Physical activity changes and influencing factors among Chinese pregnant women: a longitudinal study

Abstract

Objective

Participating in physical activity during pregnancy has benefited a lot from maternal and child health. However, there are few longitudinal studies describing activity patterns and related factors during pregnancy. The aim of this study is to investigate longitudinal physical activity changes and the influencing factors of Chinese pregnant women.

Methods

From January to August 2020, 240 pregnant women were recruited in Hangzhou, China. Physical activity during pregnancy was assessed in the first, second, and third trimesters of pregnancy by using the Pregnancy Physical Activity Questionnaire.

Results

The daily energy consumption during first, second, and third trimesters was 20.55, 20.76, 17.19 METs-h/d. The results of repeated-measure analysis of variance and pairwise comparison showed that the total daily energy consumption of physical activity in the third trimester was significantly lower than that in the first and second trimesters, with statistical significance (p < 0.001). The generalized estimation equation showed that education level, pre-pregnancy BMI, gravidity, unnaturally conceived and pre-pregnancy exercise habits were the influencing factors of physical activity during pregnancy (p < 0.05).

Conclusion

Physical activity levels of pregnant women during different trimester were not optimistic. In order to improve physical activity during pregnancy and promote the health status of both mother and the developing baby, more attention should be paid on pregnant women with low education level, high BMI before pregnancy, primipara, unnaturally conceived and no good exercise habits before pregnancy.

Keywords:

• Pregnant women
• pregnancy
• physical activity
• influencing factors
• longitudinal study
• nursing

Introduction

Physical activity is bodily movement produced by skeletal muscle that requires energy expenditure. It is a general term for all kinds of activity with different intensities, including well-planned, organized physical activity and household/caregiving, occupational activity and transportation. With the development of the times and the change of lifestyle, insufficient physical activity and overnutrition are becoming more and more popular, and the number of obese and overweight pregnant women is rising rapidly around the world, which leads to an increase in adverse pregnancy outcomes.[1].

In recent years, studies have confirmed that appropriate physical activity not only can improve the cardiovascular and physical function of pregnant women, prevent excessive weight gain during pregnancy, reduce the risk of adverse pregnancy outcome such as gestational diabetes, gestational hypertension and premature delivery, but also can improve the quality of newborn and promote the health of the whole people [2,3]. Appropriate physical activity during pregnancy, as a changeable factor of adverse pregnancy outcome, is currently recommended by numerous researchers all over the world.

However, previous studies have found low levels of physical activity during pregnancy. A cross-sectional study in the United States shown that 42% of pregnant women were physically active <1 day/week in the third trimester, and only 9% participated physical activity ≥5 days/week [4]. Meanwhile, in a South Africa, only 25.7% of pregnant women adhered to physical activity guidelines [5]. Our group investigated the physical activity status of 1484 women in late pregnancy who were examined in nine obstetrics and gynecology hospitals in Zhejiang Province [6]. We found that the physical activity status of women in the third trimester was not optimistic, and the amount of physical activity was generally at a low level, with the total energy consumption of the daily activities only being about 14.98 METs-h/d. The number of pregnant women who had achieved the recommended standards of the guideline for the level of physical activity was only 262 (17.7%), and that there was a single form of exercise, with 92.9% choosing walking as their main form of exercise, followed by jogging, climbing stairs, and so on. It is worth us to find out the current state of physical activity during pregnancy and the reasons behind it.

In China, previous studies in mainly focused on cross-sectional investigation [7,8], lacking longitudinal cohort study on pregnant women’s physical activities during pregnancy, making it difficult to dynamically evaluate and analyze pregnant women’s physical activities. Pregnancy is a constantly changing and developing process. With the increase of gestational week, the psychological and physiological status of pregnant women changes, and the type and intensity of physical activity may also change, so it is necessary to do further research.

The purpose of this study is to explore the dynamic changes of pregnant women’s physical activities at different stages of pregnancy and related influencing factors, so as to provide reference for further implementing scientific and accurate exercise management and formulating targeted intervention strategies.

Materials and methods

Participation and criteria for inclusion

Pregnant women were conveniently recruited from outpatient department of obstetrics and gynecology hospital in Zhejiang Province from January to August 2020.

The inclusion criteria of the study population were as follows: (1) 10 ∼ 13 + 6weeks of gestation, (2) Singleton pregnancy, (3) No communication barrier.

The exclusion criteria were as follows: (1) Limited normal activity due to mental or physical reasons, (2) Pregnancy with heart, liver, blood system diseases. Elimination criteria: (1) Lost to follow-up or automatic withdrawal, (2) Limited physical activity or pregnancy termination due to pregnancy comorbidities or complications, (3) Incomplete clinical data selection.

Sample size

Based on the rough estimation method of sample size [9], the sample size is 5–10 times the number of the variables. In this study, there were 15 variables, and 20% sample loss was considered during the follow-up process. So the total number of samples was calculated to be 90–180.

Data collection

Two investigators were trained on data collection before the investigation. The investigators explained the purpose, content and time required to fill in the questionnaire to pregnant women who meet the inclusion criteria, and ensured that the research information is confidential, and signed an informed consent form after obtaining their consent. Pen-paper questionnaires were distributed on site. If the participants have questions about the questionnaire, investigators required to give explanations without affecting the answers and the questionnaires were recollected and checked for the completeness. The investigator made an appointment for the next visit after the participants completed the examination and consultation, and would be reminded for the next visit time one day before, and booked for the follow-up time at the same time. The second and third follow-up visits were completed during the second (14th to 27th weeks +6) and the third trimester (≥28th weeks) of pregnancy, respectively. Physical activity of participants was investigated during the two trimesters, the time interval between the two surveys was at least 8 weeks. Research tools included a general information questionnaire and a physical activity questionnaire.

Materials

The general information questionnaire was originally developed through a literature review, clinical experiences and expert evaluation to collect general information of pregnant women. The questionnaire included age, nationality, place of residence, degree of education, family income, occupation, height and weight before pregnancy, pre-pregnant exercise habits, gravidity and parity, gestational age, previous mode of delivery, history of adverse pregnancy outcome, etc. Among them, occupation type was divided into mental and physical labor, exercising more than 150 min weekly before pregnancy was considered a good exercise habit, and pre-pregnant weight was classified according to the Health Industry Standard: Adult Weight Determination [10]. That was, BMI < 18.5 kg/m² was considered to be underweight, BMI between 18.5 kg/m² and < 24.0 kg/m² was considered to be healthy weight, and BMI ≥ 24.0 kg/m² was considered to be overweight or obese.

The Pregnant Physical Activity Questionnaire (PPAQ) was used to evaluate the pregnancy PA. It was edited by Chasan-Taber [11]in 2004 and translated into Chinese by Zhang et al. [12] in 2012, mainly used to measure the duration, frequency and intensity of activities during pregnancy. There were 31 items in the questionnaire, according to the types of activities the items could be divided into 4 domains: household/caregiving activities (14 activities), outdoor activities (4 activities), sports/exercise (8 activities), and occupational activities (5 activities). The intensity of the activity was divided into sitting (< 1.5 METs), mild intensity (1.5 METs to 2.9 METs), moderate intensity (3.0 METs to 6.0 METs), and vigorous intensity (>6.0 METs) according to the assigned metabolic equivalent (METs) of each activity. According to duration and frequency, the activity is divided into 6 different grades and each has corresponding time weight coefficient. The energy expenditure value of the exercise of each participant was calculated by the frequency of different physical activities and time weight coefficient multiplied by the energy consumption value of each participant, the sum of energy consumption value of each activity was considered as total energy consumption value of the participants, with the greater total energy consumption value of activity, the more physical activity was considered during pregnancy. The content validity index of the questionnaire was 0.940, and the retest reliability was 0.940. In this study, according to American Congress of Obstetricians and Gynecologists (ACOG) guidelines for exercise during pregnancy [13], pregnant women performed more than 7.5 METs-h/w (at least 5 days per week, 30 min a day) of moderate or above intensity exercise per week is defined as reach the exercise standard.

Statistical analysis

Excel was used for data collection by two investigators, and SPSS 23.0 statistical software was used for statistical analysis. The measurement data conforming to normal distribution were represented by mean ± standard deviation, while those not conforming to normal distribution were represented by median and quartile. Counting data were expressed in nominal numbers and percentages; The amount of physical activity measured at different time points was compared by repeated measure analysis of variance or Freidman rank sum test. The generalized estimation equation model is a statistical model that deals with repeated measurements such as longitudinal data, which solves the problem of correlation of longitudinal data and reduces the loss of information by utilizing the results of each measurement in longitudinal data; therefore, this study used generalized estimating equations modeling to explore the factors influencing the amount of physical activity of pregnant women. P values <0.05 was considered statistically significant (bilateral).

Results

General information of the participants

A total of 285 pregnant women in the first trimester were enrolled in this study, 267 of them completed follow-up in the second trimester and 18 of them failed to complete the assessment. A number of 243 participants completed follow-up in the third trimester and 14 of them lost to follow-up, and 240 of them were finally included in the investigation. The reasons for fail to follow-up were as follows, 21 participants due to limited activity caused by pregnancy complications or comorbidities, or termination of pregnancy, 14 of them withdrew from the study, 4 of them out of touch, 3 participants missed the follow-up time, 3 of them had incomplete data. The shedding rate was 15.8%. The demographic characteristics of participants was shown in Table 1.

Table 1. Demographic characteristics of the participants (n = 240).

	Number	Percentage (%)
Age (years)
<35	205	85.4
≥35	35	14.6
Nationality
Han	224	93.3
Other	16	6.7
Residence
Town	198	82.5
Country	42	17.5
Income
≤5 000	14	5.8
5001∼	67	27.9
10,001∼	121	50.4
>30,000	38	15.9
Occupation
Unemployed	36	15.0
Manual labor	48	20.0
Mental work	156	65.0
Degree of education
Junior and below	13	5.4
High school	18	7.5
Junior college	61	25.4
Undergraduate	125	52.1
Master’s degree of above	23	9.6
Pre-pregnancy weight
Underweight	36	15.0
Healthy weight	165	68.8
Overweight/Obese	39	16.2
Gravidity
1	131	54.6
2	63	26.2
≥3	46	19.2
Previous mode of delivery
None	173	72.1
Vaginal birth	30	12.5
Cesarean delivery	37	15.4
History of adverse pregnancy outcome
Yes	55	22.9
No	185	77.1
Mode of conception
natural conception	210	87.5
Unnatural conception	30	12.5
Exercise ≥150 min weekly before pregnancy
Yes	66	27.5
No	174	72.5
Exercise habits of husband
Yes	96	40.0
No	144	60.0

Energy expenditure of participants during early, second and third trimester of pregnancy

The total energy expenditure of physical activity during first, second and third trimester of pregnancy were (20.54 ± 11.27), (20.76 ± 12.71), (17.19 ± 12.69)METs-h/d. Repeated measurement analysis of variance showed that there was a statistically significant difference in total daily energy consumption of physical activity in different trimester (F = 21.702, p < 0.001). Bonferrni method was used for further comparison, The results showed that the total daily energy expenditure of physical activity in the third trimester of pregnancy was significantly lower than that of the first and second trimesters, with statistical significance (t = –4.328, p < 0.001; t = -7.241, p < 0.001).

According to the different intensity of physical activity, there were statistically significant differences in physical activity energy expenditure within different trimester (p < 0.05), sedentary energy expenditure was higher in the third trimester than that of the first and second trimester. The energy expenditure of light and moderate intensity activity in the third trimester was lower than that of the first and second trimesters, with the difference statistically significant (p < 0.05).

According to the classification of physical activity types, there were statistically significant differences in energy consumption within three different trimester (p < 0.05). Except for physical exercise, the daily energy consumption of other types of activities in the third trimester was lower than that of the first and second trimesters, with statistical significance (p < 0.05), as shown in Table 2.

Table 2. Energy expenditure of physical activities of pregnant women (M(P₂₅, P₇₅), METs-h/d).

Category	First Trimester	Second Trimester	Third Trimester	M Value	p Value
Intensity Classification
Sedentary	2.20(0.63, 4.55)	2.44(0.67, 4.81)	2.55(0.63, 6.13)	10.268	0.006
Mild	11.91(3.75, 17.20)	12.77(5.68, 17.64)	10.28(2.79, 14.53)^1)2)	71.152	<0.001
Moderate	1.87(0.75, 4.17)	2.10(0.97, 4.58)	1.70(0.79, 3.61)^1)2)	37.285	<0.001
Vigorous	0(0, 0)	0(0, 0)	0(0, 0)	24.226	<0.001
Type Classification
Household/caregiving	9.60(0, 11.10)	9.86(0.23, 11.48)	6.40(0, 10.26)^1)2)	65.760	<0.001
Occupational  Activity	2.09(0.91, 4.28)	2.63(1.12, 4.36)	1.81(0.91, 3.93)^1)2)	30.093	<0.001
Physical Activity	0.31(0.06, 1.34)	0.34(0.11, 1.29)	0.27(0.06, 1.05)	10.602	0.005
Transportation	1.05(0.48, 2.48)	1.05(0.48, 2.48)	0.78(0.30, 1.73)^1)2)	82.498	<0.001

1) Compared with first-trimester pregnancy, p < 0.05;2) Compared with second-trimester pregnancy, p < 0.05.

Factors related to physical activity of pregnant women

A generalized estimating equation was established, with the participants as the main repeated variable in the equation. The first, second and third trimester as the within-subject repeated variables in the equation. And pregnant women’s physical activity reach the standard or no as the dependent variable, did not reach the standard = 0, reach the standard = 1. The general demographic information as the independent variable. The way of assigning values to the independent variables is shown in Table 3. The parameter estimation and the results of hypothesis testing in the model show that the literacy level of the pregnant women, the pre-pregnancy body weight, the number of pregnancies, mode of conception, and pre-pregnancy exercise habits affect whether their physical activity is up to standard (p < 0.05), while there is no statistically significant difference between pregnant women’s age, place of residence, total monthly household income, type of occupation, previous mode of delivery, history of adverse pregnancy and delivery, and husband’s exercise habits and whether their exercise is up to standard (p > 0.05). See Table 4.

Table 3. Dummy coding.

Variables	Dummy coding
Age	<35 = 0; ≥35 = 1
Place of residence	Town = 0; Rural area = 1
Family income(Yuan)	<5 000 = 0; 5 000∼<10 001 = 1; 10 001∼<30 000 = 2; >30 000 = 3
Occupation	No job(Z1 = 0, Z2 = 0); Manual labor(Z1 = 1, Z2 = 0); Mental work(Z1 = 0, Z2 = 1)
Education level	Junior high school and below (Z1 = 0, Z2 = 0, Z3 = 0, Z4 = 0);Senior high school (Z1 = 1, Z2 = 0, Z3 = 0, Z4=0); College(Z1 = 0, Z2 = 1, Z3 = 0, Z4 = 0); Undergraduate(Z1 = 0, Z2 = 0, Z3 = 1, Z4 = 0); Master’s degree or above (Z1 = 0, Z2 = 0, Z3 = 0, Z4 = 1)
Prepregnant weight	Healthy Weight = 0; Underweight = 1; Overweight or Obese = 2
Gravidity	1 = 0; 2 = 1; ≥3 = 2
Previous mode of delivery	None(Z1 = 0, Z2 = 0); History of vaginal delivery (Z1 = 1, Z2 = 0); Cesarean delivery(Z1 = 0, Z2 = 1)
Mode of Conceive	Naturally Conceived = 0; Non-naturally Conceived = 1
History of adverse pregnancy outcome	None = 0; Yes = 1
Prepregnant exercise ≥ 150 min	None = 0; Yes = 1
Husband’s exercise habit	None = 0; Yes = 1

Table 4. Analysis of influencing factors of exercise during pregnancy.

Category	βvalue	Standard error	Wald χ^2	p value	OR value	95% CI
						Upper limit	Lower limit
Constant	−2.296	0.900	6.511	0.011	0.101	0.017	0.587
Education level
Undergraduate	1.577	0.784	4.053	0.044	4.842	1.043	22.488
Master’s degree or above	2.039	0.855	5.685	0.017	7.686	1.438	41.086
Prepregnant weight
Underweight	1.171	0.329	12.708	<0.001	3.225	1.694	6.141
Gravidity
2	2.192	0.470	21.718	<0.001	8.955	3.562	22.517
≥3	3.014	0.662	20.739	<0.001	20.378	5.568	74.575
Mode of Conception
Non-naturally Conceived	−3.294	0.575	32.792	<0.001	0.037	0.012	0.115
Prepregnant weekly exercise ≥150 min
Yes	1.478	0.311	22.529	<0.001	4.385	2.382	8.073

Discussion

This study evaluated the physical activity changes and influencing factors among pregnant women in Hangzhou. We found that pregnant women’s total daily physical activity energy expenditure in the first, second and third trimester were about 20.55, 20.76 and 17.19 METs-h/d, respectively, which was similar to survey results conducted in Beijing [4] and Guangzhou [5]. However, compared to Australia (30.0METs-h/d) [14] and the United States (25.4METs-h/d) [15], the physical activity of pregnant women in China was at a low level during pregnancy. In terms of the trend of physical activity changes, the first and second trimesters were similar, but a significant decrease was observed in the third trimester, which was consistent with the findings of Feng et al. [16] in their investigation among pregnant women in Beijing. This could be attributed to the influence of Chinese traditional culture. Relative to the second trimester, the first trimester is an important period of fetal growth and development, the amount of physical activity of pregnant women in the first trimester is relatively conservative, and to the second trimester, the growth of the fetus in the womb environment is relatively stable, the physical activity of pregnant women has increased. However, as the pregnancy progresses, the body of a woman in the third trimester becomes heavier, and the symptoms of fatigue and discomfort become more and more obvious, so physical activity decreases. However, a number of studies [17,18] have suggested that proper exercise in the third trimester of pregnancy can not only effectively alleviate the discomfort, but also increase the strength of pelvic muscle groups and ligaments and promote natural delivery. Therefore, it is very important to popularize the importance of proper and regular physical activity during pregnancy and correct the wrong ideas in traditional culture to improve the level of physical activity during pregnancy in China. It is necessary to pay more attention to pregnant women’s physical activities, spread the benefits of exercise during pregnancy, encourage and guide them to participate in physical exercise, so as to improve their health literacy.

The result in the study showed that the energy consumption across different trimester of pregnancy was consistent. According to the different intensity of physical activity, mild intensity showed largest energy consumption, followed by sedentary and moderate intensity activity, vigorous intensity exercise showed the least energy consumption. According to different types of activities, occupational activities consume the most energy, followed by household/caregiving activities and outdoor activities, and exercise consume the least energy, which was consistent with the study conducted by Yang at al [8]. In addition, through longitudinal analysis of the characteristics of physical activity changes in each stage of pregnancy, it was found that there was no significant difference in physical activity energy expenditure between the first and the second trimester, while from the second to the third trimester, energy expenditure of mild and moderate intensity activities showed a downward trend except for sedentary and vigorous physical activities. Chinese pregnant women tend to choose relatively mild and sedentary activities during pregnancy, and their energy expenditure mainly came from occupational and household/caregiving activities, while the energy consumption from active exercise was not ideal, and the proportion in the third trimester was even lower. Previous studies have also shown that even in non-pregnant populations, where domestic caregiving and occupational activities remain the most important physical activities, women’s levels of all types of physical activity decrease after pregnancy compared to pre-pregnancy, with the greatest decrease being in exercise [19,20]. This was in contrast to the recommendation proposed by ACOG in 2020 [13], which suggests that pregnant women without contraindications to exercise, engage in moderate-intensity physical activity for 30 min or more on most days of the week. There is still space for improvement in this aspect. These findings suggest that healthcare institutions include the whole exercise supervision of pregnant women in the pregnancy healthcare project, provide personalized and professional exercise guidance and establish exercise management files according to the health status and preferences of pregnant women, so as to achieve scientific, safe and planned exercise during pregnancy. At the same time, it is suggested that families and society should provide more support for pregnant women to encourage exercise, create a national fitness atmosphere, and enhance pregnant women’s sense of participation, satisfaction, gain, happiness and security in sports.

At the same time, under the influence of the traditional social pattern of gender division of labor, women in China often play multiple roles in the family and society, and the majority of pregnant women are still the main caregivers in the family, not only taking care of their families and doing household chores, but also taking care of their tasks at work, so they don’t have enough time to participate in exercise. Therefore, the support of society and the family is important to increase the motivation of pregnant women to exercise [21,22]. Healthcare workers should pay attention to the role of family support in health education, including family members as the object of pregnancy health care guidance, encouraging pregnant women’s families to provide emotional support and care, and in the action is not only limited to accompanying, but also need to share the household care activities, reduce the pressure of family life, and play the power of family support [23]. In addition, in order to improve the health of the entire population, government departments need to continue to improve the legal system for women’s and children’s health, increase investment in women’s and children’s health, expand the supply of high-quality health resources, improve the establishment of peripheral sports facilities, advocate for the joint participation of social groups in fitness activities, and create a general environment for fitness for the entire population, so as to enhance pregnant women’s sense of participation in exercise, their sense of fulfillment, their sense of gain, their sense of well-being, and their sense of security.

In this study, pregnant women with higher education level had higher level of physical activity, consistent with the result of Tan et al. [24]. This may be attributed to the fact that pregnant women with higher education level are less influenced by traditional ideas and have higher understanding and acceptance of relevant policies [25]. Furthermore, pregnant women with higher education level had more access to knowledge about healthy life during pregnancy and had a more scientific and comprehensive understanding about the form, intensity and safety of exercise. Therefore, at this particular stage of pregnancy, they were more likely to accept health guidance from professional personnel, particularly those in obstetrics and gynecology. They were also more willing to proactively adjust their lifestyles and actively engage in physical exercise. Medical staff should pay more attention to pregnant women with low education level, disseminate relevant knowledge and methods of exercise during pregnancy, ensure that they fully understand the benefits of exercise for both mother and baby, strengthen the effect of education regularly, and effectively improve the level of exercise during pregnancy for those with low education level.

Pre-pregnancy exercise also had significant association with women’s level of physical activity during pregnancy. Women with good exercise habits before pregnancy were more likely to maintain and persist higher exercise level during pregnancy (β = 1.478, p < 0.001). Research [24] indicated that the lack of interest and habit of physical exercise before pregnancy, and even the absence of healthy lifestyle habits, directly influence the level of physical activity during pregnancy. The reason was that women with good exercise habits before pregnancy had accumulated and mastered the knowledge and skills related to exercise, and the internal driving force also promoted them to maintain a high level of exercise during pregnancy. Therefore, it is important to increase the promotion and dissemination of exercise knowledge, so that women of childbearing age can identify with the benefits of sports, be given personalized sports guidance according to their sports status, mobilize their subjective initiative, and help women of childbearing age to establish good fitness and exercise awareness and habits.

Furthermore, the results of this study also showed that women with a lower pre-pregnancy weight were more likely to meet the exercise standards during pregnancy, which was consistent with the conclusion from Rauff et al. [26] that women with a lower pre-pregnancy weight were more willing to participate in exercise during pregnancy than overweight or obese women. It may be caused by women with lower pre-pregnancy weight were relatively easy to exercise during pregnancy since they feel more flexible. Meanwhile, some women with lower pre-pregnancy weight also pay more attention to the changes in weight and body shape. With the advance of gestational week, it is also an effective way to resist the burden of weight gain by sufficient energy consumption through exercise. Therefore, women’s pre-pregnancy health care is very important. Healthcare providers should fully assess and understand the pre-pregnancy healthcare needs of women of childbearing age, provide continuous healthcare from pre-pregnancy to delivery, establish a good relationship with them, and manage weight effectively. Based on the characteristics of cross-fields, it is suggested that multiple disciplines, including nutritionists and exercise specialists, collaborate to develop scientific and standardized guidance programs, and build a multi-department linkage management platform.

Compared with nullipara, the multipara women were more likely to reach the standard. Gebregziabher et al. [27] found that the amount of exercise of multipara was 7.68 times of primipara, which was similar to our findings. Probably the women who had experienced pregnancy had better understanding of exercise during pregnancy, and mothering children requires higher level of activity [28]. However, Ribeiro et al. [29] pointed out that fewer gravidity women have a higher proportion of participation in physical exercise, among them primipara women most likely to exercise, which is different from the result of our study, which may be due to cultural differences. Mother in China tend to pay more attention to the first child and tend to rest to avoid abortion.

In addition, the method of conception was also found to be related to physical activity levels during pregnancy, with non-natural conceived women were less likely to reach physical activity standards (β = –3.294, p < 0.001). Previous study [30] pointed out that since women who need fertility treatment due to difficulty in conception have more concerns about fetal safety and the entire pregnancy progress, the difficulty of reaching the physical activity standard during pregnancy increases, which might help explain the result of our study, that was, nullipara women were less likely to reach the standard. Therefore, both social and healthcare institutions should pay more attention to the physical and mental health of unnaturally conceived women. Nurses, as important participants in the health management of pregnancy, should conduct a comprehensive assessment of exercise risks, and develop tailored and scientifically based exercise programs to eliminate safety concerns.

Limitation

It should be noted that this study was a single-center longitudinal investigation conducted in a specialized obstetrics and gynecology hospital in Zhejiang Province, China, with a limited sample size, certain geographical limitations, and possible bias in the representativeness of the study population. In the future, more rigorous prospective clinical studies with large samples and multiple centers should be conducted, and their correlation with perinatal outcomes should be further followed up and explored, so as to provide a reference basis for the implementation of scientific and precise exercise management and the development of targeted intervention strategies.

Conclusions

In conclusion, the level of physical activity during different stages of pregnancy was not optimistic, activity level during the third trimester was significantly lower than that of the first and second trimester. Education level, pre-pregnancy weight, gravidity, mode of conception and pre-pregnancy exercise habits were the influencing factors of physical activity during pregnancy. Healthcare providers should pay attention to the physical activity and dynamic changes of pregnant women, comprehensively evaluate the influencing factors of physical activity during pregnancy and meet the diversified and multi-level needs of pregnant women for exercise.

Ethics approval and consent to participate

The study protocol was approved by the Women’ hospital, School of Medicine, Zhejiang University Institutional Review Board (approval number: IRB-20200043-R). All participants provided informed consent.

Authors’ contributions

Suwen Feng responsible for the concept and design. Le Zhang and Jinlan Piao analyzed and interpreted the data. Wei Zhang and Ningning Liu participated in designing the study and drafted the initial manuscript. Xuehui Zhang, Yu Shen, Ying Jin, and Fangfnag Wang carried out the data acquisition. All authors contributed to the article and approved the submitted version.

Consent to publication

Not applicable.

Disclosure statement

No potential conflict of interest was reported by the author(s). The authors have no relevant financial or non-financial interests to disclose.

Data availability statement

The data that support the findings of this study are available from the corresponding author, Suwen Feng, upon reasonable request. All data generated or analyzed during this study are included in this published article.

Additional information

Funding

The study was financially supported by the Foundation of Educational Commission of Zhejiang Province of China (Grant numbers[Y202249563]), the Foundation of Health Commission of Zhejiang Province of China (Grant numbers[2022KY826]), and the Foundation of Health Commission of Zhejiang Province of China (Grant numbers [2024KY1145]).