MATTERNAL PHYSICAL ACTIVITY AND HYPERTENSION.pptx

MATERNAL PHYSICAL ACTIVITY AND EFFECTS ON HYPERTENSION

BY

EZE CHIDIEBERE E

FETHA

INTRODUCTION

● Available data, though sparse, consistently show that women who engage in recreational physical activity during pregnancy have approximately 50% reduction in the risk for Pre eclampsia

● Available data support the American College of Obstetrician and Gynecologists' recommendations that promote exercise during pregnancy

INTRODUCTION

● The belief that women should remain physically active during pregnancy is prevalent in many cultures, and can be traced back to ancient times (Kitzinger 2000).

● Traditionally, the nature of women's work both within and outside the home has been such that most of the activities would have to be performed during pregnancy

INTRODUCTION

● In most countries throughout history, only socially privileged women have had a choice about the level and type of physical activity they undertake during pregnancy.

● In the late twentieth century, as more women were comfortably off, and with the spread of labour saving machines to do household tasks, the concept of antenatal exercises developed.

INTRODUCTION CONTD.

● Although there is a range of possible effects of exercise and other physical activity during pregnancy, this review deals primarily with those related to prevention of pre-eclampsia, and its consequences.

DEFINITION OF PHYSICAL ACTIVITY

● Physical activity is the bodily movement that is produced by the contraction of skeletal muscles and that substantially increases energy expenditure. There are basically four(4) levels of physical activity

● Inactive level● LowActivity level● Medium Activity level ● High activity

INACTIVITY

●There is no activity beyond baseline activities of daily living.

Health Benefits;

● No health benefits ● Being inactive is unhealthy.

LOW LEVEL PHYSICAL ACTIVITY

● Low activity is activity beyond baseline but fewer than 150 minutes (2 hours and 30 minutes) of moderate-intensity physical activity a week or the equivalent amount (75 minutes, or 1 hour and 15 minutes) of vigorous-intensity activity.

Benefits;● some ● Low levels of activity are clearly preferable to an inactive lifestyle.

MEDIUM LEVEL PHYSICAL ACTIVITY

● Medium activity is 150 minutes to 300 (5 hours) minutes of moderate-intensity activity a week (or 75 to 150 minutes of vigorous-intensity physical activity a week). In scientific terms, this range is approximately equivalent to 500 to 1,000 metabolic equivalent (MET) minutes a week. Benefits;● Activity at the high end of this range has additional and more extensive health benefits than activity at the low end.

HIGH LEVEL PHYSICAL ACTIVITY

● High activity is more than the equivalent of 300 minutes of moderate-intensity physical activity a week.

Benefits;● Current science does not allow researchers to identify an upper limit of activity above which there are no additional health benefits.

INTRODUCTION TO HYPERTENSION IN PREGNANCY

● High blood pressure in pregnancy also known as Pre-eclampsia is part of a spectrum of conditions known as the hypertensive disorders of pregnancy. Hypertension (high blood pressure) is common during pregnancy.

● Around 10% of women have raised blood pressure at some point before delivery.

TYPES OF HYPERTENSIVE DISORDERS IN PREGNANCY

● Hypertensive disorders of pregnancy are usually classified into four categories:

(i) GESTATIONAL HYPERTENSION : a rise in blood pressure during the second half of pregnancy.

(ii) PRE-ECLEMPSIA : usually hypertension with proteinuria (protein in urine) during the second half of pregnancy

TYPES OF HYPERTENSIVE DISORDERS IN PREGNANCY

● (iii) CHRONIC HYPERTENSION: a rise in blood pressure before pregnancy or before 20 weeks' gestation

● (iv) Pre-eclampsia superimposed on chronic hypertension the outcome of most such pregnancies is good, complications of pre-eclampsia and severe hypertension are associated with a substantive increase in morbidity and mortality for both the woman and her baby

CAUSES OF HYPERTENSION IN PREGNANCY

● The cause of pre-eclampsia is uncertain, but current belief is that reduced blood supply to the placenta leads to abnormal function of endothelial cells , possibly as a result of oxidative stress.

● Some researchers suspect poor nutrition and high body fat

● Genetics plays a role as well.

RISK FACTORS FOR HYPERTENSION IN PREGNANCY

● Hypertension in pregnancy is most often seen in first-time pregnancies, in pregnant teens, and in women over 40. Other risk factors include:

● A history of high blood pressure prior to pregnancy

● A history of pre eclampsia

RISK FACTORS CONTD.

● Carrying more than one baby

● History of diabetes, kidney disease, lupus, or rheumatoid arthritis

● A history of obesity● Having a mother or sister who had preeclampsia

COMPLICATIONS OF HYPERTENSION IN PREGNANCY

● Pre-eclampsia affects 2% to 8% of pregnancies (WHO 2010). It is a multisystem disorder, which may involve the brain, liver, kidneys and placenta. There are two complications of pre-eclampsia;

● Maternal Complications and

● Complications on the Foetus

MATERNAL COMPLICATIONS

Maternal complications include:

● Eclampsia● Stroke● liver and kidney failure ● Coagulopathy (rare)

COMPLICATIONS ON THE FOETUS

● For the baby, there is an increased risk of poor growth and preterm birth.

PHYSIOLOGICAL EFFECTS OF PHYSICAL ACTIVITY ON HYPERTENSION DURING PREGNANCY

● It has been suggested that the physiological changes associated with regular exercise may protect against pre-eclampsia (Weissgerber 2004).

● Postulated mechanisms for such an effect include;

(I) Enhanced placental growth and vascularity


● These may possibly be as an adaptive response to intermittent reductions in placental blood flow during exercise

(II) Reduced oxidative stress And

(III) Correction of vascular endothelial dysfunction, particularly with aerobic exercise (Clapp 2003)


● Regular exercise is associated with an increase in plasma volume and cardiac output.

● Exercise has also been shown to lower plasma triglycerides (Williams 2006)

● Exercise has also been shown to lower inflammatory cytokines (Clapp 2000)


● It has also been shown that insulin resistance is reduced in Physically active women during pregnancy (Mayer-Davis 2008), all of which are elevated in pre-eclampsia

● Exercise is associated with emotional well-being and reduction in stress and anxiety (Marquez 2000)


● Moderate and vigorous-intensity physical activity is associated with improved insulin sensitivity and reductions in fat mass

● Aerobic dance and walking, the most popular forms of exercise among pregnant and non pregnant women have been shown to result in a reduction in plasma insulin even during pregnancy.


● Preeclampsia,though characterized clinically by maternal high blood pressure and proteinuria

● Also characterized by subclinical metabolic disorders such as hypertriglyceridemia,excessive lipid peroxidation or oxidative stress,insulin resistance, and elevated plasma homocysteine


● Results from observational studies and from randomized trials have consistently demonstrated an inverse relation between recreational physical activity and blood pressure in non pregnant and pregnant women


● Results from randomized controlled trials indicate that aerobic exercise performed by non pregnant women aged 18yrs or older results in statistically significant reductions in resting systolic and diastolic blood pressures.

● Physical activity profoundly affects many of these physiological functions


● Exercise therapy is also associated with reductions in diastolic blood pressures in pregnant women with a history of mild hypertension, gestational hypertension,or family history of hypertensive disorder.


● In 2004, Butler et al reported that mean triglyceride concentrations were lower (23.6 mg·dL1) among pregnant women who spend much time performing physical activity as compared with inactive women.


● The study by Butler in 2004 also suggest that habitual physical activity performed during pregnancy may mitigate the pregnancy-associated dyslipidemia commonly noted in hypertensive and diabetic pregnancies.


● Lastly, recreational physical activity has been linked to improvements in emotional well-being and reductions in stress and anxiety

● Investigators have shown that pregnant women experiencing anxiety and/or depression are at a threefold increased riskfor preeclampsia.


● It is reasonable to speculate that the risk of preeclampsia, particularly those cases attributable to maternal psychosocial stress, maybe impacted by the psychophysiological benefits of regular physical activity.

WHAT ARE THE CURRENT GAPS IN KNOWLEDGE ?

● Despite increased attention to physical activity in pregnancy over the past two decades, much remains unknown about the long-and short-term feto-maternal effects of exercise during pregnancy.

● We believe the time is right to motivate a paradigm shift towards identifying maternal and fetal benefits of exercise in pregnancy.

WHAT ARE THE CURRENT GAPS IN KNOWLEDGE ?

● Further invesigations should be designed to study in greater detail the types,frequency,duration, and dose-response patterns of recreational physical activity in relation to pregnancy-related disorders.

● Knowledge gained from such studies will provide insights toward preventing sports related injuries among expectant mothers.

CONCLUSION

● Current studies and literatures does not support concerns that once promoted many to think about pregnancy as a period of confinement.

● It is encouraging that the ACOG and other similar organizations now publish guidelines that more assertively promote physical activity during pregnancy.

CONCLUSION

● Additional research is needed to increase the precision;with which exercise programs maybe designed for all groups of pregnant women (e.g.,those with pre-gestational diabetes, essential hypertension, or those who are obese)

REFERENCES

● Butler C.L., M.A. Williams, T.K. Sorensen, I.O. Frederick, and W.M. Leisenring. Relationship between maternal recreational physical activity and plasma lipids in early pregnancy.Am.J. Epidemiol.160:350–359,2004

● Clapp, J.F.III. Pregnancy outcome:physical activities inside versus outside the workplace. Semin. Perinatol.20:70–76,1996.

REFERENCES

● Marcoux S., J.Brisson, and J. Fabia. The effect of leisure time physical activity on the riskof pre-eclampsia and gestational hypertension.J. Epidemiol. Community Health. 43: 147–152, 1989

● Sorensen T.K, M.A. Williams, E.E. Dashow, M.L. Thompson, and DA Luthy. Recreational physical activity during pregnancy and risk of pre-eclampsia. Hypertension 41:1273–1280,2003.

REFERENCES

● Yeo S, Steele N, Chang M-C, Leclaire S, Rovis D, Hayashi R. Effect of exercise on blood pressure in pregnant women with a high risk of gestational hypertensive disorders. Journal of Reproductive Medicine 2000;45(4):293-8.

● Collings CA, Curet LB, Mullin JP. Maternal and fetal responses to a maternal aerobic exercise program. American Journal of O and G 1983;145:702-7.

REFERENCES

● Sackett N, Wang W, Woolson R, Bracken MB. Work, leisure-time physical activity, and risk of preeclampsia and gestational hypertension. American Journal of Epidemiology 2004;160(8):758-65.

● Patrick T. Exercise intervention to reduce recurrent pre-eclampsia. http://commons.cit.nih.gov.crisp (accessed May 2002).

REFERENCES

● Little B, Benson P, Beard R, Hayworth J, Hall F, Dewhurst J, et al. Treatment of hypertension in pregnancy by relaxation and biofeedback. Lancet 1984;1(8328):865-7.

MATTERNAL PHYSICAL ACTIVITY AND HYPERTENSION.pptx

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