Enhanced Neonatal Health and Neonatal Cardiac Effect Developmentally
Condition: Physical Exercise
Study type: Interventional

Summary: 
      AHA and ACSM recognize lack of exercise is a major risk factor for developing cardiovascular
      disease (CVD), and other CVD risk factors such as obesity. It is important to note that CVD
      is the sixth leading cause of death and children are more likely to be undiagnosed due to
      their age and lack of symptoms. Further, according to the CDC, over one-third of children and
      adolescents are overweight or obese and at increased risk of CVD. Although many programs for
      children aim to decrease CVD risks and obesity few, if any, programs begin the intervention
      during prenatal development. Our preliminary findings suggest that regular maternal exercise
      improves cardiovascular health (lower heart rate, increased heart rate variability),
      normalizes body fat composition, and improves nervous system and motor tone even after birth.
      Norepinephrine is essential for fetal development, influences many tissues (heart, nerve
      cells, skeletal muscle, and fat cells), and can stimulate growth factors. It is believed that
      exercise hormones, such as norepinephrine, released during maternal exercise influence these
      growth factors during development.

      The central hypothesis of this proposal is that regular maternal exercise during pregnancy
      will improve the health of offspring before and after birth as evidenced by lower resting
      heart rate, increasing heart rate variability improved neurological maturation, and decreased
      adiposity. We have three specific aims to test this hypothesis through the Enhanced Neonatal
      Health and Neonatal Cardiovascular Efficiency Developmentally (ENHANCED) by Mom project (IRB
      approved #12-002524). Aim 1 will establish the association between maternal exercise during
      pregnancy and the heart health of offspring before and after birth. Aim 2 will determine the
      relationship between modes of regular maternal exercise and neonate neurological and muscular
      maturation as this relates to health of the child after birth. Aim 3 will elucidate the
      influence of different modes of maternal exercise during pregnancy on fetal and infant body
      composition as this relates to risk of obesity and CVD disease. These studies will provide
      novel insight into how different types of maternal exercise during pregnancy influence the
      overall health of offspring. Furthermore, these findings may have significant implications on
      the public health as it may provide evidence of pregnancy as the earliest intervention for
      attenuating cardiovascular disease risk of children.
    

Detailed description: 
      Recent studies have shown alarming increases in some of the major modifiable risk factors for
      heart disease (cholesterol, blood pressure, adiposity) in young children. We have previously
      found an association between self-reported exercise during pregnancy and improved heart
      measures of the fetus and neonate. In addition, a limited number of studies in which exercise
      was self-reported have demonstrated improved heart and adipose measures in the fetus or
      neonate with effects that persist into childhood. Previous prenatal exercise intervention
      studies using a prescribed exercise regimen have demonstrated the feasibility of such an
      approach; however, these studies have focused on maternal health and pregnancy outcomes such
      as birth weight. At this point, there is a gap in our understanding as to how carefully
      controlled, regular maternal aerobic exercise programs may lead to improvements in
      cardiovascular and adiposity risk factors in utero and in neonates.

      The central hypothesis of this project is that maternal exercise during pregnancy will
      improve the health of the offspring. Specifically, the objectives of the research proposed in
      this application are to determine the effects of regular maternal exercise on heart function,
      adiposity, and neur0motor function of offspring

      The data gathered will be the first documentation, by direct measurement, of the effects of
      maternal aerobic exercise on selected heart and obesity outcomes during the prenatal and
      postnatal periods. The potential impact of the proposed research on public health education
      regarding heart disease and obesity prevention is of public import.
    

Intervention name(s): Aerobic Exercise training
Intervention type(s): Behavioral
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: women were randomly assigned to either aerobic exercise intervention or no exercise.
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention