Physical activity and risk of neural tube defects.
ABSTRACT Owing to its association with known risk factors for neural tube defects (NTDs) and its impact on physiologic processes relevant to fetal development, physical activity was identified as a potential risk factor for NTD-affected pregnancy.
Using data from a population-based case-control study of deliveries occurring in California from 1989 to 1991, we estimated the potential risk of having an NTD-affected pregnancy associated with variation in maternal physical activity. In-person interviews were conducted with 538 (88% of eligible) mothers of NTD cases and with mothers of 539 (88%) nonmalformed controls on average 5 months from the term delivery date. An index reflecting reported frequency and exertion level for six activity groups (e.g., jogging and running) was used to summarize each woman's physical activity level in the periconceptional period.
Unadjusted analyses indicated that compared to women considered inactive by this index, physically active women had 30-50% lower risk for NTD-affected pregnancies. After adjustment for several potential confounders and an evaluation of potential effect modification, results suggested that the association was restricted to women who did not take multivitamin/mineral supplements during the periconceptional period. Excluding mothers with reported medical problems did not substantially alter findings.
This study suggests that the benefits of physical activity may extend to reduction of NTD risk among certain subgroups of women.
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ABSTRACT: Objective: Approximately one-third of US reproductive-aged women are obese, and prepregnancy obesity is a strong risk factor for adverse fetal and infant outcomes. The annual number of preventable adverse fetal and infant outcomes associated with prepregnancy obesity in the US was estimated. Design and Methods: Adverse fetal and infant outcomes for which statistically significant associations with prepregnancy obesity had been reported by peer-reviewed meta-analyses, which included fetal deaths and nine different major birth defects, were assessed. The true prevalence of prepregnancy obesity was estimated by multiplying self-reported prepregnancy obesity by a bias factor based on the difference between measured and self-reported obesity in US adult women. A Monte Carlo simulation approach was used to model the attributable fraction and preventable number, accounting for uncertainty in the estimates for: strength of the association with obesity, obesity prevalence, and outcome prevalence. Results: Eliminating the impact of prepregnancy obesity would potentially prevent the highest numbers of four outcomes: fetal deaths (6,990; uncertainty interval [UI] 4,110-10,080), congenital heart defects (2,850; UI 1,035-5,065), hydrocephalus (490; UI 150-850), and spina bifida (405; UI 305-505). If 10% of women with prepregnancy obesity achieved a healthy weight before pregnancy or otherwise mitigated the impact of obesity, nearly 300 congenital heart defects and 700 fetal deaths per year could potentially be prevented. Conclusion: This simulation suggests that effective prevention strategies to reduce prepregnancy obesity or the risk associated with obesity could have a measurable impact on infant health in the US.Obesity 06/2013; 21(6):1276-83. DOI:10.1002/oby.20156 · 4.39 Impact Factor
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ABSTRACT: Overweight and obesity have significant implications during pregnancy and childbirth. The objective of this review was to provide a comprehensive overview of the effect of physical activity on pregnancy outcomes, the change of physical activity during pregnancy, and women's perception of being physically active during pregnancy, with a particular focus on women who are overweight or obese. Many studies have investigated the beneficial effect of exercise during pregnancy, including reduced risk of gestational diabetes, preeclampsia, and operative birth, in addition to improved cardiovascular function, overall fitness, psychological well-being, and mood stability. Benefits for the infant include reduced risks of prematurity and improved fetal growth, although there is more limited information about longer-term health benefits for both women and infants. The existing literature examining physical activity patterns during pregnancy has generally focused on women of all body mass index categories, consistently indicating a reduction in activity over the course of pregnancy. However, the available literature evaluating physical activity during pregnancy among women who are overweight or obese is more limited and contradictory. A number of studies identified barriers preventing women from being active during pregnancy, including pregnancy symptoms, lack of time, access to child care, and concerns about their safety and that of their unborn baby. Conversely, significant enablers included positive psychological feelings, family influence, and receiving advice from health professionals. Very few studies have provided insights about perceptions of being active during pregnancy in the overweight and obese population. There is a need for a detailed description of physical activity patterns during pregnancy in women who are overweight or obese, and more randomized trials evaluating exercise interventions for women who are overweight or obese, with a focus on clinical outcomes.International Journal of Women's Health 07/2013; 5:389-98. DOI:10.2147/IJWH.S34042
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ABSTRACT: Obesity is presently the most prevalent health threat in the western world, and its influence on general health is rapidly increasing. Obesity has also developed as a major and frequent risk factor for pregnancy complications. Complications often encountered in obese pregnant women are hypertensive disorders, gestational diabetes mellitus, caesarean section, and postpartum and postoperative infections. The incidence of pulmonary embolism and primary postpartum haemorrhage is most likely also increased. Anaesthetic complications are more frequent. Neonatal consequences of obesity include an increased rate of congenital anomalies, stillbirth, and macrosomia. This article focuses on practical implications of obesity in pregnancy and childbirth for the caregiver.European Clinics in Obstetrics and Gynaecology 07/2005; 1(2):74-88. DOI:10.1007/s11296-005-0019-0