Physical Activity and Risk of Cesarean Delivery in Hispanic Women

in Journal of Physical Activity and Health
Restricted access

Purchase article

USD  $24.95

Student 1 year subscription

USD  $115.00

1 year subscription

USD  $153.00

Student 2 year subscription

USD  $218.00

2 year subscription

USD  $285.00

Background: Rates of cesarean delivery continue to increase among Hispanics, the largest minority group in the United States. Prior studies of the relationship between physical activity and cesarean delivery have been conflicting, limited by questionnaires not validated for pregnancy, and conducted primarily among non-Hispanic whites. Methods: We evaluated this association among participants (n = 1313) in Proyecto Buena Salud, a prospective cohort of Hispanic women conducted from 2006 to 2011. Physical activity was measured via the Pregnancy Physical Activity Questionnaire. Results: In total, 320 (24.4%) participants delivered via cesarean. In multivariable analyses, increasing levels of sedentary activity in mid/late pregnancy were associated with higher odds of cesarean delivery (odds ratio = 1.54; 95% confidence interval, 1.02–3.33; Ptrend = .05); however, there were no clear patterns between physical activity and cesarean delivery. When we repeated the analysis excluding planned cesarean deliveries (n = 126), high levels of prepregnancy moderate-intensity physical activity (odds ratio = 0.61; 95% confidence interval, 0.38–0.99) and increasing moderate-intensity physical activity in mid/late pregnancy (Ptrend = .03) were associated with reduction in odds. Increasing levels of household/caregiving physical activity in pre and mid/late pregnancy were associated with a 50% reduction in odds (Ptrend < .05). Conclusions: In this prospective cohort of Hispanics, sedentary activity increased odds of cesarean delivery, and moderate-intensity and household/caregiving physical activity reduced odds of unplanned cesarean deliveries.

The authors are with the Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA.

Chasan-Taber (LCT@schoolph.umass.edu) is corresponding author.
  • 1.

    Bodner K, Wierrani F, Grünberger W, Bodner Adler B. Influence of the mode of delivery on maternal and neonatal outcomes: a comparison between elective cesarean section and planned vaginal delivery in a low-risk obstetric population. Arch Gynecol Obstet. 2011;283(6):1193–1198. PubMed ID: 20505947 doi:10.1007/s00404-010-1525-y

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Karlström A, Lindgren H, Hildingsson I. Maternal and infant outcome after caesarean section without recorded medical indication: findings from a Swedish case–control study. BJOG. 2013;120(4):479–486. doi:10.1111/1471-0528.12129

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Ecker J. Elective cesarean delivery on maternal request. JAMA. 2013;309(18):1930–1936. PubMed ID: 23652524 doi:10.1001/jama.2013.3982

  • 4.

    Visco A, Viswanathan M, Lohr K, et al. Cesarean delivery on maternal request: maternal and neonatal outcomes. Obstet Gynecol. 2006;108(6):1517–1529. PubMed ID: 17138788 doi:10.1097/01.AOG.0000241092.79282.87

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Martin J, Hamilton B, Osterman MJK, Driscoll A, Drake P. Births: final data for 2016. Natl Vital Stat Rep. 2018;67(1):1–55. PubMed ID: 29775434

    • Search Google Scholar
    • Export Citation
  • 6.

    Edmonds J, Hawkins S, Cohen B. The influence of detailed maternal ethnicity on cesarean delivery: findings from the U.S. birth certificate in the State of Massachusetts. Birth. 2014;41(3):290–298. PubMed ID: 24750358 doi:10.1111/birt.12108

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Motel S, Patten E. The 10 largest Hispanic origin groups: characteristics, rankings, top counties. June 27, 2012. http://www.pewhispanic.org/2012/06/27/the-10-largest-hispanic-origin-groups-characteristics-rankings-top-counties/.

    • Export Citation
  • 8.

    Spong C, Berghella V, Wenstrom K, Mercer B, Saade G. Preventing the first cesarean delivery: summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists workshop. Obstet Gynecol. 2012;120(5):1181–1193. PubMed ID: 23090537

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    ACOG Committee Opinion No. 650: physical activity and exercise during pregnancy and the postpartum period. Obstet Gynecol. 2015;126(6):135–142. PubMed ID: 26595585 doi:10.1097/AOG.0000000000001214

    • Search Google Scholar
    • Export Citation
  • 10.

    Tinloy J, Chuang C, Zhu J, Pauli J, Kraschnewski J, Kjerulff K. Exercise during pregnancy and risk of late preterm birth, cesarean delivery, and hospitalizations. Womens Health Issues. 2014;24(1):e99–e104. PubMed ID: 24439953 doi:10.1016/j.whi.2013.11.003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Petersen AM, Leet TL, Brownson RC. Correlates of physical activity among pregnant women in the United States. Med Sci Sports Exerc. 2005;37(10):1748–1753. PubMed ID: 16260976 doi:10.1249/01.mss.0000181302.97948.90

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Poyatos León R, García Hermoso A, Sanabria Martínez G, Álvarez Bueno C, Sánchez López M, Martínez Vizcaíno V. Effects of exercise during pregnancy on mode of delivery: a meta-analysis. Acta Obstet Gynecol Scand. 2015;94(10):1039–1047. doi:10.1111/aogs.12675

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Di Mascio D, Magro Malosso E, Saccone G, Marhefka G, 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):561–571. PubMed ID: 27319364 doi:10.1016/j.ajog.2016.06.014

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Bovbjerg M, Siega Riz A, Evenson K, Goodnight W. Exposure analysis methods impact associations between maternal physical activity and cesarean delivery. J Phys Act Health. 2015;12(1):37–47. PubMed ID: 24509873 doi:10.1123/jpah.2012-0498

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Evenson KR, Savitz DA, Huston SL. Leisure-time physical activity among pregnant women in the US. Paediatr Perinat Epidemiol. 2004;18(6):400–407. PubMed ID: 15535815 doi:10.1111/j.1365-3016.2004.00595.x

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Chasan-Taber L, Schmidt MD, Pekow P, Sternfeld B, Manson J, Markenson G. Correlates of physical activity in pregnancy among Latina women. Matern Child Health J. 2007;11(4):353–363. PubMed ID: 17345155 doi:10.1007/s10995-007-0201-8

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Owe K, Nystad W, Stigum H, Vangen S, Bø K. Exercise during pregnancy and risk of cesarean delivery in nulliparous women: a large population-based cohort study. Am J Obstet Gynecol. 2016;215(6):791.e1–791.e13. doi:10.1016/j.ajog.2016.08.014

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Bungum TJ, Peaslee DL, Jackson AW, Perez MA. Exercise during pregnancy and type of delivery in nulliparae. J Obstet Gynecol Neonatal Nurs. 2000;29(3):258–264. PubMed ID: 10839574 doi:10.1111/j.1552-6909.2000.tb02047.x

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Bovbjerg M, Siega Riz A. Exercise during pregnancy and cesarean delivery: North Carolina PRAMS, 2004–2005. Birth. 2009;36(3):200–207. PubMed ID: 19747266 doi:10.1111/j.1523-536X.2009.00324.x

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Nielsen E, Andersen P, Hegaard H, Juhl M. Mode of delivery according to leisure time physical activity before and during pregnancy: a multicenter cohort study of low-risk women. J Pregnancy. 2017;2017:6209605. PubMed ID: 28386483 doi:10.1155/2017/6209605

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Ko Y, Chen C, Lin P. Physical activities during pregnancy and type of delivery in nulliparae. Eur J Sport Sci. 2015;16(3):374–380. PubMed ID: 25837804 doi:10.1080/17461391.2015.1028468

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Tinius R, Cahill A, Cade WT. Impact of physical activity during pregnancy on obstetric outcomes in obese women. J Sports Med Phys Fitness. 2017;57(5):652–659. PubMed ID: 26564274

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Melzer K, Schutz Y, Soehnchen N, et al. Effects of recommended levels of physical activity on pregnancy outcomes. Am J Obstet Gynecol. 2010;202(3):266.e1–266.e6. doi:10.1016/j.ajog.2009.10.876

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24.

    Chasan-Taber L, Fortner R, Gollenberg A, Buonnaccorsi J, Dole N, Markenson G. A prospective cohort study of modifiable risk factors for gestational diabetes among Hispanic women: design and baseline characteristics. J Womens Health. 2010;19(1):117–124. doi:10.1089/jwh.2009.1416

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25.

    Chasan-Taber L, Schmidt MD, Roberts DE, Hosmer D, Markenson G, Freedson PS. Development and validation of a pregnancy physical activity questionnaire. Med Sci Sports Exerc. 2004;36(10):1750–1760. PubMed ID: 15595297 doi:10.1249/01.MSS.0000142303.49306.0D

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Ainsworth BE, Haskell WL, Herrmann SD, et al. 2011 Compendium of Physical Activities: a second update of codes and MET values. Med Sci Sports Exerc. 2011;43(8):1575–1581. PubMed ID: 21681120 doi:10.1249/MSS.0b013e31821ece12

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Tropp LR, Erkut S, Coll CG, Alarcon O, Vazquez Garcia HA. Psychological acculturation: development of a new measure for Puerto Ricans on the U.S. Mainland. Educ Psychol Meas. 1999;59(2):351–367. PubMed ID: 21415932 doi:10.1177/00131649921969794

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Skow R, King E, Steinback C, Davenport M. The influence of prenatal exercise and pre-eclampsia on maternal vascular function. Clin Sci. 2017;131(17):2223–2240. PubMed ID: 28798074 doi:10.1042/CS20171036

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Melamed N, Hadar E, Keidar L, Peled Y, Wiznitzer A, Yogev Y. Timing of planned repeat cesarean delivery after two or more previous cesarean sections—risk for unplanned cesarean delivery and pregnancy outcome. J Matern Fetal Neonatal Med. 2014;27(5):431–438. PubMed ID: 23795868 doi:10.3109/14767058.2013.818130

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Chiossi G, Lai Y, Landon M, et al. Timing of delivery and adverse outcomes in term singleton repeat cesarean deliveries. Obstet Gynecol. 2013;121(3):561–569. PubMed ID: 23635619 doi:10.1097/AOG.0b013e3182822193

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Gawade P, Pekow P, Markenson G, Plevyak M, Goh W, Chasan-Taber L. Physical activity before and during pregnancy and duration of second stage of labor among Hispanic women. J Reprod Med. 2009;54(7):429–435. PubMed ID: 19691259

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Kottwitz A. Mode of birth and social inequalities in health: the effect of maternal education and access to hospital care on cesarean delivery. Health Place. 2014;27:9–21. PubMed ID: 24513591 doi:10.1016/j.healthplace.2014.01.005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 92 92 17
Full Text Views 6 6 0
PDF Downloads 2 2 0