The Effect of Physical Activity on Pregnancy - Assignment Example

The Effect of Physical Activity on Pregnancy School P1: R6 P2: R2 P3: R7, R8, R10, R13 P4: R9, R14 P5: R3 P6: R1, R4 P7: P8: P9: P10: R5, R12 P11: R11 P12 Topic The effect of physical activity on pregnancy Introduction Problem Background P1: Pregnancy is a critical period in terms of regulation of body weight. On one hand, excessive gestational weight gain and maternal obesity are common and can lead to poor obstetrical outcomes both for the infant and the mother (Ferraro, Gaudet, and Adamo, 2012). On the other hand, physical activity during pregnancy can pose significant risks to the placenta. Physical activity during pregnancy also poses the risk of miscarriage because of the possibility of accidents during exercise. Pregnancy is typically associated with rest and care, and exercise seems quite out of place an activity to be endorsed on regular basis during such a critical period in a woman’s life. While certain forms of physical activity have been proven harmless and indeed helpful during pregnancy, many forms of exercise are too intense and physically demanding to be endorsed during pregnancy without posing significant risk to the health of the mother and the baby. In addition to that, there is possibility of the past research being biased in favor of endorsement of exercise as an activity during pregnancy because the importance of physical activity has been extremely emphasized by media in the present age. This imparts the need to conduct a first-hand research to find out to what extent, exercise can be trusted as a safe and healthy activity during pregnancy. Problem Statement P2: Many high school athletes tend to carry on their physical activity during the years of childbearing, and need to be educated on the safety of physical activity in the period of pregnancy and postpartum. In 1985, the American College of Obstetricians and Gynecologists (ACOG) gave conservative recommendations for physical activity during pregnancy, though evidence at that time was limited (ACOG, 1985). For instance, ACOG suggested women to limit intense continuous physical activity to 15 minutes per session while setting the heart rate at the limit of 140 beats/min. Based on ACOG guidelines, research over the last two decades has placed emphasis on safety and benefits of exercise during the peripartum period. Many elderly pregnant women are also physically active to some extent because of their work routines and social activities. However, there is also a considerable population of pregnant women who are physically inactive or negligibly active. Presence or absence of physical activity has implications on the health of not only the mother but also the baby. In the recent years, researchers have started to analyze physical activity’s role in the light of chronic disease prevention for the mother as well as offspring. In order to promote safe physical activity behaviors during pregnancy, it is imperative that the optimal intensity and frequency of workout is assessed. In addition to that, pregnant mothers vary in their needs for and tendency to do exercise because of a host of factors that include but are not limited to age and weight. Research Objectives There are three objectives of this research: To carry out a systematic literature review to identify the effect of exercise on blood pressure and weight gain of pregnant women. To carry out an experiment to identify the effect of physical activity on blood pressure and weight gain. To draw comparison between the results of this research and results of past researches and identify factors responsible for the possible disparity between results. Research Questions The aforementioned objectives will be achieved by finding answers to the following questions: What is the effect of exercise on blood pressure of pregnant women? What is the effect of exercise on weight gain of pregnant women? Literature Review P3: Effects of physical activity on pregnancy form a very important subject and there is ample research available on it. Available research consistently provides evidence for physical activity’s beneficial effect on self-esteem, body-image, and health during pregnancy. For instance, exploring the effects of participation of pregnant women in an aerobic exercise program led Wallace et al. (1986) to the conclusion that self-esteem of the exercisers was higher whereas their fatigue was lower in comparison to sedentary controls. Hall and Kaufmann (1987) found that high attendance of pregnant women in the exercise classes led them to developing less tension and better self-image in comparison to women whose attendance in exercise classes was low. Research also suggests the presence of a positive relationship between mental health physical activity and during pregnancy (Poudevigne and O’Connor, 2005). Goodwin et al. (2000) studied different aspects of well-being and mood during pregnancy through a range of self-reported categories of exercise and found better well-being in the exercisers along the dimensions of anxiety and insomnia. Heightened recognition of physical activity’s beneficial mental effects and perinatal mood disturbances have been studied a lot, though the current literature does not offer a detailed insight into mental health and maternal physical activity. P4: Observational epidemiological studies and randomized trials have often proposed the existence of an inverse relationship between blood pressure in pregnant and nonpregnant women and recreational physical activity. Investigators in a randomized controlled trials’ meta-analysis observed significant reduction in resting diastolic and systolic blood pressures in the nonpregnant women that performed aerobic exercise (Kelly, 1999). Pregnant women with a history of gestational hypertension, mild hypertension, or other hypertensive disorders have also been found to have reduced diastolic blood pressure as a result of exercise therapy (Yeo et al., 2000). P5: Regular sustained exercise during pregnancy has been a subject of research because changes in the visceral blood flow associated with exercise, carbohydrate utilization, shear stress, and body temperature might have adverse impact on the pregnancy. Potential adverse effects during pregnancy include abortion, growth restriction, hypoxia, malformation, death as a result of premature separation of placenta, brain damage, and premature labor. Adverse neonatal outcomes include but are not limited to acidosis, low Apgar score, poor such, failure to thrive, seizures, and hypertonia. Problems that may surface during infancy and childhood include short attention span, poor coordination, poor growth, and cognitive impairment. Long-term negative effects that may show through adolescence and young adulthood include poor athletic performance, obesity, insulin resistance, and diabetes (Barker, 2000). This review of actual observed outcomes reveals that concerns about physical activity of the mother during pregnancy are not warranted. The review also suggests that most varieties of physical activity during pregnancy offer the offspring some benefit rather than risk. P6: Patterns of physical activity depict that a majority of pregnant women do not exercise as per the recommended guidelines (ACOG, 2011). Pregnant women experience a range of barriers that may include but are not limited to sickness, tiredness, lack of facilities, lack of time, and busy work routine. In such a busy schedule that is physically demanding, physical activity becomes a secondary preference. While women are being increasingly encouraged to take physical exercise within controlled levels and as per the recommendations of the certified healthcare organizations, providing information does not suffice in persuading women to engage in physical activity during pregnancy because of the existence of a range of constraints. Research has also found the optimum time to start physical activity during pregnancy. While women that are physically active before pregnancy should continue to do so as long as they can do it comfortably, for women in general, “exercise needs to start during the first trimester – if not pre-pregnancy – to gain the greatest benefit. Promoting physical exercise during the first half of pregnancy appears to be highly beneficial, especially to first time-mothers” (Dignon and Reddington, 2013). While many research studies are optimistic about the effects of exercise on pregnancy, it is noteworthy that exercise varies in forms and many of its forms have not been considered in the research to date. In addition, women generally included in the research studies might not represent the society at large because of the marginality of study designs and data quality. Hypotheses The hypotheses for this research are as follows: Hypothesis 1 Exercise during pregnancy reduces blood pressure Hypothesis 2 Exercise during pregnancy helps control weight gain Hypothesis 3 Exercise during pregnancy is good for the health of both the mother and the baby. Methodology P7: This research will have two main objectives; to carry out a systematic literature review of the effects of exercise on pregnancy so as to find out what past research says about the effect of exercise on blood pressure and weight gain during pregnancy, and to carry out an experiment to evaluate the effect of exercise on blood pressure and weight gain in order to be able to draw comparison between this research’s results and past researchers’ results. Finally, factors responsible for possible difference or disparity between the results of this research and past researches will be discussed. The latter will be achieved by getting the responses of experts in the healthcare sector. Research methodologies for these objectives are described as follows: Part 1: Systematic literature review P8: The search will include identification of articles through literature search on LILACS and MEDLINE databases. Key words will be used for search including (physical exercise OR physical activity OR movement) AND (gestation OR pregnancy). The inclusion criteria for the articles will be; they should be in English and have been published from 2000 onwards. In addition, the articles should refer to case-control, cohort epidemiological, or cross-sectional studies. The principles outcomes of the research explained in the selected articles might include but will not be limited to preeclampsia, gestational weight gain, birth weight, and mode of delivery. P9: The search process will primarily comprise conduction of a references’ survey on the basis of key words. References identified on the selected articles will be sifted with the help of inclusion criteria as search filters. The criteria will include: articles with abstracts, with sample of human females, published from 2000 onwards, and published in English. The process’s second stage will comprise reading of the remaining abstracts that will lead to verification of the other inclusion criteria like target outcomes and search design. Studies suitable for inclusion in the study will finally be identified after excluding review articles, articles whose aim was not to explore the selected mother-child outcomes, and articles with an experimental design. P10: In order to carry out an appraisal of the methodological quality of the studies, each of the selected articles will be assigned a score as per the criteria laid out by Downs and Black (1998). This will lead to adaptation of the original checklist while the criteria related solely to the intervention studies will be ruled out. As a result of this, a certain number of items will be finally evaluated. Two reviewers will be tasked to evaluate the studies independently. The evaluators will assign scores to the studies whose concordance will be assessed according to the Intra-Class Correlation Coefficient (ICC). Results to measure the concordance among a variety of evaluation methods will be classified in accordance with the scale used by Shrout (1998). This scale has five categories; virtually no concordance, weak concordance, reasonable concordance, moderate concordance, and substantial concordance. Studies will be organized as; year of publication, study design, language, instrument used to measure physical activity, sample size, health outcomes for mother and baby, age of research participants, weight of research participants, and estimators used to score and analyze the methodological quality. This process will lead to grouping of the studies that have found similar outcomes. The mean of scores given to the studies will be calculated. Part 2: Experimental design P11: The methodology will replicate the methodology used by Rocha et al. (2014) who carried out research to explore the effects of exercise on maternal outcome in rats. In their research, they distributed 33 pregnant female rats into three groups, each containing 11 rats. The first group of rats did not exercise at all. The second group of rats exercised from day 0 to 20th of pregnancy. The third group of rats did exercise from the 7th to 20th day of pregnancy. The researchers indirectly measured systolic blood pressure and body weight during pregnancy. They anaesthetized the rats on the 21st gestational day and withdrew uterine content in order to analyze the parameters of reproductive outcome and fetal development. In this research, the same methodology will be used except for the fact that research participants will be women and only those women will be included in the research who voluntarily allow the measurement of systolic blood pressure and monitoring of body weight during pregnancy. In addition to that, women’s consent for analysis of reproductive outcome parameters and fetal development will also be taken. Conclusion P12: Physical activity during pregnancy is a very important subject of research. Right level, duration, and intensity of exercise during pregnancy can have beneficial impact on the health of both the mother and the baby. This research will explore the relationship between physical activity during pregnancy and two variables including blood pressure and weight gain. Results produced as a result of this research will be very valuable for the healthcare professionals in general and expecting mothers in particular. Further research can be carried out to study the effect of different variables on the relationship between physical activity during pregnancy and the two variables studied in this research i.e. blood pressure and weight gain. Different factors including age of mother at pregnancy, genetic predisposition of the mother to obesity and blood pressure, and other environmental factors need to be studied in terms of their effect on pregnant mothers that exercise. In addition to this, physical activity is of a variety of forms and future research may adopt the same methodology adopted in this research to explore the effect of different forms of exercise on pregnancy. References: 1. American Congress of Obstetricians and Gynaecologists. (2011) Exercise during pregnancy. American Congress of Obstetricians and Gynaecologists: Washington. 2. American College of Obstetricians and Gynecologists (1985). Technical Bulletin: Exercise During Pregnancy and the Postnatal Period. Washington DC: ACOG. 3. Barker, D. J. P. (2000). Fetal Origins of Cardiovascular and Lung Disease. New York: National Institutes of Health. 4. Dignon, A., and Reddington, A. (2013). The physical effect of exercise in pregnancy on pre-eclampsia, gestational diabetes, birthweight and type of delivery: a structu. Evidence Based Midwifery. Retrieved from https://www.rcm.org.uk/learning-and-career/learning-and-research/ebm-articles/the-physical-effect-of-exercise-in-pregnancy. 5. Downs, S. H., and Black, N. (1998). The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 52, 377-384. 6. Ferraro, Z. M., Gaudent, L., and Adamo, K. B. (2012). The potential impact of physical activity during pregnancy on maternal and neonatal outcomes. Obstetrical and Gynecological Survey. 67(2), 99-110. 7. Goodwin, A., Astbury, J., and Mcmeeken J. (2000). Body image and psychological well-being in pregnancy. A comparison of exercisers and non-exercisers. Aust. N. Z. J. Obstet. Gynaecol. 40, 442–447. 8. Hall, D. C., and Kaufmann, D. A. (1987). Effects of aerobic and strength conditioning on pregnancy outcomes. Am. J. Obstet. Gynecol. 157, 1199–1203. 9. Kelly, G. A. (1999). Aerobic exercise and resting blood pressure among women: a meta-analysis. Preven. Med. 28, 264–275. 10. Poudevigne, M. S., and O’Connor, P. J. (2005). Physical activity and mood during pregnancy. Med. Sci. Sports Exerc. 37, 1374–1380. 11. Rocha, R., Peracoli, J. C., Volpato, G. T., Damasceno, D. C., and Campos, K. E. (2014). Effect of exercise on the maternal outcome in pregnancy of spontaneously hypertensive rats. Acta Cir. Bras. 29(9). 12. Shrout, P. E. (1998). Measurement reliability and agreement in psychiatry. Stat Methods Med Res. 7, 301-317. 13. Wallace, A. M., Boyer, D. B., Dan, A., and Holm, K. (1986). Aerobic exercise, maternal self-esteem, and physical discomforts during pregnancy. Journal of Nurse Midwifery. 31, 255–262. 14. Yeo, S., Steele, N. M., Chang, M. C., Leclaire, S. M., Ronis, D. L., and Hayashi, R. (2000). Effect of exercise on blood pressure in pregnant women with a high risk of gestational hypertensive disorders. J. Reprod. Med. 45, 293–298. Read More