Exercise in Placental Weight

Original Research ajog.
org
OBSTETRICS
Exercise in pregnancy: an association with
placental weight?
Gunvor Hilde, PT, PhD; Anne Eskild, MD, PhD; Katrine Mari Owe, PhD; Kari B, PT, PhD; Elisabeth K. Bjelland, PhD
BACKGROUND: Women with high levels of physical exercise have an in women exercising 6 times weekly (difference, 18.8 g; 95% confi-
increased demand for oxygen and nutrients. Thus, in pregnancies of dence interval, 12.0e25.5). Likewise, in nonexercisers in pregnancy
women with high levels of exercise, it is conceivable that the supply of week 30, crude mean placental weight was 684.9 g compared with 661.6
oxygen and nutrients to the placenta is suboptimal, and growth could be g in women exercising 6 times weekly (difference, 23.3 g; 95% confi-
impaired. dence interval, 14.9e31.6). The largest difference in crude mean
OBJECTIVE: The objective was to study the association of frequency of placental weight was seen between nonexercisers at both time points and
exercise during pregnancy with placental weight and placental to birth- women exercising 6 times weekly at both time points (difference, 31.7 g;
weight ratio. 95% confidence interval, 19.2e44.2). Frequency of exercise was not
STUDY DESIGN: This was a prospective study of 80,515 singleton associated with placental to birthweight ratio.
pregnancies in the Norwegian Mother and Child Cohort Study. Frequency CONCLUSION: We found decreasing placental weight with increasing
of exercise was self-reported by a questionnaire at pregnancy weeks 17 frequency of exercise in pregnancy. The difference in placental weight
and 30. Information on placental weight and birthweight was obtained by between nonexercisers and women with exercising 6 times weekly was
linkage to the Medical Birth Registry of Norway. small and may have no clinical implications.
RESULTS: Placental weight decreased with increasing frequency of
exercise (tests for trend, P < .001). For nonexercisers in pregnancy week Key words: birthweight, exercise, Norwegian Mother and Child Cohort
17, the crude mean placental weight was 686.1 g compared with 667.3 g Study, placental weight, pregnancy
E xercise increases the demand for

oxygen and nutrients in working
skeletal muscles.1,2 Thus, in pregnant
the results are inconsistent.9-11 The
ndings in the Danish study4 suggest
that placental weight may decrease with
(www.fhi.no/morogbarn).13 The women
were recruited at a routine fetal ultraso-
nographic examination in pregnancy
women with high exercise levels, it is increasing frequency of exercise in early weeks 17e19. This examination is part
conceivable that the supply of oxygen pregnancy (test for trend, P .060). A of the public antenatal health care pro-
and nutrients to the growing fetal- disproportional size of the placenta gram, offered free of charge to all preg-
placental unit may be suboptimal. The relative to birthweight may indicate an nant women living in Norway.
growth of the fetal-placental unit could unfavorable intrauterine environment The Norwegian Mother and Child
thereby be affected. Results from clin- for the fetus.12 Two small studies have Cohort Study had no exclusion criteria,
ical3 and observational studies4,5 suggest addressed a possible association of and 40.6% of all eligible women agreed
that women with high levels of exercise exercise during pregnancy with placental to participate. The present study is based
during pregnancy give birth to offspring weight relative to birthweight, but on version 8 of the quality-assured data
with slightly lower mean birthweight the results in these studies were les, released for research in 2014.
than women with low levels of exercise conicting.10,11 Data were obtained through 2 self-
without increasing the risk of having Therefore, we studied whether the administered questionnaires, distrib-
offspring with birthweight below 2500 g frequency of exercise in pregnancy is uted and returned by postal mail. The
or below the 10th percentile.4,6 associated with placental weight or with rst questionnaire was completed
The placenta plays a key role in fetal placental weight relative to birthweight. during the second trimester (mean 17.4
growth and development.7,8 Except for 1 We used information about exercise in weeks, SD 2.2 weeks) and included
epidemiological study in Denmark,4 pregnancy weeks 17 and 30 in a cohort questions about sociodemographic
studies on the association of exercise of 80,815 women with a singleton factors, general health, reproductive
during pregnancy with placental weight pregnancy. history, and leisure time exercise. The
are based on small study samples, and second questionnaire was completed
Materials and Methods during the third trimester (mean 30.6
Study design, study population, and weeks, SD 1.5 weeks) and included
Cite this article as: Hilde G, Eskild A, Owe KM, et al. follow-up questions about maternal health and
Exercise in pregnancy: an association with placental
During the years 1999e2008, all preg- leisure time exercise.
weight? Am J Obstet Gynecol 2017;216:168.e1-9.
nant women scheduled to give birth Information about placental weight,
0002-9378/$36.00 at 50 hospitals in Norway were targeted birthweight, and other pregnancy out-
2016 Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.ajog.2016.10.018 for recruitment to the Norwe- comes was obtained by linkage to the
gian Mother and Child Cohort Study Medical Birth Registry of Norway. This
168.e1 American Journal of Obstetrics & Gynecology FEBRUARY 2017

ajog.org OBSTETRICS Original Research
The associations of type of exercise

FIGURE
with placental weight were investigated
Flow chart of the study sample (n [ 80,515)
in the supplemental analyses. We
grouped the type of exercise as follows:
no exercise (strolling or none), brisk
walking, noneweight-bearing exercise
(cycling or swimming), low-impact ex-
ercise (prenatal aerobics, low-impact
aerobics, dancing, cross-country skiing,
or tness training), high-impact exercise
(running, jogging, orienteering, or ball-
games), and other exercise (horseback
riding or other). A mixed exercise group
included women without a single
dominant type of exercise (for example,
1 session of jogging and 1 session of
swimming weekly).
Hilde et al. Exercise and placental weight. Am J Obstet Gynecol 2017. We identied potentially confounding
factors by using directed acyclic graphs19
and assessed factors that may be associ-
registry contains information about all weight of the bowl was subtracted from ated with leisure-time exercise20 and
births in Norway after pregnancy week the sum weight. The placental to birth- with placental weight.21 Values for con-
16 as obtained by compulsory notica- weight ratio was calculated as placental founding factors were obtained from the
tion by the midwife or the doctor weight (grams) divided by birthweight questionnaires: BMI (kilograms per
attending the delivery.14 (grams). square meter) before pregnancy based
Of the women who agreed to partici- The main exposure variables were on self-reported weight and height,
pate in the Norwegian Mother and Child frequency of leisure time exercise in cigarette smoking during pregnancy
Cohort Study, 94.9% returned the rst pregnancy weeks 17 and 30. In the (yes/no), nausea with vomiting before
questionnaire and 91.0% returned the questionnaires, the participants reported pregnancy week 17 (yes/no), and years of
second questionnaire. Women with a how often they performed the following education (<13 years, 13e16 years, 17
singleton pregnancy, and who had exercises: strolling, brisk walking, years, and missing). Additionally, we
answered both questionnaires, were running (jogging or orienteering), bicy- obtained information from the Medical
eligible for our data analyses, a total of cling, training in a tness center, swim- Birth Registry of Norway on maternal
87,076 women. We excluded 6561 ming, aerobics (low or high impact), age (years), parity (para 0, para 1, and
women with missing information on 1 prenatal aerobic, dancing, cross-country para 2), maternal diabetes (including
or more of the following study factors: skiing, ball games, horseback riding, and diabetes type 1, type 2, and gestational
exercise in pregnancy week 17 (559 other exercises.16,17 diabetes) (yes/no), preeclampsia (yes/
missing), exercise in pregnancy week 30 Based on the denition of exercise no), and hemoglobin concentrations
(573 missing), placental weight (2317 by Caspersen et al,18 strolling was cate- <9 g/dL in pregnancy (yes/no).
missing), birthweight (52 missing), pre- gorized as nonexercise. We combined all
pregnancy body mass index (BMI) (2242 exercise frequencies (excluding strolling) Statistical methods
missing), and smoking during preg- into 1 variable categorized as the The associations of exercise frequency
nancy (1465 missing), leaving 80,515 following: never, 1e3 times monthly, and type with placental weight and with
singleton pregnancies to our study 1e2 times weekly, 3e5 times weekly, placental to birthweight ratio were esti-
sample (Figure). and 6 times weekly. Nonexercisers mated as crude and adjusted unstan-
were those who responded never to all dardized beta coefcients with 95%
Study factors exercises listed or who reported strolling condence intervals (CI) by applying
Placental weight in grams was our main only.16 We also combined the frequency linear regression analyses. The beta co-
outcome measure. The newborn and the of exercise at pregnancy weeks 17 and 30 efcients can be interpreted as a change
placenta were routinely weighed shortly into 1 variable, and we categorized the in placental weight (grams) by a change
after birth. According to Norwegian frequency at both time points as follows: in the category of exercise frequency.
standardized routines, the placentas never, <3 times weekly, 3 times Nonexercisers were used as the reference
were placed in a bowl immediately after weekly, and 6 times weekly. Switch in group. We performed separate analyses
birth and weighed fresh with mem- frequency of exercise from week 17 to in women with a BMI <25 kg/m2 and in
branes and umbilical cord attached, week 30 was dened as a change in women with a BMI 25 kg/m2 and also
independent of delivery mode.15 The frequency. in primiparous and in multiparous
FEBRUARY 2017 American Journal of Obstetrics & Gynecology 168.e2

Original Research OBSTETRICS ajog.org
women. We used the general linear

TABLE 1
model with polynomial contrast to assess
Characteristics of the study sample (n [ 80,515 singleton pregnancies)
trends in mean placental weight and
placental to birthweight ratio according Characteristics n, % Mean (SD)
to the increasing frequency of exercise. Maternal age, y 30.2 (4.5)
In additional analyses, we also studied 2
the association of exercise frequency Prepregnancy body mass index, kg/m 24.1 (4.3)
with the odds of having placental weight Parity
among the 5% smallest using logistic Para 0 36,880 (45.8)
regression analyses, and we used the Para 1 28,461 (35.3)
nonparametric trend test (nptrend) to
assess trends according to the increasing Para 2 15,174 (18.8)
frequency of exercise. We used the sta- Maternal diabetes 1158 (1.4)
tistical software packages IBM SPSS Preeclampsia 2873 (3.6)
version 20.0 (IBM Corp, Armonk, NY)
Hemoglobin <9 g/dL 289 (0.4)
and STATA 14 SE (StataCorp, College
Station, TX) for the statistical analyses. Nausea with vomiting 29,373 (36.5)
Educational level, y
Ethical considerations 12 26,125 (32.4)
The Norwegian Mother and Child
13e16 31,943 (39.7)
Cohort Study was approved by the
Regional Committee for Medical and 17 18,458 (22.9)
Health Research Ethics (S-97045; Missing 3989 (5.0)
S-95113) and by the Norwegian Data Smoking during pregnancy 6618 (8.2)
Protection Authority. All participants
Married /cohabitant 77,493 (96.2)
signed an informed consent form. This
a
particular study is approved by The Gestational length, wks 39.5 (1.7)
Norwegian Mother and Child Cohort Birthweight, g 3607.1 (541.5)
Study Steering Committee at the Nor- Placental weight, g 680.1 (197.0)
wegian Institute of Public Health (PDB
1595; reference 14/1185). Placental to birthweight ratio 0.1893 (0.0496)
a
n 80,200.
Hilde et al. Exercise and placental weight. Am J Obstet Gynecol 2017.
Results
Mean maternal age was 30.2 years (SD
4.5 years), 45.8% were rst-time
mothers, and in 68.6% of the women 6 times weekly was 18.8 g (95% CI, and women who exercised 6 times
the prepregnancy BMI was <25 kg/m2. 12.0e25.5) (test for trend, P < .001) weekly in pregnancy week 17 (Table 2).
Overall, the mean placental weight was (Table 2). After adjustment for the potentially
680.1 g (SD 197.0 g), and the mean A similar pattern was observed for confounding factors listed in the previ-
birthweight was 3607.1 g (SD 541.5 g) exercise in pregnancy week 30, and the ous text, the associations of exercise
(Table 1). crude decrease in the mean placental frequency in pregnancy with a placental
In pregnancy week 17, 22.4% of the weight from nonexercisers to women weight were attenuated, and the
women never took part in leisure-time exercising 6 times weekly was 23.3 g decreasing trend was no longer statisti-
exercise, and in pregnancy week 30 the (95% CI, 14.9e31.6) (test for trend, cally signicant for exercise frequency in
proportion of nonexercisers was 32.7%. P < .001). Women who exercised 6 pregnancy week 17 (Table 2).
A total of 13.3% of the women were times weekly in pregnancy week 17 and Prepregnancy BMI and parity were
nonexercisers at both time points in pregnancy week 30 had 31.7 g (95% the main confounding factors. In sepa-
(Table 2). The corresponding pro- CI, 19.2e44.2) lower placental weight rate analysis in women with a BMI <25
portions of women who exercised than nonexercising women (test for kg/m2 and in women with a BMI 25
6 times weekly were 5.0%, 2.9%, trend, P < .001). kg/m2, as well as in primiparous and
and 1.3%. Overall, the lowest mean placental multiparous women, the trend of
Crude mean placental weight weight was observed in women who decreasing placental weight with
decreased by increasing frequency of exercised 6 times weekly in both increasing frequency of exercise was still
exercise in pregnancy week 17, and the pregnancy week 17 and pregnancy week present (Table 3). Again, adjustment for
crude mean decrease in placental weight 30, followed by women who exercised other study factors attenuated the
from nonexercisers to women exercising 6 times weekly in pregnancy week 30 associations. However, a statistically

TABLE 2
The associations of exercise frequency during pregnancy with placental weight (n [ 80,515 singleton pregnancies)
Placental weight, g
Exercise frequency Pregnancies, Test for Adjusted Ba Test for
during pregnancy n, % Mean (SD) Crude B (95% CI) trend (95% CI) trend
Pregnancy week 17
Never (reference) 18,008 (22.4) 686.1 (189.7) 0.0 P < .001 0.0 P .079
1e3 times monthly 15,975 (19.8) 683.9 (194.1) e2.2 (e6.4 to 2.0) e0.7 (e4.9 to 3.5)
1e2 times weekly 23,683 (29.4) 681.2 (216.0) e4.9 (e8.7 to e1.1) e0.3 (e4.1 to 3.6)
6 times weekly 3997 (5.0) 667.3 (182.0) e18.8 (e25.5 to e12.0) e3.6 (e10.4 to 3.2)
Pregnancy week 30
1e3 times monthly 15,486 (19.2) 682.7 (181.4) e2.2 (e6.1 to 1.7) 0.9 (e3.0 to 4.8)
1e2 times weekly 21,581 (26.8) 680.4 (224.0) e4.5 (e8.0 to e1.0) 2.0 (e1.6 to 5.6)
Combined weeks 17 and 30
<3 times weekly 22,213 (27.6) 682.0 (214.8) e3.7 (e8.2 to 0.9) 2.0 (e2.6 to 6.5)
Change in frequency b
36,843 (45.8) 681.5 (195.3) e4.1 (e8.4 to 0.1) 1.7 (e2.6 to 5.9)
Linear regression analyses with associations presented as unstandardized beta coefficients with 95% confidence intervals and tests for trend using the general linear model with polynomial contrast.
B, beta coefficient; CI, confidence interval.
a
Adjusted for prepregnancy body mass index (kilograms per square meter), parity, diabetes, preeclampsia, maternal age, hemoglobin <9 g/dL, nausea with vomiting before pregnancy week 17,
education level, and smoking during pregnancy; b Switching from exercising <3 times weekly to 3 times weekly or vice versa from week 17 to week 30 or switching from never at 1 time point to
exercising at any frequency at the other time point.
signicant inverse trend was present in In supplemental analyses, we found pregnancy. We found no association of
women with a BMI <25 kg/m2 (test for that high-impact exercise in pregnancy exercise frequency with placental weight
trend, P .003) and in primiparous week 17 was associated with 21.2 g (95% relative to birthweight.
women (test for trend, P .037). CI, 15.5e26.9) lower placental weight The participation rate in the Norwe-
Frequency of exercise in pregnancy than no exercise (Supplemental Table). A gian Mother and Child Cohort Study
was also positively associated with the similar association was estimated for was rather low (40.6%). Women
risk (crude odds ratio) of having a high-impact exercise in pregnancy week younger than 25 years and women with
placenta among the 5% smallest (tests 30 (difference, 22.0 g; 95% CI, low socioeconomic status were under-
for trend, P < .01) (Table 4). The asso- 12.3e31.6). Among the women who represented.13 However, the mean
ciations were attenuated after adjusting reported exercise >6 times weekly in placental weight in our sample did not
for the other study factors. pregnancy week 17, a total of 29.3% also differ from the mean placental weight in
The mean placental to birthweight reported high-impact exercise (data not all singleton pregnancies in Norway
ratio was 0.1893 (SD 0.0496) (Table 1). shown). during the study period.22 We have no
We found no association of frequency reason to believe that the association of
of exercise with the placental to Comment exercise frequency with placental weight
birthweight ratio (Table 5). An adjust- In this prospective cohort study of in our sample is not valid for all preg-
ment for the potentially confounding 80,515 singleton pregnancies, we found nancies in Norway.23
factors did not alter this nding (data that placental weight decreased with Self-reported exercise often repre-
not shown). increasing frequency of exercise during sents an overestimate.24 Our estimated

TABLE 3
The associations of exercise frequency at pregnancy week 30 with placental weight stratified by maternal
prepregnancy BMI and parity
Placental weight, g
Exercise frequency at Pregnancies, Test for Test for
pregnancy week 30 n, % Mean (SD) Crude B (95% CI) trend Adjusted Ba (95% CI) trend
Prepregnancy BMI <25
kg/m2 (n 55,194)
1e3 times monthly 10,172 (18.4) 668.3 (176.3) e2.1 (e6.8 to 2.5) e0.9 (e5.5 to 3.8)
1e2 times weekly 15,201 (27.5) 668.7 (207.2) e1.7 (e5.9 to 2.4) 0.5 (e3.7 to 4.7)
6 times weekly 2003 (3.6) 656.0 (150.0) e14.4 (e23.1 to e5.7) e9.7 (e18.5 to e0.9)
Prepregnancy BMI 25
kg/m2 (n 25,321)
Never (reference) 9974 (39.4) 708.6 (202.5) 0.0 P .127 0.0 P .429
1e3 times monthly 5314 (21.0) 710.2 (187.7) 1.6 (e5.5 to 8.7) 3.0 (e4.1 to 10.0)
1e2 times weekly 6380 (25.2) 708.2 (257.5) e0.4 (e7.1 to 6.3) 2.1 (e4.6 to 8.9)
3e5 times weekly 3325 (13.1) 698.3 (192.1) e10.3 (e18.7 to e2.0) e6.0 (e14.4 to 2.4)
6 times weekly 328 (1.3) 696.0 (160.6) e12.6 (e36.1 to 10.8) e6.1 (e29.5 to 17.3)
Primiparous women,
para 1 (n 36,880)
Never (reference) 9539 (25.9) 668.0 (193.7) 0.0 P < .001 0.0 P .037
1e3 times monthly 6579 (17.8) 666.7 (174.0) e1.3 (e7.4 to 4.7) 0.3 (e5.7 to 6.3)
1e2 times weekly 10,768 (29.2) 665.4 (210.8) e2.6 (e7.9 to 2.7) 0.1 (e5.3 to 5.4)
Multiparous women,
para 2 (n 43,635)
Never (reference) 16,776 (38.4) 694.5 (193.7) 0.0 P .042 0.0 P .606
1e3 times monthly 8907 (20.4) 694.5 (185.8) 0.0 (e5.1 to 5.2) 1.2 (e4.0 to 6.3)
1e2 times weekly 10,813 (24.8) 695.3 (235.5) 0.8 (e4.0 to 5.6) 3.5 (e1.4 to 8.3)
6 times weekly 765 (1.8) 684.2 (174.3) e10.3 (e24.8 to 4.3) e0.1 (e14.6 to 14.3)
Linear regression analyses with associations presented as unstandardized beta coefficients with 95% confidence intervals and tests for trend using the general linear model with polynomial contrast.
B, beta coefficient; BMI, body mass index; CI, confidence interval.
a
Adjustments for diabetes, preeclampsia, maternal age, hemoglobin <9 g/dL, nausea with vomiting before pregnancy week 17, educational level, and smoking during pregnancy; additional
adjustment in prepregnancy BMI strata was parity, whereas additional adjustment in parity strata was prepregnancy BMI.
associations of exercise with placental Cohort.17 By using a prospective study factors. The most important con-
weight could therefore represent un- design, the frequency of exercise is un- founding factors were prepregnancy
derestimates. However, the questions likely to be systematically erroneously BMI and parity. We made separate
used to assess exercise frequency in our reported by placental weight. analyses among women with BMI <25
study have shown acceptable validity The trend of decreasing placental and BMI 25 kg/m2 in addition to
when compared with an accelerometer weight with increasing frequency of among para 0 and para 1 women. We
in a subsample of pregnant women exercise was attenuated after an found decreasing placental weight with
within the Norwegian Mother and Child adjustment for potentially confounding the increasing frequency of exercise also

TABLE 4
The associations of exercise frequency during pregnancy with 5th percentile placental weight (80,515 singleton
pregnancies)
Placental weight, 5th percentile
Exercise frequency
during pregnancy Pregnancies, n Pregnancies, n, % Crude OR (95% CI) Adjusted ORa (95% CI)
Pregnancy week 17
Never (reference) 18,008 795 (4.4) 1.0 1.0
1e3 times monthly 15,975 700 (4.4) 0.99 (0.89e1.10) 0.99 (0.89e1.09)
1e2 times weekly 23,683 1154 (4.9) 1.11 (1.01e1.22) 1.06 (0.96e1.16)
3e5 times weekly 18,852 958 (5.1) 1.16 (1.05e1.28) 1.04 (0.95e1.15)
6 times weekly 3997 235 (5.9) 1.35 (1.16e1.57) 1.14 (0.97e1.32)
Test for trend, P < .001
Pregnancy week 30
Never (reference) 26,315 1225 (4.7) 1.0 1.0
1e3 times monthly 15,486 704 (4.5) 0.98 (0.89e1.07) 0.95 (0.86e1.04)
1e2 times weekly 21,581 985 (4.6) 0.98 (0.90e1.07) 0.91 (0.84e1.00)
3e5 times weekly 14,802 785 (5.3) 1.15 (1.05e1.26) 1.01 (0.91e1.11)
6 times weekly 2331 143 (6.1) 1.34 (1.12e1.60) 1.11 (0.92e1.33)
Test for trend, P < .001
Never (reference) 10,710 491 (4.6) 1.0 1.0
<3 times weekly 22,213 1038 (4.7) 1.02 (0.91e1.14) 0.97 (0.86e1.08)
b
Change in frequency 36,843 1700 (4.6) 1.01 (0.91e1.12) 0.94 (0.85e1.05)
3 times weekly 9698 545 (5.6) 1.24 (1.09e1.40) 1.06 (0.93e1.20)
6 times weekly 1051 68 (6.5) 1.44 (1.11e1.87) 1.15 (0.88e1.50)
Test for trend, P .001
Crude and adjusted odds ratios are estimated by using logistic regression analyses for the association between exercise frequency during pregnancy and the 5th percentile placental weight. Trends
according to increasing frequency of exercise were assessed by using the nonparametric trend test.
CI, confidence interval; OR, odds ratio.
a
Odds ratios were adjusted for prepregnancy body mass index (kilograms per square meter), parity, diabetes, preeclampsia, maternal age, hemoglobin <9 g/dL, nausea with vomiting before
pregnancy week 17, educational level, and smoking during pregnancy; b Switching from exercising <3 times weekly to 3 times weekly or vice versa from week 17 to week 30 or switching from
never at 1 time point to exercising at any frequency at the other time point.
in these subgroups of women; however, Comparison with other studies reported. Whether exercise in the third
the trend was not statistically signicant A study of 79,692 pregnancies from the trimester of pregnancy is associated with
in all subgroups. Danish National Birth Cohort reported placental weight has, to our knowledge,
Duration of pregnancy is closely decreasing placental weight with not previously been studied.
linked to placental weight. In the Nor- increasing frequency of exercise in the
wegian Mother and Child Cohort rst part of the pregnancy (test for trend, Interpretation
Study, exercise was not associated with P .060).4 Other studies that have We found decreasing placental weight
the duration of pregnancy and thus was addressed the association of exercise in with increasing frequency of exercise
not a confounding factor.16 Neverthe- pregnancy with placental weight are during pregnancy. Placental to birth-
less, we made supplemental analyses small, and the results from these studies weight ratio, however, was not associated
restricted to pregnancies lasting 37 are conicting.9-11 The association of with the frequency of exercise. This
weeks or longer, and the estimated as- exercise in pregnancy with placental to nding suggests that birthweight and
sociations in these pregnancies were not birthweight ratio were estimated in 2 of placental weight decrease in similar
different from the sample as a whole the previously mentioned studies, and patterns by the increased frequency of
(data not shown). both a high10 and low11 ratio was exercise.

TABLE 5
The associations of exercise frequency during pregnancy with placental to birthweight ratio (n [ 80,515 singleton
pregnancies)
Placental to birthweight ratio
Exercise frequency Pregnancies, n, % Mean ratio (SD) Crude B (95% CI) Test for trend
Pregnancy week 17
Never (reference) 18,008 (22.4) 0.1903 (0.0489) 0.0 P .267
1e3 times monthly 15,975 (19.8) 0.1890 (0.0487) e0.001 (e0.002 to e0.001)
1e2 times weekly 23,683 (29.4) 0.1893 (0.0547) e0.001 (e0.002 to 0.001)
3e5 times weekly 18,852 (23.4) 0.1887 (0.0467) e0.002 (e0.003 to e0.001)
6 times weekly 3997 (5.0) 0.1894 (0.0453) e0.001 (e0.003 to 0.001)
Pregnancy week 30
1e3 times monthly 15,486 (19.2) 0.1889 (0.0450) e0.001 (e0.002 to 0.001)
<3 times weekly 22,213 (27.6) 0.1890 (0.0545) e0.001 (e0.003 to e0.001)
Change in frequencya 36,843 (45.8) 0.1895 (0.0483) e0.001 (e0.002 to 0.001)
3 times weekly 9698 (12.0) 0.1884 (0.0465) e0.002 (e0.003 to e0.001)
Linear regression analyses with associations presented as unstandardized beta coefficients with 95% confidence intervals and P value for trend using the general linear model with polynomial
contrast.
a
Switching from exercising <3 times weekly to 3 times weekly or vice versa from week 17 to week 30 or switching from never at 1 time point to exercising at any frequency at the other time point.
A high frequency of exercise in preg- exercise levels have better cardiovascular exercise >6 times weekly may harm the
nancy has been associated with a slightly tness than women who do not exercise.26 pregnancy or that the present recom-
lower mean birthweight3-6 and with a Therefore, it is plausible that the blood mendations of at least 20e30 minutes of
reduced risk of having a newborn with a ow to the uterus is increased. If so, the daily exercise at moderate intensity in
high birthweight.4,6,25 Our results sug- availability of oxygen and nutrition for the pregnancy should be changed.27 How-
gest that pregnant women who exercise fetal-placental circulation may be normal ever, we cannot completely rule out
at high levels have increased odds of or even increased, although the placenta is possible adverse effects of very high
having a placenta among the 5% small- small. Unfortunately, we had no infor- exercise volumes on placental growth.
est. Thus, our ndings suggest that high mation about the blood ow to the uterus In conclusion, placental weight
exercise frequency may lead to a shift in or about the fetal-placental circulation. decreased with increasing frequency of
the placental weight distribution toward We also lacked specic information exercise in this study of 80,515 preg-
smaller placentas. about the intensity and duration of nancies. However, the difference
In previous studies, both high and low exercise. We used the type of exercise as a in mean placental weight was small
placental to birthweight ratios have proximate measure for such informa- between nonexercisers and women
been linked to adverse pregnancy out- tion. Only women who engaged in with daily exercise. n
comes.12 Because we found no association high-impact exercise had a signicant
of exercise frequency with placental to decrease in placental weight, and a large References
birthweight ratio, pregnancies of high- proportion of the high-impact exercisers 1. Rowell LB. Human cardiovascular adjust-
frequency exercisers may not be high- were also frequent exercisers. Hence, our ments to exercise and thermal stress. Physiol
risk pregnancies. Women with high results give little reason to believe that Rev 1974;54:75-159.

2. Saltin B, Rowell LB. Functional adaptations to Norwegian Mother and Child Cohort Study future directions. Res Q Exerc Sport
physical activity and inactivity. Fed Proc (MoBa). Int J Epidemiol 2006;35:1146-50. 2000;71(Suppl 2):1-14.
1980;39:1506-13. 14. Irgens LM. The Medical Birth Registry of 25. Owe KM, Nystad W, Bo K. Association be-
3. Thangaratinam S, Rogozinska E, Jolly K, et al. Norway. Epidemiological research and surveil- tween regular exercise and excessive newborn
Effects of interventions in pregnancy on maternal lance throughout 30 years. Acta Obstet Gynecol birth weight. Obstet Gynecol 2009;114:770-6.
weight and obstetric outcomes: meta-analysis Scand 2000;79:435-9. 26. Garber CE, Blissmer B, Deschenes MR,
of randomised evidence. BMJ 2012;344:e2088. 15. Staff A, Harsem NK, Roald B, Staer-Jensen et al. American College of Sports Medicine po-
4. Juhl M, Olsen J, Andersen PK, Nohr EA, J, Jeansson S. Placenta. Veileder i fdselshjelp sition stand. Quantity and quality of exercise for
Andersen AM. Physical exercise during preg- [Placenta. Guidelines for obstetric care 2008] [In developing and maintaining cardiorespiratory,
nancy and fetal growth measures: a study within Norwegian]. 2008;40:151-5. musculoskeletal, and neuromotor tness in
the Danish National Birth Cohort. Am J Obstet 16. Owe KM, Nystad W, Skjaerven R, Stigum H, apparently healthy adults: guidance for pre-
Gynecol 2010;202:63.e1-8. Bo K. Exercise during pregnancy and the scribing exercise. Med Sci Sports Exerc
5. Fleten C, Stigum H, Magnus P, Nystad W. gestational age distribution: a cohort study. Med 2011;43:1334-59.
Exercise during pregnancy, maternal prepreg- Sci Sports Exerc 2012;44:1067-74. 27. American College of Obstetricians and Gy-
nancy body mass index, and birth weight. 17. Brantsaeter AL, Owe KM, Haugen M, necologists. Physical activity and exercise dur-
Obstet Gynecol 2010;115:331-7. Alexander J, Meltzer HM, Longnecker MP. ing pregnancy and the postpartum period.
6. Wiebe HW, Boule NG, Chari R, Validation of self-reported recreational exercise ACOG Committee opinion no. 650. Obstet
Davenport MH. The effect of supervised prenatal in pregnant women in the Norwegian Mother Gynecol 2015;126:e135-42.
exercise on fetal growth: a meta-analysis. and Child Cohort Study. Scand J Med Sci
Obstet Gynecol 2015;125:1185-94. Sports 2010;20:e48-55. Author and article information
7. Wheeler T, Elcock CL, Anthony FW. Angio- 18. Caspersen CJ, Powell KE, From the Department of Obstetrics and Gynecology,
genesis and the placental environment. Placenta Christenson GM. Physical activity, exercise, Akershus University Hospital, Lrenskog (Drs Hilde and
1995;16:289-96. and physical tness: denitions and distinctions Eskild), Institute of Clinical Medicine, University of Oslo,
8. Pugh CW, Ratcliffe PJ. Regulation of angio- for health-related research. Public Health Rep Oslo (Dr Eskild), Norwegian National Advisory Unit on
genesis by hypoxia: role of the HIF system. Nat 1985;100:126-31. Womens Health, Oslo University Hospital, Rikshospitalet,
Med 2003;9:677-84. 19. Shrier I, Platt RW. Reducing bias through Oslo (Dr Owe), Domain for Mental and Physical Health,
9. Collings CA, Curet LB, Mullin JP. Maternal directed acyclic graphs. BMC Med Res Meth- Norwegian Institute of Public Health, Oslo (Drs Owe and
and fetal responses to a maternal aerobic exer- odol 2008;8:70. Bjelland), Department of Sports Medicine, Norwegian
cise program. Am J Obstet Gynecol 1983;145: 20. Owe KM, Nystad W, Bo K. Correlates of School of Sport Sciences, Oslo (Dr B), and Health
702-7. regular exercise during pregnancy: the Norwe- Services Research Unit, Akershus University Hospital,
10. Clapp JF 3rd, Capeless EL. Neonatal mor- gian Mother and Child Cohort Study. Scand J Lrenskog (Dr Bjelland), Norway.
phometrics after endurance exercise during Med Sci Sports 2009;19:637-45. Received May 2, 2016; revised Oct. 5, 2016;
pregnancy. Am J Obstet Gynecol 1990;163: 21. McNamara H, Hutcheon JA, Platt RW, accepted Oct. 17, 2016.
1805-11. Benjamin A, Kramer MS. Risk factors for high This study was supported by South-Eastern Norway
11. Ramirez-Velez R, Bustamante J, and low placental weight. Paediatr Perinat Epi- Regional Health Authority grant 273910. The Norwegian
Czerniczyniec A, Aguilar de Plata AC, Lores- demiol 2014;28:97-105. Mother and Child Cohort Study is supported by the
Arnaiz S. Effect of exercise training on eNOS 22. Haavaldsen C, Samuelsen SO, Eskild A. The Norwegian Ministry of Health and the Ministry of
expression, NO production and oxygen meta- association of maternal age with placental Education and Research, National Institutes of Health/
bolism in human placenta. PLoS One 2013;8: weight: a population-based study of 536,954 National Institute of Environmental Health Sciences
e80225. pregnancies. BJOG 2011;118:1470-6. contract N01-ES-75558, National Institutes of Health/
12. Haavaldsen C, Samuelsen SO, Eskild A. 23. Nilsen RM, Vollset SE, Gjessing HK, et al. National Institute of Neurological Disorders and Stroke
Fetal death and placental weight/birthweight Self-selection and bias in a large prospective grant 1 UO1 NS 047537-01 and grant 2 UO1 NS
ratio: a population study. Acta Obstet Gynecol pregnancy cohort in Norway. Paediatr Perinat 047537-06A1.
Scand 2013;92:583-90. Epidemiol 2009;23:597-608. The authors report no conflict of interest.
13. Magnus P, Irgens LM, Haug K, Nystad W, 24. Sallis JF, Saelens BE. Assessment of phys- Corresponding author: Elisabeth K. Bjelland, PhD.
Skjaerven R, Stoltenberg C. Cohort prole: the ical activity by self-report: status, limitations, and Elisabeth.Krefting.Bjelland@ahus.no

SUPPLEMENTAL TABLE
The associations of exercise type during pregnancy with placental weight (n [ 80,515 singleton pregnancies)
Placental weight, g
Exercise type during pregnancy Pregnancies, n, % Mean (SD) Crude B (95% CI) Adjusted Ba (95% CI)
Pregnancy week 17
No exercise (reference) 18,008 (22.4) 686.1 (189.7) 0.0 0.0
Brisk walking 12,774 (15.9) 677.6 (222.4) e8.4 (e13.2 to 3.7) e2.0 (e6.7 to 2.7)
Noneweight-bearing exercise 8363 (10.4) 677.5 (186.6) e8.5 (e13.4 to e3.7) e4.1 (e8.9 to 0.7)
Low-impact exercise 9642 (12.00) 677.2 (199.0) e8.8 (e13.7 to e4.0) 1.5 (e3.4 to 6.4)
High-impact exercise 4367 (5.4) 664.9 (168.2) e21.2 (e26.9 to e15.5) e8.5 (e14.3 to e2.8)
Other exercise 3878 (4.8) 674.4 (180.3) e11.7 (e18.0 to e5.4) e2.4 (e8.7 to 3.8)
Mixed exercise 23,483 (29.2) 682.8 (198.1) e3.2 (e7.0 to 0.5) e0.5 (e4.2 to 3.2)
Pregnancy week 30
No exercise (reference) 26,315 (32.7) 684.9 (187.5) 0.0 0.0
Brisk walking 10,558 (13.1) 672.1 (191.8) e12.7 (e17.0 to e8.4) e2.7 (e7.0 to 1.6)
Noneweight-bearing exercise 6859 (8.5) 682.8 (244.6) e2.1 (e8.3 to 4.1) 2.7 (e3.5 to 8.9)
Low-impact exercise 8781 (10.9) 672.9 (214.3) e12.0 (e17.0 to e7.0) e0.4 (e5.4 to 4.6)
High-impact exercise 899 (1.1) 662.9 (143.7) e22.0 (e31.6 to e12.3) e8.6 (e18.0 to 0.9)
Other exercise 5500 (6.8) 680.4 (168.6) e4.4 (e9.4 to 0.6) 4.7 (e0.3 to 9.6)
Mixed exercise 21,603 (26.8) 681.0 (195.0) e3.8 (e7.3 to e0.4) 0.7 (e2.8 to 4,1)
Linear regression analyses with associations presented as unstandardized beta coefficients with 95% confidence intervals.
a
Adjusted for prepregnancy body mass index (kilograms per square meter), parity, diabetes, preeclampsia, maternal age, hemoglobin <9 g/dL, nausea with vomiting before pregnancy week 17,
educational level, and smoking during pregnancy.

Exercise in Placental Weight

Hochgeladen von

Dokumentinformationen

Copyright

Verfügbare Formate

Dieses Dokument teilen

Dokument teilen oder einbetten

Freigabeoptionen

Stufen Sie dieses Dokument als nützlich ein?

Sind diese Inhalte unangemessen?

Copyright:

Verfügbare Formate

Exercise in Placental Weight

Hochgeladen von

Copyright:

Verfügbare Formate

Original Research ajog.

E xercise increases the demand for

168.e1 American Journal of Obstetrics & Gynecology FEBRUARY 2017

The associations of type of exercise

FEBRUARY 2017 American Journal of Obstetrics & Gynecology 168.e2

women. We used the general linear

168.e3 American Journal of Obstetrics & Gynecology FEBRUARY 2017

FEBRUARY 2017 American Journal of Obstetrics & Gynecology 168.e4

168.e5 American Journal of Obstetrics & Gynecology FEBRUARY 2017

FEBRUARY 2017 American Journal of Obstetrics & Gynecology 168.e6

168.e7 American Journal of Obstetrics & Gynecology FEBRUARY 2017

FEBRUARY 2017 American Journal of Obstetrics & Gynecology 168.e8

168.e9 American Journal of Obstetrics & Gynecology FEBRUARY 2017

Das könnte Ihnen auch gefallen