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.
Effect of Prenatal Dance on PE Risk
Background– Preeclampsia (PE) described:
• Complex disorder of pregnancy & downstream CVD• BP > 140/90 after 20 weeks, with proteinuria• Characterized by endothelial dysfunction, affecting the
placenta• Causes include infection and metabolic disorder of
pregnancy, affecting placental function• Genetic predisposition • Immune, cardiovascular & metabolic dysfunction• Responsible for 15-40% of preterm birth (PTB: <37
weeks), low birth weight (LBW: <5.5 lbs) and - likely - adverse fetal programming (e.g. autism, CVD)
Effect of Prenatal Dance on PE Risk
BackgroundFrom Mor, G., Trophoblast as Immune Regulators in Immunology of Pregnancy, Chapter 19, 2006
0
100
200
300
400
500
600
1st 2nd 3rd
Trimester (normal pregnancy)
Concentration (ng/ml) *except Leptin
(pg/ml)
G-CSF (pg/ml)IL-8 (pg/ml)MCP-1 (pg/ml)VEGF (pg/ml)EGF (pg/ml)Leptin (ng/ml)
Effect of Prenatal Dance on PE Risk
Background– Evidence for a beneficial effect of PA
• Lombardi, 1999 (military study)• Sorenson, 2003 (PA & risk of PE)• Saftlas, 2004 (leisure activity)• Rudra, 2005 (RPE & prepregnancy PA)
– Methods: largely recall of varying modalities– Difficulties
• Standardization• Translation for public health enhancement
Effect of Prenatal Dance on PE Risk
Purpose of This Project– To determine rates of 1) PE, and
2) PTB & LBW, in a community prenatal dance program versus the larger pregnant community.
Secondary Purpose– To determine if a community
prenatal dance program that is standardized, quality controlled, and culturally sensitive can reproduce the finding of reduced risk for PE consistent with other exercise studies.
Effect of Prenatal Dance on PE Risk Method
– Retrospective– Control Group
• PE Control Group: 9,949 women delivering at a major U.S. teaching hospital in 2004-2005
• PTB & LBW Control Group: 4,053 subset of community residents who delivered at the hospital 2004-2005
– Experimental Group 119 women…• Self-selecting Subgroup: 88 program compliant women• High-risk, assigned Subgroup: 31 women in a controlled environment
– Outcome Measures • PE • PTB & LBW
Effect of Prenatal Dance on PE Risk Design
– Community-Based Prenatal Dance program• Standardized, proprietary program • In existence for 30 years• Excellent compliance record among diverse
groups • Able to easily track progress and compliance• Allows us to account for group support• Reduces standardization & translational issues
Effect of Prenatal Dance on PE Risk Design
– Program Components• Centering floorwork (neutral
posture, slow breathing, TrA activation)
• Graham/Hawkins, Feldenkrais, Alexander, Ideokinesis, Belly Dance, Pilates & Yoga
• Relaxation Response (as per Benson)• Strength work based on needs of prenatal
posture• Special birth preparation exercises• Aerobic Dancing 20-30 minutes 2 X/week• Opportunity for socialization and support
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.
PE Rate - Dance vs. Control
1.68
7.85
0
1
2
3
4
5
6
7
8
9
Dance Control
%
Effect of Prenatal Dance on PE Risk
Power Table
Number of pre-eclampsia cases 11 14 20 25 31
Critical value 2/9 3/11 5/15 7/18 10/21
2-tail p-value .065 .057 .041 .043 .071
Power against:
2:1 odds .23 .26 .30 .37 .53
3:1 odds .46 .52 .62 .73 .87
4:1 odds .62 .70 .80 .89 .97
Effect of Prenatal Dance on PE RiskPTB - Dance vs. Control
5.04
12.5
0
2
4
6
8
10
12
14
Dance Control
%
Notes: 6 PTB infants, none with LBW or belonging to PE mothers.
Effect of Prenatal Dance on PE Risk
LBW - Dance vs. Controls
0.84
11.1
0
2
4
6
8
10
12
Dance Control
%
Effect of Prenatal Dance on PE RiskFig. 4. PA Group2 Gestational Age
0
2
4
6
8
10
12
14
16
number of women
35 weeks36 weeks37 weeks38 weeks39 weeks40 weeks41 weeks42 weeks43 weeks
Fig. 5. PA Group2 Birth Weight - lbs
0
1
2
3
4
5
6
7
8
9
10
0 5 10 15 20 25 30 35 40
participant number
lbs
Fig. 3. PA group Birth Weight - lbs
0
1
2
3
4
5
6
7
8
9
10
0 20 40 60 80 100
participant number
lbs
Fig. 2. PA group Gestational age
0
5
10
15
20
25
30
number of women
35 weeks36 weeks37 weeks38 weeks39 weeks40 weeks41 weeks42 weeks
Effect of Prenatal Dance on PE Risk
Conclusions– Findings support the hypothesis that a standardized
community-based prenatal dance program results in
low rates of 1) PE and 2) PTB & LBW. – Participating in such a program may help dance
professionals, serious amateurs, and general population participants remain healthy in this critical period, thereby promoting long-term health.
Effect of Prenatal Dance on PE Risk
The “Take-Home” Messages – There may be an ideal physical activity form for a
healthy pregnancy, birth and recovery: Group Dance with intentional choreography that maximizes benefits.
– Efficacious Prenatal Dance forms are untapped resources for our discipline…both as a benefit for our artists and as a way to engage the public in meaningful dance experiences within the community.
Our research team
Ann Cowlin, MA, Yale University Department of Athletics, New Haven, Connecticut, USA. Movement Specialist. Consultant, School of Medicine. <[email protected]>
Robyn Brancato Ovozek, CNM, MA; Obstetrics, Brookdale Hospital, Brooklyn, New York, USA. Certified Nurse Midwife.
Gil Mor, MD, PhD, Yale University School of Medicine, New Haven, Connecticut,
USA. Director, Reproductive Immunology Unit, Department of Obstetrics, Gynecology and Reproductive Sciences.
Daniel Zelterman, PhD, Yale University School of Medicine, New Haven, Connecticut, USA. Professor of Biostatistics, Department of Epidemiology and Public Health.
Brian Karsif, MD, MPH, Yale University School of Medicine, New Haven, Connecticut, USA. Assistant Clinical Professor, Department of Obstetrics, Gynecology and Reproductive Sciences. Coordinator, Maternal/Child Health, Connecticut State Medical Society and Dept. of Public Health.
Peggy DeZinno, RN, BSN, Yale-New Haven Hospital, New Haven, Connecticut, USA. Coordinator, WELL/A Mother’s Place at YNHH.
Thank you for your attention.References 1
1. Clapp, JF 3rd. (2002). Exercising Through Your Pregnancy. Addicus Books. 2. Dempsey, J. C., Butler, C. L., Sorensen, T. K., Lee, I. M., Thompson, M. L., & Miller, R. S. et al. (2004). A case-
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4. Ning, Y., Williams, M. A., Butler, C. L., Muy-Rivera, M., Frederick, I. O., & Sorensen, T. K. (2005). Maternal recreational physical activity is associated with plasma leptin concentrations in early pregnancy. Human Reproduction (Oxford, England), 20(2), 382-389.
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6. Saftlas, A. F., Logsden-Sackett, N., Wang, W., Woolson, R., & Bracken, M. B. (2004). Work, leisure-time physical activity, and risk of preeclampsia and gestational hypertension. American Journal of Epidemiology, 160(8), 758-765.
7. Lombardi, W., Wilson, S., & Peniston, P. B. (1999). Wellness intervention with pregnant soldiers. Military Medicine, 164(1), 22-29.
8. Rudra CB, Williams MA, Lee IM, Miller RS, Sorensen TK.(2005). Perceived exertion during prepregnancy physical activity and preeclampsia risk. Medicine & Science in Sports & Exercise, 37(11), 1836-41.
9. Mor, G. (2006). Trophoblast as Immune Regulator, Immunology of Pregnancy, ch. 19. 10. Parnell, M. M., Holst, D. P., & Kaye, D. M. (2005). Augmentation of endothelial function following exercise
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Thank you for your attention.References 2
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Unpublished dissertation, Case Western Reserve University, Cleveland, OH.
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