Exercise during pregnancy and gestational diabetes related adverse effects: a randomized controlled trial

Ejercicio, embarazo y diabetes

Guidelines for Physical Activity During Pregnancy: Comparisons From Around the World

Guías de actividad física durante el embarazo

Adaptaciones cardiacas hemodinámicas, estructurales y funcionales a un programa de ejercicio físico supervisado durante el embarazo: ensayo clínico aleatorizado = Hemodynamic, structural and functional cardiac adaptations in a supervised physical exercise program during pregnancy: a randomized controlled trial

Introducción: Diversos cambios ocurren en el sistema cardiovascular materno durante el embarazo, lo que genera un gran estrés sobre este sistema especialmente durante el tercer trimestre, pudiendo acentuarse en presencia de determinados factores de riesgo. Los objetivos de este estudio fueron, valorar las adaptaciones cardiovasculares producidas por un programa específico de ejercicio físico; su seguridad sobre el sistema cardiovascular materno y los resultados del embarazo; y su eficacia en el control de los factores de riesgo cardiovascular. Material y métodos: El diseño del estudio fue un ensayo clínico aleatorizado. 151 gestantes sanas fueron evaluadas mediante un ecocardiograma y un electrocardiograma en la semana 20 y 34 de gestación. Un total de 89 gestantes participaron en un programa de ejercicio físico (GE) desde el primer hasta el tercer trimestre de embarazo, constituido principalmente por 25-30 minutos de trabajo aeróbico (55-60% de la frecuencia cardiaca de reserva), trabajo de fortalecimiento general y específico, y un trabajo de tonificación del suelo pélvico; desarrollado 3 días a la semana con una duración de 55-60 minutos cada sesión. Las gestantes aleatoriamente asignadas al grupo de control (GC; n=62) permanecieron sedentarias durante el embarazo. El estudio fue aprobado por el Comité Ético de investigación clínica del Hospital Universitario de Fuenlabrada. Resultados: Las características basales fueron similares entre ambos grupos. A diferencia del GC, las gestantes del GE evitaron el descenso significativo del gasto cardiaco indexado, entre el 2º y 3ºT de embarazo, y conservaron el patrón geométrico normal del ventrículo izquierdo; mientras que en el GC cambió hacia un patrón de remodelado concéntrico. En la semana 20, las gestantes del GE presentaron valores significativamente menores de frecuencia cardiaca (GC: 79,56±10,76 vs. GE: 76,05±9,34; p=0,04), tensión arterial sistólica (GC: 110,19±10,23 vs. GE: 106,04±12,06; p=0,03); tensión arterial diastólica (GC: 64,56±7,88 vs. GE: 61,81±7,15; p=0,03); tiempo de relajación isovolumétrica (GC: 72,94±14,71 vs. GE: 67,05±16,48; p=0,04); y un mayor tiempo de deceleración de la onda E (GC: 142,09±39,11 vs. GE: 162,10±48,59; p=0,01). En la semana 34, el GE presentó valores significativamente superiores de volumen sistólico (GC: 51,13±11,85 vs. GE: 56,21±12,79 p=0,04), de llenado temprano del ventrículo izquierdo (E) (GC: 78,38±14,07 vs. GE: 85,30±16,62; p=0,02) y de tiempo de deceleración de la onda E (GC: 130,35±37,11 vs. GE: 146,61±43,40; p=0,04). Conclusión: La práctica regular de ejercicio físico durante el embarazo puede producir adaptaciones positivas sobre el sistema cardiovascular materno durante el tercer trimestre de embarazo, además de ayudar en el control de sus factores de riesgo, sin alterar la salud materno-fetal. ABSTRACT Background: Several changes occur in the maternal cardiovascular system during pregnancy. These changes produce a considerable stress in this system, especially during the third trimester, which can be increased in presence of some risk factors. The aims of this study were, to assess the maternal cardiac adaptations in a specific exercise program; its safety on the maternal cardiovascular system and pregnancy outcomes; and its effectiveness in the control of cardiovascular risk factors. Material and methods: A randomized controlled trial was designed. 151 healthy pregnant women were assessed by an echocardiography and electrocardiography at 20 and 34 weeks of gestation. A total of 89 pregnant women participated in a physical exercise program (EG) from the first to the third trimester of pregnancy. It consisted of 25-30 minutes of aerobic conditioning (55-60% of their heart rate reserve), general and specific strength exercises, and a pelvic floor muscles training; 3 times per weeks during 55-60 minutes per session. Pregnant women randomized allocated to the control group (CG) remained sedentary during pregnancy. The study was approved by the Research Ethics Committee of Hospital Universitario de Fuenlabrada. Results: Baseline characteristics were similar between groups. Difference from the CG, pregnant women from the EG prevented the significant decrease of the cardiac output index, between the 2nd and 3rd trimester of pregnancy, and preserved the normal left ventricular pattern; whereas in the CG shifted to concentric remodeling pattern. At 20 weeks, women in the EG had significant lower heart rate (CG: 79,56±10,76 vs. EG: 76,05±9,34; p=0,04), systolic blood pressure (CG: 110,19±10,23 vs. EG: 106,04±12,06; p=0,03); diastolic blood pressure (CG: 64,56±7,88 vs. EG: 61,81±7,15; p=0,03); isovolumetric relaxation time (GC: 72,94±14,71 vs. GE: 67,05±16,48; p=0,04); and a higher deceleration time of E Wave (GC: 142,09±39,11 vs. GE: 162,10±48,59; p=0,01). At 34 weeks, the EG had a significant higher stroke volume (CG: 51,13±11,85 vs. EG: 56,21±12,79 p=0,04), early filling of left ventricular (E) (CG: 78,38±14,07 vs. EG: 85,30±16,62; p=0,02) and deceleration time of E wave (CG: 130,35±37,11 vs. EG:146,61±43,40; p=0,04). Conclusion: Physical regular exercise program during pregnancy may produce positive maternal cardiovascular adaptations during the third trimester of pregnancy. In addition, it helps to control the cardiovascular risk factors without altering maternal and fetus health.

Influencia del ejercicio físico desarrollado durante el embarazo en la respuesta cardiaca fetal = Influence of a physical activity program performed during pregnancy on fetal heart response

INTRODUCCIÓN: El riesgo de padecer enfermedades cardiovasculares y los índices de obesidad infantil han ido en aumento durante los últimos años empobreciendo la salud de la población. La Teoría de Barker relaciona el estado de salud de la madre con el desarrollo fetal, asociando a un deficiente estado físico y hábitos de vida negativos de la mujer embarazada con el aumento del riesgo de padecer cardiopatías en la infancia y adolescencia, así como predisponer al recién nacido a padecer sobrepeso y/u obesidad en su vida posterior. Por otro lado los estudios efectuados sobre ejercicio físico durante el embarazo reportan beneficios para salud materna y fetal. Uno de los parámetros más utilizados para comprobar la salud fetal es su frecuencia cardiaca, mediante la que se comprueba el buen desarrollo del sistema nervioso autónomo. Si se observa este parámetro en presencia de ejercicio materno podría encontrarse una respuesta crónica del corazón fetal al ejercicio materno como consecuencia de una adaptación y mejora en el funcionamiento del sistema nervioso autónomo del feto. De esta forma podría mejorar su salud cardiovascular intrauterina, lo que podría mantenerse en su vida posterior descendiendo el riesgo de padecer enfermedades cardiovasculares en la edad adulta. OBJETIVOS: Conocer la influencia de un programa de ejercicio físico supervisado en la frecuencia cardiaca fetal (FCF) en reposo y después del ejercicio materno en relación con gestantes sedentarias mediante la realización de un protocolo específico. Conocer la influencia de un programa de ejercicio físico en el desarrollo del sistema nervioso autónomo fetal, relacionado con el tiempo de recuperación de la FCF. MATERIAL Y MÉTODO: Se diseñó un ensayo clínico aleatorizado multicéntrico en el que participaron 81 gestantes (GC=38, GE=43). El estudio fue aprobado por el comité ético de los hospitales que participaron en el estudio. Todas las gestantes fueron informadas y firmaron un consentimiento para su participación en el estudio. Las participantes del GE recibieron una intervención basada en un programa de ejercicio físico desarrollado durante la gestación (12-36 semanas de gestación) con una frecuencia de tres veces por semana. Todas las gestantes realizaron un protocolo de medida de la FCF entre las semanas 34-36 de gestación. Dicho protocolo consistía en dos test llevados a cabo caminando a diferentes intensidades (40% y 60% de la frecuencia cardiaca de reserva). De este protocolo se obtuvieron las principales variables de estudio: FCF en reposo, FCF posejercicio al 40 y al 60% de intensidad, tiempo de recuperación de la frecuencia cardiaca fetal en ambos esfuerzos. El material utilizado para la realización del protocolo fue un monitor de frecuencia cardiaca para controlar la frecuencia cardiaca de la gestante y un monitor fetal inalámbrico (telemetría fetal) para registrar el latido fetal durante todo el protocolo. RESULTADOS: No se encontraron diferencias estadísticamente significativas en la FCF en reposo entre grupos (GE=140,88 lat/min vs GC= 141,95 lat/min; p>,05). Se encontraron diferencias estadísticamente significativas en el tiempo de recuperación de la FCF entre los fetos de ambos grupos (GE=135,65 s vs GC=426,11 s esfuerzo al 40%; p<,001); (GE=180,26 s vs GC=565,61 s esfuerzo al 60%; p<,001). Se encontraron diferencias estadísticamente significativas en la FCF posejercicio al 40% (GE=139,93 lat/min vs GC=147,87 lat/min; p<,01). No se encontraron diferencias estadísticamente significativas en la FCF posejercicio al 60% (GE=143,74 lat/min vs GC=148,08 lat/min; p>,05). CONLUSIÓN: El programa de ejercicio físico desarrollado durante la gestación influyó sobre el corazón fetal de los fetos de las gestantes del GE en relación con el tiempo de recuperación de la FCF. Los resultados muestran un posible mejor funcionamiento del sistema nervioso autónomo en fetos de gestantes activas durante el embarazo. ABSTRACT INTRODUCTION: The risk to suffer cardiovascular diseases and childhood obesity index has grown in the last years worsening the health around the population. Barker´s Theory related maternal health with fetal development establishing an association between a poorly physical state and an unhealthy lifestyle in the pregnant woman with the risk to suffer heart disease during childhood and adolescence, childhood overweight and/or obese is related to maternal lifestyle. By the other way researches carried out about physical exercise and pregnancy show benefits in maternal and fetal health. One of the most studied parameters to check fetal health is its heart rate, correct fetal autonomic nervous system development and work is also corroborated by fetal heart rate. Looking at this parameter during maternal exercise a chronic response of fetal heart could be found due to an adaptation and improvement in the working of the autonomic nervous system. Therefore its cardiovascular health could be enhanced during its intrauterine life and maybe it could be maintained in its posterior life descending the risk to suffer cardiovascular diseases in adult life. OBJECTIVES: To know the influence of a supervised physical activity program in the fetal heart rate (FHR) at rest, FHR after maternal exercise related to sedentary pregnant women by a FHR assessment protocol. To know the influence of a physical activity program in the development of the autonomic nervous system related to FHR recovery time. MATERIAL AND METHOD: A multicentric randomized clinical trial was design in which 81 pregnant women participated (CG=38, EG=43). The study was approved by the ethics committee of all of the hospitals participating in the study. All of the participants signed an informed consent for their participation in the study. EG participants received an intervention based on a physical activity program carried out during gestation (12-36 gestation weeks) with a three days a week frequency. All of the participants were tested between 34-36 weeks of gestation by a specific FHR assessment protocol. The mentioned protocol consisted in two test performed walking and at a two different intensities (40% and 60% of the reserve heart rate). From this protocol we obtained the main research variables: FHR at rest, FHR post-exercise at 40% and 60% intensity, and FHR recovery time at both walking test. The material used to perform the protocol were a FH monitor to check maternal HR and a wireless fetal monitor (Telemetry) to register fetal beats during the whole protocol. RESULTS: There were no statistical differences in FHR at rest between groups (EG=140,88 beats/min vs CG= 141,95 beats/min; p>,05). There were statistical differences in FHR recovery time in both walking tests between groups (EG=135,65 s vs CG=426,11 s test at 40% intensity; p<,001); (EG=180,26 s vs CG=565,61 s test at 60% intensity; p<,001). Statistical differences were found in FHR post-exercise at 40% intensity between groups (EG=139,93 beats/min vs CG=147,87 beats/min; p<,01). No statistical differences were found in FHR at rest post-exercise at 60% intensity between groups (EG=143,74 beats/min vs CG=148,08 beats/min; p>,05). CONCLUSIONS: The physical activity program performed during gestation had an influence in fetal heart of the fetus from mother in the EG related to FHR recovery time. These results show a possible enhancement on autonomic nervous system working in fetus from active mothers during gestation.

Maternal Obesity During Pregnancy Associates With Premature Mortality and Major Cardiovascular Events in Later Life

Acknowledgements We thank Ms Katie Wilde, Data Management Team, University of Aberdeen and Lynsey Waugh, Information and Services Division of NHS Scotland for their help with data extraction and linkage. Funding sources This work was supported by funding from the Chief Scientist Office, Scotland. We also acknowledge support from Tommy’s and the British Heart Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. None of the authors are related to any of the funders

Role of brain allopregnanolone in the plasticity of γ-aminobutyric acid type A receptor in rat brain during pregnancy and after delivery

The relation between changes in brain and plasma concentrations of neurosteroids and the function and structure of γ-aminobutyric acid type A (GABAA) receptors in the brain during pregnancy and after delivery was investigated in rats. In contrast with plasma, where all steroids increased in parallel, the kinetics of changes in the cerebrocortical concentrations of progesterone, allopregnanolone (AP), and allotetrahydrodeoxycorticosterone (THDOC) diverged during pregnancy. Progesterone was already maximally increased between days 10 and 15, whereas AP and allotetrahydrodeoxycorticosterone peaked around day 19. The stimulatory effect of muscimol on 36Cl− uptake by cerebrocortical membrane vesicles was decreased on days 15 and 19 of pregnancy and increased 2 days after delivery. Moreover, the expression in cerebral cortex and hippocampus of the mRNA encoding for γ2L GABAA receptor subunit decreased during pregnancy and had returned to control values 2 days after delivery. Also α1,α2, α3, α4, β1, β2, β3, and γ2S mRNAs were measured and failed to change during pregnancy. Subchronic administration of finasteride, a 5α-reductase inhibitor, to pregnant rats reduced the concentrations of AP more in brain than in plasma as well as prevented the decreases in both the stimulatory effect of muscimol on 36Cl− uptake and the decrease of γ2L mRNA observed during pregnancy. These results indicate that the plasticity of GABAA receptors during pregnancy and after delivery is functionally related to fluctuations in endogenous brain concentrations of AP whose rate of synthesis/metabolism appears to differ in the brain, compared with plasma, in pregnant rats.

Life satisfaction and health related quality of life during pregnancy and puerperium

Poster submitted to the 22nd International Conference Stress and Anxiety Research Society (STAR), Palma de Mallorca, July, 12-14, 2001.

Heterogeneity in testing practices for infections during pregnancy: national survey across Switzerland.

QUESTION Detection and treatment of infections during pregnancy are important for both maternal and child health. The objective of this study was to describe testing practices and adherence to current national guidelines in Switzerland. METHODS We invited all registered practicing obstetricians and gynaecologists in Switzerland to complete an anonymous web-based questionnaire about strategies for testing for 14 infections during pregnancy. We conducted a descriptive analysis according to demographic characteristics. RESULTS Of 1138 invited clinicians, 537 (47.2%) responded and 520 (45.6%) were eligible as they are currently caring for pregnant women. Nearly all eligible respondents tested all pregnant women for group B streptococcus (98.0%), hepatitis B virus (HBV) (96.5%) and human immunodeficiency virus (HIV) (94.7%), in accordance with national guidelines. Although testing for toxoplasmosis is not recommended, 24.1% of respondents tested all women and 32.9% tested at the request of the patient. Hospital doctors were more likely not to test for toxoplasmosis than doctors working in private practice (odds ratio [OR] 2.52, 95% confidence interval [CI] 1.04-6.13, p = 0.04). Only 80.4% of respondents tested all women for syphilis. There were regional differences in testing for some infections. The proportion of clinicians testing all women for HIV, HBV and syphilis was lower in Eastern Switzerland and the Zurich region (69.4% and 61.2%, respectively) than in other regions (range 77.1-88.1%, p <0.001). Most respondents (74.5%) said they would appreciate national guidelines about testing for infections during pregnancy. CONCLUSIONS Testing practices for infections in pregnant women vary widely in Switzerland. More extensive national guidelines could improve consistency of testing practices.

Guidelines for nutrition care during pregnancy /

"July, 1990."

Eating wisely during pregnancy.

Mode of access: Internet.