Penelope Pekow - Academia.edu (original) (raw)

Papers by Penelope Pekow

Research paper thumbnail of Physical activity patterns during pregnancy in a diverse population of women

Participation in physical activity during pregnancy may reduce the risk of gestational diabetes m... more Participation in physical activity during pregnancy may reduce the risk of gestational diabetes mellitus and preeclampsia and help prevent excess maternal weight gain. However, studies describing patterns and correlates of activity during pregnancy are sparse. The purpose of this cross-sectional study was to describe total physical activity (household/caregiving, occupational, leisure, sports/exercise, and transportation) and correlates of total physical activity in a racially and economically diverse sample of 233 prenatal care patients. Bilingual interviewers administered three 24-hour physical activity recalls among women in the first trimester (11%), second trimester (36%), and third trimester (53%) of pregnancy. Median total energy expenditure (MET-hours/day) was similar among women in the first and second trimesters (33.4 and 33.8 MET-hours/day, respectively) and was slightly, but not statistically significantly, lower among women in the third trimester (32.6 MET-hours/day). Moderate intensity activity followed a similar pattern, being statistically significantly lower among women in the third trimester; vigorous intensity activity was low among women in each trimester of pregnancy. In terms of activity type, household/ caregiving activity was the largest contributor to both total and combined moderate and vigorous intensity energy expenditure among women in each trimester, constituting 24%-40% of total energy expenditure. Overall, total energy expenditure was highest in white non-Hispanic women and positively associated with increasing education and a history of previous live births (p < 0.01). Results from this study highlight the importance of including household/caregiving and occupational activities in addition to sports/exercise activities in the assessment of total energy expenditure during pregnancy.

Research paper thumbnail of Physical activity and gestational weight gain: a meta-analysis of intervention trials

BJOG: An International Journal of Obstetrics & Gynaecology, 2011

Objective-Hispanic women have high rates of excessive and inadequate gestational weight gain (GWG... more Objective-Hispanic women have high rates of excessive and inadequate gestational weight gain (GWG) according to Institute of Medicine (IOM) guidelines. Observational studies suggest that physical activity may be associated with GWG but have been conflicting and were largely conducted in non-Hispanic white populations. Design and Methods-We prospectively evaluated the association between physical activity and compliance with GWG guidelines, total GWG, and rate of GWG among 1,276 Hispanic participants in Proyecto Buena Salud, a cohort study in Western Massachusetts. The Pregnancy Physical Activity Questionnaire was used to assess pre, early, mid, and late pregnancy physical activity according to both intensity (i.e., sedentary, moderate, and vigorous) and type (i.e., housework/caregiving, occupational, and sports/exercise). Results-A total of 26.9% of women gained within IOM guidelines, 21.2% had inadequate GWG, and 51.9% experienced excessive GWG. Overall, we did not observe statistically significant associations between type or intensity of physical activity during pre, early, mid, and late pregnancy and inadequate or excessive GWG, total GWG, or rate of GWG. Conclusions-In this prospective cohort study of Hispanic women, after controlling for important risk factors, pregnancy physical activity did not appear to be associated with GWG.

Research paper thumbnail of Second stage of labor and intraventricular hemorrhage in early preterm infants in the vertex presentation*

Journal of Maternal-Fetal and Neonatal Medicine, 2013

To investigate the association between exposure to second stage of labor and duration of second s... more To investigate the association between exposure to second stage of labor and duration of second stage, and risk of intraventricular hemorrhage (IVH) among infants delivered <30 weeks of gestation. We conducted a retrospective cohort study among 158 singleton vertex deliveries (97 vaginal and 61 cesarean). Multivariable logistic regression was used to evaluate the risk of IVH related to second stage. Infants exposed to second stage as compared to those not exposed to second stage irrespective of their mode of delivery had increased risk of mild IVH (odds ratio [OR] 2.69; 95% confidence interval [CI] 1.15, 6.29) but not of severe IVH (OR 1.14; 95% CI 0.33, 3.84). No relation with risk of mild (OR 0.98; 95% CI 0.95, 1.01) and severe (OR 1.00; 95% CI 0.95, 1.05) IVH was observed for each 1 min increase in duration of second stage. We also observed no significant association between quartiles of duration of second stage and risk of mild (p = 0.20) and severe (p = 0.29) IVH. We did not observe any significant interaction by gestational age, chorioamnionitis, birth weight or presenting complaint on admission. The risk of mild IVH was increased in those exposed to a second stage of labor. However, no clear association was observed between duration of second stage and mild or severe IVH.

Research paper thumbnail of Using highly detailed administrative data to predict pneumonia mortality

Background: Mortality prediction models generally require clinical data or are derived from infor... more Background: Mortality prediction models generally require clinical data or are derived from information coded at discharge, limiting adjustment for presenting severity of illness in observational studies using administrative data.

Research paper thumbnail of Physical activity before and during pregnancy and duration of second stage of labor among Hispanic women

The Journal of reproductive medicine

To study a possible association between physical activity and the duration of second stage of lab... more To study a possible association between physical activity and the duration of second stage of labor among Hispanic women. We evaluated this relationship in the Latina Gestational Diabetes Mellitus Study, a prospective cohort of Hispanic obstetric patients. The Kaiser Physical Activity Survey was used to collect information on physical activity in prepregnancy, early pregnancy and mid-pregnancy. Duration of labor was abstracted from medical records. A total of 725 women with a singleton pregnancy and a spontaneous vaginal delivery were included, which yielded > 80% power to detect a clinically meaningful mean difference of 30 minutes. The mean duration of second-stage of labor was 34.3 min (SD 42.02). After adjusting for established risk factors, no significant differences in duration of labor were observed among women according to physical activity level in prepregnancy, early pregnancy, or midpregnancy. Findings confirm prior literature demonstrating the absence of an associatio...

Research paper thumbnail of Physical activity patterns during pregnancy in a diverse population of women

Participation in physical activity during pregnancy may reduce the risk of gestational diabetes m... more Participation in physical activity during pregnancy may reduce the risk of gestational diabetes mellitus and preeclampsia and help prevent excess maternal weight gain. However, studies describing patterns and correlates of activity during pregnancy are sparse. The purpose of this cross-sectional study was to describe total physical activity (household/caregiving, occupational, leisure, sports/exercise, and transportation) and correlates of total physical activity in a racially and economically diverse sample of 233 prenatal care patients. Bilingual interviewers administered three 24-hour physical activity recalls among women in the first trimester (11%), second trimester (36%), and third trimester (53%) of pregnancy. Median total energy expenditure (MET-hours/day) was similar among women in the first and second trimesters (33.4 and 33.8 MET-hours/day, respectively) and was slightly, but not statistically significantly, lower among women in the third trimester (32.6 MET-hours/day). Moderate intensity activity followed a similar pattern, being statistically significantly lower among women in the third trimester; vigorous intensity activity was low among women in each trimester of pregnancy. In terms of activity type, household/ caregiving activity was the largest contributor to both total and combined moderate and vigorous intensity energy expenditure among women in each trimester, constituting 24%-40% of total energy expenditure. Overall, total energy expenditure was highest in white non-Hispanic women and positively associated with increasing education and a history of previous live births (p < 0.01). Results from this study highlight the importance of including household/caregiving and occupational activities in addition to sports/exercise activities in the assessment of total energy expenditure during pregnancy.

Research paper thumbnail of Physical activity and gestational weight gain: a meta-analysis of intervention trials

BJOG: An International Journal of Obstetrics & Gynaecology, 2011

Objective-Hispanic women have high rates of excessive and inadequate gestational weight gain (GWG... more Objective-Hispanic women have high rates of excessive and inadequate gestational weight gain (GWG) according to Institute of Medicine (IOM) guidelines. Observational studies suggest that physical activity may be associated with GWG but have been conflicting and were largely conducted in non-Hispanic white populations. Design and Methods-We prospectively evaluated the association between physical activity and compliance with GWG guidelines, total GWG, and rate of GWG among 1,276 Hispanic participants in Proyecto Buena Salud, a cohort study in Western Massachusetts. The Pregnancy Physical Activity Questionnaire was used to assess pre, early, mid, and late pregnancy physical activity according to both intensity (i.e., sedentary, moderate, and vigorous) and type (i.e., housework/caregiving, occupational, and sports/exercise). Results-A total of 26.9% of women gained within IOM guidelines, 21.2% had inadequate GWG, and 51.9% experienced excessive GWG. Overall, we did not observe statistically significant associations between type or intensity of physical activity during pre, early, mid, and late pregnancy and inadequate or excessive GWG, total GWG, or rate of GWG. Conclusions-In this prospective cohort study of Hispanic women, after controlling for important risk factors, pregnancy physical activity did not appear to be associated with GWG.

Research paper thumbnail of Second stage of labor and intraventricular hemorrhage in early preterm infants in the vertex presentation*

Journal of Maternal-Fetal and Neonatal Medicine, 2013

To investigate the association between exposure to second stage of labor and duration of second s... more To investigate the association between exposure to second stage of labor and duration of second stage, and risk of intraventricular hemorrhage (IVH) among infants delivered <30 weeks of gestation. We conducted a retrospective cohort study among 158 singleton vertex deliveries (97 vaginal and 61 cesarean). Multivariable logistic regression was used to evaluate the risk of IVH related to second stage. Infants exposed to second stage as compared to those not exposed to second stage irrespective of their mode of delivery had increased risk of mild IVH (odds ratio [OR] 2.69; 95% confidence interval [CI] 1.15, 6.29) but not of severe IVH (OR 1.14; 95% CI 0.33, 3.84). No relation with risk of mild (OR 0.98; 95% CI 0.95, 1.01) and severe (OR 1.00; 95% CI 0.95, 1.05) IVH was observed for each 1 min increase in duration of second stage. We also observed no significant association between quartiles of duration of second stage and risk of mild (p = 0.20) and severe (p = 0.29) IVH. We did not observe any significant interaction by gestational age, chorioamnionitis, birth weight or presenting complaint on admission. The risk of mild IVH was increased in those exposed to a second stage of labor. However, no clear association was observed between duration of second stage and mild or severe IVH.

Research paper thumbnail of Using highly detailed administrative data to predict pneumonia mortality

Background: Mortality prediction models generally require clinical data or are derived from infor... more Background: Mortality prediction models generally require clinical data or are derived from information coded at discharge, limiting adjustment for presenting severity of illness in observational studies using administrative data.

Research paper thumbnail of Physical activity before and during pregnancy and duration of second stage of labor among Hispanic women

The Journal of reproductive medicine

To study a possible association between physical activity and the duration of second stage of lab... more To study a possible association between physical activity and the duration of second stage of labor among Hispanic women. We evaluated this relationship in the Latina Gestational Diabetes Mellitus Study, a prospective cohort of Hispanic obstetric patients. The Kaiser Physical Activity Survey was used to collect information on physical activity in prepregnancy, early pregnancy and mid-pregnancy. Duration of labor was abstracted from medical records. A total of 725 women with a singleton pregnancy and a spontaneous vaginal delivery were included, which yielded > 80% power to detect a clinically meaningful mean difference of 30 minutes. The mean duration of second-stage of labor was 34.3 min (SD 42.02). After adjusting for established risk factors, no significant differences in duration of labor were observed among women according to physical activity level in prepregnancy, early pregnancy, or midpregnancy. Findings confirm prior literature demonstrating the absence of an associatio...