Climate change and women's health: Turning leadership into action.

Climate change is considered the greatest long-term challenge we face, and it comes with a direct impact on women's health and pregnancy outcomes. There are many balances that physicians make in deciding elements of care, but environmental impact has not been a consideration. Health care leaders must recognize the impact of their decisions on carbon footprints and creatively look towards changes that will improve global conditions.

Association between physical activity in obese pregnant women and pregnancy outcomes: the UPBEAT pilot study.

BACKGROUND: Obesity in pregnancy is associated with fetal macrosomia, a raised neonatal fat mass and an increased risk of obesity and poor metabolic health in childhood which persists into adulthood. The offspring of obese women are more likely to be obese than the offspring of lean women when they become pregnant themselves, perpetuating a cycle of obesity and its associated negative metabolic consequences. Increasing physical activity during pregnancy could improve insulin sensitivity and reduce the risk of maternal and offspring adverse outcomes. The UK Pregnancy Better Eating and Activity Trial (UPBEAT) is a trial of a complex intervention designed to improve pregnancy outcomes through dietary changes and physical activity. Data from the pilot trial of 183 women were available for analysis. The relationship between the time spent at different physical activity levels and maternal and infant pregnancy outcomes was examined. KEY MESSAGES: Strong evidence exists that physical activity improves insulin sensitivity in non-pregnant populations, and lifestyle interventions of proven effectiveness in non-pregnant populations have been developed. Women who are active in pregnancy demonstrate better glucose control and favourable pregnancy outcomes. There is a lack of effective interventions to support obese pregnant women to be physically active. CONCLUSIONS: No difference was detected in objectively measured physical activity between women randomised to the intervention and control arms of the UPBEAT pilot trial. Light-intensity physical activity was lower in early pregnancy in women who delivered macrosomic infants. Maternal sedentary time at 35-36 weeks' gestation was positively associated and moderate-intensity physical activity was inversely associated with neonatal abdominal circumference. Maternal physical activity is associated with infant birth weight and abdominal circumference and is an appropriate target for intervention to improve infant outcomes. The challenge remains to develop an effective intervention to support obese pregnant women to be physically active.

Association between physical activity in obese pregnant women and offspring health.

BACKGROUND: Obesity in pregnancy is associated with macrosomia, neontatal fat mass and increased obesity and diabetes in the offspring. Physical activity during pregnancy may mediate the relationship between maternal insulin action and infant body composition. Interventions to increase physical activity might therefore improve metabolic outcomes for pregnant women and reduce the risk of obesity and diabetes in their offspring. The UK Pregnancy Better Eating and Activity Trial (UPBEAT) is a complex intervention, designed to improve pregnancy outcome through dietary change and increased physical activity. The analysis presented here includes data from 183 women recruited to the pilot phase of UPBEAT. METHODS: Physical activity was assessed by accelerometer at recruitment, at 27-28weeks' gestation and at 35-36weeks' gestation. The relationship between sedentary behaviour and moderate and vigorous physical activity (MVPA) and infant body composition at birth was examined using Spearman partial correlations. RESULTS: Maternal sedentary time at recruitment was inversely associated with neonatal abdominal circumference (-0.333, p=0.016), but at 35-36weeks' gestation was positively associated with neonatal abdominal circumference (0.435, p=0.023). Sedentary time was not associated with these outcomes at 27-28weeks' gestation. MVPA at 35-36weeks' gestation was inversely associated with neonatal abdominal circumference (-0.466, p=0.014). No associations between physical activity and birthweight were apparent. CONCLUSIONS: Our findings suggest that physical activity during pregnancy is associated with infant body composition and that maternal physical activity is an appropriate target for intervention to improve infant outcomes. UPBEAT is funded by NIHR-UK (RP-0407-10452).

Health impacts of pedestrian head-loading: a review of the evidence with particular reference to women and children in sub-Saharan Africa.

Across sub-Saharan Africa, women and children play major roles as pedestrian load-transporters, in the widespread absence of basic sanitation services, electricity and affordable/reliable motorised transport. The majority of loads, including water and firewood for domestic purposes, are carried on the head. Load-carrying has implications not only for school attendance and performance, women's time budgets and gender relations, but arguably also for health and well-being. We report findings from a comprehensive review of relevant literature, undertaken June-September 2012, focussing particularly on biomechanics, maternal health, and the psycho-social impacts of load-carrying; we also draw from our own research. Key knowledge gaps and areas for future research are highlighted.