1. Effect of a community dance program on the rate of preeclampsia in pregnancy Ann Cowlin, MA , Yale University Department of Athletics, New Haven, Connecticut, USA; Robyn Brancato Ovozek, CNM, MA ; Brookdale Hospital, Brooklyn, New York, USA; Gil Mor, MD, PhD ; Daniel Zelterman, PhD; Brian Karsif, MD, MPH, Yale University School of Medicine, New Haven, Connecticut, USA; Peggy DeZinno, RN, BSN , Yale-New Haven Hospital, New Haven, Connecticut, USA.
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9. Effect of Prenatal Dance on PE Risk NOTES: • In Dance group, 5 cases of elevated BP and 4 cases of proteinuria >20 weeks, not progressing to PE. • Both cases of PE diagnosed in final month.
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11. Effect of Prenatal Dance on PE Risk Notes: 6 PTB infants, none with LBW or belonging to PE mothers.
PE is a serious and growing pregnancy disorder…defined as BP > 140/90 after 20 weeks with proteinurea….overt symptoms also include sudden swelling or edema of face and hands. U.S. has been around 4% annually, but is rising. Our community runs around 8% and has for some time. In developing world runs as high as 50%. Results in immune, CV and metabolic dysfunction that carries into later life for mother. Fetal programming = altered vascular responses, predisposition to CV disorders Sequellae often include pre-term birth (PTB <37 weeks) and low birth weight (LBW <5.5 lbs. or 3,000 gm.)
Normal pregnancy involves modulating cytokine and cytochemical responses directed by the interplay of the trophoblast - or invading fetal cells - and the maternal immune system. Trimester 1: pro-inflammatory responses permitting fertilization & adequate implantation Trimester 2: anti-inflammatory protection for mother and fetus Trimester 3: pro-inflammatory responses permitting an adequate rejection response to initiate labor and birth In a PE pregnancy, this pattern is blunted. Eventually, we would like to determine how this pattern is affected by physical activity.
What about evidence to date? Mostly epidemiological info. 1999 military study -- PA improved rates of PE in racially diverse population of pg soldiers 2003 PA & risk -- case controlled study demonstrating association of reduced risk of PE with maternal PA 2004 leisure activity -- associated with reduced rates of PE 2005 RPE -- level of perceived exertion in pre-pregnancy PA has inverse relationship to risk for PE 24 – 54 – 75% reductions The standardization and translational difficulties were areas we could bypass. So we were curious if we could duplicate these findings in some way.
So we set out to find out the PE rate might be of our dancing groups versus the larger population in our area, and how do these results compare with other findings.
Method: We examined hospital and public health records (FIMR) to determine outcomes for control groups. PE records available from care coordination records, but PTB & LBW only available through FIMR, thus smaller control. Experimental group - Compliance - had to begin the program prior to first modulation (16-24 weeks) and participate regularly until either gave birth or were removed from program for medical reasons. Reason for secondary measures of PTB & LBW - allow us to assess the “treatment” value of the program. Self-reporting subgroup information gathered from outcome records for the program, including attendance records and self-reporting of birth outcomes of participants…which tend to be very dependable. If you have given birth you will understand why! Questionnaires included questions such as were told you had a diagnosis of PE? Elevated BP? Proteinurea? Due date and baby’s birth date? Baby’s birth weight? For the High Risk assigned group information was maintained during the course of their pregnancies that enabled us to draw the information from our own files.
This study is part of a larger HIC approved experimental protocol underway on the immunology of healthy versus preeclamptic pregnancies. Epidemiological studies indicate aerobic activity may help prevent preeclampsia, but have not controlled for differences in amount, type, or intensity of activity. Laboratory-based interventions to control for variables inflict translational difficulties. To control for variables and bypass translational issues, we examined a standardized 30-year old community program.
Control - 781/ 9949 Experimental - 2/119
300 women observed and randomized in a 1:1 fashion Estimate of the power of this study. If the observed number of PE cases is 20, for example, and if these are distributed as 5 in the physical activity and 15 in the control group then the two-tailed p-value of .041 rejects the null hypothesis of no benefit. If the benefit provides a 3:1 odds (that is cases are 3 times as likely to appear in the control group) then the probability (power) of detecting such a difference is 62%. The power increases with the numbers of PE cases observed and larger underlying odds ratios. More extreme observed imbalances of PE cases such as 4 / 16 would provide even further evidence of a benefit with a more extreme level of significance.
Control - 505/4053 Experimental - 6/119
Control - 450/4053 Experimental - 1/119
Top row: gestational age Bottom row: birth weight Self-selecting mothers on Left High-risk, assigned mothers on Right
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