Prenatal exercise has been linked to positive effects on offspring health in animal and human studies, with changes in breast milk composition suggested as a possible explanatory mechanism. This exploratory study investigated whether prenatal exercise interventions affected the metabolome and lipidome of transitional human breast milk in healthy pregnant women compared to standard care. The present study is based on the FitMum randomized controlled trial (Copenhagen University Hospital – North Zealand, 2018–2021), which included in total 220 healthy inactive pregnant women (≤15+0 weeks’ gestation). Participants were randomly assigned to structured supervised exercise training (EXE) three times per week throughout pregnancy, motivational counselling on physical activity (MOT) offered as seven individual and group sessions during pregnancy, or standard care (CON). Physical activity was monitored continuously from inclusion throughout one year postpartum by a wrist-worn activity tracker. Samples of transitional breast milk were collected from 99 participants 7–14 days postpartum and exploratory and hypothesis-generating analyses were conducted using untargeted metabolomics and lipidomics. After adjustment for multiple comparisons, no significant overall differences in metabolites or lipids were observed between EXE or MOT and CON. However, subsequent nominal and secondary analyses of specific subsets revealed subtle distinctions. Cluster analysis identified higher levels of 1,7-Dimethyluric acid in both EXE and MOT versus CON (p < 0.05) and elevated oxoglutarate in EXE relative to MOT (p = 0.04). Further nominal species-level analyses of triglycerides and lipid reactions, along with pathway enrichment, showed an overall reduction in triglyceride species in EXE and a predicted conversion pathway from diacylglycerol to phospholipid species in both intervention groups. Importantly, the two interventions impacted different lipid processes and pathways. While prenatal exercise interventions did not induce major metabolomic or lipidomic changes in breast milk early postpartum, subsequent nominal analyses uncovered specific metabolite and lipid differences that may influence offspring metabolism. ClinicalTrial.gov; NCT03679130; Sep 20, 2018. A study protocol paper has been published (http://dx.doi.org/10.1136/bmjopen-2020-043671) and a statistical analysis plan is available with the trial registration at (https://clinicaltrials.gov/ct2/show/NCT03679130?cond=fitmum draw=2 rank=1)

The prevalence of obesity in the pediatric population is increasing, driven by a multifactorial etiology that includes genetic predisposition as well as both prenatal and postnatal influences. We aimed to explore associations between child physical activity (PA) at ages one and three years and body composition at age three. Furthermore, we investigated associations between maternal PA during pregnancy and child body composition at age three. Mother-child pairs (n = 68) from a pregnancy PA intervention study were included. Children’s PA was assessed at one- and three-year follow-ups using 7-day accelerometry and categorized into 24-hour PA and daytime PA (6 a.m. – 8 p.m.). Child body composition was measured by Dual-energy X-ray absorptiometry and expressed as fat-free mass (FFM) and body fat percentage (BF

OBJECTIVE:Maternal physical activity (PA), sedentary time (ST) and body-mass index (BMI) might influence placental development. We examined associations between PA, ST during pregnancy and pre-pregnancy BMI, and placental structural outcomes as well as mRNA expression levels of vascular growth factors. METHODS:The FitMum randomized controlled trial included 220 healthy, pregnant women. PA and ST were objectively measured 24/7 from inclusion before gestational week 15 + 0 until delivery. This secondary analysis of FitMum includes all participants with an available placenta sample (n = 118). Placental sections were stained with immunofluorescence and H&E. Villous density as well as vessel area were assessed with Visiopharm software. Placental samples with sufficient quality (n = 107) were bulk RNA-sequenced and genes relevant for placental vascularization were selected for analysis. Associations of moderate-to-vigorous intensity PA (MVPA), ST and pre-pregnancy BMI, with villous density, vessel surface area, placental weight, and mRNA-counts, were analyzed with multiple regressions. RESULTS:Increased MVPA was associated with increased placental weight (p = 0.005), while higher pre-pregnancy BMI was associated with lower area of medium-sized and large blood vessels in the placenta (p = 0.002). No associations were observed between MVPA or ST and histologic outcomes or mRNA expression levels. CONCLUSION:PA during pregnancy was not associated with vessel per villous area or villous density nor mRNA expression levels of vascular growth factors, but with increased placental weight. High pre-pregnancy BMI was associated with lower area of medium-sized and large blood vessels in the placenta, suggesting metabolic status before pregnancy may play a key role in placental vascular development.

Objectives: To assess the tracking of physical activity (PA) from 1 to 3 years of age, and to investigate associations between maternal prenatal and postpartum PA and sedentary behavior (SB) with child PA at age 1 and 3 years. Study design: This longitudinal study included 129 mother-child dyads from the FitMum randomized controlled trial and 1- and 3-year follow-ups (FitBaby and FitKids). Maternal PA and SB were measured using a commercial activity tracker and the Pregnancy Physical Activity Questionnaire. Child PA was measured by accelerometry at ages 1 and 3 years. Associations were analyzed using linear regression and Spearman rank correlation. Results: Child PA at 1 year was associated with PA at 3 years (rho: 0.36, P = .014) as more PA at 1 year was associated with more PA at 3 years. Children's PA was lower in the 1-year-old children, with a mean daytime counts per minute of 2594 ± 1114, compared with 3836 ± 1305 in the 3-year-old children (P < .001). No associations were observed between maternal PA or SB during pregnancy or postpartum and child PA at age 1 and 3 years. Conclusions: PA tracked from age 1 year to 3 years of age, suggesting that PA early in life is important. Maternal PA and SB during pregnancy and the postpartum year were not associated with child PA. These findings highlight early childhood as an important period for promoting PA.

Induction of labor is a common procedure, and in Denmark, approximately one in four vaginal deliveries are induced. The association between induction and maternal postpartum infections such as endometritis, surgical site infection after cesarean section, urinary tract infection, and sepsis has been sparsely investigated. Our objective was to investigate the association between induction of labor and risk of maternal postpartum infection and to identify potential risk factors for infection. In a nationwide cohort study, all deliveries with live-born singletons from January 1, 2007, to December 31, 2017 ( n  = 546 864) were included. Deliveries were grouped into categories of spontaneous onset of labor, induction of labor, and elective cesarean section. The primary outcome was any infection within 30 days postpartum based on discharge diagnosis codes and redeemed antibiotic prescriptions for endometritis, surgical site infection, urinary tract infection, and sepsis. Analyses were done using logistic regression. Infection within 30 days postpartum was found among 8.5% of the women undergoing induction of labor compared to 6.8% of the women with spontaneous onset of labor. In adjusted logistic regression analyses, the risk of postpartum infection was significantly increased after induction of labor compared to spontaneous onset of labor (adjusted ORs [aOR], 1.24; 95% confidence interval [CI], 1.21–1.27). Women with rupture of membranes were not at increased risk of postpartum infection (aOR 1.01; 95%CI 0.94–1.09). The risk of postpartum maternal sepsis was not significantly associated with induction of labor. Antibiotic treatment during pregnancy, pre-eclampsia, and long education were all associated with increased risk of maternal postpartum infection, while either a low or high body mass index and previous deliveries were associated with decreased risk. Induction of labor was associated with an increased risk of maternal postpartum infection. However, the absolute risk was 1.7% higher for the women with induced labor compared to spontaneous onset of labor, which we believe should not be a cause for concern. Unexpectedly, low and high body mass index was associated with decreased risk of infection, and rupture of membranes was not associated with increased risk after induction of labor, which might reflect actual clinical management.

Postpartum physical activity (PA) is linked to improved mental health and sleep. Yet, many women do not return to pre-pregnancy PA levels, and sedentary behavior may increase. This study mapped PA, sedentary time, and sleep from early pregnancy to one year postpartum, and examined if prenatal PA interventions affect these outcomes postpartum. In the FitMum randomized controlled trial, 220 healthy, inactive pregnant women (< 15 + 0 weeks gestation) were assigned to standard care (CON), supervised exercise (EXE), or motivational PA counselling (MOT). Participants wore wrist-worn activity trackers from inclusion to one year postpartum and completed the Pregnancy Physical Activity Questionnaire and Pittsburgh Sleep Quality Index. We found that postpartum daily steps increased by ~ 2,000 compared to late pregnancy (p < 0.001), while moderate-to-vigorous-intensity PA (MVPA) declined (p < 0.001). Sedentary time remained similar. Sleep duration dropped postpartum in the first three months (p < 0.05), while sleep quality improved (p = 0.006). Prenatal PA interventions had minimal impact postpartum, however, EXE participants reported slightly better sleep than MOT at one year. In conclusion, PA patterns and sleep changed postpartum, with more daily steps, less MVPA, and reduced sleep duration. Prenatal PA interventions had limited effect. Longitudinal studies are needed to optimize timing of interventions for maternal health. The study is registered at ClinicalTrials.gov; NCT03679130;20/09/2018.

Objectives We aimed to compare Garmin-estimated daily minutes of moderate-to-vigorous-intensity physical activity (MVPA) with daily minutes of MVPA assessed using heart rate (HR) thresholds based on maximum HR and HR reserve (HRR), respectively. Furthermore, we explored pregnancy-related HR changes.Methods The FitMum study included 220 healthy pregnant women before gestational age week 15+0 wearing Garmin vívosport activity trackers continuously until delivery. The activity trackers measured MVPA based on a proprietary algorithm including HR and accelerometry (model 1). We assessed MVPA as time above 64% of maximum HR with (model 2a) and without (model 2b) a minimum of 10 consecutive minutes of MVPA. In model 3, we assessed MVPA as time above 40% of HRR.Results Model 2a assigned less MVPA compared with model 1 (mean bias: −3.66 min/day). Model 2b assigned more MVPA compared with model 1 (mean bias: 16.82 min/day) and Model 2a (mean bias: 20.48 min/day). Model 3 assigned more MVPA compared with model 2b (mean bias: 12.00 min/day). Resting and average HR increased during pregnancy.Conclusion Using HR for assessing MVPA offers transparency. The Garmin algorithm (model 1) assigned more MVPA compared with the HR model (model 2a). Removing the 10-min bout criterion resulted in more MVPA (Model 2a vs 2b). Using the HRR for assessing MVPA (model 3) resulted in more MVPA compared with using the maximum HR (model 2b). Resting and average HR resembled findings from previous studies.

OBJECTIVE:Since the legalization of elective abortion in Denmark in 1973, the abortion limit has been at gestational week 12. The abortion limit has recently been debated, leading to its extension to gestational week 18 by 2025. However, research on abortion limits is lacking in Danish and international contexts. This initial study aimed to examine Danish non-abortion-seeking pregnant women's attitudes towards elective abortion and abortion limits in Denmark, in relation to their own pregnancy and perceptions of the fetus. METHODS:This exploratory study was based on qualitative semi-structured interviews with 13 non-abortion-seeking pregnant women. All the interviews were conducted using video links. The interviews were transcribed verbatim and analyzed using thematic analysis. RESULTS:All participants supported abortion as a women's right. However, the responses showed a lack of knowledge about abortion procedures as well as cultural silence linked to abortion. Abortion was viewed as the responsibility and burden of women. The participants were equivocal about the placement of the abortion limit due to their own pregnancy experiences, but gestational week 12 was seen as an important milestone in securing the pregnancy and the expected child. CONCLUSION:This study highlights that issues of elective abortion and abortion limits are linked to ambivalence Abortion was voiced as a woman's right, but also as a woman's responsibility, and burden. The fact that an embryo or fetus, is removed during an abortion procedure made it difficult and ambivalent for the participating women to articulate specific attitudes towards raised abortion limits.

Per- and polyflouralkyl substances (PFAS) are a group of persistent chemicals used extensively in industries and consumer products due to their water-repellent properties. Studies have linked PFAS exposure to adverse health effects, and human exposure to PFAS, especially during pregnancy, is of great concern. In this study, we report how serum PFAS concentrations during pregnancy correlated with serum PFAS of partners from the same household. Further, we report how serum PFAS concentrations change during the course of pregnancy and associations between PFAS and blood lipid concentrations as well as exploratory analyses of associations between physical activity and PFAS concentrations. In this secondary analysis of data from the FitMum study conducted from 2018 to 2021, 216 healthy, pregnant women, and 110 of their partners were included. Non-fasting venous blood samples were collected from the mothers at three test visits during pregnancy and at delivery, where blood from partners were also collected. Serum samples from all timepoints were analyzed for 15 short- and long-chained PFAS using liquid chromatography triple quadrupole linear ion trap mass spectrometry. Total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglyceride blood concentrations were measured at three test visits during pregnancy and at delivery. Physical activity was measured with a wrist-worn activity tracker 24/7 from inclusion before gestational age week 15 + 0 and throughout pregnancy. In serum samples we detected the following PFAS: PFOS, PFOA, PFHxS, PFNA, PFDA, and PFUnDA. The maternal median concentrations at baseline were: PFOS: 4.09 ng/mL, PFOA: 0.81 ng/mL, PFHxS: 0.29 ng/mL, PFNA: 0.42 ng/mL, PFDA: 0.25 ng/mL, and PFUnDA: 0.19 ng/mL. Partner serum PFAS concentrations were 3–145

Pregnant women with a history of mental disorders, neglect, or low social support are at increased risk of mental health problems. It is crucial to identify psychosocial risk factors in early pregnancy to reduce the risk of short- and long-term health consequences for mother and child. The Antenatal Risk Questionnaire has been found acceptable as a psychosocial screening tool among pregnant women in Australia, but it has not been tested in a Scandinavian context. The aim of this study was to explore the experiences of pregnant women when using the Antenatal Risk Questionnaire and the Edinburgh Postnatal Depression Scale as part of a model to identify psychosocial vulnerabilities in pregnancy in Denmark. We conducted individual interviews (n = 18) and used thematic analysis. We identified two main themes: (1) Feeling heard and (2) An occasion for self-reflection. Overall, the pregnant women deemed the online ANRQ/EPDS acceptable as a screening tool. The screening model provided a feeling of being heard and provided an occasion for self-reflection about mental health challenges related to pregnancy and motherhood. However, some women expressed that the screening raised concerns and fear of the consequences of answering honestly. A non-judgmental, open, emphatic, and reassuring approach by clinicians may help reduce stigma.

INTRODUCTION:Induction of labor is a common procedure, and in Denmark, approximately one in four vaginal deliveries are induced. The association between induction and maternal postpartum infections such as endometritis, surgical site infection after cesarean section, urinary tract infection, and sepsis has been sparsely investigated. Our objective was to investigate the association between induction of labor and risk of maternal postpartum infection and to identify potential risk factors for infection. MATERIAL AND METHODS:In a nationwide cohort study, all deliveries with live-born singletons from January 1, 2007, to December 31, 2017 (n = 546 864) were included. Deliveries were grouped into categories of spontaneous onset of labor, induction of labor, and elective cesarean section. The primary outcome was any infection within 30 days postpartum based on discharge diagnosis codes and redeemed antibiotic prescriptions for endometritis, surgical site infection, urinary tract infection, and sepsis. Analyses were done using logistic regression. RESULTS:Infection within 30 days postpartum was found among 8.5% of the women undergoing induction of labor compared to 6.8% of the women with spontaneous onset of labor. In adjusted logistic regression analyses, the risk of postpartum infection was significantly increased after induction of labor compared to spontaneous onset of labor (adjusted ORs [aOR], 1.24; 95% confidence interval [CI], 1.21-1.27). Women with rupture of membranes were not at increased risk of postpartum infection (aOR 1.01; 95%CI 0.94-1.09). The risk of postpartum maternal sepsis was not significantly associated with induction of labor. Antibiotic treatment during pregnancy, pre-eclampsia, and long education were all associated with increased risk of maternal postpartum infection, while either a low or high body mass index and previous deliveries were associated with decreased risk. CONCLUSIONS:Induction of labor was associated with an increased risk of maternal postpartum infection. However, the absolute risk was 1.7% higher for the women with induced labor compared to spontaneous onset of labor, which we believe should not be a cause for concern. Unexpectedly, low and high body mass index was associated with decreased risk of infection, and rupture of membranes was not associated with increased risk after induction of labor, which might reflect actual clinical management.

Background A physically active lifestyle is beneficial during pregnancy. However, little is known about physical activity (PA) behaviour and psychosocial factors in women during and after pregnancy. This study examined exercise behavioural regulation, exercise self-efficacy, health-related quality of life, sickness absence and musculoskeletal pain in pregnant women offered either structured supervised exercise training, motivational counselling on PA, or standard prenatal care in the FitMum randomised controlled trial. Methods Two hundred and eighteen healthy inactive pregnant women were randomised to structured supervised exercise training ( n = 87), motivational counselling on PA ( n = 86) or standard prenatal care ( n = 45). The women answered the Behavioural Regulation in Exercise Questionnaire-2 (BREQ-2), the Pregnancy Exercise Self-Efficacy Scale (P-ESES-DK) and the Short Form 36 Health Survey Questionnaire (SF-36) at baseline (gestational age (GA) of max 15 weeks), GA 28 and 34 weeks, and one year after delivery. Sickness absence and low back and/or pelvic girdle pain were likewise reported in questionnaires at baseline and GA 28 weeks. Results Participants offered structured supervised exercise training or motivational counselling on PA had higher autonomous motivation for exercise during pregnancy compared with participants receiving standard prenatal care (e.g., difference in intrinsic regulation at GA 28 weeks, structured supervised exercise training vs. standard prenatal care: mean difference in score 0.39 [0.16; 0.64], p < 0.001). Participants offered structured supervised exercise training also had higher exercise self-efficacy during pregnancy (e.g., GA 28 weeks, structured supervised exercise training vs. standard prenatal care: mean difference in score 6.97 [2.05; 12.02], p = 0.005). All participants reported high exercise self-efficacy at baseline and medium exercise self-efficacy during pregnancy and one year after delivery. No differences were found between groups in health-related quality of life, sickness absence or low back and/or pelvic girdle pain during pregnancy. No group differences were found one year after delivery. Conclusion Structured supervised exercise training and motivational counselling on PA had important effects on autonomous exercise motivation during pregnancy. Exercise self-efficacy was also increased with structured supervised exercise training compared to standard prenatal care. No group differences in health-related quality of life, sickness absence, or pain were found during and after pregnancy. No effects were found one year post-delivery after intervention cessation. Trial registration The study was approved by the Danish National Committee on Health Research Ethics (#H-18011067) and the Danish Data Protection Agency (#P-2019–512). The study adheres to the principles of the Helsinki declaration. Written informed consent was obtained at inclusion.

Objective: To evaluate if SARS-CoV-2 is detectable in vaginal swabs and whether antibodies against SARS-CoV-2 are present in maternal and umbilical cord blood of pregnant women with COVID-19. Design: Prospective cohort study. Setting: Department of Obstetrics and Gynaecology, Copenhagen University Hospital – North Zealand, Denmark. Population: Pregnant women tested positive for SARS-CoV-2 in a pharyngeal swab between August 20th, 2020 and March 1st, 2021 who gave birth during the same period. Methods: Maternal blood sample and vaginal swabs were collected at inclusion. If included during pregnancy, these samples were repeated at delivery in addition to an umbilical cord blood sample. Swabs were analysed for SARS-CoV-2 and blood samples for SARS-CoV-2 total antibodies. Placental and neonatal swabs were performed on clinical indications. Main outcome measures: SARS-CoV-2 in vaginal swabs and SARS-CoV-2 total antibodies in maternal and umbilical cord blood. Results: We included 28 women, hereof 4 serious maternal or fetal outcomes including 1 neonatal death. Within the first eight days after a maternal positive pharyngeal swab, SARS-CoV-2 was detectable in two vaginal (2/28) and two placental swabs (2/4), whereas SARS-CoV-2 antibodies were detected in 1/13 women. After eight days, SARS-CoV-2 was not detectable in vaginal swabs and SARS-CoV-2 antibodies were observed in 19/21 of women. Antibodies in cord blood of seropositive mothers appeared after 16 days. Conclusion: Vertical transmission of SARS-CoV-2 seems plausible since SARS-CoV-2 is detectable in the vagina up to eight days after a positive pharyngeal swab at which time the neonate is not yet protected by antibodies.

INTRODUCTION. We aimed to investigate the prevalence of SARS-CoV-2 infection and SARS-CoV-2 antibodies in parturient women and their newborns during the first Danish COVID-19 wave and to identify associations with maternal background characteristics, self-reported symptoms, and pregnancy outcomes. METHODS. In a single-centre, prospective cohort study from Denmark, we invited 1,883 women with singleton pregnancies giving live birth from 25 May 2020 to 2 November 2020. Hereof, 953 (50.6%) women were included. Nasopharyngeal swabs, maternal and umbilical cord blood samples, and questionnaires were collected. Medical records were available for participants and non-participants. RESULTS. SARS-CoV-2 antibodies were found in 1.3% of the women. All newborns of seropositive women had SARS-CoV-2 antibodies in cord blood. No association was found between SARS-CoV-2 antibodies and pregnancy outcomes. Self-reported loss of smell correlated with seropositivity (p < 0.001). No women were hospitalised due to COVID-19 during pregnancy or had a positive nasopharyngeal swab intrapartum. CONCLUSIONS. The prevalence of COVID-19 in pregnancy was low during the first wave. Maternal SARS-CoV-2 antibodies were associated with antibodies in cord blood, loss of smell and positive SARS-CoV-2 swab during pregnancy, but not with any adverse pregnancy outcomes. FUNDING. Ferring Pharmaceuticals funded part of the study. TRIAL REGISTRATION. The study was approved by the Regional Committee on Health Research Ethics (H-20028002) and the Danish Data Protection Agency (P-2020-264).

The main objective of the study was to investigate the effects of prenatal exercise interventions on maternal body composition at 28 weeks gestation and 7-14 days after delivery. We also explored associations between physical activity (PA) per se and body composition. This study presents secondary outcomes of the FitMum randomized controlled trial, which included healthy inactive pregnant women at gestational age ≤ 15+0 weeks. They were randomized to structured supervised exercise training, motivational counselling on PA, or standard care. Maternal body composition was measured by doubly labeled water at 28 weeks gestation (n = 134) and by dual-energy X-ray absorptiometry scan 7-14 days after delivery (n = 117). PA, including moderate-to-vigorous-intensity PA (MVPA), active kilocalories, and steps, were measured continuously from inclusion to delivery by a wrist-worn activity tracker. One hundred fifty pregnant women were included with a median pre-pregnancy body mass index (BMI) of 24.1 (21.6-27.9) kg/m2. We found no differences between groups in fat mass, fat percentage or fat-free mass at 28 weeks gestation or 7-14 days after delivery. Visceral adipose tissue mass and bone mineral density measured 7-14 days after delivery did not differ between groups either. Linear regression analyses adjusted for pre-pregnancy BMI showed that a higher number of daily steps was associated with lower fat mass, fat percentage, and visceral adipose tissue mass at 28 weeks gestation and 7-14 days after delivery. Active kilocalories during pregnancy was positively associated with fat-free mass 7-14 days after delivery. Neither structured supervised exercise training nor motivational counselling on PA during pregnancy affected maternal body composition at 28 weeks gestation or 7-14 days after delivery compared to standard care. Interestingly, when adjusted for pre-pregnancy BMI, higher number of daily steps was associated with lower fat content during pregnancy and after delivery, whereas MVPA and active kilocalories were not. Trial registration: ClinicalTrials.gov; NCT03679130; 20/09/2018.

Objective Maternal blood lipid and glucose concentrations during pregnancy affect fetal growth and the risk of pregnancy and delivery complications. We aimed to investigate the effects of physical activity (PA) during pregnancy on maternal blood lipid and hemoglobin A1c (HbA1c) concentrations. We hypothesized that higher PA was associated with improved lipid profile and glycemic control. Methods In a secondary analysis of a randomized controlled trial, we included 216 pregnant women before week 15 + 0 and tested the effects of two different PA interventions throughout pregnancy compared to standard care on maternal blood lipid and HbA1c concentrations. Additionally, we investigated the effect of PA per se measured by an activity tracker. Total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglyceride, and HbA1c concentrations were measured at week <= 15 + 0, 28+0-6, 34+0-6, and at delivery (week 32 + 1 to 42 + 0). Effects of the interventions and PA per se were tested using linear mixed effects models and linear regression analyses, respectively. Results No effects of the PA interventions were detected on maternal lipids or HbA1c during pregnancy. In PA per se analyses, more minutes per week of moderate-to-vigorous intensity PA were associated with less increase in TC (-1.3E-04, P = .020) and LDL-C (-8.5E-05, P = .035) as pregnancy progresses. More active kilocalories were associated with less increase in TC (-5.5E-05, P < .001), HDL-C (-9.5E-06, P = .024), and LDL-C (-3.2E-05, P = .005). Conclusion Whilst there were no effects of offering PA interventions, higher PA was associated with reduced increases in TC, HDL-C, and LDL-C as pregnancy progressed.

Objectives Telemonitoring of high-risk pregnancy complications is a new approach that offers remote obstetric caregiving using mobile and wireless technologies. New evidence shows that home-based obstetric telemonitoring is not only feasible but also a safe alternative to inpatient or frequent outpatient care. As little is known how performing obstetric telemonitoring is perceived, this study examined how women with pregnancy complications experienced performing home-based telemonitoring. Methods A qualitative, semi-structured interview study was conducted with women with ongoing experience in performing home-based telemonitoring procedures for high-risk pregnancy complications. Purposeful sampling strategy and data saturation were applied followed by verbatim transcription. The data were analyzed using systematic text condensation. Results Fifteen informants participated in the study and four major themes emerged. The study revealed that performing telemonitoring was overall positively experienced as an ‘Empowering yet challenging responsibility’ as well as an ‘Extended patient-clinician partnership.’ There were pros and cons as to the influence of telemonitoring in everyday life; ‘Tele-comfort yet ambivalence’ and that it could be accompanied by annoying practical issues; ‘Accompanying remote issues.’ Conclusions Performing obstetric telemonitoring was experienced as an empowering yet challenging responsibility as well as an extended partnership between the clinician and the pregnant woman. Pros and cons were voiced as to the influence and ambivalence of telemonitoring in everyday life, and that it could be accompanied by annoying practical issues. Patient aspects and experiences of telemonitoring are important clinical knowledge that must be considered when a telemonitoring plan is tailored preferably in a shared decision-making process.

Pregnancy is often associated with poor sleep and high sedentary time (SED). We investigated the effect of physical activity (PA) interventions on sleep and SED in pregnant women. A secondary analysis of a randomized controlled trial (n = 219) explored the effect of structured supervised exercise training (EXE) or motivational counseling on PA (MOT) compared to standard prenatal care (CON) on sleep and SED during pregnancy. Three times during pregnancy, sleep was determined by the Pittsburgh Sleep Quality Index (PSQI) and SED by the Pregnancy Physical Activity Questionnaire (PPAQ). Also, a wrist-worn consumer activity tracker measured sleep and SED continuously. Data from the activity tracker confirmed that sleep time decreases, and SED increases by approx. 30 and 24 min/day, respectively, from baseline (maximum gestational age (GA) week 15) to delivery. Compared to CON, the global PSQI score was better for EXE in GA week 28 (−0.8 [−1.5; −0.1], p = 0.031) and for both EXE and MOT in GA week 34 (−1 [−2; −0.5], p = 0.002; −1 [−2; −0.1], p = 0.026). In GA week 28, SED (h/day) from PPAQ was lower in EXE compared to both CON and MOT (−0.69 [−1; −0.0], p = 0.049; −0.6 [−1.0; −0.02], p = 0.042). In conclusion, PA interventions during pregnancy improved sleep quality and reduced SED.