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Physical i ness and ma e nal body composi ion indices
du ing p egnancy and pos pa um: he GESTAFIT p ojec .
Jou nal:
Eu opean Jou nal o Spo Science
Manusc ip ID
D a
Manusc ip Type:
O iginal Pape
Keywo ds:
Body composi ion, Bone heal h, Ca dio ascula /Ca dio espi a o y,
Fi ness
URL: h p:/mc.manusc ip cen al.com/ ejs Email: [email p o ec ed]
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1Ti le: Physical i ness and ma e nal body composi ion indices du ing p egnancy and
2pos pa um: he GESTAFIT p ojec .
3Running head: Fi ness and body composi ion du ing ges a ion and pos pa um.
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4ABSTRACT
5We explo ed he associa ion o physical i ness (PF) du ing p egnancy wi h ma e nal body
6composi ion indices along p egnancy and pos pa um pe iod. The s udy comp ised 159
7p egnan women (32.9±4.7 yea s old). Assessmen s we e ca ied ou a he 16 h and 34 h
8ges a ional weeks (g.w.) and six weeks pos pa um. Ca dio espi a o y i ness (CRF),
9muscula s eng h (absolu e and ela i e alues) and lexibili y we e measu ed. Body
10 composi ion indices we e ob ained by using dual-ene gy X- ay abso p iome y a
11 pos pa um. The esul s, a e adjus ing o po en ial co a ia es a he 16 h g.w., indica ed
12 ha g ea e CRF was associa ed wi h lowe pos pa um indices o al a mass, and oid
13 and gynoid a mass (all, p<0.05). G ea e absolu e uppe -body muscula s eng h was
14 associa ed wi h g ea e p e-p egnancy body mass index (BMI), ges a ional weigh gain
15 (GWG); and pos pa um indices body weigh , BMI, lean mass, a ee mass, a mass,
16 gynoid a mass, T-sco e and Z-sco e bone mine al densi y (BMD) (all, p<0.05). G ea e
17 uppe -body lexibili y was associa ed wi h lowe p e-p egnancy BMI; and pos pa um
18 indices body weigh , BMI, lean mass, a ee mass, a mass, and oid a mass and gynoid
19 a mass, and wi h g ea e GWG (all, p<0.05). A he 34 h g.w., g ea e CRF was
20 addi ionally associa ed wi h g ea e pos pa um T-sco e and Z-sco e BMD (bo h, p<0.05).
21 In conclusion, his s udy e eals ha g ea e PF le els, especially du ing ea ly p egnancy,
22 may p omo e a be e body composi ion in he pos pa um pe iod. The e o e, clinicians
23 and heal h p omo e s should encou age women o main ain o imp o e PF le els om
24 ea ly p egnancy.
25
26 Keywo ds: Ca dio espi a o y i ness; s eng h; lexibili y; bone densi y; ges a ion.
27
28
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29 HIGHLIGHTS
30 Gi en ha obesi y is on he ise oday, i is impo an o ind s a egies o cope
31 wi h i , especially du ing p egnancy.
32 The esul s o he p esen s udy sugges ha g ea e physical i ness du ing ea ly
33 p egnancy is key o p omo ing be e body composi ion in he pos pa um pe iod.
34 I should be o clinical in e es o encou age p egnan women o main ain o
35 imp o e hei physical i ness le els.
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36 INTRODUCTION
37 The ising p e alence o obesi y, pa icula ly among women in childbea ing age, is an
38 inc easing public heal h conce n1. In ac , in he Eu opean egion, he cu en p e alence
39 o ma e nal obesi y anges om 7 o 37%2.
40 In his con ex , ma e nal body composi ion indices a e co ela es wi h ma e nal and oe al
41 heal h. Fo example, excessi e ges a ional weigh gain (GWG) has been associa ed wi h
42 ad e se ma e nal (such as ges a ional diabe es, caesa ean sec ion) and oe al ou comes
43 (small o la ge o ges a ional age and in an mo ali y)1-4. The e o e, eaching an op imal
44 GWG du ing he p egnancy cou se is highly ecommended. Fu he mo e, women end o
45 e ain some o he body a accumula ed du ing p egnancy a he pos pa um pe iod, being
46 hea ie a 1 yea pos pa um compa ed wi h hei p e-p egnancy body weigh 2.
47 In addi ion, main aining an adequa e bone mine al densi y (BMD) is especially impo an
48 du ing p egnancy and b eas eeding, since majo changes occu in he ma e nal calcium
49 homeos asis and bone me abolism in o de o ul il he demand o calcium and
50 phospho us o he placen a, oe us and b eas milk5, 6.
51 In his sense, adequa e PF le el du ing p egnancy, h ough speci ic physical ac i i y o
52 exe cise ecommenda ions7, 8 is a modi iable ac o ha migh be associa ed wi h a be e
53 body composi ion and hus, ma e nal and child’s gene al heal h s a us and well-being1, 2,
54 9. Mo eo e , i has been sugges ed ha g ea e PF le els may also ha e a posi i e impac
55 on ma e nal BMD10, 11. Hence, he sc eening o PF du ing p egnancy could be an
56 in e es ing op ion, especially in women a high isk o excessi e GWG o low BMD.
57 Ne e heless, as a as we a e awa e, whe he g ea e PF le els du ing p egnancy may
58 in luence ma e nal body composi ion has no been p e iously epo ed. Consequen ly, he
59 aim o he p esen esea ch was o s udy he associa ion o PF du ing p egnancy wi h
60 GWG and ma e nal body a and BMD in pos pa um pe iod.
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61 METHODS
62 S udy design and pa icipan s
63 The p esen c oss-sec ional s udy is pa o he GESTAFIT p ojec . The comple e
64 p ocedu e and he inclusion-exclusion c i e ia (see Supplemen a y Table S1) ha e been
65 published elsewhe e12. A o al o 159 Spanish p egnan women en olled in his s udy in
66 h ee u ns ( om No embe 2015 o Ap il 2018), o easibili y easons. The pa icipan s
67 we e ec ui ed by he esea ch eam a he 12 h ges a ional weeks (g.w.), du ing hei i s
68 gynaecologis check up a he “San Cecilio” Uni e si y Hospi al (G anada, Spain). A
69 w i en in o med consen was signed by all in e es ed pa icipan s a e being in o med
70 abou he s udy aims and p ocedu es.
71 P ocedu es
72 A e he ec ui men , pa icipan s we e in i ed o ake pa in he s udy a he Spo and
73 Heal h Uni e si y Resea ch Ins i u e (iMUDS). The assessmen s we e ca ied ou a he
74 16 h (±2 g.w.) and 34 h g.w. and one mon h a e bi h (pos pa um pe iod). The
75 assessmen s we e always conduc ed in 1 day in he same o de : i s ly, pa icipan s illed
76 an au o-adminis e ed anamnesis o m assessing hei sociodemog aphic and clinical
77 cha ac e is ics. The ea e , each pa icipan pe o med he PF es s (i.e., back-sc a ch es ,
78 handg ip es , eadmill p o ocol).
79 Sociodemog aphic and clinical da a
80 Sociodemog aphic da a, including age, numbe o child en, ma i al s a us and educa ional
81 le el; and clinical da a, including abo ions and lac a ion op ions (exclusi e
82 b eas eeding, mixed eeding o o mula eeding) we e collec ed.
83 Body composi ion indices
84 P e-p egnancy body weigh was sel - epo ed. On he i s and second e alua ions, body
85 weigh and heigh we e assessed using a scale (InBody R20; Biospace, Seoul, Ko ea) and
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86 a s adiome e (Seca 22, Hambu g, Ge many), espec i ely. Body mass index (BMI) was
87 calcula ed as weigh (kg) di ided by squa ed heigh (m2), including p e-p egnancy BMI.
88 Mo eo e , GWG (kg) was calcula ed as he weigh a he 34 h g.w. minus weigh a he
89 16 h g.w. A he pos pa um e alua ion, o al lean mass, a mass, a ee mass, and oid
90 and gynoid a mass, and BMD o he whole body we e measu ed using a dual-ene gy x-
91 ay abso p iome y (DXA) de ice (Hologic Disco e y QDR, Nasdaq: HOLX). To al
92 body BMD was calcula ed (g/cm2). Bone T-sco e was de ined as he numbe o s anda d
93 de ia ions [SDs] below he mean alue o heal hy young women, and he bone Z-sco e
94 was de ined as he numbe o SDs below he mean o heal hy women o he same age13.
95 Physical i ness es s
96 Ca dio espi a o y i ness (CRF) was e alua ed h ough ma e nal maximal oxygen in ake
97 (VO2max). I was es ima ed wi h he Modi ied B uce eadmill p o ocol14, a submaximal,
98 inc emen al, mul is age and con inuous eadmill es . The es inco po a ed p og essi e
99 inc emen s in he wo kload and eloci y e e y 3 minu es o de e mine limi s o maximal
100 exe ion. Women we e asked o walk on he eadmill un il he ma e nal hea a e eached
101 75% o he age-p edic ed maximal hea a e. I he pa icipan eques ed o end he
102 eadmill es , hen he es was also s opped be o e eaching he hea a e alue. Al hough
103 submaximal eadmill es ing is common and sa e du ing p egnancy14, 15, women we e
104 secu ed wi h a ha ness du ing he es o p e en isk o alls.
105 Uppe -body muscula s eng h was e alua ed by handg ip s eng h, used as a e e ence o
106 measu e global body s eng h, as desc ibed elsewhe e16. A digi al dynamome e (TKK
107 5101 G ip-D; Takey, Tokyo, Japan) was used. The pa icipan s pe o med he handg ip
108 s eng h es wice, al e na ely wi h bo h hands. The bes alue o 2 a emp s o each hand
109 was eco ded and he a e age o bo h hands was used as absolu e muscula s eng h.
110 Rela i e uppe -body muscula s eng h was calcula ed as absolu e handg ip s eng h
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111 di ided by hei body weigh , measu ed in each assessmen , and used in he analyses as
112 ecommended o add ess he con ounding o s eng h by weigh s a us17.
113 Uppe -body lexibili y was e alua ed wi h he back-sc a ch es , as a measu e o o e all
114 shoulde ange o mo ion. The dis ance be ween (o o e lap o ) he middle inge s behind
115 he back was measu ed wi h a ule 18. The back-sc a ch es ou come is posi i e o highe
116 lexibili y (i.e. hands o e lapping behind he back) and nega i e o lowe lexibili y (i.e.
117 g ea e dis ance be ween middle inge s behind he back). The bes sco e o 2 a emp s
118 o each a m was eco ded, and he a e age o bo h a ms was used o he analyses.
119 S a is ical analyses
120 All analyses we e pe o med using he SPSS (IBM SPSS S a is ics o Windows, e sion
121 22.0, A monk, NY) and he le el o signi icance was se a p<0.05. Desc ip i e s a is ics
122 [(mean and s anda d de ia ion (SD) o quan i a i e a iables, and he numbe o women
123 (%) o ca ego ical a iables)] we e used o desc ibe baseline cha ac e is ics o he
124 pa icipan s. Linea eg ession analyses we e pe o med o explo e he independen
125 associa ion o CRF, muscula s eng h, and lexibili y as p edic o s, wi h di e en
126 ma e nal body composi ion ou comes (dependen a iables). Each se , sepa a ely,
127 examined he ela ionship be ween one p edic o and one body composi ion ou come.
128 These p edic o s we e explo ed in wo models based on he pe iod e alua ed: Fi s , alues
129 o he PF es s e alua ed a he 16 h g.w. we e in oduced as p edic o s o ma e nal
130 ou comes. Second, alues o he PF es s e alua ed a he 34 h g.w. we e in oduced as
131 p edic o s o ma e nal ou comes, when applicable. The ela i e uppe -body muscula
132 s eng h, a he han absolu e s eng h, as p e iously ecommended17, was he chosen
133 muscula s eng h p edic o . Two models we e es ed. Model I was unadjus ed. Model II
134 was con olled o ma e nal age. Bone heal h ou comes we e u he adjus ed o p e-
135 p egnancy BMI (Model II), as a possible con ounde 10. Since in he GESTAFIT p ojec 12
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136 a concu en physical exe cise p og am was ca ied ou un il deli e y, alues a he 34 h
137 g.w. (Model II) we e addi ionally adjus ed o he exe cise in e en ion (con ol o
138 in e en ion g oup), in o de o co ec he possible e ec o he exe cise p og am on hese
139 a iables.
140 RESULTS
141 The inal sample size was composed o 159 Spanish p egnan women. None heless, some
142 o hem did no a end he second (a he 34 h g.w.) o las e alua ion (pos pa um) o did
143 no e u n all he ques ionnai es duly comple ed, which mean a loss o da a in some
144 ou comes (Supplemen a y Figu e S1).
145 The sociodemog aphic and clinical cha ac e is ics o he pa icipan s a e shown in
146 Supplemen a y Table S2. The mean age o he women a he ec ui men was 32.9±4.6
147 yea s old. Mos o hem we e nullipa ous (61%) and op ed o exclusi e b eas eeding
148 (>66%).
149 The ma e nal body composi ion indices and he PF es s o he pa icipan s a e shown in
150 Table 1. B ie ly, women’s BMI was 24.2 kg/m2 du ing he p e-p egnancy pe iod, and
151 >25.0 kg/m2 a he 16 h g.w. and du ing he pos pa um pe iod. Women’s GWG a he 34 h
152 g.w. was abou 9 kg. Pa icipan s’ o al BMD was 1.06±0.1 g/cm2 and hei bone T-sco e
153 s a us was -0.6±1.0 a he pos pa um pe iod. Type o lac a ion (b eas eeding exclusi ely,
154 mixed o a i icial lac a ion) was addi ionally included as a po en ial con ounde in bone
155 heal h ou comes. Howe e , his da a no longe changed hese esul s (da a no shown).
156 The linea eg ession model assessing he associa ions o PF es s a he 16 h g.w. wi h
157 ma e nal body composi ion indices is shown in Table 2.
158 In he adjus ed model (Model II), g ea e CRF was associa ed wi h lowe o al a mass,
159 and oid a mass, and gynoid a mass a pos pa um (β anging om -0.230 o -0.311; all,
160 p<0.05). G ea e absolu e uppe -body muscula s eng h was associa ed wi h g ea e p e-
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359 esiding olde adul s. Jou nal o aging and physical ac i i y. 1999;7(2):129-61.
360 19. Council NR. Weigh gain du ing p egnancy: eexamining he guidelines: Na ional
361 Academies P ess; 2010.
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362 20. E enson KR, Mo ola MF, A al R. Re iew o Recen Physical Ac i i y Guidelines Du ing
363 P egnancy o Facili a e Ad ice by Heal h Ca e P o ide s. Obs e Gynecol Su . 2019;74(8):481-9.
364 21. Ga cía-He moso A, Ca e o-Redondo I, Ramí ez-Vélez R, Ruiz JR, O ega FB, Lee D-C, e
365 al. Muscula s eng h as a p edic o o all-cause mo ali y in an appa en ly heal hy popula ion:
366 a sys ema ic e iew and me a-analysis o da a om app oxima ely 2 million men and women.
367 A ch Phys Med Rehabil. 2018;99(10):2100-13. e5.
368 22. Kodama S, Sai o K, Tanaka S, Maki M, Yachi Y, Asumi M, e al. Ca dio espi a o y i ness
369 as a quan i a i e p edic o o all-cause mo ali y and ca dio ascula e en s in heal hy men and
370 women: a me a-analysis. Jama. 2009;301(19):2024-35.
371 23. Solomon A, Bo odulin K, Ngandu T, Ki ipel o M, Laa ikainen T, Kulmala J. Sel - a ed
372 physical i ness and es ima ed maximal oxygen up ake in ela ion o all-cause and cause-speci ic
373 mo ali y. Scand J Med Sci Spo s. 2018;28(2):532-40.
374 24. Ma ín-Jiménez N, Acos a-Manzano P, Bo ges-Cosic M, Baena-Ga cía L, Coll-Risco I,
375 Rome o-Galla do L, e al. Associa ion o sel - epo ed physical i ness wi h pain du ing
376 p egnancy: The GESTAFIT P ojec . Scand J Med Sci Spo s. 2019.
377 25. Rod iguez-Ayllon M, Acos a-Manzano P, Coll-Risco I, Rome o-Galla do L, Bo ges-Cosic
378 M, Es é ez-López F, e al. Associa ions o physical ac i i y, seden a y ime and physical i ness
379 wi h men al heal h du ing p egnancy: The GESTAFIT p ojec . Jou nal o Spo and Heal h Science.
380 2019.
381 26. Rome o-Galla do L, So iano-Maldonado A, Ocón-He nández O, Acos a-Manzano P,
382 Coll-Risco I, Bo ges-Cosic M, e al. In e na ional FI ness Scale-IFIS: Validi y and associa ion wi h
383 heal h- ela ed quali y o li e in p egnan women. Scandina ian jou nal o medicine & science in
384 spo s. 2019.
385 27. Baena-Ga cía L, Coll-Risco I, Ocón-He nández O, Rome o-Galla do L, Acos a-Manzano P,
386 May L, e al. Co ec ion: Associa ion o objec i ely measu ed physical i ness du ing p egnancy
387 wi h ma e nal and neona al ou comes. The GESTAFIT P ojec . PLoS One. 2020;15(4):e0231230.
388 28. Ho AYY, Kung AWC. De e minan s o peak bone mine al densi y and bone a ea in young
389 women. Jou nal o Bone and Mine al Me abolism. 2005;23(6):470-5.
390 29. Apa icio VA, Ruiz-Cabello P, Bo ges-Cosic M, And ade A, Coll-Risco I, Acos a-Manzano P,
391 e al. Associa ion o physical i ness, body composi ion, ca diome abolic ma ke s and adhe ence
392 o he Medi e anean die wi h bone mine al densi y in pe imenopausal women. The
393 FLAMENCO p ojec . Jou nal o spo s sciences. 2017;35(9):880-7.
394 30. Colle an HL, Hia A, Wideman L, Lo elady CA. The E ec o an Exe cise In e en ion
395 Du ing Ea ly Lac a ion on Bone Mine al Densi y Du ing he Fi s Yea Pos pa um. Jou nal o
396 physical ac i i y & heal h. 2019;16(3).
397 31. E enson KR, Moos M-K, Ca ie K, Siega-Riz AM. Pe cei ed Ba ie s o Physical Ac i i y
398 Among P egnan Women. Ma e nal and Child Heal h Jou nal. 2009;13(3):364-75.
399 32. Rode L, Hegaa d HK, Kjæ gaa d H, Mølle LF, Tabo A, O esen B. Associa ion be ween
400 ma e nal weigh gain and bi h weigh . Obs e Gynecol. 2007;109(6):1309-15.
401 33. Shin D, Chung H, Wea he spoon L, Song WO. Validi y o P ep egnancy Weigh S a us
402 Es ima ed om Sel - epo ed Heigh and Weigh . Ma e nal and Child Heal h Jou nal.
403 2014;18(7):1667-74.
404 34. Mos J, Ma la KL, Al azan AD, Redman LM. Ad ances in assessing body composi ion
405 du ing p egnancy. Eu opean jou nal o clinical nu i ion. 2018;72(5):645-56.
406
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Table 1. Body composi ion indices and physical i ness le els o he pa icipan s
Ma e nal ou comes
n
Mean±SD
Heigh (cm)
157
163±6.21
Weigh p e ious o p egnancy (Kg)
145
65.1±12.3
P e-p egnancy body mass index (Kg/m2)
145
24.2±4.2
Values a 16 h g.w.
Weigh a 16 h g. w. (Kg)
157
67.0±11.8
Body mass index a 16 h g.w. (Kg/m2)
157
25.0±4.1
Values a 34 h g.w.
Weigh a 34 h g. w. (Kg)
123
74.6±10.8
Weigh gain (16 h g.w. o 34 h g.w.) (Kg)
121
8.7±3.4
Weigh and body composi ion a pos pa um
Weigh a pos pa um (Kg)
107
68.5±11.4
Body mass index a pos pa um (Kg/m2)
107
25.5±4.4
To al body a ee mass (Kg)
110
40.9±4.7
To al body lean mass a pos pa um (Kg)
110
38.9±4.7
To al body a mass a pos pa um (Kg)
110
26.2±7.7
To al body and oid a mass a pos pa um (Kg)
110
18.8±0.8
To al body gynoid a mass a pos pa um (Kg)
110
52.1±1.3
To al bone mine al densi y (g/cm2)
1.06±0.1
Bone mine al densi y T-sco e*
-0.6±1.0
Bone mine al densi y Z-sco e
-0.7±0.9
Physical i ness es s
Mean±SD
16 h g. w.
157
Ca dio espi a o y i ness (75% VO2max)
Uppe -body absolu e muscula s eng h;
kg/weigh (kg)
27.3±4.3
Uppe -body ela i e muscula s eng h;
kg/weigh (kg)
0.4±0.1
Uppe -body lexibili y (cm)
4.1±6.2
34 h g. w.
123
Ca dio espi a o y i ness (75% VO2max)
Uppe -body absolu e muscula s eng h;
kg/weigh (kg)
27.2±4.5
Uppe -body ela i e muscula s eng h;
kg/weigh (kg)
0.4±0.1
Uppe -body lexibili y (cm)
3.9±6.0
SD, S anda d De ia ion; g. w., ges a ional week. *No mal bone is de ined as a T-
sco e o −1.0 o highe , os eopenia is de ined as be ween −1.0 and −2.5, os eopo osis
is de ined as −2.5 o lowe 18.
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Table 2. Linea eg ession coe icien s assessing he associa ion o he physical i ness es s measu ed a he 16 h ges a ional week wi h ma e nal body composi ion and bone heal h s a us
Model I
Model II
S anda dized
Coe icien s (β)
Con idence in e al 95% (B)
p
S anda dized
Coe icien s (β)
Con idence in e al 95% (B)
p
Ca dio espi a o y i ness
P e-p egancy BMI (kg/m2)
-0.145
-0.112 (-0.252, -0.029)
0.119
-0.140
-0.108 (-0.249, 0.034)
0.134
GWG (kg)
0.095
0.052 (-0.059, 0.163)
0.352
0.099
0.054 (-0.056, 0.165)
0.331
Weigh pos pa um (kg)
-0.100
-0.183 (-0.578, 0.212)
0.359
-0.093
-0.170 (-0.563, 0.222)
0.391
BMI pos pa um (kg/m2)
-0.147
-0.110 (-0.270, 0.051)
0.178
-0.141
-0.105 (-0.265, 0.055)
0.195
To al lean mass a pos pa um (Kg)
0.021
0.015 (-0.143, 0.173)
0.848
0.024
0.018 (-0.139, 0.175)
0.819
To al a ee mass a pos pa um (Kg)
0.016
0.012 (-0.149, 0.174)
0.881
0.020
0.015 (-0.146, 0.176)
0.853
To al a mass a pos pa um (Kg)
-0.255
-0.317 (-0.573, -0.060)
0.016
-0.311
-0.250 (-0.563, -0.059)
0.016
To al and oid a mass a pos pa um (Kg)
-0.234
-0.029 (-0.055, -0.003)
0.027
-0.230
-0.029 (-0.054, -0.003)
0.028
To al gynoid a mass a pos pa um (Kg)
-0.239
-0.054 (-0.100, -0.007)
0.024
-0.234
-0.052 (-0.098, -0.007)
0.024
To al BMD a pos pa um (g/cm2)*
-0.070
-0.001 (-0.004, 0.002)
0.515
-0.036
-0.000 (-0.003, 0.002)
0.751
T-sco e BMD a pos pa um*
0.045
0.007 (-0.027, 0.041)
0.674
0.095
0.016 (-0.020, 0.052)
0.388
Z-sco e BMD a pos pa um*
0.052
0.008 (-0.024, 0.039)
0.631
0.104
0.016 (-0.017, 0.049)
0.346
Absolu e uppe -body s eng h
P e-p egancy BMI (kg/m2)
0.197
0.192 (0.031, 0.352)
0.019
0.203
0.197 (0.037, 0.357)
0.016
GWG (kg)
0.185
0.160 (0.005, 0.315)
0.043
0.184
0.159 (0.004, 0.315)
0.044
Weigh pos pa um (kg)
0.324
0.987 (0.428, 1.545)
0.001
0.311
0.947 (0.393, 1.501)
0.001
BMI pos pa um (kg/m2)
0.288
0.339 (0.121, 0.557)
0.003
0.277
0.327 (0.109, 0.544)
0.004
To al lean mass a pos pa um (Kg)
0.451
0.561 (0.349, 0.772)
<0.001
0.438
0.544 (0.334, 0.755)
<0.001
To al a ee mass a pos pa um (Kg)
0.457
0.580 (0.364, 0.796)
<0.001
0.444
0.564 (0.350, 0.779)
<0.001
To al a mass a pos pa um (Kg)
0.216
0.446 (0.062, 0.829)
0.023
0.200
0.411 (0.032, 0.791)
0.034
To al and oid a mass a pos pa um (Kg)
0.160
0.034 (-0.006, 0.073)
0.095
0.146
0.031 (-0.009, 0.070)
0.126
To al gynoid a mass a pos pa um (Kg)
0.210
0.075 (0.008, 0.142)
0.028
0.190
0.068 (0.003, 0.133)
0.042
To al BMD a pos pa um (g/cm2)*
0.161
0.003 (-0.001, 0.007)
0.092
0.185
0.004 (0.000, 0.008)
0.068
T-sco e BMD a pos pa um*
0.300
0.075 (0.030, 0.121)
0.001
0.300
0.075 (0.027, 0.124)
0.002
Z-sco e BMD a pos pa um*
0.309
0.072 (0.030, 0.114)
0.001
0.308
0.072 (0.027, 0.117)
0.002
Uppe -body lexibili y
P e-p egancy BMI (kg/m2)
-0.416
-0.287 (-0.392,-0.182)
<0.001
-0.414
-0.285 (-0.390,-0.180)
<0.001
GWG (kg)
0.274
0.153 (0.055, 0.252)
0.003
0.277
0.155 (0.056, 0.254)
0.002
Weigh pos pa um (kg)
-0.355
-0.644 (-0.973, -0.314)
<0.001
-0.352
-0.638 (-0.964, -0.313)
<0.001
BMI pos pa um (kg/m2)
-0.444
-0.311 (-0.434, -0.189)
<0.001
-0.442
-0.310 (-0.431, -0.189)
<0.001
To al lean mass a pos pa um (Kg)
-0.274
-0.202 (-0.339, -0.066)
0.004
-0.269
-0.199 (-0.334, -0.064)
0.004
To al a ee mass a pos pa um (Kg)
-0.269
-0.203 (-0.342, -0.064)
0.005
-0.265
-0.200 (-0.338, -0.061)
0.005
To al a mass a pos pa um (Kg)
-0.336
-0.415 (-0.637, -0.192)
<0.001
-0.331
-0.408 (-0.626, -0.189)
<0.001
To al and oid a mass a pos pa um (Kg)
-0.338
-0.042 (-0.065, -0.020)
<0.001
-0.333
-0.042 (-0.064, -0.019)
<0.001
To al gynoid a mass a pos pa um (Kg)
-0.253
-0.054 (-0.094, -0.015)
0.008
-0.246
-0.053 (-0.091, -0.014)
0.008
To al BMD a pos pa um (g/cm2)*
-0.043
-0.001 (-0.003, 0.002)
0.657
-0.025
-0.000 (-0.003, 0.002)
0.821
T-sco e BMD a pos pa um*
-0.198
-0.029 (-0.057, -0.002)
0.039
-0.195
-0.030 (-0.062, -0.003)
0.072
Z-sco e BMD a pos pa um*
-0.197
-0.027 (-0.053, -0.001)
0.040
-0.195
-0.028 (-0.058, -0.003)
0.074
BMI, body mass index; GWG, ges a ional weigh gain; BMD, bone mine al densi y; β, s anda dized eg ession coe icien ; B, non-s anda dized eg ession coe icien . Bold alues, p<0.05. Model I was unadjus ed. Model II was adjus ed o
ma e nal age. *Model II addi ionally adjus ed o p e-p egnancy body mass index.
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Table 3. Linea eg ession coe icien s assessing he associa ion o he physical i ness es s measu ed a he 34 h ges a ional week wi h ma e nal body composi ion and bone heal h s a us
Model I
Model II
S anda dized
Coe icien s (β)
Con idence in e al 95% (B)
p
S anda dized
Coe icien s (β)
Con idence in e al 95% (B)
p
Ca dio espi a o y i ness
Weigh pos pa um (kg)
-0.152
-0.359 (-0.877, 0.160)
0.173
-0.115
-0.270 (-0.788, 0.247)
0.302
BMI pos pa um (kg/m2)
-0.207
-0.229 (-0.404, -0.011)
0.039
-0.194
-0.176 (-0.373, 0.021)
0.079
To al lean mass a pos pa um (Kg)
0.029
0.027 (-0.173, 0.227)
0.791
0.085
0.079 (-0.120, 0.278)
0.433
To al a ee mass a pos pa um (Kg)
0.033
0.032 (-0.174, 0.237)
0.761
0.088
0.083 (-0.122, 0.288)
0.422
To al a mass a pos pa um (Kg)
-0.324
-0.522 (-0.854, -0.191)
0.002
-0.290
-0.467 (-0.801, -0.134)
0.007
To al and oid a mass a pos pa um (Kg)
-0.329
-0.055 (-0.089, -0.021)
0.002
-0.293
-0.049 (-0.084, -0.015)
0.006
To al gynoid a mass a pos pa um (Kg)
-0.318
-0.087 (-0.143, -0.031)
0.003
-0.294
-0.081 (-0.138, -0.024)
0.006
To al BMD a pos pa um (g/cm2)*
0.127
0.002 (-0.001, 0.005)
0.244
0.207
0.003 (0.000, 0.007)
0.078
T-sco e BMD a pos pa um*
0.141
0.027 (-0.014, 0.067)
0.196
0.233
0.045 (0.001, 0.090)
0.047
Z-sco e BMD a pos pa um*
0.130
0.023 (-0.015, 0.060)
0.232
0.228
0.041 (0.000, 0.083)
0.053
Absolu e uppe -body s eng h
Weigh pos pa um (kg)
0.184
0.487 (-0.022, 0.997)
0.061
0.184
0.489 (-0.019, 0.996)
0.059
BMI pos pa um (kg/m2)
0.122
0.125 (-0.074, 0.323)
0.215
0.121
0.124 (-0.075, 0.323)
0.221
To al lean mass a pos pa um (Kg)
0.364
0.391 (0.199, 0.583)
<0.001
0.369
0.397 (0.206, 0.587)
<0.001
To al a ee mass a pos pa um (Kg)
0.369
0.406 (0.210, 0.602)
<0.001
0.374
0.412 (0.217, 0.606)
<0.001
To al a mass a pos pa um (Kg)
0.075
0.134 (-0.208, 0.475)
0.440
0.069
0.123 (-0.217, 0.462)
0.476
To al and oid a mass a pos pa um (Kg)
0.023
0.004 (-0.031, 0.039)
0.808
0.022
0.004 (-0.031, 0.039)
0.822
To al gynoid a mass a pos pa um (Kg)
0.083
0.026 (-0.033, 0.085)
0.390
0.067
0.021 (-0.038, 0.079)
0.484
To al BMD a pos pa um (g/cm2)*
0.163
0.003 (0.000, 0.006)
0.090
0.165
0.003 (-0.001, 0.006)
0.100
T-sco e BMD a pos pa um*
0.276
0.060 (0.020, 0.100
0.004
0.266
0.057 (0.016, 0.098)
0.006
Z-sco e BMD a pos pa um*
0.284
0.057 (0.020, 0.095)
0.003
0.274
0.055 (0.017, 0.093)
0.005
Uppe -body lexibili y
Weigh pos pa um (kg)
-0.309
-0.562 (-0.901, -0.223)
0.001
-0.308
-0.561 (-0.896, -0.225)
0.001
BMI pos pa um (kg/m2)
-0.394
-0.277 (-0.403, -0.151)
<0.001
-0.394
-0.277 (-0.403, -0.151)
<0.001
To al lean mass a pos pa um (Kg)
-0.166
-0.125 (-0.268, 0.018)
0.085
-0.162
-0.122 (-0.264, 0.019)
0.089
To al a ee mass a pos pa um (Kg)
-0.160
-0.123 (-0.270, -0.023)
0.097
-0.156
-0.121 (-0.266, -0.024)
0.101
To al a mass a pos pa um (Kg)
-0.342
-0.429 (-0.655, -0.203)
<0.001
-0.341
-0.428 (-0.650, -0.205)
<0.001
To al and oid a mass a pos pa um (Kg)
-0.339
-0.043 (-0.066, -0.020)
<0.001
-0.337
-0.043 (-0.066, -0.020)
<0.001
To al gynoid a mass a pos pa um (Kg)
-0.320
-0.070 (-0.109, -0.030)
0.001
-0.322
-0.070 (-0.109, -0.032)
<0.001
To al BMD a pos pa um (g/cm2)*
0.045
0.001 (-0.002, 0.003)
0.642
0.125
0.002 (-0.001, 0.004)
0.242
T-sco e BMD a pos pa um*
-0.095
-0.015 (-0.044, -0.015)
0.326
-0.050
-0.008 (-0.042, -0.025)
0.632
Z-sco e BMD a pos pa um*
-0.099
-0.014 (-0.041, -0.013)
0.308
-0.057
-0.009 (-0.040, -0.023)
0.590
BMI, body mass index; GWG, ges a ional weigh gain; BMD, bone mine al densi y; β, s anda dized eg ession coe icien ; B, non-s anda dized eg ession coe icien . Bold alues, p<0.05. Model I was unadjus ed.
Model II was adjus ed o ma e nal age, and exe cise in e en ion a he 34 h ges a ional week. *Model II addi ionally adjus ed o p e-p egnancy body mass index.
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Fo Pee Re iew Only
Table 4. Linea eg ession coe icien s assessing he associa ion o he ela i e uppe -body s eng h measu ed a he 16 h and 34 h ges a ional week wi h ma e nal
body composi ion and bone heal h s a us
Model I
Model II
S anda dized
Coe icien s
(β)
Con idence in e al 95%
(B)
p
S anda dized
Coe icien s
(β)
Con idence in e al 95%
(B)
p
Rela i e uppe -body s eng h (16 h ges a ional week)
P e-p egancy BMI (kg/m2)
-0.639
-32.310 (-38.840, -25.780)
<0.001
-0.641
-32.453 (-39.101, -25.804)
<0.001
GWG (kg)
0.271
12.266 (4.324, 20.208)
0.003
0.283
12.801 (4.793, 20.808)
0.002
Weigh pos pa um (kg)
-0.561
-89.624 (-115.483, -63.764)
<0.001
-0.546
-87.316 (-113.060, -61.571)
<0.001
BMI pos pa um (kg/m2)
-0.498
-30.771 (-41.240, -20.301)
<0.001
-0.487
-30.074 (-40.565, -19.582)
<0.001
To al lean mass a pos pa um (Kg)
-0.353
-22.978 (-34.688, -11.269)
<0.001
-0.340
-22.132 (-33.750, -10.513)
<0.001
To al a ee mass a pos pa um (Kg)
-0.350
-23.219 (-35.198, -11.241)
<0.001
-0.337
-22.384 (-34.282, -10.486)
<0.001
To al a mass a pos pa um (Kg)
-0.575
-61.829 (-78.782, -44.876)
<0.001
-0.561
-60.377 (-77.089, -43.666)
<0.001
To al and oid a mass a pos pa um (Kg)
-0.553
-6.035 (-7.788, -4.283)
<0.001
-0.542
-5.915 (-7.656, -4.173)
<0.001
To al gynoid a mass a pos pa um (Kg)
-0.504
-9.375 (-12.473, -6.278)
<0.001
-0.487
-9.064 (-12.092, -6.037)
<0.001
To al BMD a pos pa um (g/cm2)*
0.055
0.054 (-0.138, 0.246)
0.579
0.080
0.083 (-0.177, 0.344)
0.528
T-sco e BMD a pos pa um*
0.011
0.138 (-2.374, 2.649)
0.914
0.153
2.033 (-1.226, 5.291)
0.219
Z-sco e BMD a pos pa um*
0.017
0.206 (-2.127, 2.539)
0.862
0.163
2.006 (-1.029, 5.040)
0.193
Rela i e uppe -body s eng h (34 h ges a ional week)
Weigh pos pa um (kg)
-0.529
-92.112 (-121.104, -63.120)
<0.001
-0.516
-89.762 (-118.898, -60.627)
<0.001
BMI pos pa um (kg/m2)
-0.501
-33.649 (-45.056, -22.241)
<0.001
-0.493
-33.087 (-44.614, -21.560)
<0.001
To al lean mass a pos pa um (Kg)
-0.291
-20.447 (-33.402, -7.493)
0.002
-0.271
-19.074 (-32.048, -6.100)
0.004
To al a ee mass a pos pa um (Kg)
-0.286
-20.522 (-33.780, -7.264)
0.003
-0.267
-19.182 (-32.477, -5.887)
0.005
To al a mass a pos pa um (Kg)
-0.597
-69.942 (-88.045, -51.839)
<0.001
-0.586
-68.687 (-86.736, -50.637)
<0.001
To al and oid a mass a pos pa um (Kg)
-0.562
-6.689 (-8.583, -4.795)
<0.001
-0.551
-6.560 (-8.466, -4.654)
<0.001
To al gynoid a mass a pos pa um (Kg)
-0.553
-11.237 (-14.501, -7.974)
<0.001
-0.546
-11.104 (-14.309, -7.899)
<0.001
To al BMD a pos pa um (g/cm2)*
0.058
0.065 (-0.152, 0.282)
0.554
0.139
0.155 (-0.116, 0.427)
0.260
T-sco e BMD a pos pa um*
0.032
0.449 (-2.287, 3.186)
0.746
0.181
2.564 (-0.809, 5.937)
0.135
Z-sco e BMD a pos pa um*
0.035
0.465 (-2.077, 3.007)
0.717
0.185
2.422 (-0.726, 5.571)
0.130
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