The effects of exercise on birth weight: a meta-analysis.Abstract: Previous research regarding the effects of exercise on pregnancy outcomes has been inconsistent. The purpose of this study was to adopt an objective research technique, meta-analysis, to summarize and analyze different studies with controversial results. Three coding variables (i.e., exercise duration, pre-pregnancy weight, and age) were selected in this study for comparisons. Though the effect size (ES) of the pregnant mothers who exercised under 30 minutes was greater than that of those who exercised between 30 and 60 minutes, the overall ES (-107.838, 95% CI = -482.93 to 267.26) indicated no significant birth weight differences between the two groups. On the whole, the results of this study support the notion that a significant positive relationship exists between birth weight and the pre-pregnancy weight. However, regression analysis In statistics, a mathematical method of modeling the relationships among three or more variables. It is used to predict the value of one variable given the values of the others. For example, a model might estimate sales based on age and gender. indicated that a significant p <. 05) positive relationship existed between birth weight and the pre-pregnancy weight of the pregnant mothers (R =.75, p =.04). The conclusions of this study should be cautiously interpreted since they are limited to the selected studies under investigation. Directions and recommendations for future research are discussed. ********** Physiological factors such as cardiac output cardiac output n. Abbr. CO The volume of blood pumped from the right or left ventricle in one minute. It is equal to the stroke volume multiplied by the heart rate. , oxygen consumption, hormones, etc. will alter when a person exercises. Such physiological variables also change during pregnancy (Bell & O'Neill, 1994; Gorski, 1985; Spatling, Fallenstein, Huch, Huch, & Rooth, 1992). The combined effects of exercise during pregnancy are a major concern for most medical care providers, educators, the general public, as well as pregnant women and their families. The most common question being raised is whether oxygen and nutrients are shunted from the uterus to the working muscles during exercise. As a consequence, will women deliver immature or underweight Underweight An situation where a portfolio does not hold a sufficient amount of securities to satisfy the accepted benchmark of the portfolio's asset allocation strategy. Notes: babies because of exercise activity during pregnancy? Previous research studies have indicated that low birth weight (i.e., not more than 2500 g) babies were inferior to normal weight babies in reference to future growth and development. There appears to be a higher frequency of learning disabilities and behavioral problems (McCormick, Gortmaker, & Sobol, 1990; Ornstein, Ohlsson, Edmonds, & Asztalos, 1991; Sommerfeldt, Ellersten, & Markestad, 1996; Sommerfeldt, Troland, Ellersten, & Markestad, 1996; Szatmari, Saigal, Rosenbaum, Campbell, & King, 1990), lower Intelligence Quotient intelligence quotient n. Abbr. IQ An index of measured intelligence expressed as the ratio of tested mental age to chronological age, multiplied by 100. (Ornstein, Ohlsson, Edmonds, & Asztalos, 1991; Pharoah, Stevenson, Cooke, & Stevenson, 1994; Sommerfeldt, Ellersten, & Markestad, 1995), and motor clumsiness such as impaired balance (Largo Largo, town (1990 pop. 65,674), Pinellas co., W Fla., on the Pinellas peninsula and the Gulf Coast, across the bay from Tampa; settled 1853, inc. 1905. It is a packing, canning, and shipping center in a citrus fruit and fishing area. et al., 1989; Marlow, Roberts, & Cook, 1989) among low birth weight babies. The direct causes of low birth weight babies are not fully understood. However, many factors have been examined to determine their effects on pregnancy outcomes. These factors include supplements (e.g., Scholl & Johnson, 2000), nutrition (e.g., Breslin, 1998), and exercise (see Pivarnik, 1998 and Sternfeld, 1997 for a thorough review). Among these factors, the most controversial one seems to be the effects of exercise on pregnancy outcomes, particularly on the changes in birth weight. In their study, Bell, Palma Palma or Palma de Mallorca (päl`mä thā mälyôr`kä), city (1990 pop. 325,120), capital of Majorca island and of Baleares prov., Spain, on the Bay of Palma. , and Lumley (1995) compared women who were doing vigorous exercise vigorous exercise A form of exercise that is intense enough to cause sweating and/or heavy breathing/ and/or ↑ heart rate to near maximum; VE is formally defined as that which requires > 6 METs; there is a graded inverse relationship between total physical prior to pregnancy and continued exercising during pregnancy with those who did not do regular vigorous exercise (controls). They found women who did more than 4 sessions (30 minutes each session) of vigorous exercise weekly at 25 weeks gestation had babies whose mean birth weight was 315g lower than their counterparts. Other studies also supported the idea that strenuous physical activity in pregnancy could be associated with low birth weight and earlier deliveries (Bell & O'Neill, 1994; Clapp & Dickstein, 1984). Researchers also indicated that a number of other factors seem to be related to poor pregnancy outcomes, as well. These factors may include, but are not limit to, the following: (a) maternal weight prior and during pregnancy (e.g., Cnattingius, Bergstrom, Lipworth, & Kramer, 1998; Edwards, Hellerstedt, Alton, Story, & Himes, 1996; Kumari, 2001; Ogunyemi, Hullett, Leeper, & Risk, 1998), (b) maternal nutrition, such as nutrient deficiencies or toxicities, use of some herbal supplements, eating disorders eating disorders, in psychology, disorders in eating patterns that comprise four categories: anorexia nervosa, bulimia, rumination disorder, and pica. Anorexia nervosa is characterized by self-starvation to avoid obesity. (e.g., Brown & Kahn, 1997; Story & Alton, 1995), (c) socioeconomic issues, like poverty, low levels of education, limited availability When customers of the PSTN make telephone calls, they commonly make use of a telecommunications network called a switched-circuit network. In a switched-circuit network, devices known as switches are used to connect the caller to the callee. of food (e.g., Jonas, Roder, & Chan, 1992; Otterblad-Olausson, Cnattingius, ex: Goldenberg, 1997), (d) lifestyle choices, such as smoking, alcohol or other drug use (e.g., Kallen, 2001; Korea, Pastuszak, & Ito, 1998), (e) age, for example, teens and women over age 35 (e.g., Gortzak-Uzan, Hallak, Press, Katz, & Shoham-Vardi, 2001; Seoud et al., 2002), (f) previous pregnancies, such as short intervals between pregnancies, poor prior pregnancy outcomes, multiple births (e.g., Meyer, Buescher, & Surles, 1999; Zhu, Haines, Le, McGrath-Miller, & Boulton, 2001), and (g) maternal health Maternal health care is a concept that encompasses preconception, prenatal, and postnatal care. Goals of preconception care can include providing health promotion, screening and interventions for women of reproductive age to reduce risk factors that might affect future pregnancies. concerns, like high blood pressure, diabetes, or other chronic diseases (e.g., Lopez, Smith, & Gutierrez, 2002; Sibai, 1996; Xiong, Demianczuk, Saundersm, Wang, & Fraser, 2002). Pivarnik, Mauer, Ayres, Kirshon, Dildy, and Cotton (1994), however, compared nine aerobically trained, physically active pregnant women who continued to exercise throughout gestation with five healthy yet sedentary sedentary /sed·en·tary/ (sed´en-tar?e) 1. sitting habitually; of inactive habits. 2. pertaining to a sitting posture. sedentary of inactive habits; pertaining to a fat, castrated or confined animal. pregnant women. They concluded that average birth weight and length of gestation did not significantly differ between the subject groups. Sternfeld, Quesenberry, Eskenazi, and Newman (1995) investigated the effect of different aerobic exercise aerobic exercise, n sustained repetitive physical activity, such as walking, dancing, cycling, and swimming, that elevates the heart rate and increases oxygen consumption resulting in improved functioning of cardio-vascular and respiratory systems. levels on pregnancy outcomes with 388 women between the ages of 18 and 42 and found that exercise levels were not associated with mean birth weight and other pregnancy outcomes. Several other studies also indicated that physical activity was not associated with changes in birth weight (Dale, Mullinax, & Bryan, 1982; Jarrett & Spellacy, 1983; Rice & Fort, 1991; Rose, Haddow, Palomake, & Knight, 1991). Conversely, after assessing 800 prenatal patients, Hatch et al. (1993) asserted that in fit and low-risk patients, exercise was positively related to fetal growth. They indicated that low to moderate exercise level patients had a mean birth weight about 100 g higher than the non-exercisers. In addition, large birth weight increments (about 300 g) were found for those who exercised throughout pregnancy at levels approximating 3,000 Kcal per week. Similarly, Brodey (1993) also concluded that pregnant women who expended ex·pend tr.v. ex·pend·ed, ex·pend·ing, ex·pends 1. To lay out; spend: expending tax revenues on government operations. See Synonyms at spend. 2. up to 1,000 Kcal a week doing both high and low impact activities (e.g., stationary biking, aerobics, jogging, and strength training) delivered babies who weighed 5% more than those by the sedentary mothers. Comparatively, mothers who expended 2,000 Kcal a week delivered babies weighing 10% more (Brodey, 1993). Likewise, Johnson et al. (1994) demonstrated that exercise was associated with higher mean birth weight and head circumference in African American African American Multiculture A person having origins in any of the black racial groups of Africa. See Race. pregnant women. Because of the controversy in these studies regarding the effects of maternal exercise on birth weight, there is a need to quantitatively and objectively summarize the findings of related studies. The purpose of this paper was to summarize and analyze studies regarding maternal exercise and birth weight using meta-analysis (Glass, 1977; Hedges & Olkin, 1985). Meta-analysis is a strategy that statistically analyzes summary findings of empirical research Noun 1. empirical research - an empirical search for knowledge inquiry, research, enquiry - a search for knowledge; "their pottery deserves more research than it has received" (Glass, 1977). Hedges and Olkin (1985) described meta-analysis as "the rubric RUBRIC, civil law. The title or inscription of any law or statute, because the copyists formerly drew and painted the title of laws and statutes rubro colore, in red letters. Ayl. Pand. B. 1, t. 8; Diet. do Juris. h.t. used to describe quantitative methods for combining evidence across studies" (p. 13). The outcome of the meta-analysis is derived from four steps. First, evaluations relevant to a specific topic are collected. Secondly, specific features of these evaluations are described quantitatively. Next, outcomes are formulated into a common measure called the effect-size, the standardized difference between the experimental and the control groups on a specific criterion. Finally, the researcher utilizes statistical methods to find relations between study features and study outcomes (Bangert-Drowns, 1986). Since meta-analysis usually relies on "data" in the form of summary statistics derived from the primary analyses of studies, it can be regarded as an analysis of the results of statistical analyses (Hedges &-Olkin, 1985). METHOD All of the research articles selected for this study were based on a literature exploration using (a) computer and (b) hand search techniques. The computer search was restricted to the following databases: Medline, ProQuest Direct, PsycINFO, ERIC, SPORT Discuss, and Books & Dissertations. The hand search was based on the references listed in journal articles and books/dissertations. The key words used for computer search were exercise, pregnancy, pregnancy outcome', and `birth weight'. According to according to prep. 1. As stated or indicated by; on the authority of: according to historians. 2. In keeping with: according to instructions. 3. the afore-said procedures in the literature search, 40 articles were identified to be related to the topic under investigation and appropriate for initial review. A majority of the articles came from Medline, while ERIC provided the least number of articles. After a thorough examination of the 40 articles, 31 of them did not meet the criteria for this study because one or more of the following criteria were missing: (a) standard deviation In statistics, the average amount a number varies from the average number in a series of numbers. (statistics) standard deviation - (SD) A measure of the range of values in a set of numbers. , e.g., Dale, Mullinax, & Bryan, 1982; Hall & Kaufmann, 1987, (b) sample size, e.g., Clapp, 1996, (c) control group, e.g., Jarrett & Spellacy, 1983, or (d) other reasons such as using animals as subjects (e.g., Matsuno, Esrey, Perrault & Koski, 1999). As a result, only nine studies that met the criteria for meta-analysis were selected. In this study, nine studies were examined to determine the effects of exercise duration on birth weight. To meet the criteria to be included in this meta-analysis, all of the following elements needed to be present in a study: (a) use birth weight as the dependent variable, (b) provide sample size, mean and standard deviation for each group; if not, provide values of the F ratio or [c.sup.2] with degrees of freedom, and (c) have acceptable measurement quality, e.g., the use of a control group. Because the purpose of this study was to examine the effects of exercise on birth weight, exercise duration was selected as the coding variable. Two other variables of interest, pre-pregnancy weight and age, which might potentially influence the effect sizes also were coded. Due to the limited number of studies, exercise duration was divided into two levels: (a) those who exercised up to but not more than 30 minutes, and (b) those who exercised between 30 and 60 minutes. The total sample size of the nine articles used for this study was 951. The MetaWin Verson 2.0 (Rosenberg, Adams, & Gurevitch, 2000) computer program was used to examine (a) the differences of birth weight, age, and pre-pregnancy weight between the exercise group and control group, and (b) the effect size of birth weight between pregnant mothers who exercised less than 30 minutes versus those who exercised between 30 and 60 minutes. In addition, linear regression Linear regression A statistical technique for fitting a straight line to a set of data points. analyses were used to examine (a) the relationship between birth weight and age as well as pre-pregnancy weight of the experimental group, and (b) the relationship of age and pre-pregnancy weight differences between the experimental group and control groups. RESULTS A total of 951 pregnant women were included in this study, 542 participants in the experimental group and 409 participants in the control group. Descriptive statistics descriptive statistics see statistics. and birth weight of the experimental and control groups are shown in Table 1. The effect size (ES) of the birth weight differences between the experimental and control groups was -109.20 (95% CI = -432.071 to 213.663). This indicated no significant birth weight differences between the two groups since the confidence intervals confidence interval, n a statistical device used to determine the range within which an acceptable datum would fall. Confidence intervals are usually expressed in percentages, typically 95% or 99%. crossed zero. Similarly, no significant pre-pregnancy weight differences were found between the experimental and control groups (ES = -0.776, 95% CI = -2.406 to 0.853). However, the age of the experimental group mothers was slightly higher than their counterparts (ES = 0.743, 95% CI = 0.006 to 1.480). In spite of this, the age of the experimental and control group mothers was very similar since such a small ES (i.e., 0.74) was not considered clinically important. On the other hand, when examining the birth weight of those who exercised under 30 minutes versus those who exercised between 30 and 60 minutes, both groups had a negative ES. The ES of the former was -236.047 while that of the latter was -4.143. Though the pregnant women who exercised a longer duration had a smaller absolute ES value, the overall ES (-107.838, 95% CI = -482.93 to 267.26) indicated no significant birth weight differences between the two groups because the confidence intervals crossed zero. Since age and pre-pregnancy weight could act as confounding variables, their relationship with birth weight was examined. Liner regression analyses indicated no significant (p > .05) relationship between birth weight and the age of the experimental group (R = .04, p = .91) as well as the pre-pregnancy weight differences of the exercise and control groups (R = .05, p = .46). However, significant (p < .05) positive relationship was found between birth weight and the pre-pregnancy weight of the experimental group (R = .75, p = .04). DISCUSSION The purpose of this study was to use meta-analysis to examine the effects of exercise on birth weight. Only nine of the 40 articles reviewed were used for this study because the remainder did not meet the criteria for a meta-analysis. It seems that it is not a common practice in medical articles to provide standard deviations for the results (for examples, Dale, Mullinax, & Bryan, 1982; Hall & Kaufmann, 1987; Klebaboff, Shiono, & Carey, 1990; Rafla & Cook, 1999; Rafla, 2000; Rose, Haddow, Palomaki, & Knight, 1991; Schramm, Stockbauer, & Hoffman, 1996). Further, the research methodology of some of the articles is questionable, for example, no control group was used in the study (e.g., Jarrett & Spellacy, 1983). Though exercise intensity is an important variable that can affect birth weight, it was excluded from this study because there were not enough articles provide this information. The main purpose of this study was to investigate the effect of exercise duration on birth weight. However, because pre-pregnancy weight and age of the experimental and control groups might influence the birth weight of the babies, these two variables were also examined because. The nonsignifcant pre-pregnancy weight difference and trivial ES of age between the experimental and control groups indicated that these two variables did not generate any significant impact on either group's outcome variable (birth weight). The ES of both exercise groups were negative, but the magnitude of those who exercised under 30 minutes was greater. This suggests that those who exercised less than 30 minutes tended to produce smaller babies than those who exercised between 30 and 60 minutes. However, in spite of this big difference in ES (i.e., -236.047 versus -4.143), no significant birth weight differences were found between the two groups. This is probably because of the small sample size in this study. If a larger sample could be included in future studies, this is a worthwhile topic for further investigation since previous researchers have suggested that pregnant women who exercised regularly delivered heavier babies than their non-exercise counterparts (Brodey, 1993; Hatch, et al., 1993; Johnson, et al., 1994). For example, Hatch et al. (1993) indicated that women expending 1000 Kcal or more a week in recreational activity throughout pregnancy had babies 310 g heavier than those who did not exercise. Further, Schramm, Stockbauer, and Hoffman (1996) demonstrated that women having very low birth weight babies (N = 782) were less likely to engage in regular and vigorous exercise during pregnancy than women with normal birth weight babies (N = 793). In this study, no relationship was found between birth weight and the age of the experimental group. Previous researchers indicated that the risk of low birth weight babies is greatest in teenage mothers or women aged 40 or older (Pivarnik, 1998). The age of all the pregnant mothers in this study was within "normal" range (i.e., between 23 and 32 years of age) and therefore may not have generated any significant difference in birth weight. On the other hand, the significant positive relationship found between birth weight and the pre-pregnancy weight was not surprising since numerous previous research studies also found a strong positive relationship between pre-pregnancy weight and birth weight as well as between maternal weight gain and birth weight (Abrams & Laros, 1986; Abrams & Neuman, 1989; Abrams & Selvin, 1995; Brown, 1988; Frentzen, Dimperio, & Cruz, 1988; Garn, Shaw, & McCabe, 1977; Hediger, Scholl, & Salmon, 1989; Hediger, Scholl, Belsky, Ances, & Salmon, 1989; Institute of Medicine, 1990; Naeye, 1979; Nahum, Stanislaw, & Huffaker, 1998; Scholl, Hediger, Ances, Belsky, & Salmon, 1990; Thorsdottir & Birgisdottir, 1998; Wen, Goldenberg, Cutter, Hoffman, & Cliver 1990). For example, Thorsdottir and Birgisdottir (1998) found in their study that women who gained between 18 and 24 kg had babies approximately 300 g heavier than those who gained between 9 and 1: kg. The purpose of this study was to introduce one of the many techniques that could summarize and analyze similar studies with inconsistent results. In 1991, Lokey, Tran, Wells, Myers, and Tran used "a meta-analytic review" to examine the effects of physical exercise on pregnancy outcomes. However, they used t-tests to compare the mean differences of the exercising and sedentary groups and no ES was reported. Based on a review of the literature, this is the first meta-analysis study to examine the effects of exercise on birth weight using a meta-analysis computer program and ES to determine the overall magnitude of two comparing groups. Only three variables, exercise duration, age, and pre-pregnancy weight, were examined in this study. Another potential variable that should be considered in future studies is ethnicity since black infants tended to weigh less and be twice as likely as white babies to have a low birth weight (Breslin, 1998). On the whole, the results of this study support the notion that a significant positive relationship exists between birth weight and the pre-pregnancy weight. This conclusion is based on the results of the meta-analysis of selected publications. Of course, many other factors other than the aforesaid Before, already said, referred to, or recited. This term is used frequently in deeds, leases, and contracts of sale of real property to refer to the property without describing it in detail each time it is mentioned; for example,"the aforesaid premises. variables also may affect pregnancy outcomes. These factors may include maternal weight, maternal nutrition, socioeconomic status socioeconomic status, n the position of an individual on a socio-economic scale that measures such factors as education, income, type of occupation, place of residence, and in some populations, ethnicity and religion. , lifestyle habits, age, poor previous pregnancy outcomes, and maternal health. It is suggested that for future medical studies, efforts should be implemented to control for potential confounding confounding when the effects of two, or more, processes on results cannot be separated, the results are said to be confounded, a cause of bias in disease studies. confounding factor factors when manipulating independent variables and assessing dependent variables. In addition, in order to facilitate future studies using meta-analysis, the researchers recommend the following information to be included in all publications: (a) sample size, (b) experimental and control groups, (c) mean and standard deviation of the dependent variables, (e) the type of statistical analysis, and (f) the results of statistical analysis. HEALTH EDUCATION RESPONSIBILITY AND COMPETENCY ADDRESSED Responsibility III: Implementing Health Education Programs Competency A: Exhibit competency in carrying out planned educational programs. Subcompetency 5: Assess, select, and apply technologies that will contribute to program objectives.
Table 1. Descriptive Statistics of the Experimental and Control Groups.
Experimental Group
Pre-pregnancy
Source Age (year) weight (kg)
Horns et al. (1996) (1) 28.4 [+ or -] 4.1 --
Lewis et al. (1988) (1) 28.4 [+ or -] 3.2 59.4 [+ or -] 8.4
Hatch et al. (1993) (1) 27.9 [+ or -] 4.6 62.2 [+ or -] 14
Botkin & Driscoll (1991) (1) 28.1 [+ or -] 5.1 --
Bell et al. (1995) (2) 31.8 [+ or -] 2.7 58.8 [+ or -] 6.9
Clapp & Capeless (1990) (2) 30.6 [+ or -] 2.5 57.7 [+ or -] 5.2
Rice & Fort (1991) (2) 23.3 [+ or -] 3.6 --
Collings et al. (1983) (2) 26.9 [+ or -] 2.8 60.3 [+ or -] 8.3
Kardel & Kase (1998) (2) 28.8 [+ or -] 2.3 59.4 [+ or -] 6.3
Birth weight
Source (gram) N
Horns et al. (1996) (1) 2496 [+ or -] 486 48
Lewis et al. (1988) (1) 3400 [+ or -] 700 18
Hatch et al. (1993) (1) 3554 [+ or -] 382 277
Botkin & Driscoll (1991) (1) 3664 [+ or -] 318 19
Bell et al. (1995) (2) 3353 [+ or -] 589 58
Clapp & Capeless (1990) (2) 3381 [+ or -] 322 77
Rice & Fort (1991) (2) 3500 [+ or -] 318 12
Collings et al. (1983) (2) 3596 [+ or -] 480 12
Kardel & Kase (1998) (2) 3651 [+ or -] 516 21
Control Group
Pre-pregnancy
Source Age (year) weight (kg)
Horns et al. (1996) (1) 27.2 [+ or -] 3.8 --
Lewis et al. (1988) (1) 27.3 [+ or -] 3.4 62.8 [+ or -] 10.6
Hatch et al. (1993) (1) 27.1 [+ or -] 4.4 62.5 [+ or -] 11.7
Botkin & Driscoll (1991) (1) 27.2 [+ or -] 5.5 --
Bell et al. (1995) (2) 31.6 [+ or -] 4.7 59.1 [+ or -] 7.6
Clapp & Capeless (1990) (2) 30.1 [+ or -] 3.3 58.1 [+ or -] 5.9
Rice & Fort (1991) (2) 26.2 [+ or -] 5.1 --
Collings et al. (1983) (2) 28.0 [+ or -] 3.7 64.4 [+ or -] 8.4
Kardel & Kase (1998) (2) 26.7 [+ or -] 1.7 63.0 [+ or -] 8.9
Control Group
Birth Weight
Source (gram) N
Horns et al. (1996) (1) 3467 [+ or -] 434 53
Lewis et al. (1988) (1) 3700 [+ or -] 500 10
Hatch et al. (1993) (1) 3389 [+ or -] 488 185
Botkin & Driscoll (1991) (1) 3523 [+ or -] 351 25
Bell et al. (1995) (2) 3364 [+ or -] 412 41
Clapp & Capeless (1990) (2) 3691 [+ or -] 348 55
Rice & Fort (1991) (2) 3455 [+ or -] 450 11
Collings et al. (1983) (2) 3354 [+ or -] 415 8
Kardel & Kase (1998) (2) 3591 [+ or -] 532 21
Data reported as mean [+ or -] standard deviation
(1) Group 1: Exercised under 30 minutes
(2) Group 2: Exercised 30 to 60 minutes
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Teenage pregnancy teenage pregnancy Adolescent pregnancy, teen pregnancy Social medicine Pregnancy by a ♀, age 13 to 19; TP is usually understood to occur in a ♀ who has not completed her core education–secondary school, has few or no marketable skills, is : risk factors for adverse perinatal perinatal /peri·na·tal/ (-na´t'l) relating to the period shortly before and after birth; from the twentieth to twenty-ninth week of gestation to one to four weeks after birth. per·i·na·tal adj. outcome. Journal of Maternal Fetal Medicine fetal medicine n. The branch of medicine that deals with the growth, development, care, and treatment of the fetus and with environmental factors that may harm the fetus. , 10, 393-397. Hall, D. C., & Kaufmann, D. A. (1987). Effects of aerobic and strength conditioning on pregnancy outcomes. American Journal of Obstetrics and Gynecology, 157, 1199-1203. * Hatch, M. C., Shu, X. O., McLean, D. E., Levin, B., Begg, M., Reuss, L., & Susser, M. (1993). Maternal exercise during pregnancy, physical fitness, and fetal growth. American Journal of Epidemiology, 137, 1105-1114. Hedges, L. V., & Olkin, I. (1985). Statistical methods for meta-analysis. Orlando, FL: Academic Press. Hediger, M., Scholl, T., & Salmon, R. (1989). Early weight gain in pregnant adolescents and fetal outcome. American Journal of Human Biology Human biology is an interdisciplinary academic field of biology, biological anthropology, and medicine which focuses on humans; it is closely related to primate biology, and a number of other fields. , 1,665-672. Hediger, M., Scholl, T., Belsky, D., Ances, I., & Salmon, R. (1989). Patterns of weight gain in adolescent pregnancy adolescent pregnancy See Teenage pregnancy. : Effects on birth weight and preterm delivery. Obstetrics and Gynecology, 74, 6-12. * Horns, P. N., Ratcliffe, L. P., Leggett, J. C., & Swanson, M. S. (1996). Pregnancy outcomes among active and sedentary primiparous pri·mip·a·ra n. pl. pri·mip·a·ras or pri·mip·a·rae 1. A woman who is pregnant for the first time. 2. A woman who has given birth to only one child. women. Journal of Obstetric ob·stet·ric or ob·stet·ri·cal adj. Of or relating to the profession of obstetrics or the care of women during and after pregnancy. obstetrical, obstetric pertaining to or emanating from obstetrics. , Gynecologic gynecologic /gy·ne·co·log·ic/ (gi?ne-) (jin?e-kah-loj´ik) pertaining to the female reproductive tract or to gynecology. and Neonatal Nursing Neonatal nursing is a specialized nursing practice of caring for newborn infants (neo meaning new, natal meaning birth) up to 28 days subsequent to birth. , 25, 49-54. Institute of Medicine. (1990). Committee on Nutritional Status nutritional status, n the assessment of the state of nourishment of a patient or subject. 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Training in pregnant women: Effects on fetal development and birth. American Journal of Obstetrics and Gynecology 178, 280-286. Klebanoff, M. A., Shiono, P. H., & Carey, J. C. (1990). The effect of physical activity during pregnancy on preterm delivery and birth weight. American Journal of Obstetrics and Gynecology, 163, 1450-1456. Korea, G., Pastuszak, A., & Ito, S. (1998). Drugs in pregnancy. New England Journal of Medicine, 338, 1128-1137. Kumari, A. S. (2001). Pregnancy outcome in women with morbid obesity morbid obesity n. The condition of weighing at least twice the ideal weight. morbid obesity Superobesity Bariatircs A condition defined as 45 kg > ideal body weight, 2 times > ideal/standard weight or, for . Largo, R. H., Pfister, D., Molinari, L., Kundu, S., Lipp, A., & Duc, G. (1989). Significance of prenatal, perinatal and postnatal postnatal /post·na·tal/ (-na´t'l) occurring after birth, with reference to the newborn. post·na·tal adj. Of or occurring after birth, especially in the period immediately after birth. factors in the development of AGA preterm infants preterm infant n. An infant born before the 37th week of gestation. preterm infant Premature infant, see there at five to seven years. Developmental Medicine and Child Neurology neurology (n  rŏl`əjē, ny–), study of the morphology, physiology, and pathology of the human nervous system. , 31,440-456.* Lewis, R. D., Yates, C. Y., & Driskell, J. A. (1988). Riboflavin riboflavin: see coenzyme; vitamin. riboflavin or vitamin B2 Yellow, water-soluble organic compound, abundant in whey and egg white. It has a complex structure incorporating three rings. and thiamin thiamin or vitamin B1 Organic compound, part of the vitamin B complex, necessary in carbohydrate metabolism. It carries out these functions in its active form, as a component of the coenzyme thiamin pyrophosphate. status and birth outcome as a function of maternal aerobic exercise. 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Low intensity exercise and varying proportions of dietary glucose and fat modify milk and mammary gland mammary gland, organ of the female mammal that produces and secretes milk for the nourishment of the young. A mammal may have from 1 to 11 pairs of mammary glands, depending on the species. Generally, those mammals that bear larger litters have more glands. compositions and pup growth. Journal of Nutrition, 129, 1167-1175. McCormick, M. C., Gortmaker, S. L., & Sobol, A. M. (1990). Very low birth weight children: Behavior problems and school difficulty in a national sample. Journal of Pediatrics, 117, 687-693. Meyer, R. E., Buescher, P. A., & Surles, K. B. (1999). Multiple deliveries and effects on birth outcomes. Matern Child Health, 3, 233-240. Naeye, R. L. (1979). Weight gain and the outcome of pregnancy. American Journal of Obstetrics and Gynecology 135, 3-9. Nahum, G. G., Stanislaw, H., & Huffaker, B. J. (1998). Accurate prediction of term birth weight from prospectively measurable maternal characteristics. Sonography sonography: see ultrasound and Interventional Radiology interventional radiology Imaging A subspecialty of radiology that provides Diagnostic information–eg, CT-guided 'skinny' needle biopsies and dye injection for analysis of various lumina and tracts–eg, arteriography, cholangiography, antegrade 5(4), 193-194, Ogunyemi, D., Hullett, S., Leeper, J., & Risk, A. (1998). Prepregnancy body mass index, weight gain during pregnancy, and perinatal outcome in a rural black population. Journal of Maternal Fetal Medicine, 7, 190-193. Ornstein, M., Ohlsson, A., Edmonds, J., & Asztalos, E. (1991). Neonatal follow-up of very low birthweight/ extremely low birthweight infants to school age: A critical overview. Acta Paediatrica Scandinavica, 80, 741-748. Otterblad-Olausson, P. M., Cnattingius, S., & Goldenberg, R. L. (1997). Determinants of poor pregnancy outcomes among teenagers in Sweden. 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References with * were used for the meta-analysis. Eddie T. C. Lam, Ph.D., Jill M. Black, Ph.D., CHES, Kathleen D. Little, Ph.D., Judith Ausherman, Ed.D., CHES and Codruta Rafiroiu, M.D., Ph.D. are in the Department of Health, Physical Education, Recreation, & Dance at Cleveland State University Cleveland State University, at Cleveland, Ohio; coeducational; founded 1964, incorporating Fenn College (est. 1923). The Cleveland-Marshall School of law was incorporated in 1969. . Address all correspondence to Eddie T. C. Lam, Ph.D., Department of Health, Physical Education, Recreation, & Dance, Cleveland State University, 2121 Euclid Avenue For the street in Ontario, California, see . Euclid Avenue is a name applied to streets in many American cities; however, Cleveland, Ohio’s Euclid Avenue received nationwide attention from the 1860s to the 1920s for its beauty and wealth. , PE 218, Cleveland, OH 44115-2214; PHONE: 216.687.5051; FAX: 216.687.5410; E-MAIL e-mail: see electronic mail. in full electronic mail Messages and other data exchanged between individuals using computers in a network. : t.lam@csuohio.edu. |
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