Physical fitness and maternal body composition indices during pregnancy and postpartum: the GESTAFIT project

Fo Pee Re iew Only 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] Eu opean Jou nal o Spo Science Fo Pee Re iew Only 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. Page 1 o 20 URL: h p:/mc.manusc ip cen al.com/ ejs Email: [email p o ec ed] Eu opean Jou nal o Spo Science 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Fo Pee Re iew Only 2 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 Page 2 o 20 URL: h p:/mc.manusc ip cen al.com/ ejs Email: [email p o ec ed] Eu opean Jou nal o Spo Science 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Fo Pee Re iew Only 3 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. Page 3 o 20 URL: h p:/mc.manusc ip cen al.com/ ejs Email: [email p o ec ed] Eu opean Jou nal o Spo Science 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Fo Pee Re iew Only 4 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. Page 4 o 20 URL: h p:/mc.manusc ip cen al.com/ ejs Email: [email p o ec ed] Eu opean Jou nal o Spo Science 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Fo Pee Re iew Only 5 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 Page 5 o 20 URL: h p:/mc.manusc ip cen al.com/ ejs Email: [email p o ec ed] Eu opean Jou nal o Spo Science 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Fo Pee Re iew Only 6 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 Page 6 o 20 URL: h p:/mc.manusc ip cen al.com/ ejs Email: [email p o ec ed] Eu opean Jou nal o Spo Science 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Fo Pee Re iew Only 7 111 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 Page 7 o 20 URL: h p:/mc.manusc ip cen al.com/ ejs Email: [email p o ec ed] Eu opean Jou nal o Spo Science 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Fo Pee Re iew Only 8 136 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- Page 8 o 20 URL: h p:/mc.manusc ip cen al.com/ ejs Email: [email p o ec ed] Eu opean Jou nal o Spo Science 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Fo Pee Re iew Only 15 311 2. Fa pou -Lambe NJ, Ells LJ, de Tejada BM, Sco C. 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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 Page 16 o 20 URL: h p:/mc.manusc ip cen al.com/ ejs Email: [email p o ec ed] Eu opean Jou nal o Spo Science 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Fo Pee Re iew Only 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. Page 17 o 20 URL: h p:/mc.manusc ip cen al.com/ ejs Email: [email p o ec ed] Eu opean Jou nal o Spo Science 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Fo Pee Re iew Only 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. Page 18 o 20 URL: h p:/mc.manusc ip cen al.com/ ejs Email: [email p o ec ed] Eu opean Jou nal o Spo Science 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Fo Pee Re iew Only 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. Page 19 o 20 URL: h p:/mc.manusc ip cen al.com/ ejs Email: [email p o ec ed] Eu opean Jou nal o Spo Science 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 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 Page 20 o 20 URL: h p:/mc.manusc ip cen al.com/ ejs Email: [email p o ec ed] Eu opean Jou nal o Spo Science 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60