Biography:

In the past Michelle F. Mottola has collaborated on articles with Ruben Barakat. One of their most recent publications is The use of animal models in exercise and pregnancy research. Which was published in journal Seminars in Perinatology.

More information about Michelle F. Mottola research including statistics on their citations can be found on their Copernicus Academic profile page.

Michelle F. Mottola's Articles: (3)

The use of animal models in exercise and pregnancy research

This article will discuss the use of animal models in exercise and pregnancy research. Although the ultimate goal is understanding mechanisms of change as a result of maternal exercise as they apply to pregnant women and the fetus, animal models deserve a place in research because of ethical constraints placed on experimentation on pregnant women. The risks identified through animal research should not be ignored if safe exercise guidelines are to be recommended to women who wish to engage in exercise during pregnancy.

Full length articleExercise during pregnancy is associated with a shorter duration of labor. A randomized clinical trial

AbstractObjective: to examine the influence of an exercise program throughout pregnancy on the duration of labor in healthy pregnant women.Study design: A randomized clinical trial was used (Identifier: NCT02109588). In all, 508 healthy pregnant women were randomly assigned between 9 and 11 weeks of gestation to either a Control Group (CG, N = 253) or an Exercise Group (EG, N = 255). A moderate aerobic exercise program throughout pregnancy (three weekly sessions) was used as the intervention. Mann-Whitney and Pearson χ2 tests were performed to analyze differences between groups. Survival techniques through the Kaplan-Meier method were used to estimate the median time to delivery of each group; and Gehan-Breslow-Wilcoxon tests were performed to compare survival distribution between the two arms. The primary outcome studied was the length of the stages of labor. Secondary outcomes included mode of delivery, gestational age, maternal weight gain, preterm delivery, use of epidural, birthweight, Apgar scores and arterial cord pH.Results: Women randomized to the EG had shorter first stage of labor (409 vs 462 min, p = 0.01), total duration of labor (450 vs 507 min, p = 0.01) as well as combined duration of first and second stages of labor (442 vs 499 min, p = 0.01). The probabilities of a woman being delivered at 250 min and 500 min (median times) were 19.1% and 62.5% in the experimental group vs 13.7% and 50.8% in the control group (Z = −2.37, p = 0.018). Results also revealed that women in the intervention group were less likely to use an epidural; and that the prevalence of neonate macrosomia was higher in the control group.Conclusion: A supervised physical exercise program throughout pregnancy decreased the duration of the first phase of labor as well as total time of the first two phases together, leading to a decrease in total labor time.

JOINT SOGC/CSEP CLINICAL PRACTICE GUIDELINENo. 367-2019 Canadian Guideline for Physical Activity throughout Pregnancy

AbstractObjectiveThe objective is to provide guidance for pregnant women, and obstetric care and exercise professionals, on prenatal physical activity.OutcomesThe outcomes evaluated were maternal, fetal, or neonatal morbidity or fetal mortality during and following pregnancy.EvidenceLiterature was retrieved through searches of Medline, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Scopus and Web of Science Core Collection, CINAHL Plus with Full-text, Child Development & Adolescent Studies, ERIC, Sport Discus, ClinicalTrials.gov, and the Trip Database from database inception up to January 6, 2017. Primary studies of any design were eligible, except case studies. Results were limited to English, Spanish, or French language materials. Articles related to maternal physical activity during pregnancy reporting on maternal, fetal, or neonatal morbidity or fetal mortality were eligible for inclusion. The quality of evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology.ValuesThe Guidelines Consensus Panel solicited feedback from end-users (obstetric care providers, exercise professionals, researchers, policy organizations, and pregnant and postpartum women). The development of this guideline followed the Appraisal of Guidelines for Research Evaluation (AGREE) II instrument.Benefits, harms, and costsThe benefits of prenatal physical activity are moderate, and no harms were identified; therefore, the difference between desirable and undesirable consequences (net benefit) is expected to be moderate. The majority of stakeholders and end-users indicated that following these recommendations would be feasible, acceptable, and equitable. Following these recommendations is likely to require minimal resources from both individual and health systems perspectives.PreambleThis guideline provide evidence-based recommendations regarding physical activity throughout pregnancy in the promotion of maternal, fetal, and neonatal health. In the absence of contraindications (see later for a detailed list), following this guideline is associated with: (1) fewer newborn complications (i.e., large for gestational age); and (2) maternal health benefits (i.e., decreased risk of preeclampsia, gestational hypertension, gestational diabetes, Caesarean section, instrumental delivery, urinary incontinence, excessive gestational weight gain, and depression; improved blood glucose; decreased total gestational weight gain; and decreased severity of depressive symptoms and lumbopelvic pain). Physical activity is not associated with miscarriage, stillbirth, neonatal death, preterm birth, preterm/prelabour rupture of membranes, neonatal hypoglycemia, low birth weight, birth defects, induction of labour, or birth complications. In general, more physical activity (frequency, duration, and/or volume) is associated with greater benefits. However, evidence was not identified regarding the safety or additional benefit of exercising at levels significantly above the recommendations. Prenatal physical activity should be considered a front-line therapy for reducing the risk of pregnancy complications and enhancing maternal physical and mental health. For pregnant women not currently meeting this guideline, a progressive adjustment toward them is recommended. Previously active women may continue physical activity throughout pregnancy. Women may need to modify physical activity as pregnancy progresses. There may be periods when following the guideline is not possible due to fatigue and/or discomforts of pregnancy; women are encouraged to do what they can and to return to following the recommendations when they are able. This guideline were informed by an extensive systematic review of the literature, expert opinion, end-user consultation and considerations of feasibility, acceptability, costs, and equity.RecommendationsThe specific recommendations in this 2019 Canadian Guideline for Physical Activity Throughout Pregnancy are provided below with corresponding statements indicating the quality of the evidence informing the recommendations and the strength of the recommendations (explanations follow).1All women without contraindication should be physically active throughout pregnancy (strong recommendation, moderate quality evidence). Specific subgroups were examined:aWomen who were previously inactive (strong recommendation, moderate quality evidence).bWomen diagnosed with gestational diabetes mellitus (weak recommendation,a low quality evidence).cWomen categorized as overweight or obese (pre-pregnancy body mass index ≥25 kg/m2) (strong recommendation,b low quality evidence).2Pregnant women should accumulate at least 150 minutes of moderate-intensityc physical activity each week to achieve clinically meaningful health benefits and reductions in pregnancy complications (strong recommendation, moderate quality evidence).3Physical activity should be accumulated over a minimum of 3 days per week; however, being active every day is encouraged (strong recommendation, moderate quality evidence).4Pregnant women should incorporate a variety of aerobic exercise and resistance training activities to achieve greater benefits. Adding yoga and/or gentle stretching may also be beneficial (strong recommendation, high quality evidence).5Pelvic floor muscle training (e.g., Kegel exercises) may be performed on a daily basis to reduce the risk of urinary incontinence. Instruction in proper technique is recommended to obtain optimal benefits (weak recommendation,d low quality evidence).6Pregnant women who experience light-headedness, experience nausea, or feel unwell when they exercise flat on their back should modify their exercise position to avoid the supine position (weak recommendation,e very low quality evidence).ContraindicationsAll pregnant women can participate in physical activity throughout pregnancy with the exception of those who have contraindications (listed below). Women with absolute contraindications may continue their usual activities of daily living but should not participate in more strenuous activities. Women with relative contraindications should discuss the advantages and disadvantages of moderate-to-vigorous intensity physical activity with their obstetric care provider prior to participation.Absolute contraindications to exercise are the following:•Ruptured membranes•Premature labour•Unexplained persistent vaginal bleeding•Placenta previa after 28 weeks’ gestation•Preeclampsia•Incompetent cervix•Intrauterine growth restriction•High-order multiple pregnancy (e.g., triplets)•Uncontrolled type 1 diabetes•Uncontrolled hypertension•Uncontrolled thyroid disease•Other serious cardiovascular, respiratory, or systemic disorderRelative contraindications to exercise are the following:•Recurrent pregnancy loss•Gestational hypertension•A history of spontaneous preterm birth•Mild/moderate cardiovascular or respiratory disease•Symptomatic anemia•Malnutrition•Eating disorder•Twin pregnancy after the 28th week•Other significant medical conditionsStrength of the RecommendationsThe GRADE system was utilized to grade the strength of the recommendations. Recommendations are rated as strong or weak based on the: (1) balance between benefits and harms; (2) overall quality of the evidence; (3) importance of outcomes (i.e., values and preferences of pregnant women); (4) use of resources (i.e., cost); (5) impact on health equity; (6) feasibility, and (7) acceptability.Strong recommendation: Most or all pregnant women will be best served by the recommended course of action.Weak recommendation: Not all pregnant women will be best served by the recommended course of action; there is a need to consider other factors such as the individual's circumstances, preferences, values, resources available, or setting. Consultation with an obstetric care provider may assist in decision-making.Quality of the EvidenceThe quality of the evidence refers to the level of confidence in the evidence and ranges from very low to high.High quality: The Guideline Consensus Panel is very confident that the estimated effect of physical activity on the health outcome is close to the true effect.Moderate quality: The Guideline Consensus Panel is moderately confident in the estimated effect of physical activity on the health outcome; the estimate of the effect is likely to be close to the true effect, but there is a possibility that it is substantially different.Low quality: The Guideline Consensus Panel's confidence in the estimated effect of physical activity on the health outcome is limited; the estimate of the effect may be substantially different from the true effect.Very low quality: The Guideline Consensus Panel has very little confidence in the estimated effect of physical activity on the health outcome; the estimate of the effect is likely to be substantially different from the true effect.aThis was a weak recommendation because the quality of evidence was low, and the net benefit between women who were physically active and those who were not was small.bThis was a strong recommendation because, despite low quality evidence supporting physical activity during pregnancy for women categorized as overweight or obese, there was evidence from randomized controlled trials demonstrating an improvement in gestational weight gain and blood glucose.cModerate-intensity physical activity is intense enough to noticeably increase heart rate; a person can talk but not sing during activities of this intensity. Examples of moderate-intensity physical activity include brisk walking, water aerobics, stationary cycling (moderate effort), resistance training, carrying moderate loads, and household chores (e.g., gardening, washing windows).dThis was a weak recommendation because urinary incontinence was was not rated as a “critical” outcome and the evidence was low quality.eThis was a weak recommendation because: (1) the quality of evidence was very low; and (2) although harms were investigated there was limited available information to inform the balance of benefits and harms. This recommendation was primarily based on expert opinion.

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