Relationship Between Moderate-to-Vigorous Physical Activity During Pregnancy

and Gestational Weight Gain and Postpartum Weight Retention

Madeline Kinzly , Esther Moe , Maggie McLain McDonnell , Kate Haas , Linn Goldberg , Diane Stadler
1

Graduate Programs in Human Nutrition, 2Division of Health Promotion and Sports Medicine,
3
Oregon Center for Clinical & Translational Research (OCTRI)
Oregon Health & Science University, Portland, OR

1,2

Principal Findings
Fewer than 50% of participants met the physical activity
recommendations at any time point during pregnancy.

Daily Minutes of MVPA

Only two participants met the physical activity

recommendation during each trimester of pregnancy.
Normal weight participants participated in more MVPA than
overweight/obese participants at each trimester of
pregnancy and at three-months postpartum.

Maternal Characteristics
Normal weight
(BMI<25kgm2)
(n=14)

Objective

Overweight
Obese
(BMI25 kg/m2)
(n=13)

(n=11)

Exceeded weight
gain
recommendation

Within weight gain

recommendation

(n=16)

Pre-pregnancy
weight (kg)*

59.3 6.7
(45.570.5)

76.1 10.5
(56.897.3)

60.4 5.3
(50.968.8)

72.2 13.3
(45.597.3)

Pre-pregnancy
BMI
(kg/m2)

22 1.3
(18.924.0)

28 2.7
(25.135.1)

22 1.8
(18.925.1)

27 3.8
(20.935.1)

Background

Weight gain during

pregnancy (% IOM
recommendation)**

99 28%
(63157)

151 61.5%
(26252)

75 21%
(2696)

159 40%
(105252)

MVPA 30 minutes/day on most if not all days of the week

is recommended during pregnancy to promote appropriate
weight gain and improve maternal and infant outcomes
(ACOG, 2009).

Weight at threemonths postpartum

(% pre-pregnancy
weight)

108 6
(101.7118)

107 6.7
(88.6116.8)

103 5
(88.6108.7)

110 4
(105.3118.0)

Weight loss by
three-months
postpartum (kg)

11.2 10.7
(7.217.5)

11.0 2.8
(5.115.0

9.8 2.4
(5.113.5)

12.1 2.6
(8.117.5)

26.36 0.14%
(4.554.5)

35.9 9.2%
(24.225.5)

20.3 8.4%
(4.530.8)

37.3 0.10%
(21.354.5)

To determine whether moderate-to-vigorous physical activity

(MVPA) performed throughout pregnancy is related to prepregnancy weight status, appropriate gestational weight gain
and postpartum weight retention.

Only about 15% of women meet this physical activity

recommendation during pregnancy (Lewis et al. 2008).
Hayes et al. (2015) reported that physical activity in early
pregnancy was the factor most strongly associated with
physical activity later in gestation.
Ruifork et al. (2014) observed that 53% of women in a
randomized controlled trial, gained more weight than
advised by the Institute of Medicine (IOM), and excessive
weight gain is even more common among women who are
overweight or obese.
Van Poppel et al. (2008) demonstrated that in
overweight/obese pregnant women, MVPA was associated
with improved insulin sensitivity, insulin response, and
decreased triglycerides at 32 weeks of pregnancy.

Weight loss
(% gestational
weight gain)

Mean SD (range)
Self-reported pre-pregnancy weight
Based on 2009 Institute of Medicine Pregnancy Weight Gain Recommendations
Significantly different from normal weight women (p-value <0.05)
Significantly different from women who met the weight gain recommendations (p-value <0.05)
** One women gained less than the IOM recommendations for weight gain
One women lost an excessive amount of weight postpartum and was excluded

Meeting PA Recommendations Based on

Pre-Pregnancy Weight Status and
Weight Gain During Pregnancy

The mean MVPA for some participants was 30

minutes/day but they did not meet the physical activity
recommendation because they didnt perform 30
minutes/day at least 4 days a week.
In the first trimester of pregnancy, normal weight
participants were 9 times more likely (p=0.014) to meet the
physical activity recommendation than overweight/obese
participants.

Odds of Meeting MVPA Based on PrePregnancy Weight Status

(Normal Weight vs Overweight/Obese)
Estimated odds
ratio

P-value

st

9.00

0.014

(1.40 58.0)

nd

7.50

0.160

(0.61 384)

3.12

0.446

(0.36 39.4)

1 Trimester
2 Trimester*
rd

3 Trimester*

Methods
Inclusion criteria: uncomplicated, singleton pregnancy,
OHSU employees or spouses of OHSU employees.
Physical activity was measured in 28 women using
Actigraph accelerometers worn on the right hip during
waking hours for 7 consecutive days during each trimester
and at three-months postpartum.
Physical activity data from women who wore the
accelerometer for at least 6 hours/day for 4 days in each
7-day period was included in the analysis.

95% CI

*Based on Fishers exact test

Participants with a higher average of MVPA at three-months

postpartum lost more of the weight they gained during
pregnancy (see figure Impact of Postpartum MVPA on
Return to Pre-Pregnancy Weight).
Given the relationships between MVPA and GWG and
return to pre-pregnancy weight, all women with
uncomplicated pregnancies, especially those who are
overweight or obese before pregnancy, should be
encouraged to be physically active during and after
pregnancy.

Impact of Postpartum MVPA on Return

to Pre-Pregnancy Weight

Recommendations for Future Studies

Women should keep a physical activity log that can be
used to verify accelerometer data and explain types of
activities associated with MVPA.
Redefine physical activity recommendations to be the:
Average of 30 minutes of MVPA/day, or
Accumulation of 150 minutes of MVPA/week.
More emphasis on physical activity is needed to help
women integrate MVPA into their lifestyles during and after
pregnancy.
Larger longitudinal studies with more robust interventions
are needed to assess the impact of physical activity during
and after pregnancy on maternal weight gain and
postpartum weight retention and on immediate and longerterm maternal and infant outcomes.

Minute-by-minute physical activity intensity (light, moderate,

and vigorous) was based on counts per minute defined by
Troiano (2008).
Women were characterized as normal weight or
overweight/obese based on pre-pregnancy BMI, and as
meeting or exceeding the 2009 IOM gestational weight gain
recommendations.
Acknowledgements
Funded in part by The Bob and Charlee Moore Institute for Nutrition & Wellness.
EM supported in part by AHRQ K12 HS019456 01
This research was made possible by support from the Oregon Clinical and Translational
Research Institute (OCTRI), grant number UL1TR000128 from the National Center for
Advancing Translational Sciences (NCATS), a component of the National Institutes of
Health (NIH), and the NIH Roadmap for Medical Research.

Contact:
Madeline Kinzly
Graduate Programs
in Human Nutrition
kinzly@ohsu.edu