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In 2002, the American College of Obstetricians and Gynecologists revised their 1994 guidelines to recommend that pregnant women without medical or obstetric complications follow exercise guidelines for nonpregnant women. In spite of these guidelines, the optimal dose of recreational physical activity (i.e., total volume of energy expenditure, and specific frequency, duration and intensity) for a pregnant woman remains to be determined. Identification of this dose has been hampered by the complexity of assessing recreational physical activity in general, and particularly during pregnancy, a demanding period characterized by changing physiology. Therefore, we reviewed the measurement methods in the epidemiologic studies that examined the association between recreational physical activity and two specific pregnancy outcomes of primary public health importance, birthweight and length of gestation. From a review of the medical literature, we identified 20 published journal articles between 1966 and 2005. Study designs, participants, and physical activity assessment measures varied widely across studies. The majority of these studies did not consistently assess type, frequency, intensity, and duration of activity and did not measure these variables during each trimester of pregnancy. Because the effect of recreational physical activity on birth outcomes is likely to be modest, measurement must be highly accurate to minimize the possibility that an effect will not be observed because of measurement error. Recommendations are made for the future assessment of recreational physical activity in epidemiologic studies of these major birth outcomes. [ABSTRACT FROM AUTHOR]

To compare the characteristics of and baseline factors associated with prevalent and incident urinary incontinence in a diverse cohort of midlife women, the authors analyzed the baseline and first five annual follow-up visits of the Study of Women's Health Across the Nation (SWAN), 1995-2001. From responses to annual questionnaires, the authors defined prevalent incontinence as at least monthly incontinence reported at baseline and incident incontinence as at least monthly incontinence first reported over follow-up. They used multiple logistic regression for their comparison. The mean age of their cohort at baseline was 45.8 (standard deviation: 2.7) years. Prevalent incontinence was 46.7%, and the average incidence was 11.1% per year. Most women reported stress, but a higher proportion developed urge incontinence (15.9% vs. 7.6% at baseline). African Americans (29.5%) and Hispanics (27.5%) had the lowest prevalence of incontinence; African Americans (11.6%) and Caucasians (13.4%) had the highest average annual incidence. Parity, diabetes, fibroids, and poor social support were associated with prevalent incontinence, while high body mass index, high symptom sensitivity, and poor health were associated with incident incontinence. In midlife women, incident incontinence is mild with different characteristics and baseline risk factors; overweight women have a higher risk of developing incontinence. [ABSTRACT FROM AUTHOR]

Objective: To describe severity of emotional and physical symptoms in a large diverse sample; to examine demographic, health status, and behavioral correlates of symptom severity; and to describe use of medications and alternative remedies for premenstrual symptoms.Methods: A total of 1194 women, ages 21-45, selected from members of a large northern California health maintenance organization, completed daily ratings of symptom severity for two menstrual cycles. An empirically derived algorithm defined symptom severity groups as minimal (n = 186), moderate (n = 801), severe (n = 151), or premenstrual dysphoric disorder (n = 56). Symptom severity as a continuous variable was defined by the two-cycle mean symptom ratings in the luteal phase. Demographic, health status, and behavioral factors and use of treatments for premenstrual symptoms were assessed by self-report.Results: Luteal phase symptom-specific ratings were generally significantly greater in the premenstrual dysphoric disorder group than in the other groups (P <.001). Symptom severity score increased with each comorbidity and decreased with each year of age. Symptom severity was also inversely associated with oral contraceptive use (emotional symptoms) and better perceived health (physical symptoms). Hispanics reported greater severity of symptoms, and Asians less, relative to whites. Use of herbal and nutritional supplements for premenstrual symptoms steadily increased from 10.8% in the minimal group to 30.4% in the premenstrual dysphoric disorder group (P <.01).Conclusion: The degree of premenstrual symptom severity varies in the population, is relatively constant within each woman over two consecutive cycles, particularly for emotional symptoms, and is influenced by age, race/ethnicity, and health status. [ABSTRACT FROM AUTHOR]

Purpose: To examine differences in activity patterns across employment and occupational classifications., Design: Cross-sectional., Setting: A 2005-2006 Coronary Artery Risk Development in Young Adults (CARDIA) study., Sample: Participants with valid accelerometry data (n = 2068)., Measures: Uniaxial accelerometry data (ActiGraph 7164), accumulated during waking hours, were summarized as mean activity counts (counts/min) and time spent (min/d) in long-bout sedentary (≥30 minutes, SED ≥30 ), short-bout sedentary (<30 minutes, SED <30 ), light physical activity (LPA), short-bout moderate-to-vigorous physical activity (<10 minutes, MVPA <10 ), and long-bout MVPA (≥10 minutes, MVPA ≥10 ) using Freedson cut-points. Employment status was self-reported as full time, part time, unemployed, keeping house, or raising children. Self-reported job duties were categorized into 23 major groups using the 2010 Standard Occupational Classification., Analysis: Omnibus differences were analyzed using adjusted analysis of covariance and repeated after stratification by race (black/white) and sex (female/male)., Results: SED ≥30 , SED <30 , LPA, and MVPA <10 differed significantly by employment and occupational categories ( P ≤ .05), while MVPA ≥10 did not ( P ≥ .50). SED ≥30 , SED <30 , and LPA differed by occupational classification in men, women, blacks, and whites ( P < .05). Mean activity counts, MVPA <10 , and MVPA ≥10 were significantly different across occupational classifications in whites ( P ≤ .05), but not in blacks ( P > .05). Significant differences in mean activity counts and MVPA <10 across occupational classifications were found in males ( P ≤ .001), but not in females ( P > .05)., Conclusion: Time within activity intensity categories differs across employment and occupational classifications and by race and sex.

Objective: To estimate whether menopause transition stage is independently associated with the development of incontinence symptoms., Methods: We conducted a longitudinal analysis, using discrete proportional hazards models, of women who were continent at baseline in the Study of Women's Health Across the Nation (SWAN), a multicenter, multiracial, multiethnic prospective cohort study of community-dwelling midlife women transitioning through menopause. At baseline and each of the six annual visits, SWAN elicited frequency and type of incontinence in a self- administered questionnaire and classified menopausal stage from menstrual bleeding patterns., Results: Compared with premenopause, being in the early perimenopause (incidence 17.8 per 100 woman years) made it 1.34 times and in the late perimenopause (incidence 14.5 per 100 woman years) made it 1.52 times more likely for women to develop monthly or more frequent incontinence. In contrast, women in postmenopause (incidence 8.2 per 100 woman years) were approximately one half as likely to develop this degree of incontinence. This pattern of association across the menopausal transition was similar for stress and urge incontinence. However, menopausal stage was not associated with developing more frequent incontinence (leaking several times per week or more). Worsening anxiety symptoms, a high baseline body mass index, weight gain, and new onset diabetes were associated with developing more frequent incontinence., Conclusion: Menopausal transition stage was associated with developing monthly or more frequent but not weekly or more frequent incontinence, suggesting that only infrequent incontinence symptoms were attributable to the perimenopause. Because modifiable factors such as anxiety, weight gain, and diabetes were associated with developing more frequent incontinence, determining whether healthy life changes and treating medical problems can prevent incontinence is a priority., Level of Evidence: II.

Objective: To evaluate whether the menopausal transition is associated with worsening of urinary incontinence symptoms over 6 years in midlife women., Methods: We analyzed data from 2,415 women who reported monthly or more incontinence in self-administered questionnaires at baseline and during the first six annual follow-up visits (1995-2002) of the prospective cohort Study of Women's Health Across the Nation. We defined worsening as a reported increase and improving as a reported decrease in frequency of incontinence between annual visits. We classified the menopausal status of women not taking hormone therapy annually from reported menstrual bleeding patterns and hormone therapy use by interviewer questionnaire. We used generalized estimating equations methodology to evaluate factors associated with improving and worsening incontinence from year to year., Results: Over 6 years, 14.7% of incontinent women reported worsening, 32.4% reported improvement, and 52.9% reported no change in the frequency of incontinence symptoms. Compared with premenopause, perimenopause and postmenopause were not associated with worsening incontinence; for example, early perimenopause was associated with improvement (odds ratio [OR] 1.19; 95% confidence interval [CI] 1.06-1.35) and postmenopause reduced odds of worsening (OR 0.80; 95% CI 0.66-0.95). Meanwhile, each pound of weight gain increased odds of worsening (OR 1.04; 95% CI 1.03-1.05) and reduced odds of improving (OR 0.97; 95% CI 0.96-0.98) incontinence., Conclusion: In midlife incontinent women, worsening of incontinence symptoms was not attributable to the menopausal transition. Modifiable factors such as weight gain account for worsening of incontinence during this life stage.