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      Physical activity in gestational trimesters and perinatal outcomes in SUS puerperal women

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          ABSTRACT

          OBJECTIVE

          Test the association between the practice of physical activity (PA) according to the gestational trimesters and the occurrence of cesarean delivery, prematurity, and low birth weight in puerperal women assisted in the Unified Health System of Santa Catarina, Brazil.

          METHODS

          A cross-sectional study was conducted with a probabilistic sample of puerperal women who gave birth in public maternity hospitals in Santa Catarina from January to August 2019. The cesarean delivery outcome was self-reported, and information on premature birth (< 37 gestational weeks) and low birth weight (< 2,500 grams) were obtained from medical records. The practice of PA during pregnancy and according to each trimester was self-reported. Multivariate Logistic Regression analyses and interviews with 3,580 puerperal women were carried out.

          RESULTS

          PA practice during any period of pregnancy was reported by 20.6% of the sample, with a gradual reduction in prevalence according to the gestational trimester (16.2%, 15.4%, and 12.8%). The highest prevalences of outcomes concerning the total sample were observed in puerperal women who did not practice PA in the third trimester, with 43.9% for cesarean delivery, 7.7% for low birth weight, and 5.5% for premature birth. The odds of cesarean delivery (OR = 1.40; 95%CI 1.10–1.76) and low birth weight (OR = 1.99; 95%CI 1.04–3.79) were, respectively, 40% and 99% higher among puerperal women who did not practice PA in the third trimester of pregnancy when compared to those who practiced PA. There was no association between PA practice and prematurity.

          CONCLUSION

          Puerperal women who did not practice PA in the third trimester of pregnancy were more likely to have cesarean delivery and low birth weight newborns.

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          Most cited references32

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          The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014

          Background Caesarean section (CS) rates continue to evoke worldwide concern because of their steady increase, lack of consensus on the appropriate CS rate and the associated additional short- and long-term risks and costs. We present the latest CS rates and trends over the last 24 years. Methods We collected nationally-representative data on CS rates between 1990 to 2014 and calculated regional and subregional weighted averages. We conducted a longitudinal analysis calculating differences in CS rates as absolute change and as the average annual rate of increase (AARI). Results According to the latest data from 150 countries, currently 18.6% of all births occur by CS, ranging from 6% to 27.2% in the least and most developed regions, respectively. Latin America and the Caribbean region has the highest CS rates (40.5%), followed by Northern America (32.3%), Oceania (31.1%), Europe (25%), Asia (19.2%) and Africa (7.3%). Based on the data from 121 countries, the trend analysis showed that between 1990 and 2014, the global average CS rate increased 12.4% (from 6.7% to 19.1%) with an average annual rate of increase of 4.4%. The largest absolute increases occurred in Latin America and the Caribbean (19.4%, from 22.8% to 42.2%), followed by Asia (15.1%, from 4.4% to 19.5%), Oceania (14.1%, from 18.5% to 32.6%), Europe (13.8%, from 11.2% to 25%), Northern America (10%, from 22.3% to 32.3%) and Africa (4.5%, from 2.9% to 7.4%). Asia and Northern America were the regions with the highest and lowest average annual rate of increase (6.4% and 1.6%, respectively). Conclusion The use of CS worldwide has increased to unprecedented levels although the gap between higher- and lower-resource settings remains. The information presented is essential to inform policy and global and regional strategies aimed at optimizing the use of CS.
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            Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: a systematic review and meta-analysis

            Gestational diabetes mellitus (GDM), gestational hypertension (GH) and pre-eclampsia (PE) are associated with short and long-term health issues for mother and child; prevention of these complications is critically important. This study aimed to perform a systematic review and meta-analysis of the relationships between prenatal exercise and GDM, GH and PE. Systematic review with random effects meta-analysis and meta-regression. Online databases were searched up to 6 January 2017. Studies of all designs were included (except case studies) if published in English, Spanish or French, and contained information on the Population (pregnant women without contraindication to exercise), Intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise, alone [“exercise-only”] or in combination with other intervention components [e.g., dietary; “exercise + co-intervention”]), Comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and Outcomes (GDM, GH, PE). A total of 106 studies (n=273 182) were included. ‘Moderate’ to ‘high’-quality evidence from randomised controlled trials revealed that exercise-only interventions, but not exercise+cointerventions, reduced odds of GDM (n=6934; OR 0.62, 95% CI 0.52 to 0.75), GH (n=5316; OR 0.61, 95% CI 0.43 to 0.85) and PE (n=3322; OR 0.59, 95% CI 0.37 to 0.9) compared with no exercise. To achieve at least a 25% reduction in the odds of developing GDM, PE and GH, pregnant women need to accumulate at least 600 MET-min/week of moderate-intensity exercise (eg, 140 min of brisk walking, water aerobics, stationary cycling or resistance training). In conclusion, exercise-only interventions were effective at lowering the odds of developing GDM, GH and PE.
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              Benefits of Physical Activity during Pregnancy and Postpartum: An Umbrella Review

              To summarize the evidence from the 2018 Physical Activity Guidelines Advisory Committee Scientific Report, including new evidence from an updated search of the effects of physical activity on maternal health during pregnancy and postpartum. An initial search was undertaken to identify systematic reviews and meta-analyses published between 2006 and 2016. An updated search then identified additional systematic reviews and meta-analyses published between January 2017 through February 2018. The searches were conducted in PubMed®, CINAHL, and Cochrane Library and supplemented through hand-searches of reference lists of included articles and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The original and updated searches yielded a total of 76 systematic reviews and meta-analyses. Strong evidence demonstrated that moderate-intensity physical activity reduced the risk of excessive gestational weight gain, gestational diabetes, and symptoms of postpartum depression. Limited evidence suggested an inverse relationship between physical activity and risk of preeclampsia, gestational hypertension, and antenatal anxiety and depressive symptomology. Insufficient evidence was available to determine the impact of physical activity on postpartum weight loss, postpartum anxiety, and affect during both pregnancy and postpartum. For all health outcomes, there was insufficient evidence to determine whether the relationships varied by age, race/ethnicity, socioeconomic status, or pre-pregnancy weight status. The gestational period is an opportunity to promote positive health behaviors that can have both short- and long-term benefits for the mother. Given the low prevalence of physical activity in young women in general, and the high prevalence of obesity and cardiometabolic diseases among the U.S. population, the public health importance of increasing physical activity in women of child-bearing age, before, during, and following pregnancy is substantial.
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                Author and article information

                Journal
                Rev Saude Publica
                Rev Saude Publica
                rsp
                Revista de Saúde Pública
                Faculdade de Saúde Pública da Universidade de São Paulo
                0034-8910
                1518-8787
                13 October 2021
                2021
                : 55
                : 58
                Affiliations
                [I ] orgnameUniversidade Federal de Santa Catarina orgdiv1Programa de Pós-Graduação em Ciências da Reabilitação Araranguá SC Brasil originalUniversidade Federal de Santa Catarina. Programa de Pós-Graduação em Ciências da Reabilitação. Araranguá, SC, Brasil
                [II ] orgnameUniversidade Federal de Santa Catarina Curitibanos SC Brasil originalUniversidade Federal de Santa Catarina. Coordenadoria Especial de Biociências e Saúde Única. Curitibanos, SC, Brasil
                [III ] orgnameUniversidade Federal de Santa Catarina orgdiv1Departamento de Saúde Pública Florianópolis SC Brasil originalUniversidade Federal de Santa Catarina. Departamento de Saúde Pública. Florianópolis, SC, Brasil
                [IV ] orgnameUniversidade Federal de Santa Catarina orgdiv1Departamento de Ciências da Saúde Araranguá SC Brasil originalUniversidade Federal de Santa Catarina Departamento de Ciências da Saúde. Araranguá, SC, Brasil
                [I ] Brasil original Universidade Federal de Santa Catarina. Programa de Pós-Graduação em Ciências da Reabilitação. Araranguá, SC, Brasil
                [II ] Brasil original Universidade Federal de Santa Catarina. Coordenadoria Especial de Biociências e Saúde Única. Curitibanos, SC, Brasil
                [III ] Brasil original Universidade Federal de Santa Catarina. Departamento de Saúde Pública. Florianópolis, SC, Brasil
                [IV ] Brasil original Universidade Federal de Santa Catarina Departamento de Ciências da Saúde. Araranguá, SC, Brasil
                Author notes
                Correspondence: Ana Lúcia Danielewicz Universidade Federal de Santa Catarina Departamento de Ciências da Saúde 88906-072 Araranguá, SC, Brasil E-mail: ana.lucia.d@ 123456ufsc.br

                Authors’ Contribution: Study design and planning: TPS, ALD, AFB. Data collection, analysis, and interpretation: ALD, AFB, KJPW, TT. Manuscript preparation or review: ALD, TPS, AFB. Final version approval: ALD, AFB, TPS. Public responsibility for the content of the article: TPS, ALD, AFB, KJPW, TT.

                Conflict of Interest: The authors declare no conflict of interest.

                Correspondência: Ana Lúcia Danielewicz Universidade Federal de Santa Catarina Departamento de Ciências da Saúde 88906-072 Araranguá, SC, Brasil E-mail: ana.lucia.d@ufsc.br

                Contribuição dos Autores: Concepção e planejamento do estudo: TPS, ALD, AFB. Coleta, análise e interpretação dos dados: ALD, AFB, KJPW, TT. Elaboração ou revisão do manuscrito: ALD, TPS, AFB. Aprovação da versão final: ALD, AFB, TPS. Responsabilidade pública pelo conteúdo do artigo: TPS, ALD, AFB, KJPW, TT.

                Conflito de Interesses: Os autores declaram não haver conflito de interesses.

                Author information
                https://orcid.org/0000-0002-9055-0588
                https://orcid.org/0000-0002-7266-563X
                https://orcid.org/0000-0002-3649-3121
                https://orcid.org/0000-0001-9331-1550
                https://orcid.org/0000-0003-1563-0470
                Article
                00250
                10.11606/s1518-8787.2021055003067
                8522735
                45d26aeb-8472-49ef-9054-0b48b31db5db

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 19 August 2020
                : 27 November 2020
                Page count
                Figures: 0, Tables: 8, Equations: 0, References: 30
                Funding
                Funded by: Foundation for Research Support of the State of Santa Catarina
                Award ID: 2017TR1364
                Funding: Foundation for Research Support of the State of Santa Catarina (Fapesc - grant term 2017TR1364).
                Categories
                Original Article

                pregnant women,exercise,natural childbirth,cesarean section,premature birth,cross-sectional studies

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