Supplemental Table 1. Description of Studies Reviewed by Health Outcome
Selected Studies on Leisure-Time Physical Activity and Gestational Diabetes Mellitus (87)
Author
Study
Total
Cases of
LTPA#
Pre-Pregnancy
Pregnancy
Participants
GDM#
Measure
LTPA#
LTPA#
aOR (95% CI)#
aOR (95% CI)#
Design
Population
Zhang et
U.S.
Prospective 21,765
al., 2006
Nurses’
questionnaire
(95)
Health
HI: >40.4 MET-hr/wk
Study II
Ref: <4.8 MET-hr/wk
Redden et
U.S.
Cross-
al., 2010
PRAMS
Sectional
11,403
1,428
1,052
Standardized
Standardized
0.81 (0.68-1.01)
NA
0.69 (0.46-1.03)
NA
0.14 (0.05-0.38)*
NA
questionnaire
HI: ≥ 5 d/wk
(76)
Ref: <1 d/wk
Rudra et
U.S.
Prospective 897
42
Minnesota LTPA
al., 2006
OMEGA
Questionnaire
(82)
Study
HI: ≥ 15 MET-hr/wk
1
Ref: None
U.S. Alpha
Case-
Study
Control
688
216
Minnesota LTPA
0.49 (0.28-0.87)*
NA
NA
0.51 (0.27-0.97)*
NA
0.67 (0.31-1.43)
Questionnaire
HI: ≥ 30 MET-hr/wk
Ref: None
Dempsey
U.S.
Prospective 909
et al.,
OMEGA
HI: ≥ 28 MET-hr/wk
2004 (31)
Study
Ref: None
Dempsey
U.S. Alpha
Case-
et al.,
Study
Control
541
42
155
Stanford 7day Recall
Minnesota LTPA
Questionnaire
HI: ≥ 30 MET-hr/wk
2004 (30)
Ref: None
Oken et
U.S. Project
al., 2006
Viva
(64)
Prospective 1,805
91
Pregnancy Risk
0.70 (0.30-1.68)
0.91 (0.37-2.21)
Assessment and
Monitoring System
HI: ≥ 14 hr/wk
2
Ref: <2 hr/wk
Chasan-
U.S. Latina
Prospective 1,006
33
Taber et.
Pregnancy
Activity Survey
al, 2008
Study
(KPAS)
(20)
Kaiser Physical
0.80 (0.20-2.70)
0.80 (0.20-2.30)
0.13 (0.06-0.27)*
0.77 (0.71-0.84)*
Pre-pregnancy:
HI: KPAS ≥ 12.3
Ref: KPAS <7.9
Pregnancy:
HI: KPAS ≥ 10.7
Ref: KPAS <6.8
Harizopou
Greek
Cross-
lou et al.,
Hospital
Sectional
2009 (40)
Study
160
40
International Physical
Activity Questionnaire
HI: ≥ 10 MET-hr/wk
Ref: < 10 MET-hr/wk
Selected Studies on Leisure Time Physical Activity and Preeclampsia
Author
Study
Design
Total
Cases of
Physical Activity
Pre-Pregnancy
Pregnancy
3
Population
Participants
Pre-
Measure
eclampsia
Sorenson
U.S. Seattle, Case-
584
201
et al.,
WA
2003 (86)
Hospital
and year prior
Study
Pre-pregnancy:
Control
Structured Interview
LTPA
LTPA
aOR (95% CI)
aOR (95% CI)
0.63 (0.34-1.18)
0.44 (0.23-0.84)*
1.12 (0.48-2.61)
0.56 (0.12-2.56)
for < 20wk gestation
HI: >36.8MET-hr/wk
Ref: None
Pregnancy:
HI: >31.5MET-hr/wk
Ref: None
Saftlas et
U.S. New
Case-
al, 2004
Haven, CN
Control
(83)
Clinic Study
2638
44
Structured Interview
for < 16 wk gestation
and year prior
HI: Any, Ref: None
Rudra et
U.S. Seattle, Case-
714
244
Structured Interview
RPE
4
al., 2005
WA
(81)
Control
for and year prior
0.22 (0.11-0.44)*
Hospital
Ratings of Perceived
LTPA
Study
Exertion (RPE):
0.50 (0.28-0.88)*
---
HI: 7-10, Ref: 0-2
LTPA:
HI: >30.0MET-hr/wk
Ref: None
Rudra et
U.S.
Prospective 2241
111
Stanford 7day Recall
al., 2008
OMEGA
at ~15 wks gestation
(80)
Study
and Minnesota LTPA
0.60 (0.30-1.26)
0.96 (0.52-1.75)
Survey for year prior
Pre-pregnancy:
HI: >31.5MET-hr/wk
Ref: None
Pregnancy:
HI: >31.5MET-hr/wk
5
Ref: None
Magnus et
MoBa
Prospective 59,573
2315
See Table 1. Only
1-5 x/mo
al, 2008
used Wk 17 LTPA.
0.96 (0.85-1.07)
(55)
Ref: None
6-12 x/mo
1-5 x/mo
---
0.96 (0.85-1.08)
6-12 x/mo
13-24 x/mo
13-24 x/mo
0.89 (0.78-1.03)
>25 x/mo
>25 x/mo
0.79 (0.65-0.96)*
Osterdal et DNBC
Prospective 85,139
2264
See Table 1. Only
1-44 min/wk
al, 2008
used Wk 16 LTPA.
0.99 (0.81-1.20)
(67)
Ref: None
45-74 min/wk
1-44 min/wk
1.04 (0.90-1.20)
45-74 min/wk
---
75-149 min/wk
75-149 min/wk
0.95 (0.83-1.09)
150-269 min/wk
150-269 min/wk
6
270-419 min/wk
0.92 (0.78-1.08)
>420 min/wk
270-419 min/wk
0.99 (0.77-1.28)
>420 min/wk
1.03 (0.74-1.44)
Fortner et
U.S. Latina
al., 2011
GDM Study
Prospective 1043
30
(36)
Kaiser LTPA Survey
Sports/Exercise:
Sports/Exercise:
at ~15 wks gestation
1.0 (0.4-2.5)
0.4 (0.1-1.6)
Sports/Exercise:
Total Activity
Total Activity
HI: 4th quartile
2.1 (0.7-6.2)
0.1 (0.01-1.3)
Ref: 1st quartile
Total Activity:
HI: 4th quartile
Ref: 1st quartile
Selected Studies on Leisure-Time Physical Activity Intervention and Gestational Weight Gain (GWG) in Overweight and
Obese Women
Author
Study
Design
Total
BMI
Intervention
Results
Successful in
7
Population
Participants
category
preventing
excessive weight
gain?
Goal to optimize
No difference
Not successful –
Gray-
Cree women Prospective Intervention
All BMI
Donald et
of James
N=112;
categories. gestational weight
al., 2000
Bay,
Historic
gain by use of
GWG or rate of
prescription
(38)
Canada
controls,
exercise groups &
GWG
given.
N=107.
dietary education via
Not successful –
between groups in No exercise
media campaign
Polley et
Low
al., 2002
(75)
RCT
(N=121)
Normal
Randomized into
Among
income;
weight,
stepped behaviour
overweight/ obese Exercise
Pittsburgh ,
over-
intervention, N=30;
women 59% had
U.S.
weight/
or usual prenatal care, excessive GWG
focused on
obese
N=30; Intervention
in intervention
increased
received educational
group; 32% in
walking & a
materials.
usual care group
more active
intervention
8
lifestyle.
Olson et
Low &
al., 2004
middle/
(65)
Prospective Enrolled in
Normal or
Goal to use 2 tiers a)
Among historic
Not successful-
intervention,
over-
health care provider
controls 45%
except in low
upper
N=179;
weight
information b)
gained excessive;
income women.
income in
Historic
materials mailed
41% in
No exercise
Upstate NY,
controls,
including newsletter,
intervention
prescription
U.S.
N=381
postcards, etc.
group, p>0.05;
given.
Found overweight
low income
women benefited
most.
Kinnunen
6 maternity
3 clinics
All BMI
Individual counseling
46% of women in
Not successful-
et al.,
clinics from
were
categories. on diet and physical
intervention
did not increase
2007 (50)
Finland
intervention
activity plus
group; 30% in
activity or
(N=49); 3
information on
control group
prevent
were control
weight gain
exceeded GWG,
excessive GWG.
9
(N=56)
recommendations.
p>0.05.
Supervised group
received
exercise sessions
standard
once per week,
care; all
45-60min.
women were
Encouraged 800
primiparous
MET minutes
per week.
Claesson
Sweden
Prospective
N=155
et al.,
case-
2008 (21)
Obese
To decrease total
Intervention
Successful- in
intervention;
GWG to < 7 kg using
group had lower
controlling GWG
control
N=193
behavioral
GWG & lost
for obese
intervent-
control
intervention by
more weight at
women,
ion
group-
weekly motivational
postnatal check-
especially
received
talk using trained
up than control
nulliparous.
standard care
midwife.
but no difference
Offered aqua
in number of
aerobic classes
women who
1-2 times/wk.
10
gained < 7 kg.
Asbee et
U.S.
RCT
Intervention
All BMI
Counseling sessions
Intervention
Partially
al., 2009
group
categories
by Dietitian and
group had lower
successful; Not
(8)
(N=57);
feedback on GWG.
GWG than
able to assess
Control
Recommended
Control group,
exercise effect
(N=43)
moderate PA 3-5
difference of 3.13
on overweight or
group-
times per week.
kg, p<0.01.
obese women in
received
sample.
standard
care.
Guelinckx
Belgium
RCT
3 groups;
Obese
Passive intervention
Dietary habits
Not successful-
et al.,
Passive
(brochure on
improved in
Percentage with
2010 (39)
intervention
nutrition, PA, weight
intervention
>11.2 kg GWG
group, N=37;
gain) vs Active
groups but all
was same for all
Active
intervention
women decreased
groups. No
intervention
(brochure plus
PA; no difference
exercise
11
group, N=42;
nutritionist in 3
in GWG;
prescription
Control,
groups sessions) to
Excessive GWG
given.
N=43;
improve diet, PA &
same in all
routine
control GWG
groups.
prenatal care
Mottola et
Canada
Single-arm
Intervention
Over-
Nutrition & Exercise
GWG on NELIP
Successful-
al., 2010
interventio
group
weight
Lifestyle Intervention
was 6.84.1 kg;
prevented
(61)
n matched
(N=65)
and obese
(NELIP) consisting
0.380.2
excessive GWG.
to
Historical
of GDM dietary
kg/week; 80% did Exercise
historical
controls
program with
not gain
prescription
controls
(N=260)
walking, using
excessively.
(30% heart rate
(4 to 1)
matched by
pedometer to count
reserve) started
BMI; age;
steps.
at 25 min, 3-4
parity
times/week;
adding 2 min per
week; until 40
12
minutes reached.
Shirazian
U.S.
Single-arm
Intervention
et al.,
interventio
2010 (85)
Obese
Lifestyle
Intervention
Successful-
(N=21)
modification program
GWG was
Intervention
n matched
matched to
consisting of
8.1±7.4 kg; GWG
group did not
to
historical
information on
in Control group
have as much
historical
controls
nutrition, exercise &
was 15.4±7.5 kg;
GWG as control.
controls
(N=20) with
weight control.
p<0.008
No exercise
standard care
prescription
given.
Phelan et
U.S.
RCT
N=90
Normal
Fit for Delivery-
No significant
Not successful-
al., 2011
Control
weight,
behavioral
effect on
Overweight/obes
(71)
group-
over-
intervention– aims to
overweight/ obese e women not
routine care;
weight
decrease high fat
but did prevent
different than
Intervention
and obese
foods, increase
excessive weight
control for
group, N=87;
physical activity &
gain in normal
GWG.
NW, N=97
self-monitoring.
weight women
Exercise
13
Vinter et
Denmark
RCT
Control
prescription-
group &
emphasized
N=92
walking 30 min
Intervention
most days of the
group;
week.
N=360; 304
Obese
Lifestyle in
Limited GWG in
Partially
al., 2011
followed
Pregnancy (LiP)
intervention
Successful –
(91)
until
included dietary
group (7.0 kg)
Excessive GWG
delivery; LiP
guidance, physical
compared to
exceeded in
or control
training and personal
control group (8.6
35.4% in
coaching.
kg)
intervention
group compared
to 46.6% in
control group
(p=0.058). No
exercise
14
prescription
given.
Artal et
U.S.
Self-
Diet
Obese
Standard GDM diet
GWG/week lower Successful in
al., 2007
selected
+exercise
with
for both groups;
in Diet+exercise
limiting GWG.
(7)
intervent-
(N=39); Diet
GDM
intervention
Encouraged 60%
ion
alone
group.
VO2peak at least 5
(N=57);
days/week; 50%
of exercise group
≥ 150 min/week.
Davenport
Canada
Pilot Study
Control
Over-
Goal to evaluate
CM+Walking
Partially
et al.,
Interventio
(N-20)-
weight
monitored walking
group had
Successful in
2008 (27)
n matched
conventional
and obese
program to
improved glucose
preventing
to control
management
with
conventional
regulation & used
excessive GWG
by age,
(CM);
GDM
management alone on fewer insulin
(50%), however
BMI and
Intervention-
indices of glucose
units/kg/day in
GDM improved
insulin
CM plus
control
late pregnancy.
in CM+Walking
15
usage.
walking
Fifty % of women group.
(N=10)
in both groups did Walking=25
not have
min, added 2
excessive GWG.
min/week until
40 min, 3-4
times per week.
Selected Studies on Leisure-Time Physical Activity and Birth Weight
Author
Study
Total
Birth
Physical Activity
SGA# / Low
LGA#/
Participants
Weight
Measure
Birth Weight
Macrosomia
aOR (95% CI)
aOR (95% CI)
Design
Population
Outcome
Alderman
U.S. CO
Retrospec-
et al.,
Hospital
tive
1998 (1)
Study
291
SGA: 22
Recalled frequency
LGA: 36
and duration of
0.8 (0.3-2.3)
0.3 (0.2-0.7)*
specific activities
during pregnancy
HI: > 2 hrs/wk
Ref: None
16
Voldner et
Norway,
Prospective 553
Macro-
Standardized
Pre-pregnancy:
al., 2008
Oslo
somia: 184
questionnaire for
2.9 (1.2-7.3)
(92)
Hospital
pre-pregnancy, 1st,
Study
2nd, and 3rd
Trimester:
trimester LTPA
Adjusted OR’s
Ref: > 1 hr/wk
not reported
----
1st, 2nd, or 3rd
LO: < 1 hr/wk
Hegaard et Denmark
Prospective 4458 with
Low Birth
Survey on sport
2nd Trimester
2nd Trimester
al., 2009
Hospital
term
Weight and participation
Sports
Sports
(43)
Study
deliveries
Macro-
(yes/no) and LTPA
1.1 (0.4-2.7)
0.85 (0.4-1.6)
somia (#’s
classification in 2nd
LTPA
LTPA
not given)
and 3rd Trimester
1.7 (0.6-4.7)
0.7 (0.3-1.5)
Sports:
3rd Trimester
3rd Trimester
HI: > 3hr/wk
Sports
Sports
Ref: none
0.8 (0.3-2.8)
1.5 (0.8-2.9)
LTPA:
LTPA
LTPA
17
HI: Moderate/Heavy
0.6 (0.1-4.3)
1.1 (0.4-2.8)
Ref: Sedentary
Owe et al.,
MoBa
2009 (68)
Juhl et al.,
2010 (47)
DNBC
Prospective 36,869
LGA:
See Table 1
Nulliparous
(16,064
4,033
HI: > 3x/wk
Results
multiparous,
(2,263
Ref: none
20,805
multi-
0.85 (0.68-1.06)
nulliparous)
parous,
2nd Trimester
1,770
0.72 (0.56-0.93)*
nulliparous
3rd Trimester
)
0.77 (0.61-0.96)*
Prospective 79,692
---
Prepregnancy
SGA:7797
See Table 1
(Hazard Ratios)
(Hazard Ratios)
LGA: 8268
>5 hr/wk
>5 hr/wk:
>5 hr/wk:
>3-5 hr/wk
1.04 (0.87-1.23
0.72 (0.57-0.91)*
>2-3 hr/wk
>3-5 hr/wk:
>3-5 hr/wk:
>1-2 hr/wk
0.83 (0.72-0.95)*
0.89 (0.77-1.04)
>0-1 hr/wk
>2-3 hr/wk
>2-3 hr/wk
18
Ref: None
1.00 (0.89-1.14)
0.85 (0.74-0.98)*
>1-2 hr/wk
>1-2 hr/wk
0.83 (0.76-0.91)*
0.90 (0.82-0.98)*
>0-1 hr/wk
>0-1 hr/wk
0.87 (0.81-0.93)*
0.98 (0.92-1.05)
Mudd et
U.S.
Retrospec-
596
SGA (63
Recall of Pregnancy
Subcohort:
Subcohort:
al., In
POUCH
tive
Subcohort,
Subcohort,
LTPA at 3-9 years
1.10 (0.59-2.06)
0.68 (0.34-1.34)
Press (62)
Study
418 Non-
19 Non-
postpartum
Non-Subcohort:
Non-Subcohort:
Subcohort
Subcohort)
HI:> 150 min/wk
0.20 (0.04-1.08)
0.30 (0.14-0.64)*
; LGA (68
Ref: None
Subcohort,
75 NonSubcohort)
Selected Studies on Leisure-Time Physical Activity and Preterm Delivery
Author
Study
Population
Design
Total
Cases of
Physical Activity
Pre-Pregnancy
Pregnancy
Participants
Preterm
Measure
LTPA
LTPA
19
Delivery
Hatch et
U.S. PA/NY Prospective 557
al., 1998
Clinic Study
Not Stated
(41)
aOR (95% CI)
Standardized
Delivery 32 wks
questionnaire at 13,
0.01 (0.00-0.52)*
28, and 36 wks
Delivery 34 wks
gestation
Misra et
U.S. MD
al., 1998
Clinic Study
Prospective 1166 with
198
(59)
---
0.04 (0.00-0.65)*
HI: > 1000 kcal/wk
Delivery 36 wks
Ref: none
0.11 (0.02-0.81)*
Interview on 1st and
2nd trimester LTPA
LTPA info
aOR (95% CI)
---
0.51 (0.27-0.95)*
HI: > 60 days
Ref: <60 days
Evenson et U.S. PIN
al, 2002
(34)
Study
Prospective 1699
1.06 (0.71-1.57)
1st Trimester
193
Telephone interview
(113
on Vigorous LTPA
0.80 (0.48-1.35)
Spon-
for pre-pregnancy, 1st
2nd Trimester
taneous)
and 2nd Trimester
0.52 (0.24-1.11)
Any vs. None
20
Juhl et al,
DNBC
Prospective 87,232
4,279
2008 (46)
See Table 1
>0-5 MET-
Ref: None
hrs/wk:
>0-5, >5-10, >10-15,
>15 MET-hrs/wk
---
0.77 (0.68-0.87)*
>5-10 METhrs/wk:
0.82 (0.74-0.91)*
>10-15 METhrs/wk:
0.83 (0.71-0.96)*
>15 METhrs/wk:
0.88 (0.78-1.00)
Owe et al,
MOBA
Prospective 61,098
3181
See Table 1.
Week 17, 3-5
2011
LTPA reported in
x/wk:
(in press)
weeks 17 and 30 used
0.82(0.73-0.91)*
(70)
Ref: None
Gestational age
21
3-5 x/wk
2.45 days longer
vs. No LTPA
(p<0.0001)
Week 30, 3-5
x/wk:
0.74 (0.65-0.83)*
Selected Studies on Leisure-Time Physical Activity and Child Weight Status
Author
Study
Design
Population
Clapp,
1996 (22)
U.S. Study
Total
Outcome
Participants
ExposureControl
40
Physical Activity
Results
Measure
Child
20 women exercised
Birth (Exercise v. Control)
Weight,
vigorously
Weight: 3.4±0.8 v. 3.6±0.7 kg
Skinfolds
throughout
(p<0.05)
at 5 yrs
pregnancy, 20
women did not
(exercise directly
Fat: 10.5%±0.9 v. 15.1%±0.6
(p<0.05)
5 yrs (Exercise v. Control)
22
monitored)
Weight: 18.0±0.5 v. 19.5±0.6 kg
(p<0.05)
Sum of Skinfolds: 37±1 v. 44±2 mm
(p<0.05)
Mattran et
U.S. MI
al, 2011
Clinic Study tive
(56)
Retrospec-
23
Child
Modifiable Activity
1st and 2nd trimester LTPA not
weight,
Questionnaire
significantly related to child
weight-
administered at 16-
outcomes
for-height
22mo postpartum
3rd trimester LTPA
z-score at
MET-hrs/wk in 1st,
Weight rs = -0.39 (p=0.06)
16-22 mo
2nd, 3rd trimester
Weight-for-Height z-score rs= -0.40
(p=0.06)
#
Abbreviations: aOR = adjusted Odds Ratio, 95%CI=95% Confidence Interval, GDM=Gestational Diabetes Mellitus, LTPA=Leisure-
Time Physical Activity, SGA=Small for Gestational Age, LGA=Large for Gestational Age
*significant p-value <0.05
23