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Exposure Analysis Methods Impact Associations Between Maternal Physical Activity and Cesarean Delivery

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  • BACKGROUND: Previous studies report conflicting results regarding a possible association between maternal physical activity (PA) and cesarean delivery. METHODS: 7-day PA recalls were collected by telephone from n=1205 pregnant women from North Carolina, without prior cesarean, during two time windows: 17-22 weeks and 27-30 weeks completed gestation. PA was treated as a continuous, non-linear variable in binomial regressions (log-link function); models controlled for primiparity, maternal contraindications to exercise, pre-eclampsia, pregravid BMI, and percent poverty. We examined both total PA and moderate-to-vigorous PA (MVPA) at each time. Outcomes data came from medical records. RESULTS: The dose-response curves between PA or MVPA and cesarean risk at 17-22 weeks followed an inverse J-shape, but at 27-30 weeks the curves reversed and were J-shaped. However, only (total) PA at 27-30 weeks was strongly associated with cesarean risk; this association was attenuated when women reporting large volumes of PA (>97.5th percentile) were excluded. CONCLUSION: We did not find evidence of an association between physical activity and cesarean birth. We did, however, find evidence that associations between PA and risk of cesarean may be non-linear and dependent on gestational age at time of exposure, limiting the accuracy of analyses that collapse maternal PA into categories.
  • This is an author's peer-reviewed final manuscript, as accepted for publication. The published article is copyrighted by Human Kinetics, Inc., and can be found at: http://journals.humankinetics.com/jpah-back-issues/jpah-volume-12-issue-1-january/exposure-analysis-methods-impact-associations-between-maternal-physical-activity-and-cesarean-delivery
  • Keywords: childbirth, exposure coding, exercise, prospective, cohort study
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  • Bovbjerg, M. L., Siega-Riz, A. M., Evenson, K. R., & Goodnight, W. (2015). Exposure analysis methods impact associations between maternal physical activity and cesarean delivery. Journal of Physical Activity & Health, 12(1), 37-47. doi:10.1123/jpah.2012-0498
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  • 12
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  • 1
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  • Funding for this study was provided by National Institutes of Health: (NIH: Bethesda, Maryland)/National Institute of Child Health and Human Development (HD37584, HD052468-01A2), NIH/National Cancer Institute (CA109804-01), NIH/National Institute of Diabetes and Digestive and Kidney Diseases (DK061981-05), and NIH General Clinical Research Center (RR00046). Funding was also provided by the University of North Carolina at Chapel Hill Department of Obstetrics and Gynecology (UNC-OB/GYN: Chapel Hill, North Carolina).
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