Relationships between Objectively Measured Sedentary Behavior during Pregnancy and Infant Birthweight.

BACKGROUND: Although numerous studies have assessed physical activity during pregnancy and relationships with infant outcomes, such as birthweight, few have evaluated sedentary behavior. Our objective was to evaluate sedentary behavior across pregnancy and relationships with infant birthweight in a sociodemographically diverse sample. METHODS: We measured device-assessed sedentary behavior and physical activity over three days at 16-18, 24-26, and 32-34 weeks gestation and infant birthweight from medical records among 71 participants. We used linear regression to assess relationships between sedentary behavior at each evaluation period with birthweight-for-gestational age Z-scores (BW-for-GA). RESULTS: There were no linear relationships between sedentary behavior and BW-for-GA at any evaluation period. We observed a modest curvilinear relationship between sedentary behavior at 16-18 weeks and BW-for-GA (R2 = 0.073, p = 0.021). Low and high levels of sedentary behavior predicted lower BW-for-GA. Multivariate models suggested that this relationship was independent of physical activity levels. CONCLUSIONS: Considering the high levels of sedentary behavior during pregnancy observed in many studies, even modest associations with birthweight merit further consideration. Relationships might not be evident later in pregnancy or if only linear relationships are considered. More detailed studies could help guide recommendations on sedentary behavior during pregnancy and the development of more comprehensive interventions.

Variations in Relationships Between Perceived Stress and Birth Outcomes by Immigration Status.

INTRODUCTION: Past research shows that stress during pregnancy predicts adverse birth outcomes. These patterns might differ based on immigration status. Our objective was to analyze differences in relationships between perceived stress during pregnancy and birth outcomes by immigration status. METHODS: We recruited 81 pregnant women in Canada for a prospective longitudinal study of stress during pregnancy and infant development. Participants completed the Perceived Stress Questionnaire at 16-18, 24-26 and 32-34 weeks of pregnancy. Birth records were available for 73 women, including 24 non-immigrants, 18 long-term immigrants (≥ 5 years), and 31 recent immigrants (< 5 years). We used General Linear Models to test relationships between perceived stress and birthweight, birthweight for gestational age Z-scores, and gestational age, and differences based on immigration status. RESULTS: Controlling for sociodemographic covariates, we observed interactive relationships between immigration status and perceived stress with birthweight at 16-18 (p = 0.032, partial η2 = 0.11) and 24-26 weeks pregnancy (p = 0.012, partial η2 = 0.15). Results were similar for birthweight for gestational age Z-scores at 16-18 weeks (p = 0.016, partial η2 = 0.13) and 24-26 weeks pregnancy (p = 0.013, partial η2 = 0.14). Perceived stress predicted smaller birthweight measurements among long-term immigrants. No relation was found between perceived stress, immigration status and gestational age. DISCUSSION: Risk of adverse health outcomes, including birth outcomes, tends to increase with duration of residence among immigrants. Stress during pregnancy might represent one risk factor for adverse birth outcomes among long-term immigrant women. Promoting psychosocial health screening and care among immigrant women, and assuring continued care with acculturation, might improve both maternal and infant health outcomes.

Psychosocial Stress, Sedentary Behavior, and Physical Activity during Pregnancy among Canadian Women: Relationships in a Diverse Cohort and a Nationwide Sample.

BACKGROUND: Past research shows that psychosocial stress and distress predict sedentary behavior and physical activity, but few studies focus on pregnant women. Our objective was to analyze relationships between psychosocial stress and distress with sedentary behavior and physical activity among pregnant women in Canada. METHODS: We analyzed objectively-measured sedentary behavior and physical activity at 16-18, 24-26, and 32-24 weeks pregnancy in a sociodemographically diverse cohort of 70 women in Montreal, Canada. Participants completed the Perceived Stress Questionnaire and wore an accelerometer for 3 days that quantified sitting time and steps per day. We used univariate general linear models to analyze relationships between perceived stress with sedentary behavior and physical activity at each evaluation. To assess generalizability, we analyzed relationships between psychological distress with self-reported leisure-time sedentary behavior and daily energy expenditure in transportation and leisure physical activities among a sample representative of 166,095 women in the Canadian Community Health Survey. RESULTS: In the Montreal cohort, we observed a positive association between perceived stress and sitting time, with small to moderate effect sizes (partial η2 = 0.08-0.16). We observed negative relationships between perceived stress and steps per day at the first two evaluations only, with small to moderate effect sizes (partial η2 = 0.08-0.11). Relationships for sedentary behavior were similar in the nationwide sample, but with smaller effect sizes (partial η2 = 0.02). There were no relationships between distress and physical activity in the nationwide sample. CONCLUSION: Psychosocial stress represents one risk factor for sedentarity, with relationships evident throughout pregnancy and at the population level. Relationships with physical activity are less consistent, but stress might represent a risk factor for low physical activity in early to mid-pregnancy. Results might guide the development of more comprehensive interventions targeting stress, sedentarity, and physical activity. In particular, integrating psychosocial health into interventions to reduce sedentarity, and including concrete guidelines on sedentary behavior in psychosocial health interventions, might be prioritized.

Identifying barriers and facilitators towards implementing guidelines to reduce caesarean section rates in Quebec.

OBJECTIVE: To investigate obstetricians perceptions of clinical practice guidelines targeting management of labour and vaginal birth after previous caesarean birth, and to identify the barriers to, facilitators of and obstetricians solutions for implementing these guidelines in practice. METHODS: This qualitative study was conducted in three hospitals in Montreal that represent around 10% of births in Quebec. Data was collected from 10 focus groups, followed by six semi-structured interviews. Two researchers jointly analysed the verbatim transcripts according to A manual for the use of focus groups. FINDINGS: The identified barriers to and facilitators of the implementation of guidelines can be classified into four categories: 1) the hospital level, including management and hospital policies; 2) the departmental level, including local policies, leadership, organizational factors, economic incentive, and availability of equipment and staff; 3) the health professionals motivations and attitudes, including medico-legal concerns, skill levels, acceptance of guidelines and strategies used to implement recommendations; and 4) patients motivations. CONCLUSION: Identifying the barriers to and facilitators of the adoption of recommendations is an important way to guide the development of efficient strategies. The findings of this study suggest that the adoption of guidelines may be improved if local health professionals perceptions are considered to make recommendations more acceptable and useful. Our findings also support the assumption that obstetricians seek to implement best practices, but require evidence tools and support to assess their practices and enhance their performance. In addition, peer review activities championed by opinion leaders have been identified by obstetricians as the most suitable strategy to improve the use of the guidelines in their practices.