File Name: the relationship of heg and gdm mgt by acog .zip
Obstetrics Triple A
The participants filled in a validated self-administered questionnaire, physical activity pregnancy questionnaire PAPQ in gestation, weeks 32— The questionnaire contained 53 questions with one particular question addressing the TTM and the five stages: 1 precontemplation stage, 2 contemplation stage, 3 preparation stage, 4 action stage, and 5 maintenance stage.
The results showed that receiving advice from health professionals to exercise during pregnancy increased the likeliness of being in stages , while higher age, multiparity, pregravid overweight, unhealthy eating habits, pelvic girdle pain, and urinary incontinence were more prevalent with low readiness to change exercise habits stages 1—3.
According to the TTM, more than half of the participants reported to be physically active. Moreover, most of the participants classified as inactive showed a high motivational readiness or intention to increase their physical activity level. Hence, pregnancy may be a window of opportunity for the establishment of long-term physical activity habits.
To date, intervention studies show that exercise during pregnancy may enhance quality of life and wellbeing, improve self-image and fitness, prevent excessive maternal weight gain, low back pain, pelvic girdle pain, and urinary incontinence, as well as decrease the risk of depression during pregnancy and postpartum [ 1 — 9 ].
Some observational studies have also reported associations between regular exercise during pregnancy and gestational diabetes, preeclampsia, shorter labor, fewer birth complications, and caesarean sections [ 10 — 17 ]. Present recommendations for exercise during pregnancy suggest that, in the absence of medical and obstetric complications, pregnant women should aim to perform at least 30 min of daily moderate intensity physical activity [ 18 , 19 ]. Hence, pregnant women may have a great potential to increase physical activity and reduce the risk of inactivity related complications and illnesses.
Antenatal care is part of public health promotion and prevention programs in most western countries, with pregnant women advised to attend between 5—8 visits throughout pregnancy [ 24 ]. Consequently, health care providers are in a unique position to inform and encourage pregnant women to start or continue specific and general exercise programs.
Such programs may also help to establish long-term PA habits. In several settings, the transtheoretical model TTM of change has been successful in promoting behavioral change [ 26 , 27 ]. According to this model, a specific health behavior develops over time and progresses through five stages which may be used to examine readiness to become and stay physically active 1 precontemplation, 2 contemplation, 3 preparation, 4 action, and 5 maintenance [ 26 , 27 ].
However, there is a scant knowledge about the stages of change towards physical activity among pregnant women, and search on PubMed revealed no studies on this topic. Hence, the specific aims of the present study were to 1 assess perceptions regarding readiness to become or stay physically active using the TTM and 2 to compare background and health variables across the five stages of the TTM among Norwegian pregnant women.
Results from the main study have been published previously [ 16 , 28 ]. Data collection to answer the present research questions was conducted through a self-administered questionnaire, PAPQ [ 29 ].
Healthy pregnant women were allocated to the study from the application form for birth at Oslo University Hospital between and Inclusion criteria were enrolment to the project before week 14—16 of gestation, having a singleton fetus, ability to answer PAPQ in gestation week 32—36, and being of Scandinavian origin.
Exclusion criterion was pregestational diabetes or other serious diseases due to the primary aim of the main study. However, 90 withdrew before inclusion. Further exclusions were two stillbirths, eleven relocations, and births at another hospital, and eight participants chose to withdraw. Consequently, women were invited to participate in the present study. Of these, Not all the participants answered every question, and therefore individual questions had varying response rates.
More details of the questionnaire have been described elsewhere [ 30 , 31 ]. The stages of change towards physical activity were assessed by a particular question aimed to classify the participants to one of five categories adapted from Godin and Shephard [ 32 ] and further developed by Prochaska et al.
Table 1 shows the TTM scoring system, questionnaire categories, and motivational readiness to modify behavior. The participants were asked to pick the response category that most accurately described their current physical activity behavior or their interest for physical activity. Due to low response rate in the precontemplation stage and the action stage, and in agreement with a previous Norwegian study, the five stages were merged into two new variables in some supplementary statistical analyses [ 34 ].
Hence, participants in the precontemplation, contemplation, and preparation stages 1—3 were classified as physically inactive insufficiently PA , and participants in action and maintenance stage were classified as physically active currently PA. Concurrent validity for TTM has been demonstrated with a significant association with the seven-day physical activity recall questionnaire [ 35 ], and the kappa index of test-retest intrareliability over a two-week period was 0.
For the purpose of the present study, we used a translated Norwegian version, previously used in a study to assess motivational readiness to stay or increase physical activity level [ 34 ]. Maternal prepregnant weight was self-reported. Maternal weight gain was calculated as the difference between self-reported prepregnancy weight and the weight measured at the last clinical visit prior to delivery pregnancy week The responsible midwife used a digital beam scale to measure the participant's body weight kg.
These women were classified as either normal weight or overweight, and corresponding weight gain recommendations were used in the statistical analysis. It was presumed that more women in the precontemplation, contemplation, and preparatory groups would have less favorable weight gain compared to the action and maintenance groups. All statistical analyses were conducted with SPSS statistical software version Background variables are presented as frequencies, percentages, or means with standard deviations SDs.
Mean age of the participants was The study group did not differ from nonparticipants giving birth at the same hospital, in mean maternal age, parity, gestational age at delivery, educational level, or marital status. Further information about background variables of the cohort has been presented elsewhere [ 30 ]. The distribution of participants within each stage of change is summarized in Table 2. According to the TTM, a large proportion of the participants reported to be somewhat or currently physically active, with Most participants were in maintenance stage 5 , followed by preparation stage 3.
Six women specified that they had recently started an exercise program stage 4. In total, A significantly higher proportion of these No differences were found when comparing the stages of exercise with education, being sick listed in 3rd trimester, or daily smoking.
Comparison of background and health variables between the five stages of change TTM. Results are presented as means with standard deviation SD , in addition to number and percentages. Missing data are reported for each outcome as there are different response rates for several variables.
This did not change the overall results. The relationship between maternal weight gain parameters and the TTM. The majority of the participants As far as we have ascertained, this is the first study to examine pregnant women's motivation for physical activity according to the TTM. In addition, several demographic and health indicators among women in the different stages of physical activity were compared. More than half of the participants were in stages , categorized as regularly active according to the TTM Table 1.
Only, 1. The strength of the present study is the high response rate among the women receiving the PAPQ questionnaire. In addition, the population in STORK was similar in marital status, educational level, mean maternal age, parity, gestational age at delivery, and the baby's birth weight as compared to nonparticipants giving birth at Oslo University Hospital.
Hence, the survey participants in the present study may be considered to be fairly representative for an urban Norwegian population of Scandinavian origin [ 16 , 28 ].
We used a validated form of the TTM, and the association between self-reported physical activity levels and the stages of change found in the present study, may provide some evidence for the concurrent validity of the measure. The PAPQ included a broad range of determinants, ranging from demographic characteristics to lifestyle habits such as smoking and diet , pregnancy complaints, and social support, including the physician's role to influence on physical activity level during pregnancy.
In addition, the same midwife NV completed all weighing of the participants and calculated total maternal weight gain, as well as was available to answer any questions at the time when the participants handed in the questionnaire. An obvious limitation of cross-sectional surveys is that the design precludes the establishment of causation between variables and that most data are self-reported.
Also, it is only a snapshot of the situation and may be biased by socially desirable responses. Unfortunately, due to logistic limitations, not all eligible women were approached, and unfortunately only about one fourth of the women accepted the invitation.
Hence, although the response rate of eligible women to our study may be considered high, the representativeness of the STORK study can be questioned. The TTM was originally developed to be used in promoting or stopping a certain behavior [ 32 ].
In the present study, the model was used as a measure of pregnant women's readiness to become or stay physically active, as it has been used in other study populations [ 34 ]. Hence, this is in contrast to the participants of the present study and how they perceive their physical activity level according to the TTM. The high amount of exercisers in the present study may be due to the main objective of the primary study, including evaluation of nutritional intake and physical activity on fetal macrosomia.
Hence, the women who chose to participate may have had more interest in general health compared to nonparticipants.
In addition, most of the participants reported a high educational level. Statistics Norway's survey of the living conditions in , found that those with a high level of education were more physically active than those with a low level of education.
These results differ from other studies, finding that educational attainment is a strong determinant of stage for physical activity [ 38 , 39 ].
In our study, significantly more women receiving advice from health care providers on physical activity during pregnancy reported to be in the higher stages of the TTM.
Hence, our finding highlights the importance of precise and updated information, based on the current ACOG guidelines, to be distributed by health care professionals to their pregnant clients.
Considering that most pregnant women visit their health care provider on a regular basis, this may be a window of opportunity for providing information of the benefits of regular exercise during pregnancy. Hence, midwives and physicians should be encouraged to promote physical activity in pregnancy. This is supported by several studies reporting that pregnant women tend to follow the advice of health care providers regarding maternal weight gain [ 40 , 41 ].
Previous studies have found that being sedentary before the onset of pregnancy is a risk factor not to start exercising when pregnant [ 30 , 38 , 42 ]. Our results support these findings, confirming that women who are accustomed to exercising prior to pregnancy are more likely to maintain this habit and that those not physically active prepregnancy do not start during pregnancy.
Hence, to achieve higher rates of exercise during pregnancy, health promotion programs should target the general female population in their childbearing years. According to the review of Gaston and Cramp [ 38 ], being nulliparous has been a consistent predictor of regular exercise.
Therefore, to increase the level of exercise among multiparous women, activities allowing for personal time management and flexibility in terms of place and type of activity should be stimulated.
Moreover, initiating supervised group activities and social support in a safe setting with qualified instructors may aid compliance to an exercise program. An increasing proportion of women are overweight or obese at the start of their pregnancy [ 43 ], and it is assumed that this group is less likely to adapt and maintain the recommended levels of physical activity [ 44 ]. No group differences were found between women reporting to be insufficiently PA or currently PA with respect to mean maternal weight gain or weight gain above the IOM references.
This may be because maternal weight gain has been found to be independent of exercise [ 36 ].
Cancer and Pregnancy
Section A 1. Obstetrics Anatomy Including Pelvis and fetal skull Placenta and its Abnormalities Diagnosis of Pregnancy and Antenatal Care Normal Labor Induction of Labor and Trial of Labor
Although most women with nausea and vomiting of pregnancy NVP have symptoms limited to the first trimester, a small percentage of women have a prolonged course with symptoms extending until delivery. Women with severe nausea and vomiting during pregnancy may have hyperemesis gravidarum HG , an entity distinct from NVP, which if left untreated may lead to significant maternal and fetal morbidity. Various metabolic and neuromuscular factors have been implicated in the pathogenesis of NVP and HG; however, their exact cause is unknown. Consequently, treatment of NVP and HG can be difficult as neither the optimal targets for treatment nor the full effects of potential treatments on the developing fetus are known. In the United States and Canada this translates to approximately 4,, and , women who are affected each year, respectively [ 2 ]. NVP is found more often in Western countries and urban populations and is rare among Africans, Native Americans, Eskimos, and most Asian populations [ 3 ]. Only a few studies have examined the racial distribution of NVP in a given population.
Aka: transverse cerviacal lig. Or Mackenrodt lig. The amnion develops part of labium majus, holds the ovary in place about 7th-8th day of blastocysts development. It has no muscles, nerves, lymphatics, and is avascular. It also provides all the tensile strength of fetal membranes.
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Show all documents Of the study participants, 94 The majority Although the biva- riate analyses failed to uncover any significant group differences in age, race, or the depth and duration of ongoing romantic relationships, the data presented in Table 1 provide empiric support for the hypothe- sis that the psychological context in which teenagers who have taken home pregnancy tests make deci- sions about sexual activity puts them at higher risk for erratic contraceptive use and conception than those who have not. Specifically, home test takers were more apt to not be living with a biological parent, be at high aggregate social and environmen- tal risk for conception, to have been sexually active for at least 2 years, to think that a boyfriend wanted them to be pregnant, to lack negative expectations about the effects of adolescent childbearing on their lives, and as hypothesized to be ambivalent about remaining nonpregnant.
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- Давайте мне его номер. Я сам позвоню этому… - Не беспокойтесь, - прошептала Сьюзан. - Танкадо мертв. Все замерли в изумлении. Возможные последствия полученного известия словно пулей пронзили Джаббу.
- И откуда мы знаем, что именно ищем. Одно различие от природы, другое - рукотворное. Плутоний впервые был открыт… - Число, - напомнил Джабба. - Нам нужно число. Сьюзан еще раз перечитала послание Танкадо.
Тогда Стратмор понял, что Грег Хейл должен умереть. В ТРАНСТЕКСТЕ послышался треск, и Стратмор приступил к решению стоявшей перед ним задачи - вырубить электричество. Рубильник был расположен за фреоновыми насосами слева от тела Чатрукьяна, и Стратмор сразу же его. Ему нужно было повернуть рубильник, и тогда отключилось бы электропитание, еще остававшееся в шифровалке. Потом, всего через несколько секунд, он должен был включить основные генераторы, и сразу же восстановились бы все функции дверных электронных замков, заработали фреоновые охладители и ТРАНСТЕКСТ оказался бы в полной безопасности. Но, приближаясь к рубильнику, Стратмор понял, что ему необходимо преодолеть еще одно препятствие - тело Чатрукьяна на ребрах охлаждения генератора. Вырубить электропитание и снова его включить значило лишь вызвать повторное замыкание.
Типичная для Испании туалетная комната: квадратная форма, белый кафель, с потолка свисает единственная лампочка. Как всегда, одна кабинка и один писсуар. Пользуются ли писсуаром в дамском туалете -неважно, главное, что сэкономили на лишней кабинке. Беккер с отвращением оглядел комнату.
Он в недоумении посмотрел на двухцветного. - Ты сказал - в два ночи. Панк кивнул и расхохотался.
Танкадо мертв. - Да, - сказал голос. - Мой человек ликвидировал его, но не получил ключ. За секунду до смерти Танкадо успел отдать его какому-то туристу. - Это возмутительно! - взорвался Нуматака.
Ну давай. Окажись дома. Через пять гудков он услышал ее голос.
Ты не сделаешь ничего подобного! - оборвал его Стратмор.