Research article
Predictors of Change in Physical Activity During and After Pregnancy: Project Viva

https://doi.org/10.1016/j.amepre.2006.12.017Get rights and content

Background

Few studies document longitudinal changes in physical activity from prepregnancy to the postpartum period.

Methods

This study estimated change in self-reported leisure-time physical activity in 1442 women before pregnancy, during the second trimester, and at 6 months postpartum. In addition, it also examined predictors of becoming insufficiently active during or after pregnancy.

Results

The mean (SD) age was 32.5 (4.5) years, 34% of the women were overweight or obese prepregnancy (body mass index equal to or greater than 25 kg/m2), and 76% were white. Before pregnancy, the mean total leisure physical activity was 9.6 hours per week. The reported decrease in total activity between prepregnancy and 6 months postpartum was –1.4 (95% CI=–1.0 to –1.9) hours per week, accounted for by decreases in moderate and vigorous physical activity but not walking. Prevalence of insufficiently active lifestyle (less than 150 minutes per week of total activity) increased from 12.6% before pregnancy to 21.7% during the postpartum period. The OR for becoming insufficiently active during pregnancy was 1.58 (95% CI=1.07–2.32) in women with at least one child compared with no children. Predictors of becoming insufficiently active postpartum included postpartum weight retention (OR=1.31; 95% CI=1.05–1.58 for each 5-kg increment); working longer hours in the first trimester (e.g., OR=5.12; 95% CI=1.96–13.4 for 45+ vs 0 hours); and reporting that lack of child care was a barrier to physical activity (OR=1.73; 95% CI=0.99–3.02).

Conclusions

Women reported decreases in moderate and vigorous physical activity during pregnancy that persisted at 6 months postpartum. Levels of walking did not decline. Children in the home, longer work hours, and lack of child care were predictors of becoming insufficiently active during or after pregnancy.

Introduction

Physical activity during and following pregnancy may have beneficial effects on postpartum weight retention and related health outcomes.1, 2, 3, 4 Few studies have been conducted on the longitudinal changes in physical activity from prepregnancy to the postpartum period. Although physical activity levels appear to decline during pregnancy, the magnitude and persistence of this decline during the postpartum period are unclear.5, 6, 7, 8 Furthermore, the determinants of these changes in physical activity during and following pregnancy have not been identified.

Growing interest in the social ecologic framework as the basis for investigating determinants of physical activity centers on understanding individual, interpersonal, and environmental influences.9, 10, 11, 12, 13 During and after pregnancy, individual factors could include perceived lack of time and energy, physical health, and competing priorities; interpersonal factors could include availability of child care; and environmental factors could include availability of places to exercise.14 Several authors have underscored the paucity of evidence on influences on activity from well-designed, prospective studies11, 15 and there is a particular lack of such data in the postpartum period, a potentially critical period for the development of obesity.16

The purpose of this analysis was to assess the magnitude of changes in physical activity during and after pregnancy, and to identify potential individual, social, and environmental factors that may predict changes in physical activity during and after pregnancy.

Section snippets

Methods

Project Viva is a cohort study of pregnant women and their offspring enrolled in a multisite group medical practice in the area surrounding Boston, Massachusetts, with the goal of examining the roles of prenatal factors in outcomes of pregnancy and infancy.17 This study included all eligible pregnant women in eight selected health centers, unrestricted by age or race. It excluded patients who did not obtain their initial prenatal visit within the first 22 weeks of gestation, those with multiple

Results

Table 1 includes the characteristics of the sample before, during, and after pregnancy. Most women were in their 30s, 34% were overweight or obese before pregnancy, and 24% were nonwhite. The relatively high educational level and household income are reflective of this health-insured population. Approximately 8% to 9% of women were depressed during either time period. The percentage of women working equal to or greater than 35 hours per week was 60% during the second trimester and 30% at 6

Discussion

Declines were observed in total physical activity during pregnancy that persisted to some degree at 6 months postpartum. Self-reported total physical activity declined, on average, by 2.7 hours per week during pregnancy, and remained 1.4 hours per week below prepregnancy levels at 6 months postpartum. An exception to this pattern was time spent walking, as walking at 6 months postpartum was similar to that reported for the prepregnancy period. The decline in physical activity during pregnancy

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