The Evidence Base in Exercise Knowledge of Pregnant Women: A Latent Class Analysis.

BACKGROUND: Exercise has many benefits for women with uncomplicated pregnancies. However, poor exercise knowledge may contribute to problems or barriers that reduce a woman's level of exercise after becoming pregnant. AIM: This study was performed to identify pregnancy exercise knowledge among pregnant women using latent class analysis and to examine the relationship between pregnancy exercise knowledge patterns and sociodemographic characteristics. DESIGN: A descriptive, cross-sectional approach was used in this study. METHODS: Participants were recruited from the prenatal outpatient departments of two hospitals and a certified prenatal center in Taipei, Taiwan. A total of 618 participants completed a pregnancy exercise knowledge test. The data were analyzed using WINMIRA and SPSS 20.0 software. RESULTS: Two latent classes were identified based on exercise knowledge among pregnant women. The Accurate Knowledge group (n = 543, 87.9%), which had a higher latent trait for exercise knowledge (M = 1.31, SD = 0.94), was larger than the Limited Knowledge group (n = 75, 12.1%), which had a lower latent trait (M = -0.22, SD = 1.14). The principles of exercise for pregnant women, particularly the appropriate intensity and duration, may be difficult items for women in the Limited Knowledge group to understand. Women with Limited Knowledge had significantly lower education levels and greater rates of unemployment, multiparity, and miscarriage than women in the Accurate Knowledge group. LINKING EVIDENCE TO ACTION: A two-class system for interpreting exercise knowledge among pregnant women is statistically supported. We believe that this study has evidence-based potential to help healthcare providers improve pregnant women's exercise knowledge as part of routine prenatal care to promote exercise.

Total gestational weight change and rate of change in pregnant Taiwanese women.

OBJECTIVE: The purpose of this study was to estimate and compare total gestational weight gain (GWG) and the trimester-specific mean rate of GWG based on pre-pregnancy body mass index (BMI) as recommended by the Institute of Medicine (IOM). MATERIALS AND METHODS: The medical records of 470 participants who had received antenatal care at medical teaching hospitals in northern Taiwan and who delivered after 37 weeks of pregnancy were analyzed. RESULTS: The mean total GWG was 13.84 (SD = 4.33) kg, and nearly 60% of women had not complied with the current IOM recommendations for total GWG. The best-fit model for the mean GWG rate revealed that all groups had a GWG rate of zero in the 1st trimester and had an equivalent mean GWG rate in the 3rd trimester. Women tended to have excessive weekly GWG in the 2nd and 3rd trimesters, and women with a higher pre-pregnancy BMI were more likely to have excessive weekly GWG in the 2nd and 3rd trimesters. Moreover, the plurality of normal-weight (30.4%), overweight (75.8%) and obese (62.5%) women experienced excessive weekly weight gain during the 2nd and 3rd trimesters. Few women met the recommended 2009 IOM weekly weight-gain guidelines in the 2nd trimester, but more met them in the 3rd trimester. CONCLUSION: These findings indicate that most pregnant Taiwanese women currently exceed the total and weekly GWG recommendations of the IOM. More specifically, weekly GWG in excess of the IOM recommendations is common among normal-weight, overweight and obese women.

Constructing and applying an exercise counseling model for pregnant women: A preliminary study.

Pregnant women tend to exercise less than women who have not yet been pregnant. In the present study, which involves two studies, we aimed to construct an effective, individualized exercise counseling model for pregnant women. In study 1, a three-round session that involved 10 multidisciplinary health care experts reached a consensus via the Delphi method. In the preliminary study, two healthy pregnant women were recruited from the prenatal outpatient departments of hospitals in Taipei, Taiwan. Both of them were 32 years old and primipara. The results of study 1, the established five stages of the individualized exercise counseling model for pregnant women were as follows: assessment, defining barriers that interfere with achieving the target, planning, implementation and monitoring, and evaluation. In the preliminary study, we applied this counseling model of study 1 to 2 healthy pregnant women. The 5-stage counseling model can encourage pregnant women to begin to exercise or to continue exercising. We believe that this exercise counseling model can potentially be used by nurses. It can help them to encourage pregnant women to regularly exercise, and to promote exercise as part of a healthy lifestyle.

The Physical Activity Patterns of Pregnant Taiwanese Women.

BACKGROUND: Physical activity reduces the risk of maternal disorders during pregnancy. However, many pregnant women reduce their levels of physical activity while pregnant. PURPOSE: The purpose of this study was to examine and compare the physical activity (total amount, intensity, type) of Taiwanese women during each trimester. METHODS: This cross-sectional survey used purposive sampling to enroll 581 Taiwanese women as participants. The physical activity of participants was measured using the Mandarin version of the Pregnancy Physical Activity Questionnaire. RESULTS: The levels of household/caregiving activity and occupational activity differed significantly across trimesters. Household/caregiving (43.2%-54.5%) and occupational activity (42.0%-54.0%) accounted for the largest percentages of total energy expenditure for all three trimesters. In terms of total and household/caregiving activities, multiparous women had significantly higher mean energy expenditures than their primiparous peers. Moreover, income had a pervasive influence on all types and amounts of physical activity and energy expenditures, respectively, with the exception of sports/exercise. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Further careful assessment of the types and intensities of physical activity that are suitable for pregnant women in different parity and income categories in Taiwan is necessary. Furthermore, healthcare providers should encourage pregnant women to use strategies that promote their more regular participation in enjoyable physical activities. One of these potential strategies is to do activities together with children, family members, or friends.

Using the Theory of Planned Behavior to predict pregnant women's intention to engage in regular exercise.

OBJECTIVE: the objectives of this study were to use the Theory of Planned Behavior (TPB) in order to determine to what degree pregnant women intended to exercise regularly during pregnancy, and then to evaluate the TPB model fit. DESIGN: this study was based on a cross-sectional survey with a tool which was developed specifically for this study. SETTING: we identified and invited pregnant women from two medical center hospitals and one certified prenatal center in northern Taiwan to participate. PARTICIPANTS: using purposive sampling, we selected participants who were in at least the 12th week of gestation and did not have a high-risk pregnancy. 621 completed the instrument, their mean age was 31.76 (SD=3.87). METHODS: a self-administered instrument was used to determine the firmness of participants' intention to engage in regular exercise during pregnancy. The data were analyzed using SPSS 19.0 software and LISREL 8.72 software. FINDINGS: of the pregnant women in our study, 64.2% were found to be likely to exercise regularly up until delivery. The TPB was used to arrive at specific findings with regard to "intention to exercise regularly during pregnancy." Our participants demonstrated a positive intention to exercise regularly, a positive attitude (ATT), positive subjective norms (SN) and positive perceived behavioral controls (PBC) during pregnancy. The most influential factor in determining the participants' positive intention to exercise was found to be PBC (ß=0.68, p<0.01), followed by the SN (ß=0.12, p<0.01). The participants' ATT did not significantly influence their intention. Overall, the final model explained 59% of the variation in "intention to exercise regularly." KEY CONCLUSION AND IMPLICATION FOR PRACTICE: the most important factor in determining the participants' intention to exercise regularly was PBC, followed by the SN. Medical staff members should be able to help pregnant women overcome obstacles to regular exercise, for example, by assisting in providing appropriate resources.

Impact of clinical audits on cesarean section rate.

OBJECTIVE: Many countries have noted a substantial increase in the cesarean section rate (CSR). Several methods for lowering the CSR have been described. Understanding the impact of clinical audits on the CSR may aid in lowering CSR. Thus, our aim is to elucidate the effect of clinical audits on the CSR. MATERIALS AND METHODS: We retrospectively analyzed 3781 pregnant women who gave birth in a medical center between January 2008 and January 2011. Pregnant women who delivered between January 2008 and July 2009 were enrolled as the pre-audit group (n = 1592). After August 2009, all cesarean section cases that were audited were enrolled in the audit group (n = 2189). The CSR was compared between groups. RESULTS: The overall CSR (34.5% vs. 31.1%, adjusted odds ratio [OR] = 0.83, p = 0.008) and the cesarean section rate due to dystocia (9.6% vs. 6.2%, p < 0.001) were significantly lower in the audit group than the pre-audit group. However, there was no significant difference in the rate of operative vaginal delivery between groups. Consensus on the unnecessity for cesarean section was achieved in 16 (8.2%) of 195 audit cases in the monthly audit conference. In nulliparous pregnant women (n = 2148), multivariate analysis revealed that clinical audit (OR = 0.78), maternal age (OR = 1.10), gestational age at delivery (OR = 0.80), and fetal body weight at birth (OR = 1.0005) were independent predictors of cesarean section (all p < 0.05). Most variables of maternal and perinatal morbidity and mortality did not differ before and after audits were implemented. CONCLUSION: Clinical audits appear to be an effective strategy for reducing the CSR. Therefore, we recommend strict monitoring of the indications in dystocia for cesarean section to reduce the CSR.

Efficacy of maternal tenofovir disoproxil fumarate in interrupting mother-to-infant transmission of hepatitis B virus.

UNLABELLED: The efficacy and safety of maternal tenofovir disoproxil fumarate (TDF) in reducing mother-to-infant hepatitis B virus (HBV) transmissions is not clearly understood. We conducted a prospective, multicenter trial and enrolled 118 hepatitis B surface antigen (HBsAg)- and hepatitis B e antigen-positive pregnant women with HBV DNA ≥7.5 log10 IU/mL. The mothers received no medication (control group, n = 56, HBV DNA 8.22 ± 0.39 log10 IU/mL) or TDF 300 mg daily (TDF group, n = 62, HBV DNA 8.18 ± 0.47 log10 IU/mL) from 30-32 weeks of gestation until 1 month postpartum. Primary outcome was infant HBsAg at 6 months old. At delivery, the TDF group had lower maternal HBV DNA levels (4.29 ± 0.93 versus 8.10 ± 0.56 log10 IU/mL, P < 0.0001). Of the 121/123 newborns, the TDF group had lower rates of HBV DNA positivity at birth (6.15% versus 31.48%, P = 0.0003) and HBsAg positivity at 6 months old (1.54% versus 10.71%, P = 0.0481). Multivariate analysis revealed that the TDF group had lower risk (odds ratio = 0.10, P = 0.0434) and amniocentesis was associated with higher risk (odds ratio 6.82, P = 0.0220) of infant HBsAg positivity. The TDF group had less incidence of maternal alanine aminotransferase (ALT) levels above two times the upper limit of normal for ≥3 months (3.23% versus 14.29%, P = 0.0455), a lesser extent of postpartum elevations of ALT (P = 0.007), and a lower rate of ALT over five times the upper limit of normal (1.64% versus 14.29%, P = 0.0135) at 2 months postpartum. Maternal creatinine and creatinine kinase levels, rates of congenital anomaly, premature birth, and growth parameters in infants were comparable in both groups. At 12 months, one TDF-group child newly developed HBsAg positivity, presumably due to postnatal infection and inefficient humoral responses to vaccines. CONCLUSIONS: Treatment with TDF for highly viremic mothers decreased infant HBV DNA at birth and infant HBsAg positivity at 6 months and ameliorated maternal ALT elevations. (Hepatology 2015;62:375-386.

The exercise patterns of pregnant women in Taiwan.

BACKGROUND: Unless advised otherwise by their doctor, pregnant women should get approximately 30 minutes of moderate exercise on most days. However, most pregnant women do not exercise regularly and do not meet the American College of Obstetricians Gynecology's standard for the minimum amount of exercise needed to stay healthy during pregnancy. PURPOSE: We investigate the factors related to regular exercise among pregnant women and describe the type, duration, and change in regular exercise from prepregnancy to pregnancy in Taiwan. METHODS: Pregnant women (N = 692) completed a questionnaire on exercise habits and were then grouped into regular exercise (105, 15.2%) and nonregular exercise (587, 84.8%) groups. Demographic and exercise-related variables were then investigated for their association with exercise during pregnancy. RESULTS: Work status, prepregnancy exercise, and trimester were significant predictors of regular exercise during pregnancy. The most commonly reported exercise types were walking, climbing stairs, and yoga. Nearly four fifths (n = 526, 76.0%) of participants did not exercise regularly before pregnancy, whereas 42.9% of participants continued exercising regularly after becoming pregnant. Among those who were inactive before pregnancy, 10.1% began exercising after becoming pregnant. In contrast, 57.1% of participants who had been more active before pregnancy stopped exercising regularly after becoming pregnant. Overall, it was found that participants decreased their amount (minutes × times/week) of exercise compared with their prepregnancy amount. CONCLUSIONS: Results suggest that walking and climbing stairs, each beneficial to the health of pregnant women, are the most common types of regular exercise engaged in by pregnant women in Taiwan. Regular exercise benefits the health of pregnant women. The findings of this study may be useful to doctors and nurses responsible to counsel pregnant women to exercise regularly and to have a reasonably active lifestyle during pregnancy.

Mosaic trisomy 9 at amniocentesis: prenatal diagnosis and molecular genetic analyses.

OBJECTIVE: To present prenatal diagnosis and molecular genetic analyses of mosaic trisomy 9. MATERIALS, METHODS AND RESULTS: A 35-year-old woman, gravida 3, para 1, underwent amniocentesis at 17 weeks of gestation because of her advanced maternal age. Amniocentesis revealed a karyotype of 47,XX,+9[3]/46,XX[6]. Repeat amniocentesis at 19 weeks of gestation revealed a karyotype of 47,XX,+9[6]/46,XX[19]. At 22 weeks of gestation, she was referred to a tertiary medical center for genetic counseling, and amniocentesis revealed a karyotype of 47,XX,+9[2]/46,XX[22]. Array comparative genomic hybridization analysis of uncultured amniocytes revealed no genomic imbalance in chromosome 9. However, interphase fluorescence in situ hybridization analysis of uncultured amniocytes showed that nine (18%) of 50 cells were trisomic for chromosome 9. Polymorphic DNA marker analyses also revealed a diallelic pattern with unequal biparental inheritance of chromosome 9 and a dosage ratio of 1:18 (paternal allele:maternal allele) in the uncultured amniocytes and a dosage ratio of 1:36 in the cultured amniocytes, indicating that the euploid cell line had maternal uniparental isodisomy for chromosome 9. Level II ultrasound demonstrated bilateral ventriculomegaly. The pregnancy was subsequently terminated, and a malformed fetus was delivered. Postnatal cytogenetic and polymorphic DNA marker analyses of the fetal and extraembryonic tissues confirmed the prenatal diagnosis. CONCLUSION: Mosaic trisomy 9 carries a high risk of fetal abnormalities warranting detailed sonographic investigation of congenital malformations. Mosaic trisomy 9 can be associated with maternal uniparental disomy for chromosome 9 in euploid cell lines. Array comparative genomic hybridization is limited for the detection of low-level mosaicism.

Changing quality of life in hysterectomized women.

BACKGROUND/PURPOSE: Most women undergo a hysterectomy to relieve symptoms and improve their quality of life rather than to solve a life-threatening problem. We used hierarchical linear modeling to evaluate the changes, in a 6-8-week period, in the quality of life of women who had undergone hysterectomy. METHODS: This was a prospective follow-up study of 64 women who had undergone hysterectomy and 68 controls of similar age and marital status. A quasi-experimental design was used. The World Health Organization Questionnaire on Quality of Life: BREF-Taiwan Version was used to assess quality of life before surgery, at discharge, and 2 and then 6-8 weeks after surgery. The control group was measured three times: after their initial hospital visit, and 2 and then 6-8 weeks later. RESULTS: Women with hysterectomy (H-group) had significantly lower scores for the physical health dimension of quality of life at all time-points as compared with the control group, yet postoperatively, they showed a more dramatic increase in this dimension. As for the group mean trajectories, the vaginal hysterectomy (VH) subgroup had a relatively low quality of life immediately after surgery, which then gradually improved, especially in the dimension of physical health. As for the social relationships dimension, the abdominal hysterectomy (AH) subgroup showed an upward curve similar to the pattern of their physical health dimension. The psychological and environmental dimensions did not show a clear trajectory for either group. As for individual trajectories, the social relationships and environmental dimensions showed different patterns for women with hysterectomy. CONCLUSION: Hysterectomy can improve physical health. In the VH subgroup, physical health was improved significantly, especially from 6-8 weeks postoperatively. In the AH subgroup, physical health and social relationships were improved significantly postoperatively. Social relationships and environmental dimensions tended to show different patterns for women with hysterectomy. These findings may be useful to doctors and nurses, especially in counseling women who have had, or plan to have, a hysterectomy.

Urolithiasis in pregnancy.

BACKGROUND: The aim of this study was to review our experience in the diagnosis and management of urolithiasis in pregnant women, and to discuss safety, appropriate diagnostic tools and treatment modalities with review of literatures. METHODS: Nine women with pregnancy proved to have urolithiasis were included in this study. The diagnosis was made according to their symptoms and signs, and ultrasonographic findings. Conservative treatment with hydration, analgesics and antibiotics was applied initially, followed by some minimally invasive procedures, including percutaneous nephrostomy (PCN), double J (DBJ) stenting and ureterorenoscopy (URS), if initial treatment failed. RESULTS: All patients received conservative treatment at first, and 4 patients got well till delivery, another 5 patients needed further minimally invasive procedures; 1 of them received DBJ stenting, another 1 received PCN first and changed to DBJ stenting. The remaining 3 patients were treated by ureterorenoscopy with stone manipulation. All these 5 patiens had full-term delivery without obstetric sequela, except 1 patient who received left salpingoophrectomy due to left ovarian abscess. CONCLUSIONS: During pregnancy, urolithiasis is a diagnostic and therapeutic challenge. Clinical symptoms and signs are most important in establishing diagnosis, and ultrasound examination adds accuracy. Minimally invasive procedures (such as PCN, DBJ stenting, URS) can facilitate the successful management of patients requiring further intervention due to failure of conservative treatment.