'It's not me, it's them' - a report describing the weight-related attitudes towards obesity in pregnancy among maternal healthcare providers.

BACKGROUND: Occurrences of weight stigma have been documented in prenatal clinical settings from the perspective of pregnant patients, however little is known from the viewpoint of healthcare providers themselves. Reported experiences of weight stigma caused by maternal healthcare providers may be due to negative attitudes towards obesity in pregnancy and a lack of obesity specific education. The objective of this study was to assess weight-related attitudes and assumptions towards obesity in pregnancy among maternal healthcare providers in order to inform future interventions to mitigate weight stigma in prenatal clinical settings. METHODS: A cross-sectional survey was administered online for maternal healthcare providers in Canada that assessed weight-related attitudes and assumptions towards lifestyle behaviours in pregnancy for patients who have obesity. Participants indicated their level of agreement on a 5-point likert scale, and mean scores were calculated with higher scores indicating poorer attitudes. Participants reported whether they had observed weight stigma occur in clinical settings. Finally, participants were asked whether or not they had received obesity-specific training, and attitude scores were compared between the two groups. RESULTS: Seventy-two maternal healthcare providers (midwives, OBGYNs, residents, perinatal nurses, and family physicians) completed the survey, and 79.2% indicated that they had observed pregnant patients with obesity experience weight stigma in a clinical setting. Those who had obesity training perceived that their peers had poorer attitudes (3.7 ± 0.9) than those without training (3.1 ± 0.7; t(70) = 2.23, p = 0.029, Cohen's d = 0.86). CONCLUSIONS: Weight stigma occurs in prenatal clinical environments, and this was confirmed by maternal healthcare providers themselves. These findings support advocacy efforts to integrate weight stigma related content and mitigation strategies in medical education for health professionals, including maternal healthcare providers. Future work should include prospective examination of weight related attitudes among maternal healthcare providers and implications of obesity specific education, including strategies on mitigating weight stigma in the delivery of prenatal care.

Endurance Running Training Individually Guided by HRV in Untrained Women.

da Silva, DF, Ferraro, ZM, Adamo, KB, and Machado, FA. Endurance running training individually guided by HRV in untrained women. J Strength Cond Res 33(3): 736-746, 2019-The aim of this study was to analyze the effects of heart rate variability (HRV)-guided training compared with a standardized prescription on (a) time to complete 5-km running performance (t5km), (b) peak treadmill running speed (Vpeak) and its time limit (tlim at Vpeak), and (c) autonomic cardiac modulation (i.e., parasympathetic activity and recovery) in untrained women. Additionally, we correlated changes in t5km with changes in Vpeak, tlim at Vpeak and autonomic cardiac modulation. Thirty-six untrained women were divided into a HRV-guided training group (HRVG) and a control group (CG). The CG followed a predefined program, alternating moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT). The determination of MICT or HIIT was based on the pretraining HRV for HRVG. MICT was performed if HRV was

Building a response criterion for pediatric multidisciplinary obesity intervention success based on combined benefits.

To propose a response criterion for analyzing the intervention success by verifying patient outcomes after a multidisciplinary obesity treatment program in Brazilian children and adolescents. Obese children and adolescents (n = 103) completed a 16-week multidisciplinary intervention (IG) and were compared to the control group (CG) (n = 66). A cluster of parameters (e.g. total domain of HRQoL; BMI z-score; cardiorespiratory fitness; body mass; waist circumference; fat mass; lean mass) were measured pre and post-intervention, and the sum of the median percentage variation and the percentile 25 and 75 were used from IG and CG to determine the responsiveness to the program. We are proposing four ranges in which children and adolescents may be classified after the intervention: (1) CG percentile 50 values or lower are considered non-responsive to the intervention, (2) values greater than CG percentile 50 but lower than IG percentile 50 are considered slightly responsive, (3) values greater than IG percentile 50 but lower than IG percentile 75 were considered as moderately responsive, and (4) values greater than IG percentile 75 were considered very responsive. CONCLUSIONS: This criterion may serve as a complementary tool that can be employed to monitor the response to this model of multidisciplinary intervention. What is Known: • The effectiveness of multidisciplinary obesity interventions is usually determined by comparing changes in selected outcomes in the intervention versus versus control group. • There is no consensus about what should be assessed before and after the intervention program, which makes difficult to compare different programs and to determine their rate of responsiveness. What is New: • This study proposes a response criteria to pediatric obesity interventions following a similar model compared to ours based on key variables that presents low cost and high applicability in different settings.

The Need to Objectively Measure Physical Activity During Pregnancy: Considerations for Clinical Research and Public Health Impact.

Engaging in recommended levels of physical activity during pregnancy can provide a host of physical and mental health benefits for the expecting mother and her child. However, methodological issues related to physical activity measurement have plagued many studies examining the effects of physical activity during this important life stage. Burgeoning support exists for the more widespread use of objective methods, and accelerometers specifically, for an accurate appraisal of maternal physical activity. In this commentary, we highlight discrepancies between activity estimates obtained via self-report and objective measures and describe the implications of erroneous measurement when making clinical recommendations and in conducting future physical activity and pregnancy research. Most importantly, we aim to foster academic discussion and propose a call to action requiring a paradigm shift where we acknowledge the shortcomings of self-report and move toward an empirically driven approach for physical activity measurement. Results from more high-quality research studies will help support public health messaging and facilitate trust among health care providers, clinical researchers, and expecting mothers regarding the health benefits of physical activity recommendations.

Impact of readiness to change behavior on the effects of a multidisciplinary intervention in obese Brazilian children and adolescents.

The obesity epidemic is a global challenge that requires evidence-based intervention to slow the emergence of weight-related illness in children and adolescents. Thus, effective treatments are urgently needed. This study aimed to analyze whether there is relationship between the initial stage of readiness for behavior change (SRBC) and the results obtained through participation in a multidisciplinary program of obesity treatment (MPOT). The study included 113 overweight or obese children and adolescents who participated in an intervention for 16 weeks, in which the categorical variable was the SRBC. The dependent variables included: anthropometric measures of body composition, hemodynamic parameters (e.g., blood pressure values), and health-related physical fitness. Although stages 1 and 2 had greater improvements in flexibility than those in stage 5, and stage 1 had greater percentage changes in abdominal strength than those in stage 5, children and adolescents in the highest stage had greater percentage changes for anthropometric, hemodynamic and cardiorespiratory fitness, suggesting an impact of the stage of change on the effects of a MPOT. This study suggests that SRBC plays a role in obesity treatment in Brazilian children and adolescents and warrants consideration when enrolling patients to intervention.

The incidence of maternal artefact during intrapartum fetal heart rate monitoring.

OBJECTIVE: To determine the incidence of maternal heart rate artefact (MHRA) when monitoring fetal heart rate (FHR) in labour and to determine obstetrical factors associated with MHRA. METHODS: In a prospective observational study, maternal and fetal heart rates were displayed simultaneously to document the superimposition of the maternal heart rate (MHR) on FHR tracings. All women in labour who were undergoing external fetal monitoring (EFM) at the Ottawa Hospital from October 2011 to March 2012 were eligible. Every episode of MHRA was documented and classified according to its clinical significance. Wilcoxon test, t tests, and chi-square tests were used to identify time-related differences and obstetrical factors (epidural analgesia, fetal presentation, multiple gestation, maternal BMI, umbilical cord arterial pH, five-minute Apgar scores) that were associated with a potential adverse outcome. RESULTS: We assessed 1313 tracings with simultaneous displays of the MHR and FHR in labour. MHRA was present at least once in 721 tracings (55%). Of these tracings, 35 were classified as having one or more episodes that might have led to an adverse outcome (either false positive or false negative), giving an incidence of 2.7% of all women in labour. In 33 tracings, the MHRA masked an abnormal FHR tracing. In two tracings, the MHRA masked a normal FHR, which might have resulted in misinterpretation of the tracing (i.e., false positive), leading to unnecessary intervention. CONCLUSION: The incidence of MHRA is higher than currently thought, and in more than 2% of women in labour may lead to adverse outcomes. We propose routine use of simultaneous maternal and FHR monitoring for women undergoing EFM, especially during the second stage of labour.

Objectif : Déterminer l'incidence des artéfacts de fréquence cardiaque maternelle (AFCM) dans le cadre du monitorage de la fréquence cardiaque fœtale (FCF) pendant le travail et identifier les facteurs obstétricaux associés aux AFCM. Méthodes : Dans le cadre d'une étude observationnelle prospective, les fréquences cardiaques maternelles et fœtales ont été affichées de façon simultanée afin de documenter la superposition de la fréquence cardiaque maternelle (FCM) sur les tracés de FCF. Toutes les femmes en travail qui, entre octobre 2011 et mars 2012, ont fait l'objet d'un monitorage fœtal externe (MFE) à l'Hôpital d'Ottawa étaient admissibles à l'étude. Chaque épisode d'AFCM a été documenté et classé en fonction de sa signification clinique. Le test de Wilcoxon, des tests t et des tests de chi carré ont été utilisés pour identifier les différences liées au temps et les facteurs obstétricaux (analgésie péridurale, présentation fœtale, gestation multiple, IMC maternel, pH du sang artériel issu du cordon ombilical, indices d'Apgar à cinq minutes) qui ont été associés à une issue indésirable potentielle. Résultats : Nous avons évalué 1 313 tracés ayant affiché de façon simultanée la FCM et la FCF pendant le travail. Des AFCM ont été présents à au moins une reprise dans 721 tracés (55 %). Parmi ces tracés, 35 ont été classés comme présentant un épisode ou plus qui aurait pu mener à une issue indésirable (faux positif ou faux négatif), ce qui équivaut à une incidence de 2,7 % de toutes les femmes en travail. Dans 33 tracés, les AFCM ont masqué un tracé anormal de FCF. Dans deux tracés, les AFCM ont masqué un tracé normal de FCF, ce qui aurait pu mener à une interprétation erronée du tracé (c.-à-d. faux positif) et à la mise en œuvre d'une intervention inutile. Conclusion : L'incidence des AFCM est supérieure aux estimations actuelles; chez plus de 2 % des femmes en travail, ils pourraient mener à des issues indésirables. Nous proposons l'utilisation systématique du monitorage simultané de la FCM et de la FCF pour ce qui est des femmes faisant l'objet d'un MFE, particulièrement au cours du deuxième stade du travail.

Common sleep disorders in pregnancy: a review.

In this review, we provide a comprehensive overview of common sleep disorders during pregnancy, including their characterization, prevalence, risk factors, and possible contribution to maternal and fetal outcomes. We conducted a quasi-systematic literature search of the MEDLINE database and identified 744 studies from 1991 through 2021, inclusive, that met our inclusion criteria. We synthesized the existing literature on sleep disorders during pregnancy and highlighted controversies, research gaps, and needed clinical developments. Our review covers a range of sleep disorders, including insomnia, obstructive sleep apnea, restless legs syndrome, and circadian rhythm disorders. We discuss the prevalence of these disorders in pregnancy and their potential impact on maternal and fetal health outcomes. We also explore the relationship between sleep disorders, pre-pregnancy comorbidities such as obesity, and pregnancy-related conditions such as gestational diabetes mellitus and preeclampsia. In addition to summarizing the existing literature on sleep disorders during pregnancy, we also highlight opportunities for further research in this area. We suggest that future studies should strive to employ validated and objective measurement tools for sleep disorders and prioritize utilization of longitudinal methods with participant follow-up through postpartum, mid-life, menopause, and beyond. We also put forward investigation into the impact of circadian rhythm disruption on reproductive physiology and early pregnancy outcomes as an area of important work. Overall, our review provides valuable insights on sleep and reproduction and into common sleep disorders during pregnancy and their potential impact on maternal and fetal health outcomes.

Effect of Pregnancy in 42 Elite to World-Class Runners on Training and Performance Outcomes.

PURPOSE: The International Olympic Committee expert group on pregnancy has identified a paucity of information regarding training and performance in truly elite athletes. Thus, the purpose of this study was to quantify elite runners' training volume throughout pregnancy and postpartum competition performance outcomes. METHODS: Forty-two elite (>50% competed at the World Championships/Olympic) middle-/long-distance runners' training before, during, and after pregnancy (quality/quantity/type) data (retrospective questionnaire) and competition data (published online) were collected. RESULTS: Running volume decreased significantly ( P < 0.01) from the first trimester (63 ± 34 km·wk -1 ) to the third trimester (30 ± 30 km·wk -1 ). Participants returned to activity/exercise at ~6 wk postpartum and to 80% of prepregnancy training volumes by 3 months. Participants who intended to return to equivalent performance levels postpregnancy, there was no statistical decrease in performance in the 1 to 3 yr postpregnancy compared with prepregnancy, and ~56% improved performances postpregnancy. CONCLUSIONS: This study features the largest cohort of elite runners training and competition outcomes assessed throughout pregnancy, with training volumes being approximately two to four times greater than current guidelines. For the first time, performance was directly assessed (due to the quantifiable nature of elite running), and study participants who intended to return to high-level competition did so at a statistically similar level of performance in the 1- to 3-yr period postpregnancy. Taken together, this article provides much needed insights into current training practices and performance of elite pregnant runners, which should help to inform future training guidelines as well as sport policy and sponsor expectations around return to training timelines and performance.

The short-term effect of a mHealth intervention on gestational weight gain and health behaviors: The SmartMoms Canada pilot study.

Gestational weight gain (GWG) has been shown to impact several maternal-infant outcomes. Since healthcare provider guidance on weight gain and healthy behaviors alone has failed to help women to meet guidelines during pregnancy, a practical adjunctive approach is to deliver evidence-based behavior change programs through mobile interventions. The present study aimed to assess the short-term effect of the SmartMoms Canada app to promote adequate GWG and healthy behaviors. Twenty-nine pregnant women were recruited in this app-based intervention trial to test whether a higher app usage (≥ 3.8 min·week-1) between 12-20 gestational weeks and 24-28 gestational weeks improved GWG, diet, physical activity, and sleep, compared to women with a lower app usage (< 3.8 min·week-1). Two-way mixed ANOVA for repeated measures was used to estimate the effect of the app usage and time, as well as their interaction on GWG and healthy behaviors. The likelihood ratio was used to examine the association between app usage categorization and GWG classification. Cramer's V statistic was used to estimate the effect size for interpretation of the association. Pregnant women using the SmartMoms Canada app more frequently had a higher moderate-to-vigorous physical activity (MVPA) daily average when compared with women with a lower usage (mean difference: 17.84 min/day, 95% CI: 2.44; 33.25). A moderate effect size (28.6% vs. 15.4%; Cramer's V = 0.212) was found for the association between app categorization and rate of GWG, representing a greater adherence to the GWG guidelines in women in the higher app usage group vs. the lower app usage group. Considering other physical activity, diet, and sleep variables, no app categorization effect was observed. A short-term higher usage of SmartMoms Canada app has a positive effect on objectively-measured MVPA.

A Pilot Study Evaluating the Effectiveness of the 5As of Healthy Pregnancy Weight Gain.

INTRODUCTION: Gestational weight gain (GWG) outside of the 2009 Institute of Medicine guidelines may be harmful to women and their fetuses. Prenatal health care providers (HCPs) are important sources of health information, but not all discuss GWG with their patients. The Canadian Obesity Network's 5As (ask, assess, advise, agree, and assist) of Healthy Pregnancy Weight Gain (5As) is a tool developed to help HCPs counsel their patients on GWG. The main objective of this study was to evaluate the impact of the 5As tool on patient perceptions of GWG discussions with their HCP and to identify suggestions to improve the tool. METHODS: A quasiexperimental study design was conducted whereby HCPs were trained in using the 5As tool (intervention). Patients were then queried at baseline and postintervention using an electronic questionnaire measuring patient-perceived 5As counseling. Inclusion criteria for pregnant women were (1) currently attending their first appointment with participating HCPs, (2) English-speaking, and (3) over 18 years of age. RESULTS: One hundred pregnant women (50 baseline, 50 postintervention) and 15 HCPs (11 midwives, 4 obstetricians) participated. Participants receiving care from 5As-trained HCPs reported scores twice as high (P = .047) in being asked about and were approximately 3 times more likely to be advised an exact amount of target weight gain (P = .03). HCPs suggested improving patient handouts and HCP education on GWG guidelines as well as reducing the content presented in the 5As tool. DISCUSSION: The 5As Tool is effective at initiating HCP-mediated GWG counseling; further research is needed to examine the usefulness of the 5As in clinical practice throughout the length of a full pregnancy. Whether the uptake of the 5As tool contributes to prenatal behavior change remains to be established. Future steps include modifying the tool based on HCP feedback, the development of novel knowledge translation tools, and improved HCP and patient education.

Inconsistent Weight Communication Among Prenatal Healthcare Providers and Patients: A Narrative Review.

IMPORTANCE: Gestational weight gain (GWG) is an independent and modifiable factor for a healthy pregnancy. Gestational weight gain above or below the Institute of Medicine Guidelines has been shown to impact both maternal and fetal health (eg, gestational diabetes, hypertension, downstream obesity). Healthcare providers (HCPs) have the potential to be reliable sources of evidence-based weight information and advice during pregnancy. OBJECTIVE: The aim of this study was to summarize the literature assessing GWG discussions between patients and their HCPs in a clinical setting to better understand the knowledge that is currently being exchanged. EVIDENCE ACQUISITION: A literature review was conducted by searching Ovid Medline, CINAHL, and Embase databases. All relevant primary research articles in English that assessed GWG discussions were included, whereas intervention studies were excluded. RESULTS: A total of 54 articles were included in this review. Although the overall prevalence and content of GWG counseling varied between studies, counseling was often infrequent and inaccurate. Healthcare providers tended to focus more on women experiencing obesity and excessive GWG, as opposed to the other body mass index categories or inadequate GWG. Women of higher socioeconomic status, older age, nulliparous, history of dieting, low physical activity, and those categorized as overweight/obese were more likely to receive GWG advice. Patients also reported receiving conflicting facts between different HCP disciplines. CONCLUSIONS: The evidence regarding GWG counseling in prenatal care remains variable, with discrepancies between geographic regions, patient populations, and HCP disciplines. RELEVANCE: Healthcare providers should counsel their pregnant patients on GWG with advice that is concordant with the Institute of Medicine Guidelines.

Addressing cultural, racial and ethnic discrepancies in guideline discordant gestational weight gain: a systematic review and meta-analysis.

OBJECTIVE: To systematically review the literature and describe the discrepancies in achieving the 2009 Institute of Medicine (IOM) gestational weight gain (GWG) guidelines across cultures. METHODS: Ten databases were searched from inception to April 2018. Observational cohort studies were included that examined adult women; reported on a measure of culture; compared cultural groups, and reported on GWG. Articles were broken down into papers that used the current 2009 IOM GWG guidelines and those that used others. A meta-analysis was conducted for studies using the 2009 guidelines examining the prevalence of discordant GWG across cultural groups. RESULTS: The review included 86 studies. Overall, 69% of women experienced discordant GWG irrespective of culture. White women experienced excessive GWG most often, and significantly more than Asian and Hispanic women; Black women had a higher prevalence of excessive GWG than Hispanic and Asian women; however, this difference was not significant. CONCLUSIONS: The majority of women experience excessive GWG, with White women experiencing this most often. Culturally diverse GWG guidelines are needed to individualize antenatal care and promote optimal maternal-fetal health outcomes across cultural groups.