Urban-Rural Differences In Device Measured Physical Activity During Pregnancy

PURPOSE: Moderate-vigorous physical activity (MVPA) during pregnancy is important for the health of the mother and baby. Preliminary research has shown rural women are less likely to engage in MVPA than their urban counterparts. The aim of this study is to quantify the differences between rural and urban device-measured MVPA during pregnancy. METHODS: As part of an ongoing Pregnancy 24/7 cohort study, MVPA was measured by thigh-worn activPAL3 for 7 consecutive days (24 hours/day) during each trimester of pregnancy in participants from the University of Iowa, University of Pittsburgh, and West Virginia University. A custom R package analyzed 30s epochs to determine MVPA based on MET values. Rural Urban Commuting Area (RUCA) code 4 or higher was categorized as rural. A mixed effects model was used to analyze the association between rural status and MVPA (min/day) across trimester controlling for education, income, study site, marital status, parity, race, and ethnicity. Trimester was treated as an ordinal variable because of the ease of interpretation and fit (AIC) of the models using ordinal and categorical trimester variable. RESULTS: There were 397 participants (321 urban, 76 rural) with 1041 visits in total. Rural pregnant women had 28.0% less MVPA per day (adjusted mean: 11.6 min/day) than urban women (16.1 min/day, p = 0.01) during the first trimester. Urban participants experienced a significant reduction of 2.5 min/day in MVPA each trimester (p < 0.01), while rural women experienced a 0.6 min/day reduction each trimester, significantly less than urban women (p = 0.017; Figure 1). CONCLUSION: Rural women had lower MVPA in the first trimester. They had less reductions in MVPA across pregnancy than urban women when controlling for socioeconomic status or demographic variables. Further research is needed to elucidate the causes of these differences. Interventions may need to be specifically tailored to rural pregnant women, especially during or before the first trimester.NIH: 5R01HL153095