تعیین تاثیر ورزش های مدیریت شده در بارداری درزنان باردار نخست زا بر معیارهای رشد نوزادان: یک مطالعه کارآزمایی بالینی تصادفی
محورهای موضوعی : فصلنامه زیست شناسی جانوریطیبه زارع زاده 1 , نعمت الله نعمتی 2 , حسام رمضان زاده 3 , طاهره باقرپور 4
1 - گروه تربیت بدنی و علوم ورزشی، واحد دامغان، دانشگاه آزاد اسلامی، دامغان، ایران
2 - گروه تربیت بدنی و علوم ورزشی، واحد دامغان، دانشگاه آزاد اسلامی، دامغان، ایران
3 - دکترای رفتار حرکتی، استادیار گروه علوم ورزشی، دانشکده علوم انسانی، دانشگاه دامغان، دامغان، ایران
4 - گروه تربیت بدنی و علوم ورزشی، واحد دامغان، دانشگاه آزاد اسلامی، دامغان، ایران
کلید واژه: ورزش در بارداری, زنان نخست زا, وزن نوزاد, قد نوزاد, دور سر نوزاد,
چکیده مقاله :
اثرات فعالیت فیزیکی مادران در دوران بارداری بر پیامدهای نوزادی اخیراً موضوع تحقیقات بسیاری بوده است. ارزیابی معیارهای رشد یکی از عوامل اصلی تعیین کننده رشد جسمانی و مغزی کودک در آینده و نشانه معتبری از رشد داخل رحمی می باشد بنابراین هر نوع مداخله ای در بارداری که بر رشد جنین تاثیر گذار باشد از اهمیت ویژه ای برخوردار است. هدف از این پژوهش بررسی تاثیر ورزش های مدیریت شده در بارداری بر معیارهای رشد نوزادان در زنان نخست زا میباشد. مطالعه حاضر یک کار آزمایی بالینی تصادفی کنترل شده میباشد که بر روی 80 زن باردار نخست زای سالم شهرستان دامغان انجام شده است. زنان باردار دارای شرایط ورود به مطالعه انتخاب و به روش تصادفی به دو گروه مقایسه و مداخله تقسیم شدند. گروه مداخله از هفته 18-20 حاملگی تا هفته 37-39 بارداری در برنامه مداخله ورزشی مدیریت شده به تعداد تقریبی 60 جلسه تمرینی قرار گرفتند و گروه مقایسه مراقبت های استاندارد دوران بارداری را داشتند. نتایج آزمون های تی مستقل نشان داد که در متغیرهای وزن نوزاد (342/0 = p و 957/0 = t)، دور سر نوزاد (342/0 = p و 921/0 = t)، قد نوزاد (492/0 = p و 739/0 = t) و سن بارداری (277/0 = p و 218/1 = t) بین دو گروه تفاوت معناداری وجود ندارد. یک برنامه ورزشی مدیریت شده با شدت متوسط در طول دوران بارداری، وضعیت سلامتی و رشد جنین را به خطر نمی اندازد و موجب کاهش رشد جنین نمی شود.
Recently, mothers’ physical activity during pregnancy has been the subject of many studies and no human studies have reported negative effects of prenatal exercise on fetus. This study aimed to determine the effect of managed exercise during pregnancy on fetal growth. This randomized controlled clinical trial enrolled 80 pregnant women in Damghan meeting the inclusion criteria. Samples were randomly selected using randomization website and divided into control and intervention groups. The intervention consisted of a structured individual and group aerobic exercises including individual walking, aerobic exercise, sitting Pilates exercise, and moderate to intense gestational aerobic exercise three times a week from gestational age of 18-20 weeks to 37-39 weeks. There were approximately 60 training sessions. The control group received standard care and had routine activities. The independent t-test revealed an insignificant difference between the control and intervention groups in infant weight (t = 0.957, p = 0.342), head circumference (t = 0.921, p = 0.342), and height (t = 0.739, p = 0.492) and gestational age t=1.218, p=0.277. A moderate intensity managed exercise during pregnancy does not pose a risk to maternal and fetal well-being and it does not endanger the health and growth of the fetus.
1. Aghaalinejd A Rahimi H ,Siahkohial M . 2012 . Applied physiology , first edition Tehran and , sport medicine press institute of physical education , .pp:1134-1135.
2. AlHinai, M. et al .2013. Effects of pre-pregnancy body mass index and gestational weight gain on low birth weight in Omani infants: A case-control study. Sultan QaboosUniv Med J. 13, 386–391.
3. Barakat R, Pelaez M, Cordero Y, Perales M, Lopez C, Coteron J, Mottola MF . 2016. Exercise during pregnancy protects against hypertension and macrosomia: randomized clinical trial. Am J Obstet Gynecol. ;214(5):649.e1-8.
4. Bernstein M. et al . 2005. Maternal smoking and its association with birth weight. Obstet Gynecol. 106, 986–991.
5. Clapp 3rd JF. 1996. Morphometric and neurodevelopmental outcome at age five years of the offspring of women who continued to exercise regularly throughout pregnancy. J Pediatr.;129(6):856–63. 29.
6. Cunningham F , Kenneth L , Steven B, Catherine Y. Spong , Jodi D. ( 2014) Williams Obstetrics, 24nd ed.NewYork :volume3,2 ,pages1037-1039 905-908
8. Godfrey K . et al. 1996 . Maternal nutrition in early and late pregnancy in relation to placental and fetal growth. BMJ. 312, 410–414 .
7. Duncombe D, Skouteris H, Wertheim EH, Kelly L, Fraser V, Paxton SJ . 2006 . Vigorous exercise and birth outcomes in a sample of recreational exercisers: a prospective study across pregnancy. Aust N Z J Obstet Gynaecol; . 46(4): 288-92.
8. Godfrey, K. et al. 1996. Maternal nutrition in early and late pregnancy in relation to placental and fetal growth. BMJ. 312, 410–414 .
9. Hickman S.The effects of exercise during pregnancy and postpartum. . 2007. Senior thesis final draft.
10. Kelly R. Evenson, M.S. 2014 . FACSM.Guidelines for Physical Activity during Pregnancy: Comparisons From Around the WorldAm J Lifestyle Med . ; 8(2): 102–121.
11. Leet T., Flick L. 2003 . Effect of exercise on birthweight. Clin Obstet Gynecol. ;46(2):423–431.
12. Leiferman J A, Evenson K R. 2003 . The effect of regular leisure physical activity on birth outcomes. Maternal and Child Health Jornal.; 17 (1):59-64.
13. Malshani L. Pathirathna, Kayoko Sekijima, Mieko Sadakata, Naoshi Fujiwara, Yoshiyuki Muramatsu , Kuruppu M. S. Wimalasiri .2019. Effects of Physical Activity During Pregnancy on Neonatal Birth Weight .Scientific Reports volume 9, Article number: 6000
14. Marina Vargas-Terrones,a,⁎ Taniya S. Nagpal,b and Ruben Barakat . 2019 Impact of exercise during pregnancy on gestational weight gain and birth weight: an overview☆Braz J Phys Ther.; 23(2): 164–169.
15. Mari Owe K, Nystad W, Bo K. 2009 . Association between regular exercise and excessive newborn birth weight. Obstetrics & Gynecology.; 114 (4):770-6.
16. Mokaberian M., A. Farokhi, S. Tahmasebi Boroujeni . 2015. The effect of exercise during pregnancy on health indexes of infants Motor Behavior, No 18, 13[Persian]
17.May LE, Scholtz SA, Suminski R, Gustafson KM. . 2014 . Aerobic exercise during pregnancy influences infant heart rate variability at one month of age. Early Hum Dev;90(1):33–8.
18. Mohammady M, Janani L. 2016 . Randomization in randomized clinical trials: From theory to practice]. Hayat, Journal of School of Nursing and Midwifery, Tehran University of Medical Sciences.; 22(2): 102-114. [Persian]
19.Michael Maia Schlüssel , Elton Bicalho de Souza , Michael Eduardo Reichenheim , Gilberto Kac . 2008 . Physical activity during pregnancy and maternal-child health outcomes: a systematic literature review. Cad. Saúde Pública vol.24 suppl.4
20.Park JW, Kim MH, Eo SJ, Lee EH, Kang JS, Chang HK, Leem YH. . 2013 . Maternal exercise during pregnancy affects mitochondrial enzymatic activity and biogenesis in offspring brain. Int j neurosci;123(4):253–64.
21. Pathirathna, M. L. et al. 2017 . Effects of prenatal tobacco and wood-fuel smoke exposure on birth weight in Sri Lanka. Healthcare. 5, 64,
23.Ramakrishnan, U. 2004 . Nutrition and low birth weight: from research to practice. Am. J. Clin. Nutr. 79, 17–21.
22.PetrovFieril K., Glantz A., Fagevik Olsen M . 2015 . The efficacy of moderate-to-vigorous resistance exercise during pregnancy: a randomized controlled trial. Acta Obstet Gynecol Scand.;94(1):35–42.
23. Ramakrishnan, U. 2004 . Nutrition and low birth weight: from research to practice. Am. J. Clin. Nutr. 79, 17–21.
24..Riemann MK, Kanstrup Hansen . 2008 . Effects on the foetus of exercise in pregnancy. Scand J Med Sci Sports. 10(1):12-9.
25.Sanabria-Martínez G, García-Hermoso A, Poyatos-León R, González-García A, Sánchez-López M, Martínez-Vizcaíno V . 2016. Effects of Exercise-Based Interventions on Neonatal Outcomes: A Meta-Analysis of Randomized Controlled Trials. Am J Health Promot.;30(4):214-23.
26. US Department of Health and Human Services. 2008 . Physical Activity Guidelines for Americans. Washington, DC, 2008. http://health.gov/paguidelines/ (Accessed on March 01, 2016).
27.VanRaaij JM, schonk CM, vermaat SH, Hautrast JG. 1990 . Energy cost of walking at a fixed race and self-paced before, during, and after pregnancy. Am J Clin Nutr; 51: 158-161.
28.Virginia A. Aparicio, Olga Ocón, Carmen Padilla-Vinuesa,Alberto Soriano-Maldonado, Lidia Romero-Gallardo, Milkana Borges-Cósic, Irene Coll-Risco, Pilar Ruiz-Cabello, Pedro Acosta-ManzanoFernando Estévez-López, Inmaculada C. Álvarez-Gallardo,Manuel Delgado-Fernández, Jonatan R. Ruiz, Mireille N. Van Poppel, Julio J. Ochoa-Herrera . 2016 . Effects of supervised aerobic and strength training in overweight and grade I obese pregnant women on maternal and foetal health markers: the GESTAFIT randomized controlled trial. BMC Pregnancy and Childbirth, 16: 290
29.Viengsakhone L, Yoshida Y, Rashid H, Sakamoto J. . 2010 . Factor’s affecting low birth weight at four central hospitals in Vientiane. LAO PDR. Nagoya J;( 72):51-8.
15. MariOwe K, Nystad W, Bo K. 2009 . Association between regular exercise and excessive newborn birth weight. Obstetrics & Gynecology.; 114 (4):770-6
30.Yildiz, Y. et al. 2014 . The relationship between third trimester maternal hemoglobin and birth weight/length; results from the tertiary center in Turkey. J. Matern. Fetal. Neonatal. Med. 27, 729–32,
31.Zhao, R., Xu, L., Wu, M. L., Huang, S. H. & Cao, X. J. 2018 . Maternal pre-pregnancy body mass index, gestational weight gain influence birth weight. Women Birth. 31, e20–e25,
32. Zarezadeh T , Nemati N, 2016 . Effects of 8 week regular walking on the neonate in nulliparous women .Koomesh ,Winter, 17 (2):403-410 . [Persian]
33.Zhang, Z. et al. 2008 . Association of pregnancy-induced hypertension with small-for-gestational-age babies. Zhonghua Liu
Xing Bing Xue Za Zhi. 29, 313–316.
_||_