Fit Pregnancy

September 2013Martha Ross

Putting on pregnancy weight is a sensitive issue for many women – a fact that celebrity magazines exploit with nonstop headlines about the expanding “baby bumps” of famous women.

But for JiWon Choi, an assistant adjunct professor with UC San Francisco School of Nursing’s Institute for Health & Aging, pregnancy weight gain is less about personal appearance than it is about health risks for mothers and babies. Choi is in the midst of a randomized controlled trial that will test whether a fitness-focused mobile phone app motivates previously inactive pregnant women to start exercising and enjoying healthy pregnancies.

The Study

In an analysis of previous studies on pregnancy weight gain, Choi found that women avoid exercise because of physical discomfort, fear of hurting themselves or the baby, lack of support from family or friends and inexperience working out. Prenatal care providers admit they don’t spend as much time as they should on this topic with patients because they are rushed or feel uncomfortable broaching the subject of weight gain. Yet these studies also show that supervised fitness and diet programs lead to significantly lower gestational weights.

Thus Choi’s 12-week trial, called UCSF MoTHER (Mobile Technologies to Help Enhancing Regular Physical Activity) and funded by the National Institutes of Health, will involve 50 Bay Area women ages 18-40 who are 10-20 weeks into their pregnancies. The study will test whether mobile phone-based technology can help these women stay within the Institute of Medicine (IOM) guidelines for weight gain, while lowering the incidence of pregnancy and birth complications.

Some women in the study were normal weight before becoming pregnant, while others were overweight. Before starting the study, none of the women exercised much, if at all. The first participants began in February, and Choi is recruiting more.

Participants in both the control and intervention groups answer questionnaires about diet, exercise habits and social support for exercise. They also receive information about IOM guidelines and exercise safety, as well as a wearable device to measure physical activity. The difference is that the women in the intervention group will also receive the app, which was specially designed with an interdisciplinary team of experts and features workout videos, nutrition tips and daily messages suggesting, for example, ways to overcome boredom with a routine.

Real Health Consequences

The IOM guidelines say normal-weight women should gain between 25 and 35 pounds during pregnancy; overweight women should gain less, 15-25 pounds. But in the United States, more than half of women who get pregnant are overweight or obese at the start of pregnancy, and these women are twice as likely to gain excessive weight, Choi says.

This puts them at increased risk for pre-eclampsia, gestational diabetes, premature birth, stillbirth and cesarean delivery, according to the Centers for Disease Control and Prevention. Poorly controlled gestational diabetes is associated with larger babies and infants born with low blood sugar, breathing problems and jaundice.

Because of this, the American College of Obstetricians and Gynecologists recommends regular exercise for most pregnant and postpartum women. Still, Choi says, the majority of pregnant women don’t exercise, even if they were physically active prior to pregnancy.

That was the case for Autumn Johnson, a friend of Choi’s who shares her story in one of the videos on the app. Johnson gained 70 pounds during her first pregnancy 10 years ago. She had previously been a physically fit police patrol officer but switched to a sedentary desk job when she was two months along. “It was the first time in my life I felt like I could eat whatever I wanted whenever I wanted and not have any consequences,” she says.

Johnson was wrong about the consequences. The extra weight caused her to become borderline diabetic, and doctors induced labor at 38 weeks out of concern that her daughter would be more than 10 pounds. She left the hospital needing to lose 50 pounds in four months so she could return to work as a patrol officer.

For her second pregnancy, Johnson was more careful about what she ate and exercised regularly by walking and doing water aerobics. She gained only 36 pounds and had a much easier time shedding the weight postpartum.

“Weight issues can be a struggle for people and be traumatic and upsetting,” she says, explaining why she made the video. “I like to spread the word so that another woman doesn’t have to go through what I did with my body.”

Making Exercise a Habit

Choi can relate to her study participants. Before she started having children, she didn’t exercise much. While she didn’t gain too much weight while pregnant, she also didn’t take the best care of herself as a new mom.

“When I had my youngest one, I was doing my postdoctoral training and writing manuscripts for academic journals,” Choi says. She knew that chasing her sons around a park wasn’t a substitute for a good workout.

When her husband gave her a DVD with a fitness program, Choi created space in her home and time in her daily schedule to exercise. She started to feel stronger and more energetic.

“I still do it,” Choi says, referring to the DVD workout.

In part because of her own experience, Choi hopes a mobile phone-based program will make fitness accessible to women of all abilities and lifestyles. Women don’t have to join a gym, learn a tough new sport or work classes into busy work and family schedules. They can go for walks in their neighborhoods or, like Choi, do workouts at home. The aim is for them to do up to 30 minutes of exercise five days a week.

Choi also hopes her intervention will extend beyond pregnancy and motivate women to build physical activity into their daily routines for the long term.

“When women are pregnant, that’s often the time they are motivated to change behaviors, to stop smoking, to eat better,” says Choi, the mother of three sons, ages 5, 7 and 10. “We think if we start early, [women] might make changes they will stick with after the baby is born.”

Long-Term Results

Choi plans to have her study wrapped up by the end of 2013. She says there is a “remarkable opportunity” to improve the long-term health of both women and their children. Women who exercise regularly tend to adopt other healthy habits that they share with their families.

“The mother is usually the caregiver and the role model,” Choi says. “It’s important for her to stay healthy and to have accurate health information. It’s also common for women to think it’s selfish to take time for themselves to exercise, but that’s not true.”