Does Walking Reduce Postpartum Depressive Symptoms? A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background: Rising demands for traditional postpartum depression (PPD) treatment options (e.g., psychiatry), especially in the context of the COVID-19 pandemic, are increasingly difficult to meet. More accessible treatment options (e.g., walking) are needed. Our objective is to determine the impact of walking on PPD severity. Methods: A structured search of seven electronic databases for randomized controlled trials published between 2000 and July 29, 2021 was completed. Studies were included if walking was the sole or primary aerobic exercise modality. A random-effects meta-analysis was conducted for studies reporting PPD symptoms measured using a clinically validated tool. A simple count of positive/null effect studies was undertaken as part of a narrative summary. Results: Five studies involving 242 participants were included (mean age = ∼28.9 years; 100% with mild-to-moderate depression). Interventions were 12 (n = 4) and 24 (n = 1) weeks long. Each assessed PPD severity using the Edinburgh Postnatal Depression Scale (EPDS), and was included in the meta-analysis. The pooled effect estimate suggests that relative to controls walking yielded clinically significant decreases in mean EPDS scores from baseline to intervention end (pooled mean difference = -4.01; 95% CI: -7.18 to -0.84, I2 = 86%). The narrative summary provides preliminary evidence that walking-only, supervised, and group-based interventions, including 90-120+ minutes per week of moderate-intensity walking, may produce greater EPDS reductions. Conclusions: While limited by a relatively small number of included studies, pooled effect estimates suggest that walking may help mothers manage PPD. This is the first-time walking as treatment for PPD, an exercise modality that uniquely addresses many barriers faced by mothers, has been summarized in a systematic way. Trial registration: PROSPERO (CRD42020197521) on August 16th, 2020.

Prevalence and impact of urinary symptoms on quality of life during the last month of pregnancy / Prevalência e impacto de sintomas urinários na qualidade de vida durante o último mês de gestação

Abstract Introduction Adaptations of the maternal organism can adversely affect the lower urinary tract, leading to urinary symptoms with impact in quality of life (QoL). Objective To determine the prevalence of urinary symptoms and the impact of urinary incontinence (UI) on QoL during the last month of pregnancy. Methods Retrospective cross-sectional study, envolving 96 women in the immediate postpartum period personally interviewed about urinary symptoms and QoL during their last four weeks of gestation. Women were divided into two groups according to the number of pregnancies: G1 = 1 pregnancy (n = 41) and G2 = ≥ 2 pregnancies (n = 55). Those who reported the presence of stress urinary incontinence (SUI) and/or urge incontinence (UUI) were also administered the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). Results The most common symptoms were nocturia (90.6%), urgency (82.3%), urinary frequency (71.9%) feeling of incomplete emptying (62.5%) and SUI and/or UUI (53.1%) with no differences between groups. Only the complaint of SUI in cough was significantly higher in G2 (p = 0.04). There was no difference on QoL between groups based on ICIQ-SF scores among those with UI (53.1%), however G1 reported serious impact and G2 very serious impact. Conclusion Almost all women reported some type of urinary symptom and the most prevalent were nocturia, urgency, pollakiuria, feeling of incomplete emptying and SUI and/or UUI. SUI was more prevalent among women with two or more pregnancies and during cough were significantly higher. Regardless of the number of pregnancies, the presence any type of UI had a negative impact on QoL.

Resumo Introdução As adaptações do organismo materno podem afetar negativamente o trato urinário inferior, levando a sintomas urinários e impacto na qualidade de vida (QV). Objetivo Determinar a prevalência de sintomas urinários e o impacto da incontinência urinária (IU) na QV durante o último mês de gestação. Métodos Estudo transversal retrospectivo envolvendo 96 mulheres no puerpério imediato, entrevistadas pessoalmente sobre sintomas urinários e QV durante as últimas quatro semanas de gestação. A amostra foi dividida em dois grupos, de acordo com o número de gestações: G1 = 1 gestação (n = 41) e G2 = ≥ 2 gestações (n = 55). Aquelas que relataram a presença de IU de esforço e/ou urge-incontinência responderam o International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). Resultados Os sintomas mais comuns foram noctúria (90,6%), urgência (82,3%), frequência urinária (71,9%), sensação de esvaziamento incompleto (62,5%) e IU de esforço e/ou urge-incontinência (53,1%), sem diferença entre os grupos. Apenas a queixa de IU de esforço ao tossir foi significativamente maior no G2 (p = 0,04). Não houve diferença na QV entre os grupos baseando-se nos escores do ICIQ-SF, porém o G1 relatou impacto grave e o G2, impacto muito grave. Conclusão A maioria das mulheres referiu algum sintoma urinário, sendo mais prevalentes: noctúria, urgência, frequência urinária, sensação de esvaziamento incompleto e IU de esforço e/ou urge-incontinência. Entre aquelas com mais de duas gestações, a IU de esforço foi significativamente maior durante a tosse. Independente do número de gestações, a presença de algum sintoma de IU provocou impacto negativo na QV.

Sequential Introduction of Exercise First Followed by Nutrition Improves Program Adherence During Pregnancy: a Randomized Controlled Trial.

BACKGROUND: Adhering to nutrition and exercise recommendations simultaneously during pregnancy may be challenging. The purpose was to examine adherence to the sequential introduction of nutrition and exercise behaviors during pregnancy in comparison with a simultaneous approach. METHOD: A randomized controlled trial including nutrition and exercise was executed. Using a stratified body mass index (BMI) randomization, participants (n = 88) were allocated to one of three groups at 12-18 weeks gestation. Group A received nutrition and exercise simultaneously. Group B received nutrition first and Group C received exercise first, and the second behavior was added at 25 weeks gestation for both groups. The program included weekly weighing, supervised walking sessions, and/or nutrition counseling. Adherence (primary outcome) was measured by scoring women on meeting the intervention goals (3 nutrition and 3 exercise goals) and converted to a percentage. Secondary health outcomes were gestational weight gain (GWG) and excessive GWG on the program, birthweight, macrosomia (birthweight > 4000 g), and low birthweight (birthweight < 2500 g). RESULTS: Group C (n = 23) had the highest adherence to the program (80.2 ± 14.7%) compared with Groups A (n = 17; 60.9 ± 17.9%) and B (n = 20; 66.8 ± 16.7%; p < 0.05, ηp2 = 0.26). There was a significant effect for gestational weight gain (p < 0.05; ηp2 = 0.10) as Group C gained less weight (7.7 ± 2.2 kg) over Group B (9.8 ± 2.8 kg; p = 0.04), however, not Group A (9.1 ± 3.5, p = 0.35). Non-significant small effects favored Group C for the prevention of EGWG (Cramer's V = 0.13). CONCLUSION: Introducing exercise first followed by nutrition at 25 weeks gestation can improve adherence to multiple behavior change programs and thus have a positive effect on health outcomes. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02804061.