Pregnancy WG Presentation

When I was not pregnant, and even when I was already a little pregnant, I assumed that the main difficulty in the “interesting position” was to carry my heavier belly in space. Therefore, I naively suggested, the best pastime for pregnant women is lying on the bed, optimally - on the back. Healthy sleep, regular rest and all that.

“Naive,” my 25-week belly tumbled at me and ... forbade me to sleep at night. It was not possible to sleep on the stomach (the pea was too big for the princess), on the side - the hip joints ached and the stomach began to ache, and on the back - suffocation and cramps began. And they say: pregnancy is not a disease ...

Not an option, but still a compromise was found in the pillows. Yes, it is in the plural. I brought three different pillows to the rescue: lying on my side, I clamped one small pad between my knees. On the second (small) rested my increased in size belly. Finally, the third - the big one - took its rightful place under my head. Later, I needed another, fourth, pillow: with it, I propped up my new large body from the side of the back - so as not to fall back. Surrounding myself with four different pillows, I was able to sleep relatively well. Relatively - because at the slightest change in posture I had to rebuild the entire pillow combination again, and this is not a quick process. And the place on the once seemed huge couch was catastrophically small. Besides, the husband who had lost his pillow in my favor began to snore ...

While I was having a pillow epic, my pregnant friends on blogs and forums boasted with their special pillows, created just for such delicate creatures as future moms. Once again, when I met a photo of a happy paunchy girl hugging something big, soft and cozy, I sadly looked at my four-story “nest” and ... went to the Internet to study the issue and its price. The range was amazing.

What are they like?

The most important criteria for the classification of pillows for pregnant women - is the shape, size and filler. As additional criteria, you can also highlight the price, quality, environmental friendliness, colors ... In general, we select a pillow for your individual taste and color!
Choose a shape and size

The simplest form is the i-pillow. It is a large soft "sausage" 170-190 cm long (you can choose according to your height) and a width of 30-35 cm, which you can put under your back, under your stomach, throw your legs on it or just lie down on her head. The pillow miraculously relieves the stress that has accumulated during the day that part of the body that you comfortably rest on it.

And it is very convenient for her to organize a pillow fight with children! Fun, not painful and relieves stress.

The advantages of the “sausage” shape flow from its simplicity: it is ergonomic (the “sausage” will not take up much space on the couch and in the cupboard) and is aesthetic (nothing superfluous). From the simplicity of the form follows another “plus” - the price for such a pillow, as a rule, does not bite - you can meet 1000 rubles.

Almost the same unpretentious form has the G-pillow. This is the same I-pillow, but with a special “branch” at the end, on which it is very convenient to lay your head and fall asleep.

We move further as the complexity of the form.

If the I-pillow could be shaped into an arc and fixed in this form, then you would have a boomerang pillow or a banana pillow. This figure is just created for a comfortable sleep on the side (especially during pregnancy) and it is worth noting that this pillow copes with its task perfectly. I will teach you how to enjoy the incomparable pleasure of "horizontal" rest: lie down next to your wonderful pad on the flank, put a pillow on one end, put your knees on the other end, gently place your tummy in the middle, gently hug the pillow and ... see the sweetest dreams ! It is as convenient as hugging your beloved husband, but at the same time we do not interfere with the sleep of the husband himself.

C-pillow is practically the same boomerang, but with a steeper bend. All the praises sung by the boomerang pillow can also be attributed to the C-pillow. In addition to this, the ends of this pillow can be pulled together (if you use a more supple pillow with polystyrene foam balls, which will be discussed below) and you will have a cozy hole for laying pregnant tummy. So with the help of this pillow you can make an uneasy focus - a pregnant woman lying on her stomach! I would not advise you to sleep in this position, but it is very pleasant to read a book or just to lie.

The next view - U-pillow - I can safely call an evolved C-pillow (http://pregily.com/)! Its ends are much longer (C-pillow - 170-190 cm, U-pillow - 280-340 cm), which opens up the search for new relaxing poses. Put your head on the bend of the pillow, arrange your hands on the “armrests” - it turns out to be a cozy chaise lounge. From this position, you can turn left and right, laying out their rounded shapes on the sides of the pillow. A significant advantage of this form - when turning from one side to the other, it is not necessary to turn the pillow to a new position. She carefully surrounds and supports the body from all the right sides, and what else is so necessary for pregnant women, as care and support?

The BIG pillow has an unusual shape: it is very similar to the U-pillow, but, unlike it, one end of this pillow is shorter than the other. This property allows you to find a new use for the pillow: a shorter end can be rolled into a ring and it is convenient to put your head there, having thrown your legs to the long end. The size of the pillow (280 cm) allows you to stretch it along the whole body, and even turn it around to heighten comfort.

One of the biggest (and most comfortable) pillows is the bagel pillow. Bagel - the classic shape of the pillow for pregnant women. Its length is as much as 340 cm (like the longest U-pillow). The bagel shape resembles an open rectangle with rounded corners. You can also twist this pillow as you like: under the head, under the belly, under the legs, and under the back. It is not necessary to shift the pillow when turning from side to side - this pillow is everywhere to guard your comfort and relaxing holiday.

Transcript

1. Meeting 4 Pregnancy Lead: Ken Powell Members: Loretta DiPietro Pregnancy • July 19-21, 2017
2. Experts and Consultants Consultant: – Kelly R. Evenson, Ph.D., M.S., FACSM University of North Carolina Chapel Hill Pregnancy • July 19-21, 2017 3
3. Work Group Questions 1. What is the relationship between physical activity and the health of the mother during pregnancy? 2. What is the relationship between physical activity and the health of the mother during postpartum (up to one year)? 3. What is the relationship between physical activity during pregnancy and the health of the child at birth? Pregnancy • July 19-21, 2017 4
4. Work Group Questions: Rationale • To expand on the 2008 Guidelines and better quantify the benefits (e.g., SMD or RR) of physical activity during pregnancy on selected health outcomes; • To expand on the 2008 Guidelines and provide better information on the dose and dose-response relationship between physical activity during pregnancy and selected health outcomes; • More specific dose and dose-response information could better inform policy makers and the public. Pregnancy • July 19-21, 2017 5
5. Analytical Framework Systematic Review Question Q1 - 3: What is the relationship between physical activity and (1) the health of the mother during pregnancy; (2) the health of the mother during the postpartum period (up to one year); and (3) the health of the child at birth? Target Population Pregnant women, post-partum mothers, and children at birth Comparison Pregnant women and post-partum mothers who participate in varying levels of physical activity, including no reported physical activity Intervention/Exposure All types and intensities of physical activity including lifestyle activities, leisure activities, and sedentary behavior Endpoint Health Outcomes Any health outcome, especially: • Ease or difficulty of labor and delivery • Excessive weight gain • Gestational diabetes • Lactation • Physical fitness • Postpartum depression • Preeclampsia • Preterm delivery • Quality of life • Return to “normal” weight • Weight gain • Weight status of neonate Key Definitions Postpartum period: Date of birth through one year after birth Pre-term birth: Preterm is defined as babies born alive before 37 weeks of pregnancy are completed. Induction or caesarean birth should not be planned before 39 completed weeks unless medically indicated. 6 Pregnancy • July 19-21, 2017
6. Common Inclusion/Exclusion Criteria • Language – Exclude: Studies that do not have full text in English • Publication Status – Include: Studies published in peer-reviewed journals, PAGAC-approved reports – Exclude: Grey literature • Study Subjects – Exclude: Studies of animals only Pregnancy • July 19-21, 2017 7
7. Inclusion/Exclusion Criteria • Date of Publication – Original Research: Not included – Existing Sources: Include 2006 - Present • Study Subjects – Include: Pregnant women, Postpartum mothers, and Children at birth • Study Design – Include: Systematic reviews, Meta-analyses, Pooled analyses, PAGAC- Approved reports – Exclude: Original research, Narrative reviews, Commentaries, Editorials • Exposure/Intervention – Include: All types and intensities of physical activity – Exclude: Missing physical activity, Therapeutic exercise, Single-acute sessions of physical activity, Physical fitness as the exposure, Physical activity only used as confounding variable • Outcome – Include: Any health outcome, especially: excessive weight gain, gestational diabetes, preeclampsia, ease or difficulty of labor and delivery, return to “normal” weight after delivery, lactation, physical fitness, postpartum depression, preterm delivery, quality of life, weight status of neonate Pregnancy • July 19-21, 2017 8
8. Source of Search Results • Aging Q2. What is the relationship between physical activity and physical function? • Brain Health Q2. What is the relationship between physical activity and quality of life? • Brain Health Q3. What is the relationship between physical activity and (1) affect and (2) anxiety? • Brain Health Q4. What is the relationship between physical activity and (1) sleep and (2) circadian rhythms? • Weight Management Q1. What is the relationship between physical activity and prevention of weight gain? • Weight Management Q2. In people with normal blood pressure or pre-hypertension, what is the relationship between physical activity and blood pressure? • Weight Management Q3. In adults without diabetes, what is the relationship between physical activity and type 2 diabetes? • High-Quality Existing Reports Pregnancy • July 19-21, 2017 9
9. Search Results: High-Quality Reviews1 and Reports Searches2 Aging Q2: Physical Function N = 15 Brain Health Q2: Quality-of-Life N = 21 Brain Health Q2: Affect and Anxiety N = 69 Brain Health Q2: Sleep and Circadian Rhythms N = TBD Cardiometabolic Health Q1: Prevention of Weight Gain N = 31 Cardiometabolic Health Q2: Blood Pressure N = 38 Cardiometabolic Health Q3: Type 2 Diabetes N = 112 High-Quality Existing Reports N = 1 Excluded after full text N = TBD Studies included N = TBD Excluded based on title N = TBD Articles for review of full text N = TBD Excluded based on abstracts N = TBD Abstracts screened N = TBD Titles screened N = TBD Records after duplicates removed N = TBD Studies included from supplementary strategies N = 2 1 Reviews include systematic reviews, meta-analyses, and pooled analyses. 2 The initial articles were identified by searching the titles and abstracts of each of the relevant searches’ results for topics related to the Pregnancy Work Group using the terms “gestation,” “pregn,” and “postp.” Pregnancy • July 19-21, 2017 10
10. Question 1 1. What is the relationship between physical activity and the health of the mother during pregnancy? – Is physical activity related to excessive weight gain, gestational diabetes, preeclampsia, quality of life, physical fitness, ease of labor and delivery, and musculoskeletal injury during pregnancy? – If yes, what dose of physical activity is associated with the reported quantitative benefit or risk? – Is there a dose-response relationship? If yes, what is the shape of the relationship? – Does the relationship vary by age, ethnicity, socio-economic status, or weight status? • Source of evidence to answer question – SR/MA/Existing Report Pregnancy • July 19-21, 2017 11
11. Draft Key Findings: Gestational Weight Gain • A total of 11 systematic reviews and meta-analyses have addressed the relationship between physical activity and gestational weight gain (GWG) and they provide strong evidence of a significant, but modest, inverse relationship between physical activity and gestational weight gain: – Based on a meta-analysis of 18 RCTs of 1598 women performing a structured exercise program and 1605 receiving standard care, the standardized mean difference in gestational weight gain was -1.11 kg (95% CI = -1.59 to -0.69), with women in the exercise group gaining less weight than women receiving standard care. – Other meta-analyses of RCTs reported remarkably similar standardized mean differences in GWG between exercising and control women, ranging from -0.36 kg (95% CI= -0.64 to -0.09) to - 1.50 kg (95% CI=-2.08 to -0.92). Pregnancy • July 19-21, 2017 13
12. Draft Key Findings: Gestational Weight Gain • An alternative outcome measure is meeting IOM Guidelines for weight gain during pregnancy: – Normal weight: 11.5 to 16 kg (25 to 35 lbs) – Overweight: 7 to 11.5 kg (15 to 25 lbs) – Obese 5 to 9 kg (11 to 20 lbs) • In general, women who reported physical activity during pregnancy experienced a significantly lower risk of excess weight gain compared with women who did not, with pooled effect sizes ranging from an 18% (OR=0.82; 95% CI=0.68 to 0.99) to a 23% (OR=0.77; 95%CI=0.66 to 0.88) lower risk. Pregnancy • July 19-21, 2017 14
13. Draft Key Findings: Gestational Weight Gain - Dose • The dose of physical activity prescribed in the RCTs varied among studies. Similarly, the assessment and categorization of reported LTPA was not consistent. • However, most RCT interventions used an exercise regimen involving primarily aerobic activity of moderate- intensity (walking, swimming, aerobic exercise), occurring at least 3 times per week for a duration of 30-60 min per bout. • This dose of activity is consistent with both ACOG Guidelines and the 2008 Physical Activity Guidelines Recommendations. Pregnancy • July 19-21, 2017 15
14. Data from PAGAC Report 2008 Figure published in Ann Rev Public Health 2011;32:349-365 depression, dementia Dose and dose-response curves Risk of XS GWG all-cause mortality . breast cancer Risk colon cancer diabetes hip fracture CVD, CHD, stroke Hours/week of MVPA (mostly LTMVPA) Pregnancy • July 19-21, 2017
15. Draft Key Findings: Gestational Weight Gain – Dose-Response • Most of the reviews did not assess whether there was a dose- response relationship between maternal physical activity and gestational weight gain. • The one review that attempted to answer this question (McDonald, 2016) reported that prescribed doses of exercise in the RCTs did not differ between those interventions observing significant (p<0.05) differences in weight gain between the exercise and control groups and those that did not; however, adherence to the prescribed exercise program was significantly higher in the “successful” interventions. • Wiebe (2015) also reported that among all eligible trials in the review, the standard mean difference in GWG between the exercise and control groups was moderately and inversely correlated with both the duration (in weeks) of the intervention (r=-0.51; p=0.023) and the volume (hrs/week) of exercise prescribed (r=-0.45; p=0.05). Pregnancy • July 19-21, 2017 17
16. Draft Key Findings: Gestational Weight Gain – Effect Modification • Virtually, none of the systematic reviews or meta-analyses assessed whether the purported relationship between physical activity and GWG varied by age, race/ethnicity, or socio-economic status. • With regard to weight status, we observed that most of the findings were reported among women of normal weight; however, several systematic reviews (McDonald, 2016; Muktabhant, 2015; Sui, 2012; and Wiebe, 2015) stratified their data by weight status (i.e., normal weight, overweight, or obese). These studies tended to observe larger effect sizes among women of normal weight, compared with those who were overweight or obese. • In contrast, one review of exclusively overweight or obese women (Sui 2012) reported a greater standardized mean difference in GWG between the exercise and control groups among obese women (SMD=-0.91 kg; 95% CI=-1.66 to -0.16) compared with overweight (SMD=-0.12; 95% CI= -0.52 to 0.26) women. Pregnancy • July 19-21, 2017 18
17. Draft Conclusion Statement • Strong evidence demonstrates a significant, but modest, inverse relationship between physical activity and gestational weight gain. PAGAC Grade: Strong • Limited evidence suggests that a dose of physical activity consistent with the 2015 ACOG Guidelines and the 2008 U.S. Physical Activity Guidelines (150-180 min/week of moderate-intensity activity) is associated with minimized weight gain and a lower risk of excess gestational weight gain. PAGAC Grade: Limited • Insufficient evidence is available to determine whether there is a dose- response relationship between physical activity and gestational weight gain. PAGAC Grade: Grade not assignable. • Insufficient evidence is available to determine whether the relationship between physical activity and gestational weight gain varies by age, race/ethnicity, socio-economic status, or weight status. PAGAC Grade: Grade not assignable. Pregnancy • July 19-21, 2017 19
18. Draft Research Recommendations • Conduct longitudinal research on varying exposure levels of physical activity to allow for an enhanced understanding of the dose-response associations between physical activity and gestational weight gain across a wider spectrum of exposure. • Conduct large research trials with ample sample sizes to allow for stratum-specific analyses to determine whether the influence of physical activity on GWG varies by age, race/ethnicity, socio- economic status, or initial weight status. Pregnancy • July 19-21, 2017 20
19. Committee Discussion 1. What is the relationship between physical activity and the health of the mother during pregnancy? 2. What is the relationship between physical activity and the health of the mother during the postpartum period (up to one year)? 3. What is the relationship between physical activity during pregnancy and the health of the child at birth? Pregnancy • July 19-21, 2017 21