Physical Activity in Pregnancy: Generating big data to advance promotion efforts

Background: Physical activity (PA) is beneficial to physical and mental health, providing additional benefits during pregnancy including decreased risk of depression, pre-eclampsia, and gestational diabetes. Infants whose mums were active during pregnancy are also more likely to have healthy birthweights. Pregnancy PA guidelines for women without complications recommend 150 minutes or more moderate PA per week and strength exercises on 2 or more days. Yet despite known benefits, evidence from small studies suggest around 70% of pregnant women do not meet recommendations (vs. ~40% of non-pregnant women). Not doing sufficient PA impacts the health of both women and children in the short and longer term, and has wider costs to the National Health Service (NHS) and society.

Evidence Gaps: Data is lacking about pregnancy PA in large diverse samples of women, and about how PA changes over the course of pregnancy. Women may not meet PA guidelines for many reasons, including social and cultural differences, or because of wide-ranging changes experienced in pregnancy. Long-standing perceptions that PA is risky for pregnant women (and infants) may be reinforced by healthcare professionals' lack of confidence in recommending PA. Having more knowledge about pregnancy PA, for example whether certain times may be better to encourage PA, can help to develop effective ways to promote PA.

Fellowship plan: This fellowship seeks to address key evidence gaps, through five related work packages (WP).
- In WP1 researchers will work with 8 NHS trusts to add three questions about PA into women's antenatal appointments. Questions will be asked once in each trimester to measure how active pregnant women are. Training will be given to midwives to ensure they feel confident asking and answering questions about PA. To aid wider roll out of these questions nationally, we will evaluate question implementation. WP1 will provide the first large-scale dataset about pregnancy PA internationally, which will be used to explore how PA relates to health and wellbeing in women and children.
- WP2 will use app-based technology and personal devices (i.e, fitbits) to measure PA throughout pregnancy. First, data collection measures will be tested in an existing study of 400 women with Type 1 diabetes. This information will be used to ensure that data collection in a diverse group ('cohort') of 2500 pregnant women runs smoothly. WP2 will provide information about how PA levels change over the course of pregnancy; how differing amounts of PA influence women's and infants' health; and whether specific times during pregnancy may be better to encourage PA. This will be used to develop better ways of promoting pregnancy PA (WP5).
- WP3 uses a novel foetal movement monitor to look at how a woman's pregnancy PA is related to movement in her unborn baby. It will explore whether foetal movement monitoring allows women to feel more confident about PA, and will help to inform guidelines and healthcare professionals' clinical practice.
- Taking knowledge gained about pregnancy PA in WP1-3 (in years 1-4), WP4 and WP5 will be conducted in years 5-7. WP4 will implement PA questions used in WP1 in a systematic way across NHS trusts in the UK to give a national picture of pregnancy PA; WP5 will co-develop an intervention with key stakeholders (i.e. women, midwives, policy and practice partners) to effectively promote pregnancy PA.

Women from diverse backgrounds and locations, and those who don't usually participate in research, will be included here to ensure that this research is relevant and impactful for all women in the UK. By using state-of-the-art methods and drawing on expertise across epidemiology, behavioural science, public health and antenatal care, this research will generate vital evidence to better understand and promote pregnancy PA, ultimately improving maternal-child health, providing better antenatal care, and improving UK and international public health