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The Association between Neighborhood Environments and Physical Activity from Pregnancy to Postpartum: a Prospective Cohort Study

  • Anna K. PorterEmail author
  • Daniel A. Rodríguez
  • Brian G. Frizzelle
  • Kelly R. Evenson
Article

Abstract

The objectives of this study were to determine if neighborhood measures were associated with physical activity cross-sectionally during late pregnancy (27–30 weeks’ gestation), 3 months postpartum, and 12 months postpartum, and longitudinally with an increase in physical activity from late pregnancy to 12 months postpartum. Data are from the Pregnancy, Infection, and Nutrition (PIN3) and Postpartum Prospective Cohort Study. Dichotomized self-reported recreation and total physical activity hours/week were explored cross-sectionally at three time points, and as an increase over time. Four factors from a neighborhood environmental audit were examined: arterial or thoroughfare, walkable neighborhood, physical incivilities, and decoration. Secondary spatial data included population density, hilliness, intersection density, distance to nearest major road, distance to nearest park, distance to nearest physical activity facility, and distance to nearest bus stop. Multilevel mixed-effects logistic regression models were used to assess the association between environmental variables and physical activity measures. A number of environmental variables were associated with total and recreation physical activity at the three time points in cross-sectional models. For increase in recreation physical activity over time, a moderate distance to nearest major road was significantly associated with increased recreation physical activity from 3 to 12 months postpartum (tertile 2 OR 2.13, 95% CI 1.08, 4.22). Living the furthest distance from the nearest park was inversely associated with an increase in recreation physical activity from pregnancy to 3 months postpartum (tertile 3 OR 0.50, 95% CI 0.29, 0.85). The findings of this study indicate that several aspects of the neighborhood environment, such as walkability, access to transit, distance to recreation facilities, and road networks, are associated with physical activity during different stages of pregnancy and postpartum. Since physical activity may result in long-term health benefits for both the woman and child, environments that support this activity should be encouraged.

Keywords

Recreation GIS Audit Built environment Leisure-time physical activity Women 

Notes

Acknowledgments

The PIN Study was a joint effort of many investigators and staff members whose work is gratefully acknowledged. In particular, the authors thank Molly Wen and Amy Herring for their invaluable assistance with preparing the data and advising on analyses.

Funding

Funding for this study was provided by the National Institutes of Health (NIH)/National Cancer Institute (#CA109804). Data collection was supported by NIH/National Institute of Child Health and Human Development (#HD37584), NIH General Clinical Research Center (#RR00046), and NIH/National Institute of Diabetes and Digestive and Kidney Diseases (#DK 061981). AKP was supported by a National Research Service Award T32 post-doctoral research fellowship, funded by the NIH, National Heart, Lung, and Blood Institute (#T32HL007055). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

References

  1. 1.
    Nascimento SL, Surita FG, Cecatti JG. Physical exercise during pregnancy: a systematic review. Curr Opin Obstet Gynecol. 2012;24(6):387–94.CrossRefGoogle Scholar
  2. 2.
    Committee PAGA. Physical activity guidelines advisory committee scientific report. In: Services USDoHaH, ed. Washington, DC 2018.Google Scholar
  3. 3.
    Evenson KR, Barakat R, Brown WJ, Dargent-Molina P, Haruna M, Mikkelsen EM, et al. Guidelines for physical activity during pregnancy: comparisons from around the world. Am J Lifestyle Med. 2014;8(2):102–21.CrossRefGoogle Scholar
  4. 4.
    Bø K, Artal R, Barakat R, Brown W, Davies GAL, Dooley M, et al. Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 1-exercise in women planning pregnancy and those who are pregnant. Br J Sports Med. 2016;50(10):571–89.CrossRefGoogle Scholar
  5. 5.
    Evenson KR, Mottola MF, Owe KM, Rousham EK, Brown WJ. Summary of international guidelines for physical activity after pregnancy. Obstet Gynecol Surv. 2014;69(7):407–14.CrossRefGoogle Scholar
  6. 6.
    Bø K, Artal R, Barakat R, Brown WJ, Davies GAL, Dooley M, et al. Exercise and pregnancy in recreational and elite athletes: 2016/17 evidence summary from the IOC expert group meeting, Lausanne. Part 3-exercise in the postpartum period. Br J Sports Med. 2017;51(21):1516–25.CrossRefGoogle Scholar
  7. 7.
    Bacchi E, Bonin C, Zanolin ME, Zambotti F, Livornese D, Donà S, et al. Physical activity patterns in normal-weight and overweight/obese pregnant women. PLoS One. 2016;11(11):e0166254.CrossRefGoogle Scholar
  8. 8.
    Rousham EK, Clarke PE, Gross H. Significant changes in physical activity among pregnant women in the UK as assessed by accelerometry and self-reported activity. Eur J Clin Nutr. 2006;60(3):393–400.CrossRefGoogle Scholar
  9. 9.
    Liu J, Blair SN, Teng Y, Ness AR, Lawlor DA, Riddoch C. Physical activity during pregnancy in a prospective cohort of British women: results from the Avon longitudinal study of parents and children. Eur J Epidemiol. 2011;26(3):237–47.CrossRefGoogle Scholar
  10. 10.
    Symons Downs D, Hausenblas HA. Women’s exercise beliefs and behaviors during their pregnancy and postpartum. J Midwifery Womens Health. 2004;49(2):138–44.CrossRefGoogle Scholar
  11. 11.
    Borodulin K, Evenson KR, Herring AH. Physical activity patterns during pregnancy through postpartum. BMC Womens Health. 2009;9:32.CrossRefGoogle Scholar
  12. 12.
    Schmitt NM, Nicholson WK, Schmitt J. The association of pregnancy and the development of obesity—results of a systematic review and meta-analysis on the natural history of postpartum weight retention. Int J Obes. 2007;31(11):1642–51.CrossRefGoogle Scholar
  13. 13.
    Nascimento SL, Pudwell J, Surita FG, Adamo KB, Smith GN. The effect of physical exercise strategies on weight loss in postpartum women: a systematic review and meta-analysis. Int J Obes. 2014;38(5):626–35.CrossRefGoogle Scholar
  14. 14.
    Sallis JF, Cervero RB, Ascher W, Henderson KA, Kraft MK, Kerr J. An ecological approach to creating active living communities. Annu Rev Public Health. 2006;27:297–322.CrossRefGoogle Scholar
  15. 15.
    Smith M, Hosking J, Woodward A, et al. Systematic literature review of built environment effects on physical activity and active transport—an update and new findings on health equity. Int J Behav Nutr Phys Act. 2017;11(1):14–158.Google Scholar
  16. 16.
    McCormack GR, Shiell A. In search of causality: a systematic review of the relationship between the built environment and physical activity among adults. Int J Behav Nutr Phys Act. 2011;8:125.CrossRefGoogle Scholar
  17. 17.
    O'Brien OA, Lindsay KL, McCarthy M, et al. Influences on the food choices and physical activity behaviours of overweight and obese pregnant women: a qualitative study. Midwifery. 2017;47:28–35.CrossRefGoogle Scholar
  18. 18.
    Richardsen KR, Mdala I, Berntsen S, et al. Objectively recorded physical activity in pregnancy and postpartum in a multi-ethnic cohort: association with access to recreational areas in the neighbourhood. Int J Behav Nutr Phys Act. 2016;13:78.CrossRefGoogle Scholar
  19. 19.
    Nichani V, Dirks K, Burns B, Bird A, Morton S, Grant C. Green space and physical activity in pregnant women: evidence from the growing up in New Zealand study. J Phys Act Health. 2016;13(12):1341–50.CrossRefGoogle Scholar
  20. 20.
    Laraia B, Messer L, Evenson K, Kaufman JS. Neighborhood factors associated with physical activity and adequacy of weight gain during pregnancy. J Urban Health. 2007;84(6):793–806.CrossRefGoogle Scholar
  21. 21.
    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.CrossRefGoogle Scholar
  22. 22.
    Siega-Riz AM, Herring AH, Carrier K, Evenson KR, Dole N, Deierlein A. Sociodemographic, perinatal, behavioral, and psychosocial predictors of weight retention at 3 and 12 months postpartum. Obesity (Silver Spring). 2010;18(10):1996–2003.CrossRefGoogle Scholar
  23. 23.
    Borodulin KM, Evenson KR, Wen F, Herring AH, Benson AM. Physical activity patterns during pregnancy. Med Sci Sports Exerc. 2008;40(11):1901–8.CrossRefGoogle Scholar
  24. 24.
    Evenson KR, Wen F. Measuring physical activity among pregnant women using a structured one-week recall questionnaire: evidence for validity and reliability. Int J Behav Nutr Phys Act. 2010;7:21.CrossRefGoogle Scholar
  25. 25.
    Frizzelle BG, Evenson KR, Rodriguez DA, Laraia BA. The importance of accurate road data for spatial applications in public health: customizing a road network. Int J Health Geogr. 2009;8:24.CrossRefGoogle Scholar
  26. 26.
    Evenson KR, Sotres-Alvarez D, Herring AH, Messer L, Laraia BA, Rodríguez DA. Assessing urban and rural neighborhood characteristics using audit and GIS data: derivation and reliability of constructs. Int J Behav Nutr Phys Act. 2009;6:44.CrossRefGoogle Scholar
  27. 27.
    Porter AK, Wen F, Herring AH, Rodríguez DA, Messer LC, Laraia BA, et al. Reliability and one-year stability of the PIN3 neighborhood environmental audit in urban and rural neighborhoods. J Urban Health. 2018;95(3):431–9.CrossRefGoogle Scholar
  28. 28.
    Evenson KR, Herring AH, Wen F. Self-reported and objectively measured physical activity among a cohort of postpartum women: the PIN Postpartum Study. J Phys Act Health. 2012;9(1):5–20.CrossRefGoogle Scholar
  29. 29.
    Josey MJ, Moore S. The influence of social networks and the built environment on physical inactivity: a longitudinal study of urban-dwelling adults. Health Place. 2018;54:62–8.CrossRefGoogle Scholar
  30. 30.
    Bancroft C, Joshi S, Rundle A, Hutson M, Chong C, Weiss CC, et al. Association of proximity and density of parks and objectively measured physical activity in the United States: a systematic review. Soc Sci Med. 2015;138:22–30.CrossRefGoogle Scholar
  31. 31.
    Ferrari RM, Siega-Riz AM, Evenson KR, Moos MK, Carrier KS. A qualitative study of women’s perceptions of provider advice about diet and physical activity during pregnancy. Patient Educ Couns. 2013;91(3):372–7.CrossRefGoogle Scholar
  32. 32.
    Duncombe D, Wertheim EH, Skouteris H, Paxton SJ, Kelly L. Factors related to exercise over the course of pregnancy including women’s beliefs about the safety of exercise during pregnancy. Midwifery. 2009;25(4):430–8.CrossRefGoogle Scholar
  33. 33.
    ACOG. ACOG Committee Opinion No. 650: Physical activity and exercise during pregnancy and the postpartum period. Obstet Gynecol. 2015;126(6):e135–42.CrossRefGoogle Scholar
  34. 34.
    Giles-Corti B, Timperio A, Bull F, Pikora T. Understanding physical activity environmental correlates: increased specificity for ecological models. Exerc Sport Sci Rev. 2005;33(4):175–81.CrossRefGoogle Scholar
  35. 35.
    Keller C, Todd M, Ainsworth B, et al. Overweight, obesity, and neighborhood characteristics among postpartum Latinas. J Obes. 2013;2013:916468.CrossRefGoogle Scholar
  36. 36.
    Saligheh M, Hackett D, Boyce P, Cobley S. Can exercise or physical activity help improve postnatal depression and weight loss? A systematic review. Arch Womens Ment Health. 2017;20(5):595–611.CrossRefGoogle Scholar
  37. 37.
    Dadvand P, Wright J, Martinez D, Basagaña X, McEachan RRC, Cirach M, et al. Inequality, green spaces, and pregnant women: roles of ethnicity and individual and neighbourhood socioeconomic status. Environ Int. 2014;71:101–8.CrossRefGoogle Scholar

Copyright information

© The New York Academy of Medicine 2019

Authors and Affiliations

  1. 1.Department of Epidemiology, Gillings School of Global Public HealthUniversity of North CarolinaChapel HillUSA
  2. 2.Department of Public Health, School of Health ProfessionsUniversity of Southern MississippiHattiesburgUSA
  3. 3.Department of City and Regional Planning and Institute for Transportation StudiesUniversity of CaliforniaBerkeleyUSA
  4. 4.Carolina Population CenterUniversity of North CarolinaChapel HillUSA

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