Assessing physical activity and barriers before and during pregnancy: Insights from an Italian cross-sectional study.

Camilla Lugli; Lucia Palandri; Eleonora Ferrari; Elisabetta  Fioretti; Domenico Maione; Fabio Facchinetti; Gabriella  Aggazzotti; Elena Righi

doi:10.23750/abm.v96i1.16571

Assessing physical activity and barriers before and during pregnancy: Insights from an Italian cross-sectional study.

Authors

Camilla Lugli Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy https://orcid.org/0009-0002-9280-0509
Lucia Palandri Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy https://orcid.org/0000-0001-9787-7965
Eleonora Ferrari Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy https://orcid.org/0009-0005-0704-7965
Elisabetta Fioretti Public Hygiene Service, Public Health Department, Local Health Authority of Modena, Modena, Italy
Domenico Maione Food Hygiene and Nutrition Service, Public Health Department, Local Health Authority IRCCS of Reggio Emilia, Reggio Emilia, Italy https://orcid.org/0009-0004-0089-9578
Fabio Facchinetti Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy https://orcid.org/0000-0003-4694-9564
Gabriella Aggazzotti Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy https://orcid.org/0000-0002-2497-9941
Elena Righi Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy https://orcid.org/0000-0002-3469-7446

Keywords:

physical activity, pregnancy, maternal health, health promotion, public health

Abstract

Background and aim: Physical activity (PA) during pregnancy is essential for maternal and foetal health, reducing the risk of complications such as gestational diabetes, hypertension, and excessive weight gain. Despite guidelines recommending 150 minutes of moderate-intensity PA per week, many pregnant women globally, fail to meet these recommendations. Limited studies have explored PA habits before and during pregnancy in Italy, revealing a gap in understanding PA adherence. 

Methods: We conducted a cross-sectional study of 390 women delivering a full-term baby at a University Hospital. Participants completed a questionnaire on sociodemographic, obstetric history, and PA habits before and during pregnancy. PA adherence was assessed based on duration (≥150 minutes/week) and intensity (≥3 MET). Descriptive statistics and logistic regression were used to explore associations between PA and sociodemographic factors. 

Results: 52% of the sample reported performing PA during pregnancy and 50% pre-pregnancy. Only 35% maintained their activity across both periods. PA prevalence varied throughout pregnancy, peaking in the second trimester (45%). Adherence to guidelines was low, with 21% meeting the 150 min/week threshold and 22% reaching the intensity cutoff during the third trimester. Regression identified performing pre-pregnancy PA as the strongest predictor of adherence during pregnancy, while having children was the lowest. 

Conclusions: Our study highlights the low prevalence of PA both before and during pregnancy an Italy and identifies barriers to achieving recommended activity levels. These findings emphasize the need for targeted health strategies encouraging PA during pregnancy, a pivotal time for adopting long-term healthy behaviours that benefit both maternal and foetal health

References

Morales-Suárez-Varela M, Clemente-Bosch E, Peraita-Costa I, Llopis-Morales A, Martínez I, Llopis-González A. Maternal Physical Activity During Pregnancy and the Effect on the Mother and Newborn: A Systematic Review. J Phys Act Health. 2021 Jan 1;18(1):130–47. doi:10.1123/jpah.2019-0348.

Fantuzzi G, Righi E, Aggazzotti G. A Case-Control Study on Leisure Time Physical Activity (LTPA) during the Last Three Months of Pregnancy and Foetal Outcomes in Italy. Health (N Y). 2016 Jan 28;8(2):133–43. doi: 10.4236/health.2016.82016

Davenport MH, Ruchat SM, Poitras VJ, et al. Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: a systematic review and meta-analysis. Br J Sports Med. 2018 Nov;52(21):1367–75. doi: 10.1136/bjsports-2018-099355

Shuai Y, Wu J, Li C, Li D. Effect of different physical activity interventions on perinatal depression: a systematic review and network meta-analysis. BMC Public Health. 2024 Jul 31;24(1):2076. doi: 10.1186/s12889-024-19564-w

Bisson M, Croteau J, Guinhouya BC, et al. Physical activity during pregnancy and infant’s birth weight: results from the 3D Birth Cohort. BMJ Open Sport Exerc Med. 2017;3(1):e000242. doi: 10.1136/bmjsem-2017-000242

Davenport MH, Meah VL, Ruchat SM, et al. Impact of prenatal exercise on neonatal and childhood outcomes: a systematic review and meta-analysis. Br J Sports Med. 2018 Nov;52(21):1386–96. doi: 10.1136/bjsports-2018-099836

Tsakiridis I, Bakaloudi DR, Oikonomidou AC, Dagklis T, Chourdakis M. Exercise during pregnancy: a comparative review of guidelines. J Perinat Med. 2020 Jul 28;48(6):519–25. doi: 10.1515/jpm-2019-0419

WHO Guidelines on Physical Activity and Sedentary Behaviour [Internet]. Geneva: World Health Organization; 2020 [cited 2024 Apr 26]. (WHO Guidelines Approved by the Guidelines Review Committee). Available from: http://www.ncbi.nlm.nih.gov/books/NBK566045/

Davenport MH, Ruchat SM, Sobierajski F, et al. Impact of prenatal exercise on maternal harms, labour and delivery outcomes: a systematic review and meta-analysis. Br J Sports Med. 2019 Jan;53(2):99–107. doi: 10.1136/bjsports-2018-099821

World Health Organization. Global action plan on physical activity 2018–2030: more active people for a healthier world [Internet]. Geneva: World Health Organization; 2018 [cited 2024 Apr 26]. 101 p. Available from: https://iris.who.int/handle/10665/272722

Evenson KR, Mottola MF, Artal R. Review of Recent Physical Activity Guidelines During Pregnancy to Facilitate Advice by Health Care Providers. Obstet Gynecol Surv. 2019 Aug;74(8):481–9. doi: 10.1097/OGX.0000000000000693

Evenson KR, Barakat R, Brown WJ, et al. Guidelines for Physical Activity during Pregnancy: Comparisons From Around the World. Am J Lifestyle Med. 2014 Mar;8(2):102–21. doi: 10.1177/1559827613498204

Cilar Budler L, Budler M. Physical activity during pregnancy: a systematic review for the assessment of current evidence with future recommendations. BMC Sports Sci Med Rehabil. 2022 Jul 16;14(1):133. doi: 10.1186/s13102-022-00524-z

Piercy KL, Troiano RP, Ballard RM, et al. The Physical Activity Guidelines for Americans. JAMA. 2018 Nov 20;320(19):2020–8. doi: 10.1001/jama.2018.14854

Mottola MF, Davenport MH, Ruchat SM, et al. 2019 Canadian guideline for physical activity throughout pregnancy. Br J Sports Med. 2018 Nov;52(21):1339–46. doi: 10.1136/bjsports-2018-100056

Brown WJ, Hayman M, Haakstad LAH, et al. Australian guidelines for physical activity in pregnancy and postpartum. J Sci Med Sport. 2022 Jun 1;25(6):511–9. doi: 10.1016/j.jsams.2022.03.008

Hayman M, Brown WJ, Brinson A, Budzynski-Seymour E, Bruce T, Evenson KR. Public health guidelines for physical activity during pregnancy from around the world: a scoping review. Br J Sports Med. 2023 Jul 1;57(14):940–7. doi: 10.1136/bjsports-2022-105777

Physical Activity and Exercise During Pregnancy and the Postpartum Period: ACOG Committee Opinion, Number 804. Obstet Gynecol. 2020 Apr;135(4):e178–88. doi: 10.1097/AOG.0000000000003772

Ministero della Salute. Linee di indirizzo sull’attività fisica. Revisione delle raccomandazioni per le differenti fasce d’età e situazioni fisiologiche e nuove raccomandazioni per specifiche patologie [Internet]. Ministero della Salute; 2021 [cited 2024 Apr 26]. Available from: https://www.salute.gov.it/portale/documentazione/p6_2_2_1.jsp?lingua=italiano&id=3285

Herrmann SD, Willis EA, Ainsworth BE, et al. 2024 Adult Compendium of Physical Activities: A third update of the energy costs of human activities. J Sport Health Sci. 2024 Jan 1;13(1):6–12. doi: 10.1016/j.jshs.2023.10.010

Dipietro L, Evenson KR, Bloodgood B, et al. Benefits of Physical Activity during Pregnancy and Postpartum: An Umbrella Review. Med Sci Sports Exerc. 2019 Jun;51(6):1292–302. doi: 10.1249/MSS.0000000000001941

Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1·9 million participants. Lancet Glob Health. 2018 Oct;6(10):e1077–86. doi: https:10.1016/S2214-109X(18)30357-7

Evenson KR, Wen F. National trends in self-reported physical activity and sedentary behaviors among pregnant women: NHANES 1999-2006. Prev Med. 2010 Mar;50(3):123–8. doi: 10.1016/j.ypmed.2009.12.015

Nascimento SL, Surita FG, Godoy AC, Kasawara KT, Morais SS. Physical Activity Patterns and Factors Related to Exercise during Pregnancy: A Cross Sectional Study. PloS One. 2015;10(6):e0128953. doi: 10.1371/journal.pone.0128953

Bacchi E, Bonin C, Zanolin ME, et al. Physical Activity Patterns in Normal-Weight and Overweight/Obese Pregnant Women. PloS One. 2016;11(11):e0166254. doi: 10.1371/journal.pone.0166254

Benvenuti MB, Bø K, Draghi S, Tandoi E, Haakstad LA. The weight of motherhood: Identifying obesity, gestational weight gain and physical activity level of Italian pregnant women. Womens Health. 2021 May 25;17:17455065211016136. doi: 10.1177/17455065211016136

Barbone F, Valent F, Brussi V, et al. Assessing the exposure of pregnant women to drinking water disinfection byproducts. Epidemiol Camb Mass. 2002 Sep;13(5):540–4. doi: 10.1097/00001648-200209000-00009

Società Italiana di Ginecologia e Ostetricia (SIGO), Associazione Ostetrici Ginecologi Ospedalieri Italiani (AOGOI), Associazione Ginecologi Ginecologi Universitari Italiani (AGUI), Fondazione Confalonieri Ragunese. Raccomandazioni - Nutrizione in gravidanza e durante l’allattamento [Internet]. 2018 [cited 2024 Apr 26]. Available from: https://www.sigo.it/wp-content/uploads/2018/06/LG_NutrizioneinGravidanza.pdf

von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007 Oct 20;335(7624):806–8. doi: 10.1136/bmj.39335.541782.AD

Gascoigne EL, Webster CM, West Honart A, Wang P, Smith-Ryan A, Manuck TA. Physical activity and pregnancy outcomes: An expert review. Am J Obstet Gynecol MFM. 2023 Jan;5(1):100758. doi: 10.1016/j.ajogmf.2022.100758

Evenson KR, Wen F. Prevalence and correlates of objectively measured physical activity and sedentary behavior among US pregnant women. Prev Med. 2011;53(1–2):39–43. doi: 10.1016/j.ypmed.2009.12.015

Hegaard HK, Ersbøll AS, Damm P. Exercise in Pregnancy: First Trimester Risks. Clin Obstet Gynecol. 2016 Sep;59(3):559–67. doi: 10.1097/GRF.0000000000000200

Evenson KR, Moos MK, Carrier K, Siega-Riz AM. Perceived barriers to physical activity among pregnant women. Matern Child Health J. 2009 May;13(3):364–75. doi: 10.1007/s10995-008-0359-8

Altaş ZM, Lüleci NE, Hıdıroğlu S. Evaluation of Physical Activity Level and Related Factors in Pregnancy During the COVID-19 Period. Int J Public Health. 2023;68:1605800. doi: 10.3389/ijph.2023.1605800

Owe KM, Nystad W, Bø K. Correlates of regular exercise during pregnancy: the Norwegian Mother and Child Cohort Study. Scand J Med Sci Sports. 2009 Oct;19(5):637–45. doi: 10.1111/j.1600-0838.2008.00840.x

Haakstad LAH, Bø K. Effect of regular exercise on prevention of excessive weight gain in pregnancy: a randomised controlled trial. Eur J Contracept Reprod Health Care Off J Eur Soc Contracept. 2011 Apr;16(2):116–25. doi: https: 10.3109/13625187.2011.560307

Haakstad LAH, Voldner N, Henriksen T, Bø K. Physical activity level and weight gain in a cohort of pregnant Norwegian women. Acta Obstet Gynecol Scand. 2007;86(5):559–64. doi: 10.1080/00016340601185301

Hegaard HK, Petersson K, Hedegaard M, et al. Sports and leisure-time physical activity in pregnancy and birth weight: a population-based study. Scand J Med Sci Sports. 2010 Feb;20(1):e96-102. doi: 10.1111/j.1600-0838.2009.00918.x

Román-Gálvez MR, Amezcua-Prieto C, Salcedo-Bellido I, et al. Physical activity before and during pregnancy: A cohort study. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 2021 Mar;152(3):374–81. doi: 10.1002/ijgo.13387

Wang L, Wu Y. Current Understanding and Future Challenges in Physical Activity during Pregnancy. J Clin Med. 2023 Jun 12;12(12):3986. doi: 10.3390/jcm12123986

Zhang L, Piao J, Zhang W, et al. Physical activity changes and influencing factors among Chinese pregnant women: a longitudinal study. J Matern-Fetal Neonatal Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet. 2024 Dec;37(1):2306190. doi: 10.1080/14767058.2024.2306190

Chan CWH, Au Yeung E, Law BMH. Effectiveness of Physical Activity Interventions on Pregnancy-Related Outcomes among Pregnant Women: A Systematic Review. Int J Environ Res Public Health. 2019 May 23;16(10):1840. doi: 10.3390/ijerph16101840

Muzigaba M, Kolbe-Alexander TL, Wong F. The perceived role and influencers of physical activity among pregnant women from low socioeconomic status communities in South Africa. J Phys Act Health. 2014 Sep;11(7):1276–83. doi: 10.1123/jpah.2012-0386

Righi E, Ferrari E, Lucaccioni L, et al. Parenting infants at the times of COVID-19: a cross-sectional study on parental stress in the province of Modena (Northern Italy). Acta Biomed Atenei Parm. 2024 Feb 28;95(1):e2024059–e2024059. doi: 10.23750/abm.v95i1.15344

Sun J, Piernicka M, Worska A, Szumilewicz A. A socio-ecological model of factors influencing physical activity in pregnant women: a systematic review. Front Public Health. 2023 Nov 20;11:1232625. doi: 10.3389/fpubh.2023.1232625

Campbell CG, Foster RC, Lanningham-Foster LM, Smith KM. The modified obstetric metabolic equivalent (MET): finding a MET that fits in pregnancy. J Dev Orig Health Dis. 2012 Jun;3(3):159–65. doi: 10.1017/S2040174412000025

Ruart S, Sinnapah S, Hue O, Janky E, Antoine-Jonville S. Physical Activity Counselling Received Throughout Pregnancy and Effect on Behaviours: A Quasi-Experimental Study. J Obstet Gynaecol Can JOGC J Obstet Gynecol Can JOGC. 2023 Aug;45(8):560–8. doi: 10.1016/j.jogc.2023.05.025

Lugli C, Ferrari F, Filippini T, et al. It’s (not) rocket science: public health communication experience as expressed by participants to an international workshop. Popul Med. 2024-,6(July):20. doi: 10.18332/popmed/191254

Palandri L, Urbano T, Pezzuoli C, et al. The key role of public health in renovating Italian biomedical doctoral programs. Ann Ig Med Prev E Comunita. 2024;36(3):353–62. doi: 10.7416/ai.2024.2592

Polster M, Olscamp K, Barnett EY, et al. Promoting Physical Activity During Pregnancy and the Postpartum Period. J Midwifery Womens Health. 2023;68(5):596–603. doi: 10.1111/jmwh.13513