Interventions targeting maternal obesity are a healthcare and public health priority. The objective of this review was to evaluate the adequacy and effectiveness of the methodological designs implemented in dietary intervention trials for... more
Interventions targeting maternal obesity are a healthcare and public health priority. The objective of this review was to evaluate the adequacy and effectiveness of the methodological designs implemented in dietary intervention trials for obesity in pregnancy. A systematic review of the literature, consistent with PRISMA guidelines, was performed as part of the International Weight Management in Pregnancy collaboration. Thirteen randomized controlled trials, which aimed to modify diet and physical activity in overweight and obese pregnant women, were identified. There was significant variability in the content, delivery, and dietary assessment methods of the dietary interventions examined. A number of studies demonstrated improved dietary behavior in response to diet and/or lifestyle interventions. Nine studies reduced gestational weight gain. This review reveals large methodological variability in dietary interventions to control gestational weight gain and improve clinical outcomes in overweight and obese pregnant women. This lack of consensus limits the ability to develop clinical guidelines and apply the evidence in clinical practice.
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ABSTRACT Purpose. In this review, we provide researchers and practitioners with an overview of the physical activity and pregnancy literature to promote prenatal physical activity, improve measurement, further elucidate the role of... more
ABSTRACT Purpose. In this review, we provide researchers and practitioners with an overview of the physical activity and pregnancy literature to promote prenatal physical activity, improve measurement, further elucidate the role of activity in reducing maternal health complications, and inform future research. Method. We examined past and present physical activity and pregnancy studies and highlight key papers with a focus on maternal health outcomes to best inform physical activity promotion efforts. Results. We discuss: (a) historical overview of prenatal physical activity relative to the physical activity guidelines, how they have changed over time, and how evidence of the effect of prenatal activity on maternal/fetal health outcomes has affected clinical recommendations; (b) existing tools and challenges associated with measuring prenatal physical activity; (c) empirical evidence on multilevel determinants of prenatal activity to guide future intervention work; (d) empirical evidence of prenatal activity on adverse maternal outcomes (gestational diabetes mellitus, preeclampsia, excessive gestational weight gain) from observational and intervention studies; and (e) summary/recommendations for future research and practice. Conclusions. The physical activity and pregnancy literature has evolved over the past 50 years, and there is sufficient empirical evidence to support the promotion of moderate-to-vigorous prenatal physical activity for maternal health benefits. Future studies and interventions should be carefully designed, theoretically driven, and include validated and reliable activity measures. Researchers and practitioners should also consider the multifaceted determinants and outcomes of prenatal physical activity and intervene to promote physical activity before, during, and after pregnancy.
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Research Interests:
The goal of prenatal care is to maximize health outcomes for a woman and her fetus. We examined how prenatal care is associated with meeting the 2009 Institute of Medicine (IOM) guidelines for gestational weight gain. The study used... more
The goal of prenatal care is to maximize health outcomes for a woman and her fetus. We examined how prenatal care is associated with meeting the 2009 Institute of Medicine (IOM) guidelines for gestational weight gain. The study used deidentified birth certificate data supplied by the North Carolina State Center for Health Statistics. The sample included 197,354 women (≥18 years) who delivered singleton full-term infants in 2011 and 2012. A generalized multinomial model was used to identify how adequate prenatal care was associated with the odds of gaining excessive or insufficient weight during pregnancy according to the 2009 IOM guidelines. The model adjusted for prepregnancy body size, sociodemographic factors, and birth weight. A total of 197,354 women (≥18 years) delivered singleton full-term infants. The odds ratio (OR) for excessive weight gain was 2.44 (95% CI 2.37-2.50) in overweight and 2.33 (95% CI 2.27-2.40) in obese women compared with normal weight women. The OR for insufficient weight gain was 1.15 (95% CI 1.09-1.22) for underweight and 1.34 (95% CI 1.30-1.39) for obese women compared with normal weight women. Prenatal care at the inadequate or intermediate levels was associated with insufficient weight gain (OR: 1.32, 95% CI 1.27-1.38; OR: 1.15, 95% CI 1.09-1.21, respectively) compared with adequate prenatal care. Women with inadequate care were less likely to gain excessive weight (OR: 0.88, 95% CI 0.86-0.91). Whereas prenatal care was effective for preventing insufficient weight gain regardless of prepregnancy body size, educational background, and racial/ethnic group, there were no indications that adequate prenatal care was associated with reduced risk for excessive gestational weight gain. Further research is needed to improve prenatal care programs for preventing excess weight gain.
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The purpose of this chapter is to examine how language barriers contribute to health disparities among ethnic and racial minorities in the United States. A literature search was systematically conducted using selected computer databases... more
The purpose of this chapter is to examine how language barriers contribute to health disparities among ethnic and racial minorities in the United States. A literature search was systematically conducted using selected computer databases (MEDLINE and CINAHL). Searches were limited to English-language-published research in the years from 1985 to 2003. A total of 47 published articles were included in this review. Overall these studies indicate that language barriers are associated with longer visit time per clinic visit, less frequent clinic visits, less understanding of physician's explanation, more lab tests, more emergency room visits, less follow-up, and less satisfaction with health services. The results also indicate that people who are older, poorer, and female tend to have severe language barriers compared to those who are younger, wealthier, and male. Improvement of communication between patients and providers in relation to health disparity consists of cultural competenc...
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We wished to estimate the incidence of preeclampsia among a group of Hispanic women in the greater Detroit metropolitan area. We reviewed delivery records of 559 Hispanic women from a Detroit hospital and prenatal records of 134 Hispanic... more
We wished to estimate the incidence of preeclampsia among a group of Hispanic women in the greater Detroit metropolitan area. We reviewed delivery records of 559 Hispanic women from a Detroit hospital and prenatal records of 134 Hispanic women who received care from an affiliated federally qualified health center in southwest Detroit. A retrospective chart review was conducted. The physician's diagnosis was used to study hospital patients. The health center patients were diagnosed on the basis of criteria established in the National High Blood Pressure Education Working Group Report. In 1998, Hispanic women who delivered at the study hospital had an incidence of preeclampsia or pregnancy-induced hypertension (PIH) of 1.3% (7/559), compared to non-Hispanics 5.3% (118/2241) (chi2(1) = 10.35, P < .05). The relative risk was .24. From health center prenatal records, the incidence of preeclampsia/PIH among the 134 patients was 3.7%. The difference in the incidence of preeclampsia/...
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The aim of this study was to conduct a translation and cross-cultural adaptation of the Japanese version of the Pregnancy Physical Activity Questionnaire (PPAQ) that consisted of 36 items. We translated and adapted the PPAQ to the... more
The aim of this study was to conduct a translation and cross-cultural adaptation of the Japanese version of the Pregnancy Physical Activity Questionnaire (PPAQ) that consisted of 36 items. We translated and adapted the PPAQ to the Japanese culture. This procedure included a forward step (stages I and II, translations and synthesis), quality control (stage III, back translation, and stage IV, expert committee review), and pre-testing (stage V). In the pre-test, the preliminary Japanese version was tested on ten Japanese pregnant subjects. The content, semantic, technical, conceptual, and experiential equivalents of cultural adaptation were discussed by the research members at each step. In the results section, one new item was added to address "riding a bicycle in order to go to a certain place other than for recreation or exercise", because many Japanese women often use a bicycle. The average age of the pregnant subjects in the pre-test was 32.7 years of age. The response ...
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The purpose of the present study was to compare which parts of the body fat mass tended to increase during the third trimester and at 1 month postpartum between lactating and nonlactating Japanese women. This prospective study examined 49... more
The purpose of the present study was to compare which parts of the body fat mass tended to increase during the third trimester and at 1 month postpartum between lactating and nonlactating Japanese women. This prospective study examined 49 healthy pregnant women in the third trimester, and at 1 month postpartum. Demographic data, including lactation status, were obtained from a self-administered questionnaire. Newborn information was obtained from hospital charts. Anthropometric data, including body fat mass, were measured by the bioelectrical impedance analysis (BIA) method in the third trimester, and at 1 month postpartum. At 1 month postpartum, 16 mothers (32.7%) were lactating and 33 (67.3%) were mainly feeding formula. There were no significant differences between the lactating and nonlactating women regarding their demographic data, energy intakes and body fat mass changes during the third trimester of pregnancy. The trunk fat mass change showed a significant difference (p = 0....
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The purpose of the present study was to compare which parts of the body fat mass tended to increase during the third trimester and at 1 month postpartum between lactating and nonlactating Japanese women. This prospective study examined 49... more
The purpose of the present study was to compare which parts of the body fat mass tended to increase during the third trimester and at 1 month postpartum between lactating and nonlactating Japanese women. This prospective study examined 49 healthy pregnant women in the third trimester, and at 1 month postpartum. Demographic data, including lactation status, were obtained from a self-administered questionnaire. Newborn information was obtained from hospital charts. Anthropometric data, including body fat mass, were measured by the bioelectrical impedance analysis (BIA) method in the third trimester, and at 1 month postpartum. At 1 month postpartum, 16 mothers (32.7%) were lactating and 33 (67.3%) were mainly feeding formula. There were no significant differences between the lactating and nonlactating women regarding their demographic data, energy intakes and body fat mass changes during the third trimester of pregnancy. The trunk fat mass change showed a significant difference (p = 0....
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We wished to estimate the incidence of preeclampsia among a group of Hispanic women in the greater Detroit metropolitan area. We reviewed delivery records of 559 Hispanic women from a Detroit hospital and prenatal records of 134 Hispanic... more
We wished to estimate the incidence of preeclampsia among a group of Hispanic women in the greater Detroit metropolitan area. We reviewed delivery records of 559 Hispanic women from a Detroit hospital and prenatal records of 134 Hispanic women who received care from an affiliated federally qualified health center in southwest Detroit. A retrospective chart review was conducted. The physician's diagnosis was used to study hospital patients. The health center patients were diagnosed on the basis of criteria established in the National High Blood Pressure Education Working Group Report. In 1998, Hispanic women who delivered at the study hospital had an incidence of preeclampsia or pregnancy-induced hypertension (PIH) of 1.3% (7/559), compared to non-Hispanics 5.3% (118/2241) (chi2(1) = 10.35, P < .05). The relative risk was .24. From health center prenatal records, the incidence of preeclampsia/PIH among the 134 patients was 3.7%. The difference in the incidence of preeclampsia/...
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The purpose of this chapter is to examine how language barriers contribute to health disparities among ethnic and racial minorities in the United States. A literature search was systematically conducted using selected computer databases... more
The purpose of this chapter is to examine how language barriers contribute to health disparities among ethnic and racial minorities in the United States. A literature search was systematically conducted using selected computer databases (MEDLINE and CINAHL). Searches were limited to English-language-published research in the years from 1985 to 2003. A total of 47 published articles were included in this review. Overall these studies indicate that language barriers are associated with longer visit time per clinic visit, less frequent clinic visits, less understanding of physician's explanation, more lab tests, more emergency room visits, less follow-up, and less satisfaction with health services. The results also indicate that people who are older, poorer, and female tend to have severe language barriers compared to those who are younger, wealthier, and male. Improvement of communication between patients and providers in relation to health disparity consists of cultural competenc...
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Mifepristone (RU-486) has recently been granted approval from the Food and Drug Administration for the early termination of pregnancy. Availability is anticipated during 1997. This article describes the pharmacologic function of... more
Mifepristone (RU-486) has recently been granted approval from the Food and Drug Administration for the early termination of pregnancy. Availability is anticipated during 1997. This article describes the pharmacologic function of mifepristone and discusses its potential clinical use in the United States, including its safety, efficacy, and possible complications.
Research Interests: Nursing, Pregnancy, Humans, United States, Female, and 9 moreTennessee, Nurse Practitioners, Professional Autonomy, Public health systems and services research, Drug Costs, Termination of Pregnancy, Food and Drug Administration, History of Nurse Midwifery, and United States Food and Drug Administration
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Women attain numerous benefits from physical activity during pregnancy. However, due to physical changes that occur during pregnancy, special precautions are also needed. This review summarizes current guidelines for physical activity... more
Women attain numerous benefits from physical activity during pregnancy. However, due to physical changes that occur during pregnancy, special precautions are also needed. This review summarizes current guidelines for physical activity among pregnant women worldwide. We searched PubMed (MedLINE) for country-specific governmental and clinical guidelines on physical activity during pregnancy through the year 2012. We cross-referenced with articles referring to guidelines, with only the most recent included. An abstraction form was used to extract key details and summarize. In total, 11 guidelines were identified from nine countries (Australia, Canada, Denmark, France, Japan, Norway, Spain, United Kingdom, United States). Most guidelines supported moderate intensity physical activity during pregnancy (10/11) and indicated specific frequency (9/11) and duration/time (9/11) recommendations. Most guidelines provided advice on initiating an exercise program during pregnancy (10/11). Six gui...
This study aimed to translate the Pregnancy Physical Activity Questionnaire (PPAQ) into Vietnamese, and test its reliability and validity among Vietnamese pregnant women. Intraclass correlation (ICC) and the Bland and Altman method were... more
This study aimed to translate the Pregnancy Physical Activity Questionnaire (PPAQ) into Vietnamese, and test its reliability and validity among Vietnamese pregnant women. Intraclass correlation (ICC) and the Bland and Altman method were used to assess the test-retest reliability of the PPAQ. The Pearson correlations coefficient between the PPAQ measurements and those obtained from a pedometer that measured step counts (10-day averages) were used to determine the validity of the questionnaire. The PPAQ was successfully translated from English into Vietnamese with face validity through a rigorous process of the cross-cultural validation. For the analysis of reliability, the ICC value was 0.88 (95% CI 0.83-0.94) for total activity, 0.94 for sedentary, 0.88 for light, 0.90 for moderate, and 0.87 for vigorous activities. The Bland and Altman analysis showed that the first and second PPAQ total scores did not significantly differ from zero, and mostly fell within the range of 0 +/- 1.96 S...
Research Interests: Tropical Medicine, Physical Activity, Vietnam, Vietnamese, Test Validation, and 19 morePregnancy, Humans, Questionnaire, Female, Statistical Significance, Translating, Validity and Reliability, Questionnaires, Longitudinal Studies, Adult, Public health systems and services research, Pregnant Women, Reproducibility of Results, Correlation coefficient, Physical Exercise, Housekeeping, Gestation, Test Reliability, and Motor activity
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Research Interests: Nursing, Principal Component Analysis, Qualitative Research, Exercise therapy, Intention, and 17 moreLinear models, Self Efficacy, Pregnancy, Humans, Walking, Habits, Female, Patient Compliance, Exercise, Longitudinal Studies, Adult, Pregnant Women, Gestational Age, Psychological Models, Exploratory Analysis, Pre Eclampsia, and Randomized Controlled Trials as Topic
In this review, we provide researchers and practitioners with an overview of the physical activity and pregnancy literature to promote prenatal physical activity, improve measurement, further elucidate the role of activity in reducing... more
In this review, we provide researchers and practitioners with an overview of the physical activity and pregnancy literature to promote prenatal physical activity, improve measurement, further elucidate the role of activity in reducing maternal health complications, and inform future research. We examined past and present physical activity and pregnancy studies and highlight key papers with a focus on maternal health outcomes to best inform physical activity promotion efforts. We discuss: (a) historical overview of prenatal physical activity relative to the physical activity guidelines, how they have changed over time, and how evidence of the effect of prenatal activity on maternal/fetal health outcomes has affected clinical recommendations; (b) existing tools and challenges associated with measuring prenatal physical activity; (c) empirical evidence on multilevel determinants of prenatal activity to guide future intervention work; (d) empirical evidence of prenatal activity on adverse maternal outcomes (gestational diabetes mellitus, preeclampsia, excessive gestational weight gain) from observational and intervention studies; and (e) summary/recommendations for future research and practice. The physical activity and pregnancy literature has evolved over the past 50 years, and there is sufficient empirical evidence to support the promotion of moderate-to-vigorous prenatal physical activity for maternal health benefits. Future studies and interventions should be carefully designed, theoretically driven, and include validated and reliable activity measures. Researchers and practitioners should also consider the multifaceted determinants and outcomes of prenatal physical activity and intervene to promote physical activity before, during, and after pregnancy.
Research Interests:
In this review, we provide researchers and practitioners with an overview of the physical activity and pregnancy literature to promote prenatal physical activity, improve measurement, further elucidate the role of activity in reducing... more
In this review, we provide researchers and practitioners with an overview of the physical activity and pregnancy literature to promote prenatal physical activity, improve measurement, further elucidate the role of activity in reducing maternal health complications, and inform future research. We examined past and present physical activity and pregnancy studies and highlight key papers with a focus on maternal health outcomes to best inform physical activity promotion efforts. We discuss: (a) historical overview of prenatal physical activity relative to the physical activity guidelines, how they have changed over time, and how evidence of the effect of prenatal activity on maternal/fetal health outcomes has affected clinical recommendations; (b) existing tools and challenges associated with measuring prenatal physical activity; (c) empirical evidence on multilevel determinants of prenatal activity to guide future intervention work; (d) empirical evidence of prenatal activity on adverse maternal outcomes (gestational diabetes mellitus, preeclampsia, excessive gestational weight gain) from observational and intervention studies; and (e) summary/recommendations for future research and practice. The physical activity and pregnancy literature has evolved over the past 50 years, and there is sufficient empirical evidence to support the promotion of moderate-to-vigorous prenatal physical activity for maternal health benefits. Future studies and interventions should be carefully designed, theoretically driven, and include validated and reliable activity measures. Researchers and practitioners should also consider the multifaceted determinants and outcomes of prenatal physical activity and intervene to promote physical activity before, during, and after pregnancy.
Research Interests:
Research Interests: Nursing, Clinical Trial, Risk, Physical Activity, Public Health, and 19 morePregnancy, Humans, Walking, Blood Pressure, Female, Heart rate, Patient Compliance, Risk factors, Randomized Trial, Risk Factor, Adult, Public health systems and services research, Pregnant Women, Risk Factors, Physical Exercise, Gestation, Weight Gain, Prenatal Care, and Pre Eclampsia
Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our... more
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A mother&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s underweight status and insufficient weight gain during pregnancy are risk factors for infant low birthweight. Concerns have been raised regarding... more
A mother&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s underweight status and insufficient weight gain during pregnancy are risk factors for infant low birthweight. Concerns have been raised regarding whether pregnant women are provided with accurate information about weight gain. This study explored how and from whom pregnant women in Tokyo receive information related to body weight. Four focus groups were conducted with nine pregnant women, nine nurse-midwives, and eight obstetricians between March and June 2006. The recorded interviews were content-analyzed. Weight gain was a common concern among the participants, regardless of the women&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s body size, and sufficient weight gain was rarely mentioned. However, the health-care providers were aware of their lack of expertise and training in behavior modification. Pregnant women consistently expressed a desire for reassurance and praise from health-care providers, which might be a culture-specific phenomenon. The findings point to a need for culturally appropriate and accurate communication about weight gain during pregnancy.
Research Interests: Nursing, Obstetrics, Body Image, Risk assessment, Pregnancy, and 16 moreHumans, Female, Young Adult, Tokyo, Questionnaires, Adult, Public health systems and services research, Body Weight, Risk Assessment, Parity, Health Care Provider, Gestational Age, Weight Gain, I.J. KEARNS Health Sciences NURSING, Prenatal Care, and Health Personnel
A high total homocysteine (tHcy) level during pregnancy is a risk factor for adverse perinatal outcomes, such as fetal growth restriction and preeclampsia. Caffeine is assumed to increase tHcy levels by acting as a vitamin B6 antagonist.... more
A high total homocysteine (tHcy) level during pregnancy is a risk factor for adverse perinatal outcomes, such as fetal growth restriction and preeclampsia. Caffeine is assumed to increase tHcy levels by acting as a vitamin B6 antagonist. The objective of this study was to examine a relationship between circulating tHcy levels and dietary caffeine and vitamin B6 intakes in pregnant Japanese women. A total of 321 healthy women with singleton pregnancies were recruited in metropolitan Tokyo, from June to December 2008, resulting in the final number included in the study as 254. Dietary caffeine intakes did not correlate with plasma tHcy levels. When we analyzed the data according to caffeinated beverages, caffeinated tea consumption was positively associated with plasma tHcy levels only among the women with a high intake of vitamin B6 , after controlling for confounding factors (P = 0.029). No correlation between coffee consumption and plasma tHcy levels was found. Pregnant Japanese women might need to cut down the consumption of caffeinated tea as well as take sufficient vitamin B6 in order to prevent the tHcy levels from increasing.
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Low-income women are at risk for excessive gestational weight gain. Inactive lifestyle and lack of regular moderate exercise may contribute to the risk of weight gain. This study was conducted to (1) determine the rate and characteristics... more
Low-income women are at risk for excessive gestational weight gain. Inactive lifestyle and lack of regular moderate exercise may contribute to the risk of weight gain. This study was conducted to (1) determine the rate and characteristics of low-income pregnant women who exercised regularly and met the American College of Obstetricians and Gynecologists recommendation and (2) describe how these women spent time for other physical activities compared with those who did not exercise regularly. Medicaid-recipient or uninsured pregnant women (n = 816) were asked to complete a physical activity questionnaire at rural and urban county health departments located in North Carolina. Twenty percent of low-income women met the American College of Obstetricians and Gynecologists recommendation for moderate exercise (≥10 METs-h/wk [metabolic equivalent task-hours per week]). The women who met the recommendation spent 3 hours 45 minutes per week walking as exercise, whereas those who did not meet the recommendation spent 1 hour per week (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001). Women who exercised regularly spent longer hours at work (4.25 vs. 1.75 hours per day; P = .019) and on household tasks (5.25 vs. 4.0 hours per day; P = .002) than women who did not exercise regularly. Time spent on domestic and occupation activities does not seem to prohibit low-income women from engaging in moderate exercise on a regular basis.
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To assess the psychometric properties of the Pregnancy Physical Activity Questionnaire (PPAQ) for women who read and speak Japanese. This longitudinal study used a self-report questionnaire and quantitative biometric and instrumental... more
To assess the psychometric properties of the Pregnancy Physical Activity Questionnaire (PPAQ) for women who read and speak Japanese. This longitudinal study used a self-report questionnaire and quantitative biometric and instrumental measurements (actigraph) to assess the reliability and criterion validity. A university hospital in Tokyo, Japan. Sixty-nine pregnant women living in Tokyo and its suburbs were recruited. The test-retest reliability of the Japanese version of the Pregnancy Physical Activity Questionnaire (PPAQ-J) was evaluated through intraclass correlation coefficients (ICCs) between PPAQ-J results administered three times (at recruitment, 7 and 14 days later). Criterion validity was assessed by comparing results to actigraph measures using Spearman&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s correlation coefficients. Participants wore the actigraph over the 2-week research period. Data from 58 participants were analyzed for test-retest reliability. The data of 54 participants were used to analyze criterion validity. The ICCs for the first and second and for the first and third PPAQ-J questionnaires were ≥0.56 for total activity and activities broken down by intensity and type (in metabolic equivalents [METs] × hours/day). To evaluate criterion validity, Spearman&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s correlation coefficients were calculated between the first measurement of the PPAQ-J and three published cut-points used to classify actigraph data (minutes/day); correlations ranged from .02 to .35 for total activity, -.21 to -.25 for vigorous activity, -.09 to .38 for moderate activity, and .01 to .28 for light activity. The PPAQ-J is a psychometrically sound and comprehensive measure of physical activity in pregnant Japanese women.
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Commercially available portable metabolic systems have been validated with samples of young, healthy, and well-fit subjects, but use of these systems with a special population, such as healthy but sedentary pregnant women, requires a... more
Commercially available portable metabolic systems have been validated with samples of young, healthy, and well-fit subjects, but use of these systems with a special population, such as healthy but sedentary pregnant women, requires a unique set of considerations. These include a woman&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s limited testing time necessary for fetal safety, relatively low oxygen consumption, and the unique physiology of pregnancy (woman, the placenta, and the fetus). The purpose of this study was to validate a portable metabolic testing system (VO2000) with healthy sedentary pregnant women. A total of 9 sedentary pregnant women who averaged 30 years of age (SD=3), 93 kg (SD=19) weight, 163 cm (SD=7) height, and at 19 weeks&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; gestation (SD=5) volunteered to participate. Submaximum fitness tests using the Cornell protocol were conducted once with two systems (VO2000 and CPX/D, a reference) simultaneously, and then subsequently twice with one system (VO2000). The VO2000 consistently overestimated VO2 measurement, compared to the same manufacturer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s reference system, by 4.4 +/- 3.6 (SD) ml/kg/min, and when VO2000 was used twice, the mean difference was statistically significant (1.0 +/- 1.8 [SD] ml/kg/min; t(45) = 3.9, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). The results of the study show that although VO2000 is an established and validated portable metabolic system for measurement on adult males and females who are relatively well fit, this portable system consistently overestimates VO2 readings for pregnant women compared to standard full-size system. Measurements, when repeated, were not consistent.
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... we developed of the self-rated Foreign Language Oral Skills Evaluation Matrix (FLOSEM ... of this inquiry was their first; 5 (6%) had previously experienced childbirth in the ... reported having advance consent discussions about... more
... we developed of the self-rated Foreign Language Oral Skills Evaluation Matrix (FLOSEM ... of this inquiry was their first; 5 (6%) had previously experienced childbirth in the ... reported having advance consent discussions about epidural anesthesia as outpatients during prenatal care ...
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Research Interests: Nursing, Japan, Adolescent, Students, Cross-Cultural Comparison, and 12 moreHumans, High School, United States, Female, Clinical Sciences, Cross Section, Public health systems and services research, High School Student, Breast feeding, Cross Sectional Studies, Human Lactation, and attitude to health
Cultural views are purported to be critical barriers to the use of epidural anesthesia during childbirth in Japan, even though it is not routinely available. We sought to understand the importance of the asserted cultural barriers for... more
Cultural views are purported to be critical barriers to the use of epidural anesthesia during childbirth in Japan, even though it is not routinely available. We sought to understand the importance of the asserted cultural barriers for Japanese women living in Michigan in the United States where access to epidural anesthesia is routine. We used a mixed-methods approach including self-administered, cross-sectional mail surveys and semi-structured qualitative interviews. Participants were Japanese women who received prenatal care at the University of Michigan Japanese Family Health Program. Of 78 participants in the mail survey, 63% used epidural anesthesia. Positive influences to have epidural anesthesia came from friends (58%), husbands (42%), and knowledge of the epidural anesthesia experiences of others (50%). Seventeen respondents participated in qualitative interviews. Most had learned little about epidural anesthesia while living in Japan, and some respondents had heard unsettling rumors. Many mentioned obtaining their first detailed knowledge about epidural anesthesia from friends in the United States, and expressed fear or concerns about the side effects of anesthesia. Thirteen out of fourteen interviewed participants who used or wanted epidural anesthesia expressed a desire to use it for the next childbirth. While Japanese women in this United States setting considered previously reported cultural barriers to epidural anesthesia for birth pain, many chose to have it during their labor. This finding implicates limited access as a barrier at least as important as cultural barriers to epidural anesthesia use in Japan.
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To compare a walking exercise to a stretching exercise during pregnancy in high-risk women who were sedentary and had previously experienced preeclampsia. A randomized clinical trial of the effects of the two types of physical exercises... more
To compare a walking exercise to a stretching exercise during pregnancy in high-risk women who were sedentary and had previously experienced preeclampsia. A randomized clinical trial of the effects of the two types of physical exercises was conducted between November 2001 and July 2006 in Washtenaw County, Michigan. Both groups engaged in the assigned exercise five times a week until the end of pregnancy. Women were randomized to either the walking group (n = 41) or the stretching group (n = 38). The walkers exercised an average of 36 (SD, 6) minutes at 18 weeks gestation, 34 (SD, 7) minutes at 28 weeks gestation, and 31 (SD, 12) minutes at the last week of the intervention. On average, they exercised within target heart rate ranges 35% (SD, 32%) at 18 weeks gestation, 22% (SD, 25%) at 28 weeks gestation, and 17% (SD, 25%) at the last week of the intervention. The stretching group engaged in stretching exercises following a 40-minutes videotape. On average, the walking group exercised 4 (SD, 1) times a week at 18 weeks gestation, 4 (SD, 1) time a week at 28 weeks gestation, and 3 (SD, 1) times a week at the last week of the intervention. Equally on average, the stretching group exercised 4 (SD, 2) times a week at 18 weeks gestation, 5 (SD, 1) times a week at 28 weeks gestation, and 3 (SD, 1) times a week at the last week of the intervention. No difference between groups was observed, but both exercised significantly less frequently over the time (p 0.0001). Together, participants reported average 7,040 (SD, 2,612) steps at the beginning and 5,711 (SD, 2,739) steps at the end of the study. The walkers tracked an average 8,501 (SE, 778) steps a day at 20 weeks gestation and 7,418 (SE, 788) steps at 34 weeks gestation (n.s.). The stretchers tracked an average 6,189 (SE, 704) steps at 20 weeks gestation and 4,848 (SE, 452) steps at 34 weeks gestation (p 0.05). The incidence of preeclampsia was 14.6% (95% CI, 5.6 to 29.2) among the walkers and 2.6% (95% CI; 0.07 to 13.8) among the stretchers. The incidence of gestational hypertension was 22 % (95% C.I., 8.7 to 35.2) for the walkers and 40% (95% CI, 23.2 to 55.8) for the stretchers. The mean transferrin level, an antioxidant marker, was significantly higher in the stretching group mean (412 mg/dL, 95%CI, 389 to 435) than the walkers at the time of labor (mean = 368 mg/dL, 95%CI, 346 to 391) (p 0.05). No significant group differences were observed in birth outcomes. Regular stretching exercises may promote endogenous antioxidants among women at risk for preeclampsia.
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Use of an exercise intervention for high-risk and vulnerable populations, such as pregnant women at risk for gestational hypertension or preeclampsia, requires special consideration. A comparative trial testing the effects of two types of... more
Use of an exercise intervention for high-risk and vulnerable populations, such as pregnant women at risk for gestational hypertension or preeclampsia, requires special consideration. A comparative trial testing the effects of two types of physical exercises - stretching (a comparator) and walking (a testing intervention) - for sedentary pregnant women at risk for preeclampsia - is presented in this paper. The study was designed to reduce post-randomization bias and dropout rates from both groups, and closely to monitor safety of subjects. The strengths of the study design and methods include use of a run-in phase; use of a stretching exercise as a comparator; multiple ways to measure daily physical activities and the exercise intervention; and tailored support to remove barriers to exercise for subjects. The intervention consists of 40 min of walking at moderate intensity (i.e., 55-69% of maximum heart rate and rating of perceived exhaustion 12-13) five times a week from 18 weeks gestation until birth. The comparator exercise consists of 40 min of stretching exercise without increasing heart rate to more than 10% of resting heart rate, five times a week from 18 weeks gestation until birth. The primary outcome is the incidence of preeclampsia. Secondary outcomes include the physiologic effects of the intervention and birth outcomes.
Research Interests:
Research Interests:
High levels of oxidized low-density lipoprotein (ox-LDL) during pregnancy are a risk factor for preeclampsia. Ox-LDL levels might be affected by folate and total homocysteine (tHcy) levels because of their effects on oxygen free radicals.... more
High levels of oxidized low-density lipoprotein (ox-LDL) during pregnancy are a risk factor for preeclampsia. Ox-LDL levels might be affected by folate and total homocysteine (tHcy) levels because of their effects on oxygen free radicals. The relationships between ox-LDL and folate and tHcy during pregnancy, however, remain unclear. The present study investigated whether serum folate levels and plasma tHcy levels were associated with plasma ox-LDL levels in pregnant women. A sample of 137 healthy subjects with singleton pregnancies (age 30.3 ± 4.5 years) was recruited from a prenatal clinic in metropolitan Tokyo between June and October 2008. Their levels of plasma ox-LDL, plasma tHcy, and serum folate were measured, and lifestyle variables were obtained using a questionnaire. Dietary intake was assessed by means of a validated self-administered diet history questionnaire. A negative correlation between plasma ox-LDL levels and serum folate levels was found (r(s) = -.218, p =.011). However, there was no association between plasma ox-LDL levels and plasma tHcy levels (r(s) = .055, p = .525). The mean of the logarithmic ox-LDL levels was significantly lower among the participants taking folic acid-containing supplements regularly than among those who were not, after adjusting for confounding factors (p = .024). Serum folate levels and folic acid supplementation might be associated with plasma ox-LDL levels, independent of tHcy levels. The association observed between ox-LDL and folate can be used as evidence for dietary instruction by prenatal care providers.