Skip to main content
SpringerLink
Log in

Physical Activity and Its Relationship with Preterm Birth in the Presence of Depressive Symptomology

  • Published:
Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Objective

To examine the relationship between physical activity (PA) and preterm birth (PTB) within the context of depressive symptoms (DS).

Methods

Data are from the Life-course Influences of Fetal Environments (LIFE) Study, a cohort comprised of 1410 Black women, age 18–45 years who delivered a singleton in Metropolitan Detroit, MI. DS were measured with the Center for Epidemiologic Studies Depression Scale (CES-D); a score > 23 indicates severe DS. Traditional leisure time PA (LTPA) and non-LTPA during pregnancy (walking for a purpose, climbing stairs) were both measured. Modified Poisson regression models were used to estimate the association between PTB and PA. Effect modification by severe DS was assessed via stratification.

Results

Approximately 16% of women had a PTB; 20% had CES-D scores > 23. Walking for a purpose was the most frequently reported type of PA (79%), followed by any LTPA (37.7%) and climbing stairs (13.5%). Compared with women who reported no PA, women who reported walking for a purpose (PR = 0.70, 95% CI 0.61, 1.10), partaking in LTPA (PR = 0.67, 95% CI 0.50, 0.90), or climbing stairs (PR = 0.61, 95% CI 0.45, 0.81) were less likely to have PTB. Results stratified by severe DS show the association between LTPA and PTB was more pronounced in women with severe DS, while the non-LTPA relationship with PTB was more heterogeneous.

Conclusions

Women who participated in traditional LTPA (any or walking only) and non-LTPA experienced improved birth outcomes. LTPA may buffer against PTB among pregnant Black women with severe DS as well as none or mild DS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Murphy SL, Xu J, Kochanek KD, Arias E. Mortality in the United States, 2017. NCHS Data Brief. 2018;(328):1–8.

  2. Ferre C, Callaghan W, Olson C, Sharma A, Barfield W. Effects of maternal age and age-specific preterm birth rates on overall preterm birth rates - United States, 2007 and 2014. MMWR Morb Mortal Wkly Rep. 2016;65(43):1181–4. https://doi.org/10.15585/mmwr.mm6543a1.

    Article  PubMed  Google Scholar 

  3. Merewood A, Brooks D, Bauchner H, MacAuley L, Mehta SD. Maternal birthplace and breastfeeding initiation among term and preterm infants: a statewide assessment for Massachusetts. Pediatrics. 2006;118(4):e1048–E54. https://doi.org/10.1542/peds.2005-2637.

    Article  PubMed  Google Scholar 

  4. Borghini A, Pierrehumbert B, Miljkovitch R, Muller-Nix C, Forcada-Guex M, Ansermet F. Mother's attachment representations of their premature infant at 6 and 18 months after birth. Infant Ment Health J. 2006;27(5):494–508. https://doi.org/10.1002/imhj.20103.

    Article  PubMed  Google Scholar 

  5. Vigod SN, Villegas L, Dennis CL, Ross LE. Prevalence and risk factors for postpartum depression among women with preterm and low-birth-weight infants: a systematic review. BJOG. 2010;117(5):540–50. https://doi.org/10.1111/j.1471-0528.2009.02493.x.

    Article  CAS  PubMed  Google Scholar 

  6. Oler E, Eke AC, Hesson A. Meta-analysis of randomized controlled trials comparing 17alpha-hydroxyprogesterone caproate and vaginal progesterone for the prevention of recurrent spontaneous preterm delivery. Int J Gynaecol Obstet. 2017;138(1):12–6. https://doi.org/10.1002/ijgo.12166.

    Article  CAS  PubMed  Google Scholar 

  7. Hassan SS, Romero R, Vidyadhari D, Fusey S, Baxter JK, Khandelwal M, et al. Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix: a multicenter, randomized, double-blind, placebo-controlled trial. Ultrasound Obstet Gynecol. 2011;38(1):18–31. https://doi.org/10.1002/uog.9017.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Maerdan M, Shi C, Zhang X, Fan L. The prevalence of short cervix between 20 and 24 weeks of gestation and vaginal progesterone for prolonging of gestation. J Matern Fetal Neonatal Med. 2017;30(14):1646–9. https://doi.org/10.1080/14767058.2016.1220528.

    Article  CAS  PubMed  Google Scholar 

  9. da Silva SG, Ricardo LI, Evenson KR, Hallal PC. Leisure-Time Physical Activity in Pregnancy and Maternal-Child Health: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Cohort Studies. Sports Med. 2017:47(2):295–317. https://doi.org/10.1007/s40279-016-0565-2.

  10. Ehrlich SF, Sternfeld B, Krefman AE et al. Moderate and vigorous intensity exercise during pregnancy and gestational weight gain in women with gestational diabetes. Matern Child Health J. 2016;20:1989–1992. https://doi.org/10.1007/s10995-016-2019-82019-8.

  11. Dempsey FC, Butler FL, Williams FA. No need for a pregnant pause: physical activity may reduce the occurrence of gestational diabetes mellitus and preeclampsia. Exerc Sport Sci Rev. 2005;33(3):141–9.

    Article  Google Scholar 

  12. Sealy-Jefferson S, Hegner K, Misra DP. Linking nontraditional physical activity and preterm delivery in urban African-American women. Womens Health Issues. 2014;24(4):e389–e95.

    Article  Google Scholar 

  13. Straughen JK, Sealy-Jefferson S, Bazydlo M, Helmkamp L, Misra DP. Physical Activity and Risk of Preterm Birth in a Cohort of African American Women. Womens Health Issues. 2018;28(6):488–94. https://doi.org/10.1016/j.whi.2018.04.001.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Thangaratinam S, Rogozinska E, Jolly K, Glinkowski S, Roseboom T, Tomlinson JW, et al. Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence. BMJ. 2012;344:e2088. https://doi.org/10.1136/bmj.e2088.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Muktabhant B, Lawrie TA, Lumbiganon P, Laopaiboon M. Diet or exercise, or both, for preventing excessive weight gain in pregnancy. Cochrane Database Syst Rev. 2015;(6):Cd007145. https://doi.org/10.1002/14651858.CD007145.pub3.

  16. Giurgescu C, Slaughter-Acey JC, Templin TN, Misra DP. The impact of symptoms of depression and walking on gestational age at birth in African American women. Womens Health Issues. 2017;27(2):181–7.

    Article  Google Scholar 

  17. Hegaard HK, Pedersen BK, Bruun Nielsen B, Damm P. Leisure time physical activity during pregnancy and impact on gestational diabetes mellitus, pre-eclampsia, preterm delivery and birth weight: a review. Acta Obstet Gynecol Scand. 2007;86(11):1290–6. https://doi.org/10.1080/00016340701647341.

    Article  PubMed  Google Scholar 

  18. Di Mascio D, Magro-Malosso ER, Saccone G, Marhefka GD, Berghella V. Exercise during pregnancy in normal-weight women and risk of preterm birth: a systematic review and meta-analysis of randomized controlled trials. Am J Obstet Gynecol. 2016;215(5):561–71. https://doi.org/10.1016/j.ajog.2016.06.014.

    Article  PubMed  Google Scholar 

  19. Aune D, Schlesinger S, Henriksen T, Saugstad OD, Tonstad S. Physical activity and the risk of preterm birth: a systematic review and meta-analysis of epidemiological studies. BJOG. 2017;124(12):1816–26.

    Article  CAS  Google Scholar 

  20. American College of Obstetricians Gynecologists. Physical activity and exercise during pregnancy and the postpartum period. Committee Opinion No. 650. Obstet Gynecol. 2015;126(6):e135–42.

    Article  Google Scholar 

  21. Evenson KR, Wen F. National trends in self-reported physical activity and sedentary behaviors among pregnant women: NHANES 1999–2006. Prev Med. 2010;50(3):123–8.

    Article  Google Scholar 

  22. Petersen AM, Leet TL, Brownson RC. Correlates of physical activity among pregnant women in the United States. Med Sci Sports Exerc. 2005;37(10):1748–53.

    Article  Google Scholar 

  23. Giurgescu C, Engeland CG, Templin TN. Depressive symptoms predict negative birth outcomes in African American women: A pilot study. J Midwifery Womens Health. 2015;60(5):570–7. https://doi.org/10.1111/jmwh.12337.

    Article  PubMed  Google Scholar 

  24. Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, Katon WJ. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry. 2010;67(10):1012–24.

    Article  Google Scholar 

  25. Downs DS, DiNallo JM, Kirner TL. Determinants of pregnancy and postpartum depression: prospective influences of depressive symptoms, body image satisfaction, and exercise behavior. Ann Behav Med. 2008;36(1):54–63. https://doi.org/10.1007/s12160-008-9044-9.

    Article  PubMed  Google Scholar 

  26. Ko JY, Farr SL, Dietz PM, Robbins CL. Depression and treatment among U.S. pregnant and nonpregnant women of reproductive age, 2005-2009. J Women's Health. 2012;21(8):830–6. https://doi.org/10.1089/jwh.2011.3466.

    Article  Google Scholar 

  27. Le Strat Y, Dubertret C, Le Foll B. Prevalence and correlates of major depressive episode in pregnant and postpartum women in the United States. J Affect Disord. 2011;135(1-3):128–38.

    Article  Google Scholar 

  28. Zhou J, Ko JY, Haight SC, Tong VT. Treatment of substance use disorders among women of reproductive age by depression and anxiety disorder status, 2008–2014. J Women's Health. 2019;28(8):1068–76.

    Article  Google Scholar 

  29. Bauman BL, Ko JY, Cox S, D’Angelo DV, Warner L, Folger S, et al. Vital signs: postpartum depressive symptoms and provider discussions about perinatal depression—United States, 2018. MMWR. 2020;69(19):575–81.

    PubMed  PubMed Central  Google Scholar 

  30. Daley AJ, Foster L, Long G, Palmer C, Robinson O, Walmsley H, et al. The effectiveness of exercise for the prevention and treatment of antenatal depression: systematic review with meta-analysis. BJOG. 2015;122(1):57–62. https://doi.org/10.1111/1471-0528.12909.

    Article  CAS  PubMed  Google Scholar 

  31. Demissie Z, Siega-Riz AM, Evenson KR, Herring AH, Dole N, Gaynes BN. Physical activity and depressive symptoms among pregnant women: the PIN3 study. Arch Womens Ment Health. 2011;14(2):145–57. https://doi.org/10.1007/s00737-010-0193-z.

    Article  PubMed  Google Scholar 

  32. Robledo-Colonia AF, Sandoval-Restrepo N, Mosquera-Valderrama YF, Escobar-Hurtado C, Ramirez-Velez R. Aerobic exercise training during pregnancy reduces depressive symptoms in nulliparous women: a randomised trial. J Physiother. 2012;58(1):9–15. https://doi.org/10.1016/s1836-9553(12)70067-x.

    Article  PubMed  Google Scholar 

  33. Poudevigne MS, Oconnor PJ. A review of physical activity patterns in pregnant women and their relationship to psychological health. Cham: Adis International; 2006. p. 19–38.

    Google Scholar 

  34. Juhl M, Andersen PK, Olsen J, Madsen M, Jørgensen T, Nøhr EA, et al. Physical exercise during pregnancy and the risk of preterm birth: a study within the Danish National Birth Cohort. Am J Epidemiol. 2008;167(7):859–66.

    Article  Google Scholar 

  35. Misra DP, Strobino DM, Stashinko EE, Nagey DA, Nanda J. Effects of physical activity on preterm birth. Am J Epidemiol. 1998;147(7):628–35.

    Article  CAS  Google Scholar 

  36. Wolin KY, Fagin C, Ufere N, Tuchman H, Bennett GG. Physical activity in US Blacks: a systematic review and critical examination of self-report instruments. Int J Behav Nutr Phys Act. 2010;7(1):73. https://doi.org/10.1186/1479-5868-7-73.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Joseph RP, Keller C, Adams MA, Ainsworth BE. Validity of two brief physical activity questionnaires with accelerometers among African-American women. Prim Health Care Res Dev. 2016;17(3):265–76. https://doi.org/10.1017/S1463423615000390.

    Article  PubMed  Google Scholar 

  38. Besser LM, Dannenberg AL. Walking to public transit: steps to help meet physical activity recommendations. Am J Prev Med. 2005;29(4):273–80.

    Article  Google Scholar 

  39. Osypuk TL, Slaughter-Acey JC, Kehm RD, Misra DP. Life-course social mobility and reduced risk of adverse birth outcomes. Am J Prev Med. 2016;51(6):975–82. https://doi.org/10.1016/j.amepre.2016.09.008.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Slaughter-Acey JC, Sealy-Jefferson S, Helmkamp L, Caldwell CH, Osypuk TL, Platt RW, et al. Racism in the form of micro aggressions and the risk of preterm birth among black women. Ann Epidemiol. 2016;26(1):7–13 e1. https://doi.org/10.1016/j.annepidem.2015.10.005.

    Article  PubMed  Google Scholar 

  41. Orr ST, Blazer DG, James SA. Racial disparities in elevated prenatal depressive symptoms among black and white women in eastern North Carolina. Ann Epidemiol. 2006;16(6):463–8. https://doi.org/10.1016/j.annepidem.2005.08.004.

    Article  PubMed  Google Scholar 

  42. Radloff LS. The CES-D scale a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401.

    Article  Google Scholar 

  43. Berrigan D, Troiano RP, McNeel T, DiSogra C, Ballard-Barbash R. Active Transportation Increases Adherence to Activity Recommendations. Am J Prev Med. 2006;31(3):210–6. https://doi.org/10.1016/j.amepre.2006.04.007.

    Article  PubMed  Google Scholar 

  44. Lindqvist M, Lindkvist M, Eurenius E, Persson M, Ivarsson A, Mogren I, et al. Leisure time physical activity among pregnant women and its associations with maternal characteristics and pregnancy outcomes. Sex Reprod Healthc. 2016;9:14–20. https://doi.org/10.1016/j.srhc.2016.03.006.

    Article  PubMed  Google Scholar 

  45. Kahn M, Robien K, DiPietro L. Maternal leisure-time physical activity and risk of preterm birth: a systematic review of the literature. J Phys Act Health. 2016;13(7):796–807. https://doi.org/10.1123/jpah.2015-0495.

    Article  PubMed  Google Scholar 

  46. Frank LD, Sallis JF, Conway TL, Chapman JE. Many pathways from land use to health - Associations between neighborhood walkability and active transportation, body mass index, and air quality. J Am Plan Assoc. 2006;72(1):75–87.

    Article  Google Scholar 

  47. Misra DP, Guyer B. Benefits and limitations of prenatal care: from counting visits to measuring content. JAMA. 1998;279(20):1661–2.

    Article  CAS  Google Scholar 

  48. Williams DR. Stress and the Mental Health of Populations of Color: Advancing Our Understanding of Race-related Stressors. J Health Soc Behav. 2018;59(4):466–85. https://doi.org/10.1177/0022146518814251.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Holtermann A, Krause N, van der Beek AJ, Straker L. The physical activity paradox: six reasons why occupational physical activity (OPA) does not confer the cardiovascular health benefits that leisure time physical activity does. Br J Sports Med. 2018;52(3):149–50. https://doi.org/10.1136/bjsports-2017-097965.

    Article  PubMed  Google Scholar 

  50. Karlsen S, Nazroo JY. Agency and structure: the impact of ethnic identity and racism on the health of ethnic minority people. Sociol Health Illn. 2002;24(1):1–20.

    Article  Google Scholar 

  51. Siu AL, Bibbins-Domingo K, Grossman DC, Baumann LC, Davidson KW, Ebell M, et al. Screening for depression in adults: US Preventive Services Task Force recommendation statement. JAMA. 2016;315(4):380–7.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The LIFE study was funded by NIH grant no. [R01HD058510] to Dr. Misra. Any opinions expressed are those of the author(s) alone and should not be construed as representing the opinions of the NIH. We would like to thank all of the women who participated in the LIFE study.

Funding

This study was funded by NIH grant no. 335 [R01HD058510] to Dawn P Misra.

Author information

Authors and Affiliations

  1. Office of Health Science, Georgia Department of Public Health, Atlanta, GA, USA

    Devon Sneed

  2. Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA

    Purni M. Abeysekara

  3. Division of Epidemiology and Community Health, University of Minnesota, School of Public Health, 1300 South 2nd Street Ste. 300, Minneapolis, MN, 55454, USA

    Jaime C. Slaughter-Acey

  4. College of Nursing, University of Central Florida, Orlando, FL, USA

    Carmen Giurgescu

  5. Department of Family Medicine and Public Health Science, Wayne State University School of Medicine, Detroit, MI, USA

    Rhonda Dailey

  6. Department of Epidemiology and Biostatistics, Michigan State University College of Human Medicine, East Lansing, MI, USA

    Dawn P. Misra

Authors
  1. Devon Sneed
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Purni M. Abeysekara
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jaime C. Slaughter-Acey
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carmen Giurgescu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rhonda Dailey
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dawn P. Misra
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Data collection was performed by Rhonda Dailey, and data analysis was performed by Purni M. Abeysekara and Jaime Slaughter-Acey. The first draft of the manuscript was written by Purni M. Abeysekara and Devon Sneed. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jaime C. Slaughter-Acey.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All participants in the study provided written informed consent and study protocols were approved by university and hospital Institutional Review Boards. This article does not contain any studies with animals performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sneed, D., Abeysekara, P.M., Slaughter-Acey, J.C. et al. Physical Activity and Its Relationship with Preterm Birth in the Presence of Depressive Symptomology. J. Racial and Ethnic Health Disparities 9, 670–678 (2022). https://doi.org/10.1007/s40615-021-00998-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40615-021-00998-6

Keywords

Search

Navigation