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

Schmidt, Tauana Prestes; Tuon, Talita; Wagner, Katia J. Pudla; Boing, Antonio Fernando; Danielewicz, Ana Lúcia

doi:10.11606/s1518-8787.2021055003067

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Sumário

Original Article • Rev. Saúde Pública 55 • 2021 • https://doi.org/10.11606/s1518-8787.2021055003067 copy

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

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.

Pregnant Women; Exercise; Natural Childbirth; Cesarean Section; Premature Birth; Cross-Sectional Studies

Maternal characteristics	n (%)	Cesarean delivery % (95%CI)	Premature birth % (95%CI)	Low birth weight % (95%CI)
Total sample (n = 3,580)
Age (years) (n = 3,524)
≤ 18	472 (13.4)	33.5 (29.4–37.9)	7.1 (5.1–9.9)	5.9 (4.1–8.5)
19–34	2,548 (72.3)	43.0 (41.1–44.9)	7.2 (6.2–8.3)	5.0 (4.2–5.9)
≥ 35	504 (14.3)	50.7 (46.3–55.0)	10.7 (8.2–13.8)	5.5 (3.7–7.9)
Marital status (n = 3,576)
Married/with a partner	2,916 (81.5)	44.0 (42.2–45.8)	7.6 (6.6–8.6)	5.6 (4.8–6.5)
Single/divorced/widow	660 (18.5)	37.5 (33.9–41.3)	8.2 (6.3–10.6)	3.8 (2.5–5.6)
Education (years of study) (n = 3,529)
≤ 9	1,218 (34.5)	39.6 (36.9–42.4)	7.3 (5.9–8.9)	5.5 (4.4–6.9)
10–12	1,853 (52.5)	42.4 (40.2–44.7)	8.2 (7.1–9.6)	5.0 (4.1–6.1)
≥ 13	458 (13.0)	51.9 (47.3–56.5)	5.9 (3.9–8.5)	4.9 (3.3–7.5)
Smoking during pregnancy (n = 3,555)
Yes	330 (9.3)	35.1 (30.2–40.5)	9.6 (6.8–13.4)	9.9 (7.0–13.8)
No	3,219 (90.7)	43.6 (41.9–45.3)	7.5 (6.6–8.4)	4.8 (4.1–5.6)
Alcohol use during pregnancy (3,556)
Yes	255 (7.2)	37.6 (31.9–43.8)	5.9 (3.6–9.6)	4.9 (2.8–8.6)
No	3,301 (92.8)	43.1 (41.5–44.9)	7.9 (7.0–8.9)	5.2 (4.5–6.0)
BMI before pregnancy (n = 3,322)
Low weight/adequate weight	1,752 (52.7)	37.3 (35.1–39.6)	6.8 (5.7–8.1)	5.5 (4.5–6.7)
Overweight	893 (26.9)	43.9 (40.7–47.3)	7.5 (5.9–9.4)	4.9 (3.6–6.6)
Obesity	677 (20.4)	56.8 (53.0–60.5)	8.8 (6.8–11.2)	3.8 (2.5–5.6)
Number of previous pregnancies (n = 3,579)
0	1,126 (31.5)	42.2 (39.3–45.1)	6.3 (5.0–7.9)	5.8 (4.5–7.4)
≥ 1	2,453 (68.5)	43.2 (41.2–45.1)	8.3 (7.3–9.5)	4.9 (4.2–5.9)
Physical activity before pregnancy (n = 3,546)
Yes	872 (24.6)	43.8 (40.5–47.2)	8.9 (7.2–11.0)	5.3 (3.9–7.1)
No	2,674 (75.4)	42.5 (40.6–44.4)	7.4 (6.4–8.4)	5.1 (4.3–6.1)
High-risk pregnancy (n = 3,538)
Yes	773 (21.9)	56.0 (52.5–59.5)	13.6 (11.4–16.3)	8.3 (6.5–10.6)
No	2,765 (78.1)	39.3 (37.5–41.1)	5.9 (5.1–6.9)	4.4 (3.5–5.2)
Gestational diabetes (n = 3,521)
Yes	332 (9.4)	56.5 (51.1–61.7)	11.6 (8.6–15.6)	5.7 (3.6–8.9)
No	3,189 (90.6)	41.5 (39.8–43.2)	7.3 (6.5–8.3)	5.1 (4.4–5.9)
Eclampsia (n = 3,552)
Yes	561 (15.8)	57.5 (53.3–61.5)	13.0 (10.5–16.1)	9.3 (7.1–12.1)
No	2,991 (84.2)	40.2 (38.4–41.9)	6.7 (5.8–7.6)	4.4 (3.7–5.2)
Physical activity during pregnancy (n = 3,573)
Yes	735 (20.6)	39.9 (36.4–43.5)	7.5 (5.8–9.7)	4.5 (3.3–6.5)
No	2,838 (79.4)	43.5 (41.7–45.4)	7.7 (6.7–8.7)	5.3 (4.6–6.3)
Physical activity - first trimester (n = 3,568)
Yes	578 (16.2)	41.0 (37.0–45.1)	8.3 (6.3–10.8)	4.2 (2.8–6.3)
No	2,990 (83.8)	43.2 (41.4–44.9)	7.6 (6.7–8.6)	5.4 (4.6–6.3)
Physical activity - second trimester (n = 3,566)
Yes	548 (15.4)	39.6 (35.6–43.8)	7.9 (5.9–10.5)	4.1 (2.7–6.2)
No	3,018 (84.6)	43.4 (41.6–45.2)	7.6 (6.7–8.6)	5.4 (4.6–6.4)
Physical activity - third trimester (n = 3,567)
Yes	456 (12.8)	35.5 (31.3–40.0)	7.3 (5.2–10.1)	3.3 (1.9–5.5)
No	3,111 (87.2)	43.9 (42.1–45.6)	7.7 (6.8–8.7)	5.5 (4.7–6.4)

	Crude analysis OR (95%CI)	Adjusted analysis^a OR (95%CI)
PA during pregnancy
Yes	1.00	1.00
No	1.16 (0.99–1.37)	1.20 (0.98–1.46)
PA - first trimester
Yes	1.00	1.00
No	1.09 (0.91–1.31)	1.16 (0.93–1.44)
PA - second trimester
Yes	1.00	1.00
No	1.17 (0.97–1.40)	1.24 (0.99–1.55)
PA - third trimester
Yes	1.00	1.00
No	1.41 (1.15–1.74)^b	1.40 (1.10–1.76)^b

	Crude analysis OR (95%CI)	Adjusted analysis^a OR (95%CI)
PA during pregnancy
Yes	1.00	1.00
No	1.16 (0.78–1.72)	1.34 (0.83–2.15)
PA - first trimester
Yes	1.00	1.00
No	1.28 (0.82–2.01)	1.74 (0.99–3.05)
PA - second trimester
Yes	1.00	1.00
No	1.35 (0.85–2.14)	1.49 (0.86–2.59)
PA - third trimester
Yes	1.00	1.00
No	1.70 (0.98–2.96)	1.99 (1.04–3.79)^b

	Crude analysis OR (95%CI)	Adjusted analysis^a OR (95%CI)
PA during pregnancy
Yes	1.00	1.00
No	1.02 (0.75–1.38)	1.15 (0.78–1.69)
PA - first trimester
Yes	1.00	1.00
No	0.91 (0.65–1.26)	1.07 (0.71–1.62)
PA - second trimester
Yes	1.00	1.00
No	0.96 (0.68–1.34)	1.08 (0.71–1.63)
PA - third trimester
Yes	1.00	1.00
No	1.06 (0.73–1.55)	1.12 (0.72–1.74)

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E-mail: revsp@usp.br

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[1] Correspondence: 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