retest reliability of the study, the Scale total physical activity energy expenditure group correlation coefficient of 0.87. The strength and the reliability of the total physical activity reached extremely good. Relative to total physical activity scale evaluation criterion validity the odograph 0.45, concurrent validity with respect to physical activity diary to 0.75, were statistically significant. Second, the status of physical activity during pregnancy physical activity scale recorded data, average physical activity during pregnancy energy the consumption value 32.30Met ~~ * hours. Pregnant women in the second trimester or third trimester of pregnancy, more than 90% of the time is spent in physical activity in the resting (Scale A, B grade) and mild (scale C, D), resting and mild physical activity on energy consumption accounts for more than 80% of all the energy consumed. Third trimester cost in the resting activity time and energy consumption than the second trimester increased in mild, moderate physical activity (time spent on the E-Class and above) in the scale and energy consumption decreased, and the difference was statistically significance. Throughout pregnancy in severe physical activity. 4 people pregnancy is not engaged in any moderate and above physical activity. Displayed odograph pregnancy average walking steps to 7117 steps. Qualitative analysis showed that pregnant women in the amount of physical activity during pregnancy than before pregnancy to a general decline in physical activity during pregnancy; pregnant women and perinatal care service providers are taking the attitude of support and encouragement. Physical activity during pregnancy on pregnancy outcome and infant growth and development of (a) the amount of physical activity during pregnancy on pregnancy outcome displayed odograph, walking steps will study subjects were divided into the amount of physical activity: Meditation Group low active group, the more active group and the active group. The amount of physical activity during pregnancy did not show an impact on premature. Active group of physical activity during pregnancy, compared with the sit-in group gain during pregnancy reduce. And meditation group compared to the second trimester active group for physical activity, neonatal birth weight, fetal growth rate and gestational age specific birth weight Z value decreases; average physical activity for the third trimester of pregnancy and during pregnancy is more active and active group, their newborns, the three indicators values ??were decreased compared with the sit-in group. Second trimester and pregnancy average physical activity status for active, compared with the sit-in group, birth weight index decreased; third trimester for the more active, and active, compared with the sit-in group, birth weight fell. The amount of physical activity during pregnancy found no impact on the incidence of small for gestational age children. The second trimester of the amount of physical activity did not affect the incidence of large for gestational age children; third trimester of physical activity is more active and active, compared with the sit-in by more than the decline in the incidence of gestational age children; pregnancy average physical activity active, childbirth is greater than the gestational age children the possibility Meditation Group 0.31-fold (95% CI: 0.15 to 0.62). Did not find the amount of physical activity during pregnancy on the incidence of low birth weight infants. Did not find the second trimester the amount of physical activity affect the occurrence of a huge child; third trimester of pregnancy and pregnancy average physical activity status of the more active and active relative to the sit-in group, the decline in the incidence of a huge children's; pregnancy average physical activity status more active and active, the incidence of the great children's Meditation Group 0.38-fold (95% CI: 0.18 ~~ 0.80) and 0.19-fold (95% CI: 0.06 ~~ 0.59). The decline in the second trimester, the more active group, the active group compared with the sit-in, the rate of cesarean section and social factors sectional production rate; physical activity at the third trimester of pregnancy and pregnancy average low active group, the more active groups, active and meditation group compared cesarean section rate, reduce the the sectional production rate of social factors; view from pregnancy average amount of physical activity status, low active group, the more active group and the active group, cesarean section rate were 0.60 times (Meditation Group 95% CI: 0.36 to 0.99), 0.30-fold (95% CI: 0.18 to 0.50) and 0.23-fold (95% CI: 0.13 ~~ 0.41). Low active group, the more active groups and active groups, social factors sectional yield Meditation Group 0.57-fold (95% CI: 0.34 to 0.95), 0.32-fold (95% CI: 0.19 to 0.55) and 0.20-fold (95% CI: 0.11 ~ 0.38). Did not find the amount of physical activity during pregnancy on the birth process. Not found in the amount of physical activity during pregnancy on birth APGAR score. (B) during pregnancy moderate physical activity on pregnancy outcome records data by physical activity scale, the energy consumption of moderate physical activity quartile as the cutoff point, the subjects were divided into moderate physical activity energy expenditure from low-to-high four groups: Ⅰ, Ⅱ, Ⅲ group, Ⅳ group. Pregnancy moderate physical activity energy consumption did not show an impact on premature. Ⅳ group of moderate physical activity during pregnancy energy consumption, compared with group Ⅰ, pregnancy weight gain reduced. Second trimester, third trimester Ⅲ, Ⅳ group, compared with group Ⅰ, reduced birth weight; pregnancy average moderate physical activity Ⅱ, Ⅲ, Ⅳ group, compared with group Ⅰ, birth weight loss. Second trimester and pregnancy average moderate physical activity status Ⅱ, Ⅲ, Ⅳ group, compared with group Ⅰ, the rate of fetal growth and gestational age specific birth weight Z value index decreased birth weight; third trimester of moderate physical Activities Ⅲ, Ⅳ group, compared with group Ⅰ, fetal growth rate, gestational age specific birth weight Z values, birth weight decreases exponentially. Found no pregnancy moderate physical activity, the impact of energy consumption on the incidence of small for gestational age infants. The second trimester of moderate physical activity for group Ⅳ, which is greater than the decreased incidence of gestational age children compared with group Ⅰ; the third trimester Ⅲ, Ⅳ Group, compared with group Ⅰ, gestational age children The decline in incidence; pregnancy average energy consumption of moderate physical activity for groups Ⅱ, Ⅲ, Ⅳ, childbirth is greater than the possibility of gestational age children in group I 0.55-fold (95% CI: 0.35 ~~ 0.86), 0.50-fold (95 % CI: 0.32 ~ 0.79) and 0.37-fold (95% CI: 0.23 ~ 0.60). Found no pregnancy moderate physical activity, the impact of energy consumption on the incidence of low birth weight infants. Ⅳ group of moderate physical activity for the second trimester, the incidence of its huge child than Ⅰ group decreased compared; the third trimester of moderate physical activity Ⅲ, Ⅳ group relative to the group Ⅰ, decrease the incidence of the huge children; pregnancy the average moderate physical activity energy consumption Ⅱ, Ⅲ, Ⅳ group, the incidence of the huge children are in group I 0.52 (95% CI: 0.27 to 1.00), 0.48 (95% CI: 0.25 to 0.93) and 0.38 times (95% CI: 0.19 ~ 0.77). Second trimester, III, IV group cesarean section rate, social factors sectional production rates were lower compared with group Ⅰ; third trimester of pregnancy, Ⅱ, Ⅲ, Ⅳ group cesarean section rate, social factors sectional production rate, and I group phase ratio decreased; pregnancy average of moderate physical activity energy consumption Ⅱ, Ⅲ, Ⅳ group, cesarean section rates were 0.53 times (95% CI: 0.33 to 0.85) in group I, 0.43-fold (95% CI: 0.27 to 0.68), 0.28-fold (95% CI: 0.18 ~ 0.44); The social factors sectional yield Ⅰ group were 0.53 times (95% CI: 0.32 to 0.86), 0.43-fold (95% CI: 0.27 ~~ 0.70) 0.27-fold (95% CI: 0.17 ~~ 0.43). Found no pregnancy moderate physical activity energy expenditure impact on the birth process. Pregnancy moderate physical activity energy consumption does not appear to affect birth APGAR score. (C) physical activity during pregnancy the amount of live births and neonatal birth on infant growth and development 866 subjects were collected infancy growth and development of information 695. The second trimester of physical activity active, their offspring infancy weight, BMI values ??than Meditation Group reduced; the third trimester of pregnancy for a more active, active, compared with the sit-in group, their offspring infancy weight, head circumference and BMI values were lower; pregnancy average for the more active, active, and meditation, offspring infancy weight, height, head circumference values ??are reduced, average physical activity during pregnancy status as active, compared with the sit-in group, sub- on behalf of infancy lower BMI values. Guidance application methods of clinical monitoring of physical activity during pregnancy exploration qualitative research results show strong demand for pregnant women, physical activity guidance, recommended books, network and friends is the main source of knowledge of the physical activity of pregnant women, the provider of service-oriented physical activity during pregnancy channels are very limited; knowledge that physical activity Scale and odograph of physical activity to strengthen the the natural childbirth willingness by confidence of eutocia, may thus increasing the success rate of natural childbirth; pregnant women and perinatal care work caught convenient and effective tool of monitoring physical activity, can be applied to the work of the day-to-day care. 2, considering the huge physical activity during pregnancy children predictive value of Y, the area under the ROC curve was 0.846, with good sensitivity (0.83) and specificity (0.77), can be used as clinical huge child screening of effective, simple, economic effective indicators. During pregnancy the average number of daily walking steps, respectively, the 5000 steps to the pregnancy outcome benefit, such as reducing the rate of cesarean section; reach 7500 steps more pregnancy outcome can be improved, such as newborn reduce child birth weight the huge children decrease the incidence of cesarean section rate decline. Moderate physical activity during pregnancy average E-Class (scale) of 1.1 hours, you can make more pregnancy outcomes beneficial impact, such as the birth weight reduction, a huge children decrease the incidence of cesarean section rate decreased. Moderate activity intensity increases, the active time can be shortened. Physical activity during pregnancy analysis software perinatal care workers can be more quickly and effectively provide physical activity during pregnancy monitoring guidance services. Insulin gene polymorphisms on fetal and infant growth and development of the study population, fetal insulin repeat variable sequence (INS VNTR) genotype Ⅰ / Ⅰ, Ⅰ / Ⅲ stage III / III frequencies were 91.13% , 8.70%, 0.17%, and genotype distribution to meet the Hardyweinberg population genetic balance; Ⅰ III allele frequency of 95% and 5%, respectively. The study results suggest that the INS VNTR differences exist in the distribution of the different races. The study found no insulin gene (INS VNTR) polymorphism on birth size, infant growth and development, have not been found to the interaction of physical activity during pregnancy and INS VNTR genotype on birth weight and infant growth and development. Conclusion 1, Physical Activity Scale in the study population with good reliability and validity, can be used for monitoring and evaluation in China similar to the study of human physical activity of pregnant women. 2, pregnant women every day to engage in mild and following physical activity, active physical activity decreased as the pregnancy progresses. 3 found no negative effects of physical activity during pregnancy on pregnancy outcome, to the contrary, it was found that physical activity during pregnancy in nutritional conditions generally good condition, you can make the weight gain during pregnancy, birth weight index value decreases, reducing greater than gestational age children, the incidence of great children, reduce the rate of cesarean section. Tip strengthening physical activity during pregnancy can improve China's current status of pregnancy outcome. In addition, physical activity during pregnancy stages of growth and development of the baby still has a follow-up role. Physical activity during pregnancy on the mother and offspring health effects can not be ignored. 4, pregnant women, perinatal physical activity guidance service demand exists, should develop and seek appropriate technology to carry out physical activity during pregnancy guidance. The huge children forecasting methods explored in this study, the recommended amount of physical activity during pregnancy and physical activity during pregnancy analysis software in their daily work attempt. 5, in the population of mainland China, the INS VNTR the III allele frequency and Ⅲ / Ⅲ genotype distribution frequency is low, the study did not find the INS VNTR gene polymorphisms affect the growth and development of the fetus and infancy, during the relationship needed Further studies are needed to elaborate.

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