Optimizing Pregnancy for Intergenerational Health Benefits
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Published:
Dec 18, 2017
Keywords:
Pregnancy, Physical activity, Pediatrics, Obstetrics, Exercise
Main Article Content
Abstract
Pregnancy is a critical period of body weight regulation for both mother and baby. Vital energy-sensing processes are established in utero that aid in nutrient storage and metabolic control later in life. Excessive weight gain during pregnancy and a surplus of maternal resources leads to preferential shuttling of nutrients and growth-promoting peptides across the placenta, resulting in fetal overgrowth — a well-established predictor of childhood obesity. Physical activity during pregnancy offers a safe and accessible way in which one can modify these intricate cellular networks across the maternal-placental-fetal interface to prevent dysregulation and optimize fetal birth weight. This commentary highlights the clinical utility of physical activity during pregnancy and provides practical recommendations as a way to ensure the best health and safety of mother, baby, and future generations.
Résumé
La grossesse est une période critique de la régulation du poids corporel pour la mère et le bébé. Des processus vitaux de détection d’énergie sont établis in utero qui contribuent au stockage des nutriments et au contrôle métabolique plus tard dans la vie. Une prise de poids excessive pendant la grossesse et un surplus de ressources maternelles conduit à un transfert préférentiel des nutriments et des peptides favorisant la croissance à travers le placenta, entraînant une prolifération fœtale - un prédicteur bien établi de l’obésité infantile. L’activité physique pendant la grossesse offre un moyen sûr et accessible pour modifier ces réseaux cellulaires complexes à travers l’interface materno-placentaire-fœtal afin de prévenir le dérèglement et optimiser le poids de naissance fœtal. Ce commentaire met en évidence l’utilité clinique de l’activité physique pendant la grossesse et fournit des recommandations pratiques pour assurer la meilleure santé et sécurité de la mère, du bébé et des générations futures.
Article Details
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Commentary
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References
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4. Ferraro ZM, Barrowman N, Prud’homme D, et al. Excessive gestational weight gain predicts large for gestational age neonates independent of maternal body mass index. J Matern Fetal Neonatal Med. 2011;25(5):538-42.
5. Adamo KB, Ferraro ZM, Brett KE. Can we modify the intrauterine environment to halt the intergenerational cycle of obesity? Int J Environ Res Public Health. 2012;9(4):1263-307.
6. Yu ZB, Han SP, Zhu GZ, et al. Birth weight and subsequent risk of obesity: a systematic review and meta-analysis. Obes Rev. 2011;12(7):525-42.
7. Tikanmäki M, Tammelin T, Vääräsmäki M, et al. Prenatal determinants of physical activity and cardiorespiratory fitness in adolescence - Northern Finland Birth Cohort 1986 study. BMC Public Health. 2017;17(1):346.
8. Josefson JL, Hoffmann JA, Metzger BE. Excessive weight gain in women with a normal pre-pregnancy BMI is associated with increased neonatal adipos- ity. Pediatr Obes. 2013;8(2):e33-6.
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11. Archer E. The childhood obesity epidemic as a result of nongenetic evolution: the maternal resources hypothesis. Mayo Clin Proc. 2015;90(1):77-92.
12. Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: the evidence CMAJ. 2006;174(6):801-9.
13. Ferraro ZM, Gaudet L, Adamo KB. The potential impact of physical activity during pregnancy on maternal and neonatal outcomes. Obstet Gynecol Surv. 2012;67(2):99-110.
14. Colley RC, Garriguet D, Janssen I, Craig CL, Clarke J, Tremblay MS. Physical activity of Canadian adults: accelerometer results from the 2007 to 2009 Canadian Health Measures Survey. Health Rep. 2011;22(1):7-14.
15. Adamo KB, Langlois KA, Brett KE, Colley RC. Young children and parental physical activity levels: findings from the Canadian health measures survey. Am J Prev Med. 2012;43(2):168-75.
16. Ferraro ZM, Gruslin A, Adamo KB. An active pregnancy for fetal well-being? The value of active living for most women and their babies. Br J Sports Med. 2013;47(13):813-4.
17. Olson CM, Strawderman MS. Modifiable behavioral factors in a biopsychosocial model predict inadequate and excessive gestational weight gain. J Am Diet Assoc. 2003;103(1):48-54.
18. American College of Obstetricians and Gynecologists. Exercise during pregnancy and the postpartum period. ACOG Committee No. 267. Obstet Gynecol. 2002;99:171-3.
19. Davies GA, Wolfe LA, Mottola MF, MacKinnon C. Joint SOGC/CSEP clinical practice guideline: exercise in pregnancy and the postpartum period. Can J Appl Physiol 2003;28(3):330-41.
20. Bø K, Artal R, Barakat R, et al. Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 1—exercise in women planning pregnancy and those who are pregnant. Br J Sports Med. 2016;50:571-89.
21. Artal R, Catanzaro RB, Gavard JA, Mostello DJ, Friganza JC. A lifestyle intervention of weight-gain restriction: diet and exercise in obese women with gestational diabetes mellitus. Appl Physiol Nutr Metab. 2007;32(3):596-601.
22. Dempsey JC, Sorensen TK, Williams MA, et al. Prospective study of gestational diabetes mellitus risk in relation to maternal recreational physical activity before and during pregnancy. Am J Epidemiol. 2004;159(7):663-70.
23. Dempsey JC, Butler CL, Williams MA. No need for a pregnant pause: physical activity may reduce the occurrence of gestational diabetes mellitus and preeclampsia. Exerc Sport Sci Rev. 2005;33(3):141-9.
24. Ong MJ, Guelfi KJ, Hunter T, Wallman KE, Fournier PA, Newnham JP. Supervised home-based exercise may attenuate the decline of glucose tolerance in obese pregnant women. Diabetes Metab. 2009;35(5):418-21.
25. Aune D, Saugstad OD, Henriksen T, Tonstad S. Physical activity and the risk of preeclampsia: a systematic review and meta-analysis. Epidemiology. 2014;25(3):331-43.
26. Osterdal ML, Strom M, Klemmensen AK, et al. Does leisure time physical activity in early pregnancy protect against pre-eclampsia? Prospective cohort in Danish women. BJOG. 2009;116(1):98-107.
27. Saftlas AF, Logsden-Sackett N, Wang W, Woolson R, Bracken MB. Work, leisure-time physical activity, and risk of preeclampsia and gestational hypertension. Am J Epidemiol. 2004;160(8):758-65.
28. Sorensen TK, Williams MA, Lee IM, Dashow EE, Thompson ML, Luthy DA. Recreational physical activity during pregnancy and risk of preeclampsia. Hypertension. 2003;41(6):1273-80.
29. Wolf HT, Owe KM, Juhl M, Hegaard HK. Leisure time physical activity and the risk of pre-eclampsia: a systematic review. Matern Child Health J. 2014;18(4):899-910.
30. Sui Z, Grivell RM, Dodd JM. Antenatal exercise to improve outcomes in overweight or obese women: A systematic review. Acta Obstet Gynecol Scand. 2012;91(5):538-45.
31. Streuling I, Beyerlein A, Rosenfeld E, Hofmann H, Schulz T, von Kries R. Physical activity and gestational weight gain: a meta-analysis of intervention tri- als. BJOG 2011;118(3):278-84.
32. Choi J, Fukuoka Y, Lee JH. The effects of physical activity and physical activity plus diet interventions on body weight in overweight or obese women who are pregnant or in postpartum: a systematic review and meta-analysis of randomized controlled trials. Prev Med. 2013;56(6):351-64.
33. Adamo KB, Ferraro ZM, Goldfield G, et al. The Maternal Obesity Management (MOM) Trial Protocol: A lifestyle intervention during pregnancy to minimize downstream obesity. Contemp Clin Trials. 2013;35(1):87-96.
34. Dodd JM, McPhee AJ, Turnbull D, et al. The effects of antenatal dietary and lifestyle advice for women who are overweight or obese on neonatal health outcomes: the LIMIT randomised trial. BMC Med. 2014;12(1):163.
35. Seneviratne SN, Parry GK, McCowan LM, et al. Antenatal exercise in overweight and obese women and its effects on offspring and maternal health: design and rationale of the IMPROVE (Improving Maternal and Progeny Obesity Via Exercise) randomised controlled trial. BMC Pregnancy Child- birth. 2014;14:148.
36. Juhl M, Olsen J, Anderson P, Nohr E, Anderson A. Physical exercise during pregnancy and fetal growth measures: a study within the Danish National Birth Cohort. Am J Obstet Gynecol. 2010;202(1):e1-8.
37. Hopkins SA, Cutfield WS. Exercise in pregnancy: weighing up the long-term impact on the next generation. Exerc Sport Sci Rev 2011;39(3):120-7.
38. Rifas-Shiman SL, Fleisch A, Hivert MF, Mantzoros C, Gillman MW, Oken E. First and second trimester gestational weight gains are most strongly associ-ated with cord blood levels of hormones at delivery important for glycemic
control and somatic growth. Metabolism. 2017;69:112-9.
39. Hopkins SA, Baldi JC, Cutfield WS, McCowan L, Hofman PL. Exercise training in pregnancy reduces offspring size without changes in maternal insulin sensitivity. J Clin Endocrinol Metab. 2010;95(5):2080-8.
40. Clapp JF 3rd, Capeless E. Neonatal morphometrics after endurance exercise during pregnancy. Am J Obstet Gynecol. 1990;163(6 Pt 1):1805-11.
41. Clapp JF 3rd. Morphometric and neurodevelopmental outcome at age five years of the offspring of women who continued to exercise regularly throughout pregnancy. J Pediatr. 1996;129(6):856-63.
42. Harrod CS, Chasan-Taber L, Reynolds RM, et al. Physical activity in pregnancy and neonatal body composition: the Healthy Start study. Obstet Gynecol. 2014;124(2 Pt 1):257-64.
43. Barakat R, Lucia A, Ruiz JR. Resistance exercise training during pregnancy and newborn’s birth size: a randomised controlled trial. Int J Obes (Lond ). 2009;33(9):1048-57.
44. Clapp JF 3rd. The effects of maternal exercise on fetal oxygenation and feto-placental growth. Eur J Obstet Gynecol Reprod Biol. 2003;110 Suppl 1:S80-5.
45. Jackson MR, Gott P, Lye SJ, Ritchie JW, Clapp JF 3rd. The effects of maternal aerobic exercise on human placental development: placental volumetric composition and surface areas. Placenta. 1995;16(2):179-91.
46. Jansson T, Ekstrand Y, Bjorn C, Wennergren M, Powell TL. Alterations in the activity of placental amino acid transporters in pregnancies complicated by diabetes. Diabetes. 2002;51(7):2214-9.
47. Jansson T, Powell TL. IFPA 2005 Award in Placentology Lecture. Human placental transport in altered fetal growth: does the placenta function as a nutrient sensor? -- a review. Placenta. 2006;27 Suppl A:S91-S97.
48. Jansson T, Myatt L, Powell TL. The role of trophoblast nutrient and ion transporters in the development of pregnancy complications and adult disease. Curr Vasc Pharmacol. 2009;7(4):521-33.
49. Brett KE, Ferraro ZM, Yockell-Lelievre J, Gruslin A, Adamo KB. Maternal-fetal nutrient transport in pregnancy pathologies: the role of the placenta. Int J Mol Sci. 2014;15(9):16153-85.
50. Bauer MK, Harding JE, Bassett NS, et al. Fetal growth and placental function. Mol Cell Endocrinol. 1998;140(1-2):115-20.
51. Lewis RM, Greenwood SL, Cleal JK, et al. Maternal muscle mass may influence system A activity in human placenta. Placenta. 2010;31(5):418-22.
52. Brett KE, Ferraro ZM, Holcik M, Adamo KB. Prenatal physical activity and diet composition affect the expression of nutrient transporters and mTOR signaling molecules in the human placenta. Placenta. 2015;36(2):204-12.
53. Akhavan MM, Foroutan T, Safari M, Sadighi-Moghaddam B, Emami-Abarg- hoie M, Rashidy-Pour A. Prenatal exposure to maternal voluntary exercise during pregnancy provides protection against mild chronic postnatal hypoxia in rat offspring. Pak J Pharm Sci. 2012;25(1):233-8.
54. Carter LG, Lewis KN, Wilkerson , et al. Perinatal exercise improves glucose homeostasis in adult offspring. Am J Physiol Endocrinol Metab. 2012;303(8):E1061-8.
55. Carter LG, Qi NR, De CR, Pearson KJ. Maternal exercise improves insulin sensitivity in mature rat offspring. Med Sci Sports Exerc. 2013;45(5):832-40.
56. Vega CC, Reyes-Castro LA, Bautista CJ, Larrea F, Nathanielsz PW, Zambrano E. Exercise in obese female rats has beneficial effects on maternal and male and female offspring metabolism. Int J Obes (Lond). 2015;39(4):712-9.
57. Gilbert JS, Banek CT, Bauer AJ, Gingery A, Needham K. Exercise training attenuates placental ischemia-induced hypertension and angiogenic imbalance in the rat. Hypertension. 2012;60(6):1545-51.
58. Laker RC, Wlodek ME, Wadley GD, Gallo LA, Meikle PJ, McConell GK. Exercise early in life in rats born small does not normalize reductions in skeletal muscle PGC-1alpha in adulthood. Am J Physiol Endocrinol Metab. 2012;302(10):E1221-30.
59. Parnpiansil P, Jutapakdeegul N, Chentanez T, Kotchabhakdi N. Exercise during pregnancy increases hippocampal brain-derived neurotrophic factor mRNA expression and spatial learning in neonatal rat pup. Neurosci Lett. 2003;352(1):45-8.
60. Gillman MW. Early infancy interventions to prevent childhood obesity. Obesity (Silver Spring). 2017;25(5):817-8.
2. Fraser A, Tilling K, Donald-Wallis C, et al. Association of maternal weight gain in pregnancy with offspring obesity and metabolic and vascular traits in childhood. Circulation. 2010;121(23):2557-64.
3. Fraser A, Tilling K, Donald-Wallis C, et al. Associations of gestational weight gain with maternal body mass index, waist circumference, and blood pressure measured 16 y after pregnancy: the Avon Longitudinal Study of Parents and Children (ALSPAC). Am J Clin Nutr. 2011;93(6):1285-92.
4. Ferraro ZM, Barrowman N, Prud’homme D, et al. Excessive gestational weight gain predicts large for gestational age neonates independent of maternal body mass index. J Matern Fetal Neonatal Med. 2011;25(5):538-42.
5. Adamo KB, Ferraro ZM, Brett KE. Can we modify the intrauterine environment to halt the intergenerational cycle of obesity? Int J Environ Res Public Health. 2012;9(4):1263-307.
6. Yu ZB, Han SP, Zhu GZ, et al. Birth weight and subsequent risk of obesity: a systematic review and meta-analysis. Obes Rev. 2011;12(7):525-42.
7. Tikanmäki M, Tammelin T, Vääräsmäki M, et al. Prenatal determinants of physical activity and cardiorespiratory fitness in adolescence - Northern Finland Birth Cohort 1986 study. BMC Public Health. 2017;17(1):346.
8. Josefson JL, Hoffmann JA, Metzger BE. Excessive weight gain in women with a normal pre-pregnancy BMI is associated with increased neonatal adipos- ity. Pediatr Obes. 2013;8(2):e33-6.
9. Mamun AA, Mannan M, Doi SA. Gestational weight gain in relation to offspring obesity over the life course: a systematic review and bias-adjusted meta-analysis. Obes Rev. 2014;15(4):338-47.
10. Nehring I, Lehmann S, von Kries R. Gestational weight gain in accordance to the IOM/NRC criteria and the risk for childhood overweight: a meta-analysis. Pediatr Obes 2013;8(3):218-24.
11. Archer E. The childhood obesity epidemic as a result of nongenetic evolution: the maternal resources hypothesis. Mayo Clin Proc. 2015;90(1):77-92.
12. Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: the evidence CMAJ. 2006;174(6):801-9.
13. Ferraro ZM, Gaudet L, Adamo KB. The potential impact of physical activity during pregnancy on maternal and neonatal outcomes. Obstet Gynecol Surv. 2012;67(2):99-110.
14. Colley RC, Garriguet D, Janssen I, Craig CL, Clarke J, Tremblay MS. Physical activity of Canadian adults: accelerometer results from the 2007 to 2009 Canadian Health Measures Survey. Health Rep. 2011;22(1):7-14.
15. Adamo KB, Langlois KA, Brett KE, Colley RC. Young children and parental physical activity levels: findings from the Canadian health measures survey. Am J Prev Med. 2012;43(2):168-75.
16. Ferraro ZM, Gruslin A, Adamo KB. An active pregnancy for fetal well-being? The value of active living for most women and their babies. Br J Sports Med. 2013;47(13):813-4.
17. Olson CM, Strawderman MS. Modifiable behavioral factors in a biopsychosocial model predict inadequate and excessive gestational weight gain. J Am Diet Assoc. 2003;103(1):48-54.
18. American College of Obstetricians and Gynecologists. Exercise during pregnancy and the postpartum period. ACOG Committee No. 267. Obstet Gynecol. 2002;99:171-3.
19. Davies GA, Wolfe LA, Mottola MF, MacKinnon C. Joint SOGC/CSEP clinical practice guideline: exercise in pregnancy and the postpartum period. Can J Appl Physiol 2003;28(3):330-41.
20. Bø K, Artal R, Barakat R, et al. Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 1—exercise in women planning pregnancy and those who are pregnant. Br J Sports Med. 2016;50:571-89.
21. Artal R, Catanzaro RB, Gavard JA, Mostello DJ, Friganza JC. A lifestyle intervention of weight-gain restriction: diet and exercise in obese women with gestational diabetes mellitus. Appl Physiol Nutr Metab. 2007;32(3):596-601.
22. Dempsey JC, Sorensen TK, Williams MA, et al. Prospective study of gestational diabetes mellitus risk in relation to maternal recreational physical activity before and during pregnancy. Am J Epidemiol. 2004;159(7):663-70.
23. Dempsey JC, Butler CL, Williams MA. No need for a pregnant pause: physical activity may reduce the occurrence of gestational diabetes mellitus and preeclampsia. Exerc Sport Sci Rev. 2005;33(3):141-9.
24. Ong MJ, Guelfi KJ, Hunter T, Wallman KE, Fournier PA, Newnham JP. Supervised home-based exercise may attenuate the decline of glucose tolerance in obese pregnant women. Diabetes Metab. 2009;35(5):418-21.
25. Aune D, Saugstad OD, Henriksen T, Tonstad S. Physical activity and the risk of preeclampsia: a systematic review and meta-analysis. Epidemiology. 2014;25(3):331-43.
26. Osterdal ML, Strom M, Klemmensen AK, et al. Does leisure time physical activity in early pregnancy protect against pre-eclampsia? Prospective cohort in Danish women. BJOG. 2009;116(1):98-107.
27. Saftlas AF, Logsden-Sackett N, Wang W, Woolson R, Bracken MB. Work, leisure-time physical activity, and risk of preeclampsia and gestational hypertension. Am J Epidemiol. 2004;160(8):758-65.
28. Sorensen TK, Williams MA, Lee IM, Dashow EE, Thompson ML, Luthy DA. Recreational physical activity during pregnancy and risk of preeclampsia. Hypertension. 2003;41(6):1273-80.
29. Wolf HT, Owe KM, Juhl M, Hegaard HK. Leisure time physical activity and the risk of pre-eclampsia: a systematic review. Matern Child Health J. 2014;18(4):899-910.
30. Sui Z, Grivell RM, Dodd JM. Antenatal exercise to improve outcomes in overweight or obese women: A systematic review. Acta Obstet Gynecol Scand. 2012;91(5):538-45.
31. Streuling I, Beyerlein A, Rosenfeld E, Hofmann H, Schulz T, von Kries R. Physical activity and gestational weight gain: a meta-analysis of intervention tri- als. BJOG 2011;118(3):278-84.
32. Choi J, Fukuoka Y, Lee JH. The effects of physical activity and physical activity plus diet interventions on body weight in overweight or obese women who are pregnant or in postpartum: a systematic review and meta-analysis of randomized controlled trials. Prev Med. 2013;56(6):351-64.
33. Adamo KB, Ferraro ZM, Goldfield G, et al. The Maternal Obesity Management (MOM) Trial Protocol: A lifestyle intervention during pregnancy to minimize downstream obesity. Contemp Clin Trials. 2013;35(1):87-96.
34. Dodd JM, McPhee AJ, Turnbull D, et al. The effects of antenatal dietary and lifestyle advice for women who are overweight or obese on neonatal health outcomes: the LIMIT randomised trial. BMC Med. 2014;12(1):163.
35. Seneviratne SN, Parry GK, McCowan LM, et al. Antenatal exercise in overweight and obese women and its effects on offspring and maternal health: design and rationale of the IMPROVE (Improving Maternal and Progeny Obesity Via Exercise) randomised controlled trial. BMC Pregnancy Child- birth. 2014;14:148.
36. Juhl M, Olsen J, Anderson P, Nohr E, Anderson A. Physical exercise during pregnancy and fetal growth measures: a study within the Danish National Birth Cohort. Am J Obstet Gynecol. 2010;202(1):e1-8.
37. Hopkins SA, Cutfield WS. Exercise in pregnancy: weighing up the long-term impact on the next generation. Exerc Sport Sci Rev 2011;39(3):120-7.
38. Rifas-Shiman SL, Fleisch A, Hivert MF, Mantzoros C, Gillman MW, Oken E. First and second trimester gestational weight gains are most strongly associ-ated with cord blood levels of hormones at delivery important for glycemic
control and somatic growth. Metabolism. 2017;69:112-9.
39. Hopkins SA, Baldi JC, Cutfield WS, McCowan L, Hofman PL. Exercise training in pregnancy reduces offspring size without changes in maternal insulin sensitivity. J Clin Endocrinol Metab. 2010;95(5):2080-8.
40. Clapp JF 3rd, Capeless E. Neonatal morphometrics after endurance exercise during pregnancy. Am J Obstet Gynecol. 1990;163(6 Pt 1):1805-11.
41. Clapp JF 3rd. Morphometric and neurodevelopmental outcome at age five years of the offspring of women who continued to exercise regularly throughout pregnancy. J Pediatr. 1996;129(6):856-63.
42. Harrod CS, Chasan-Taber L, Reynolds RM, et al. Physical activity in pregnancy and neonatal body composition: the Healthy Start study. Obstet Gynecol. 2014;124(2 Pt 1):257-64.
43. Barakat R, Lucia A, Ruiz JR. Resistance exercise training during pregnancy and newborn’s birth size: a randomised controlled trial. Int J Obes (Lond ). 2009;33(9):1048-57.
44. Clapp JF 3rd. The effects of maternal exercise on fetal oxygenation and feto-placental growth. Eur J Obstet Gynecol Reprod Biol. 2003;110 Suppl 1:S80-5.
45. Jackson MR, Gott P, Lye SJ, Ritchie JW, Clapp JF 3rd. The effects of maternal aerobic exercise on human placental development: placental volumetric composition and surface areas. Placenta. 1995;16(2):179-91.
46. Jansson T, Ekstrand Y, Bjorn C, Wennergren M, Powell TL. Alterations in the activity of placental amino acid transporters in pregnancies complicated by diabetes. Diabetes. 2002;51(7):2214-9.
47. Jansson T, Powell TL. IFPA 2005 Award in Placentology Lecture. Human placental transport in altered fetal growth: does the placenta function as a nutrient sensor? -- a review. Placenta. 2006;27 Suppl A:S91-S97.
48. Jansson T, Myatt L, Powell TL. The role of trophoblast nutrient and ion transporters in the development of pregnancy complications and adult disease. Curr Vasc Pharmacol. 2009;7(4):521-33.
49. Brett KE, Ferraro ZM, Yockell-Lelievre J, Gruslin A, Adamo KB. Maternal-fetal nutrient transport in pregnancy pathologies: the role of the placenta. Int J Mol Sci. 2014;15(9):16153-85.
50. Bauer MK, Harding JE, Bassett NS, et al. Fetal growth and placental function. Mol Cell Endocrinol. 1998;140(1-2):115-20.
51. Lewis RM, Greenwood SL, Cleal JK, et al. Maternal muscle mass may influence system A activity in human placenta. Placenta. 2010;31(5):418-22.
52. Brett KE, Ferraro ZM, Holcik M, Adamo KB. Prenatal physical activity and diet composition affect the expression of nutrient transporters and mTOR signaling molecules in the human placenta. Placenta. 2015;36(2):204-12.
53. Akhavan MM, Foroutan T, Safari M, Sadighi-Moghaddam B, Emami-Abarg- hoie M, Rashidy-Pour A. Prenatal exposure to maternal voluntary exercise during pregnancy provides protection against mild chronic postnatal hypoxia in rat offspring. Pak J Pharm Sci. 2012;25(1):233-8.
54. Carter LG, Lewis KN, Wilkerson , et al. Perinatal exercise improves glucose homeostasis in adult offspring. Am J Physiol Endocrinol Metab. 2012;303(8):E1061-8.
55. Carter LG, Qi NR, De CR, Pearson KJ. Maternal exercise improves insulin sensitivity in mature rat offspring. Med Sci Sports Exerc. 2013;45(5):832-40.
56. Vega CC, Reyes-Castro LA, Bautista CJ, Larrea F, Nathanielsz PW, Zambrano E. Exercise in obese female rats has beneficial effects on maternal and male and female offspring metabolism. Int J Obes (Lond). 2015;39(4):712-9.
57. Gilbert JS, Banek CT, Bauer AJ, Gingery A, Needham K. Exercise training attenuates placental ischemia-induced hypertension and angiogenic imbalance in the rat. Hypertension. 2012;60(6):1545-51.
58. Laker RC, Wlodek ME, Wadley GD, Gallo LA, Meikle PJ, McConell GK. Exercise early in life in rats born small does not normalize reductions in skeletal muscle PGC-1alpha in adulthood. Am J Physiol Endocrinol Metab. 2012;302(10):E1221-30.
59. Parnpiansil P, Jutapakdeegul N, Chentanez T, Kotchabhakdi N. Exercise during pregnancy increases hippocampal brain-derived neurotrophic factor mRNA expression and spatial learning in neonatal rat pup. Neurosci Lett. 2003;352(1):45-8.
60. Gillman MW. Early infancy interventions to prevent childhood obesity. Obesity (Silver Spring). 2017;25(5):817-8.