Study on the Correlation Between Physical Activity During Pregnancy and Delivery Mode in Nulliparous Patients：A prospective cohort study

Study on the Correlation Between Physical Activity During Pregnancy and Delivery Mode in Nulliparous Patients：A prospective cohort study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Study on the Correlation Between Physical Activity During Pregnancy and Delivery Mode in Nulliparous Patients：A prospective cohort study Shu-Qun Ren, Xiao-Ming Zhang, Qian Zhao, Lei-E Li This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4929053/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract BACKGROUND: Physical activity during pregnancy is a beneficial behavioral intervention aimed at enhancing pregnancy outcomes. Nevertheless, the association between prenatal physical activity and mode of delivery remains contentious. This study seeks to investigate whether physical activity during pregnancy correlates with the mode of delivery, with the ultimate objective of bolstering pregnant women's self-efficacy regarding physical activity and ameliorating pregnancy outcomes. OBJECTIVE: This study aims to test the hypothesis that physical activity during pregnancy is associated with a reduced risk of cesarean delivery. STUDY DESIGN: This prospective cohort study surveyed women with singleton pregnancies, free from contraindications to physical activity, utilizing the Chinese version of the Pregnancy Physical Activity Questionnaire. This instrument categorizes and quantifies physical activity by type and intensity. The primary outcome of interest is the mode of delivery. Univariate and multivariate binary logistic regression models were employed to ascertain the relationship between prenatal physical activity and mode of delivery. RESULTS: A total of 217 women participated in the physical activity survey during pregnancy and subsequently gave birth at our hospital. The median energy expenditure from physical activity during pregnancy was 145.70 (111.92, 181.69) MET-h·wk⁻¹. The mean age of the participants was 30.20±3.71 years. Among the 217 primiparas, 131 experienced vaginal deliveries, while 86 underwent cesarean sections. After comprehensive adjustment for covariates, the risk of cesarean delivery was found to be reduced by 60% in the group that adhered to the recommended levels of physical activity during pregnancy compared to the group that did not (OR: 0.40, 95% CI: 0.20 to 0.83, P=0.0130). CONCLUSION: Elevated levels of physical activity during pregnancy are associated with a reduced risk of cesarean delivery. Physical activity need not be confined to structured exercise programs; routine activities such as cleaning, shopping, and commuting on foot are effective means of increasing energy expenditure and achieving recommended physical activity levels. Physical Activity Pregnancy Delivery way Caesarean section Nulliparous patients Figures Figure 1 1. Introduction Medically indicated cesarean section (CS) is a vital medical procedure that ensures the safety of both mother and child, thereby enhancing maternal and neonatal outcomes. However, the surge in non-indicated CS rates has precipitated a heightened risk of postpartum hemorrhage [ 1 ] , infection [ 2 ] , increased maternal mortality [ 3 ] , pulmonary embolism [ 4 ] , and depression [ 5 , 6 ] . Furthermore, infants born via CS may encounter adverse outcomes, including elevated perinatal mortality and diminished neonatal immune function and stress response [ 7 – 9 ] . Current survey data indicate that the CS rate in China escalated from 28.8% in 2008 to 34.9% in 2014, and reached 36.7% in 2018 [ 10 ] , significantly surpassing the ideal CS rate of 5%-15% recommended by the World Health Organization (WHO) [ 11 ] . Physical activity is defined as any movement produced by skeletal muscles resulting in energy expenditure, encompassing planned and structured exercise, household chores, occupational activities, and transportation-related activities [ 12 ] . Physical activity during pregnancy has been advocated as a beneficial behavioral approach to ameliorate pregnancy outcomes, owing to its potential to mitigate the risk of pregnancy complications and adverse birth outcomes [ 13 – 16 ] . In 2020, the American College of Obstetricians and Gynecologists (ACOG) updated its guidelines on physical activity during pregnancy, recommending that, in the absence of contraindications, pregnant women should engage in moderate-intensity physical activity for 20–30 minutes daily [ 17 ] . Some studies suggest that physical activity during pregnancy is a modifiable factor associated with CS [ 18 , 19 ] . Physical activity may influence metabolic and hormonal changes, enhance uterine contractility, and improve maternal endurance, thereby indirectly affecting the labor process and mode of delivery. Nevertheless, the evidence remains insufficient and contentious. Haakstad et al. found that regular exercise during pregnancy increased the rate of vaginal delivery [ 20 ] . Morales et al. also reported similar findings [ 21 ] . Conversely, several studies have found no association between physical activity and mode of delivery [ 22 , 23 ] . Most existing studies focus on specific prenatal exercise programs, such as yoga, birthing balls, and resistance training, and their impact on delivery outcomes [ 24 – 26 ] , overlooking daily activities such as household chores, occupational tasks, and commuting. These activities, although distinct from structured exercise programs, are also moderate-intensity activities that can influence the mode of delivery. Given China's large population and the paucity of evidence from Chinese pregnant women compared to Western countries, and considering that previous studies have seldom included assessments of daily physical activities, this study aims to observe the relationship between physical activity during pregnancy and mode of delivery among Chinese primiparas. This research seeks to provide scientific evidence to reduce the CS rate and improve maternal and neonatal outcomes in China. 2. Materials and Methods 2.1Study Design and Participants This prospective cohort study was conducted by collecting data from nulliparous patients who regularly attended prenatal check-ups at the obstetrics outpatient clinic of Shenzhen Second People's Hospital between May and October 2023 and subsequently gave birth in the obstetrics ward. The women were enrolled in the prospective cohort during their mid-pregnancy (14–27 weeks) prenatal check-ups and signed an informed consent form. They were then followed up in late pregnancy (28 + 6 weeks to 32 weeks) until delivery. Inclusion criteria were: age ≥ 20 years; singleton pregnancy with no previous childbirth experience; no mental or cognitive impairments, enabling effective communication with researchers or independent completion of questionnaires; voluntary participation in the study and signing of an informed consent form; and being healthy prior to pregnancy, without conditions such as diabetes, hypertension, heart disease, or other physical defects. Exclusion criteria included adverse complications during pregnancy, such as placenta previa or threatened abortion; serious comorbidities during pregnancy, such as peripartum cardiomyopathy, liver diseases, and hematologic disorders; and a history of psychological or psychiatric illnesses [ 27 ] . Drop-out criteria included participants with logical errors in questionnaire completion and those with incomplete data affecting the analysis of study results. This study was approved by the Ethics Review Committee of Shenzhen Second People's Hospital (Ethics Approval Number: 2023-015-02PJ). 2.2Exposure The exposure variable in this study is physical activity during late pregnancy. The Pregnancy Physical Activity Questionnaire (PPAQ) was utilized to assess physical activity levels, recorded as a continuous variable. The PPAQ, originally developed by American scholars and localized into Chinese in 2012, exhibits a test-retest reliability of 0.944 and a content validity of 0.940, indicating robust reliability and validity, with a correlation with energy expenditure (r = 0.768, P < 0.001) [ 28 ] . The PPAQ categorizes physical activity by type and intensity, effectively addressing the limitations of differentiating various types of physical activity and has been extensively employed to assess physical activity levels during pregnancy. The Chinese version of the PPAQ comprises four dimensions with 31 items: 13 items for household activities, 5 items for transportation, 8 items for recreational exercise, and 5 items for occupational activities. Based on the intensity of the activity, the energy expenditure value, or metabolic equivalent (MET), is calculated. Each item includes six options, each corresponding to a different weight coefficient, multiplied by the corresponding energy expenditure value to derive the weekly energy expenditure (MET-h·wk⁻¹). According to ACOG guidelines, achieving ≥ 7.5 MET-h·wk⁻¹ per week is considered meeting the recommended physical activity level during pregnancy, while < 7.5 MET-h·wk⁻¹ is considered not meeting the recommended level [ 29 ] . 2.3Outcomes The primary outcome was the mode of delivery, categorized into vaginal delivery and cesarean section. 2.4Statistical Analysis Continuous variables were expressed as mean ± standard deviation (for normal distribution) or median (interquartile range) (for skewed distribution), and categorical variables were expressed as frequencies or percentages. One-way analysis of variance (ANOVA) (for normal distribution), Kruskal-Wallis H test (for skewed distribution), and chi-square test (for categorical variables) were used to determine significant differences among the groups in terms of physical activity during pregnancy. According to ACOG guidelines, participants with weekly metabolic equivalent ≥ 7.5 MET-h·wk⁻¹ were classified as meeting the recommended physical activity levels, while those with < 7.5 MET-h·wk⁻¹ were classified as not meeting the recommended levels. Baseline characteristics were compared between these two groups. Subsequently, univariate logistic regression was used to evaluate the association between variables and mode of delivery. Results were expressed as odds ratios (OR) and 95% confidence intervals (CI). For binary outcome variables, logistic regression models were employed. Both univariate and multivariate binary logistic regression models were constructed. Three different models were created: an unadjusted model (with no covariate adjustments), a minimally adjusted model (adjusting for sociodemographic variables only), and a fully adjusted model. Variables with variance inflation factors > 10 were excluded from the fully adjusted model. Analyses were conducted using the statistical software packages R ( http://www.R-project.org , The R Foundation) and EmpowerStats ( http://www.empowerstats.com , X&Y Solutions, Inc, Boston, MA, USA). P values < 0.05 (two-sided) were considered statistically significant. 3. Results 3.1Baseline Characteristics of Nulliparous Patients A total of 239 participants were initially enrolled in the study. Four participants were excluded due to placenta previa, an absolute contraindication to physical activity. Five participants were excluded due to hypertensive disorders of pregnancy, and two were excluded due to pregnancy-related arrhythmias. Additionally, 11 participants were excluded due to loss to follow-up or missing physical activity data during pregnancy. Ultimately, 217 participants completed the survey, resulting in a follow-up completion rate of 91.21%. Details are provided in the flowchart (Fig. 1 ). Figure 1 Description of participant inclusion and exclusion process. 3.2 Table 1 presents the baseline characteristics of primiparous women with varying levels of physical activity during pregnancy. The mean age of the participants was 30.20 ± 3.71 years. Of the 217 primiparous women, 131 (60.37%) experienced vaginal deliveries, while 86 (39.63%) underwent cesarean sections. Table 1 Baseline Data of nulliparous patients with adequate and inadequate of physical activity during pregnancy Maternal demographics Inadequate Physical activity (n = 131) Adequate Physical activity (n = 86) P value Maternal age, y 30.31 ± 3.82 30.02 ± 3.53 0.459 BMI (kg/m 2 ) 20.89 ± 2.98 21.20 ± 2.70 0.299 GA weeks at delivery (wk) 38.92 ± 1.07 39.30 ± 1.04 0.007 Weight gain, g 13.22 ± 11.17 15.47 ± 13.25 0.145 Labor Fundal Height (cm) 34.82 ± 4.81 34.94 ± 2.50 0.219 Labor Abdominal Circumference (cm) 97.42 ± 5.98 99.06 ± 6.20 0.049 Birthweight, g 3118.82 ± 376.53 3189.36 ± 409.43 0.240 Birthhight, cm 48.62 ± 4.58 49.37 ± 1.65 0.147 Birthhead, cm 33.33 ± 1.28 33.08 ± 1.22 0.197 Advanced maternal age 0.340 No 115(87.79%) 79(91.86%) Yes 16(12.21%) 7(8.14%) Educational Level 0.670 High School and Below 15(11.45%) 9(10.47%) Associate's or Bachelor's Degree 99(75.57%) 69(80.23%) Graduate Degree and Above 17(12.98%) 8(9.30%) Profession 0.585 Unemployed 22(16.79%) 12(13.95%) Corporate Employee 89(67.94%) 64(74.42%) Government Employee 20(15.27%) 10(11.63%) Average Monthly Household Income Per Capita (Yuan) 0.231 < 10000 43(32.28%) 19(22.09%) 10000 ~ 20000 53(40.46%) 40(46.51%) ≥ 20000 35(26.72%) 27(31.40%) Anticoagulant 0.370 No 119(90.84%) 81(94.19%) Yes 12(9.16%) 5(5.81%) pregnancy with Hypothyroidism 0.054 No 117(89.31%) 83(96.51%) Yes 14(10.69%) 3(3.49%) Pregnancy Complicated by COVID-19 0.131 No 10(7.63%) 12(13.95%) Yes 121(92.37%) 74(86.05%) Pregnancy Intention 0.016 Planned Pregnancy 107(81.68%) 58(67.44%) Unplanned Pregnancy 24(18.32%) 28(32.56%) Number of pregnancy 0.333 1 90(68.70%) 65(75.58%) 2 27(20.61%) 11(12.79%) ≥ 3 14(10.69%) 10(11.63%) Oxytocin 0.128 No 88(67.18%) 49(56.98%) Yes 43(32.82%) 37(32.02%) Epidural 0.179 No 12(9.16%) 13(15.12%) Yes 119(90.84%) 73(84.88%) Newborn Gender 0.547 Male 74(56.49%) 45(52.33%) Female 57(43.51%) 41(47.67%) Anemia 0.994 No 50(38.17%) 33(38.37%) Mild 39(29.77%) 26(30.23%) Moderate 42(32.06%) 27(31.40%) Table 1 : Baseline Data of nulliparous patients with adequate and inadequate of physical activity during pregnancy 3.3 Among the cohort of 217 primiparous women, those who experienced vaginal deliveries exhibited a significantly higher adherence to the recommended levels of physical activity during pregnancy compared to those who underwent cesarean sections. Additionally, they demonstrated a correspondingly lower incidence of failing to meet these recommended levels, with the observed differences achieving statistical significance (P = 0.011). In terms of activity type and intensity, women with vaginal deliveries participated more frequently in household activities, recreational exercises, occupational tasks, moderate-intensity activities, and exhibited greater overall energy expenditure than their counterparts with cesarean sections; however, these variances did not reach statistical significance (P > 0.05) (Table 2 ). Table 2 Comparison of Physical Activity Levels During Pregnancy Between Vaginal Delivery and Cesarean Section Groups (n = 217) Item Vaginal Delivery (n = 142) Cesarean Section(n = 75) X 2 / Z P Meeting recommended physical activity levels during pregnancy 6.481 0.011 Met recommended levels 77(54.2%) 21(28.0%) Did not meet recommended levels 65(45.8%) 54(72.0%) Type of activity [M(P25, P75), MET-h•wk − 1 ] Household activities 48.04(31.30, 74.03) 47.78(31.50, 71.05) −0.115 0.909 Transportation activities 6.13(0.00, 14.88) 6.13(2.19, 14.00) −0.066 0.948 Recreational exercise 5.38(1.13, 12.50) 2.63(0.88, 8.75) −1.846 0.065 Occupational activities 33.25(0.00, 73.15) 19.25(0.00, 66.50) −0.781 0.435 Occupational activities [M(P25, P75), MET-h•wk − 1 ] Sedentary activities 19.25(10.50, 21.00) 21.00(17.50, 21.00) −1.394 0.163 Low-intensity activities 68.08(35.88, 89.78) 70.88(33.08, 116.20) −1.104 0.270 Moderate-intensity activities 20.51(9.75.36.13) 14.00(5.69, 31.69) −1.736 0.083 High-intensity activities 0.00(0.00, 0.00) 0.00(0.00, 0.00) −0.820 0.412 Total energy expenditure [M(P25, P75), MET-h•wk − 1 ] 109.75(61.90, 149.00) 100.63(54.78, 153.16) −0.789 0.430 Table 2 Comparison of Physical Activity Levels During Pregnancy Between Vaginal Delivery and Cesarean Section Groups 3.4 Univariate Analysis of Mode of Delivery The univariate analysis reveals significant associations between the mode of delivery and several maternal and neonatal factors, including maternal age, gestational age at delivery, abdominal circumference at delivery, neonatal head circumference, advanced maternal age, and the number of pregnancies (P < 0.05) (Table 3 ). Table 3 Univariate analysis of delivery way Maternal demographics Statistics 95% CI P value Maternal age, y 30.20 ± 3.70 1.20(1.10, 1.31) <0.0001 BMI (kg/m 2 ) 21.01 ± 2.87 1.04(0.94, 1.15) 0.4426 GA weeks at delivery (wk) 39.07 ± 1.07 0.71(0.54, 0.92) 0.0111 Weight gain, g 14.11 ± 12.06 1.03(1.00, 1.06) 0.0657 Labor Fundal Height (cm) 34.87 ± 4.05 1.11(0.98, 1.24) 0.0892 Labor Abdominal Circumference (cm) 98.07 ± 6.11 1.06(1.01, 1.11) 0.0216 Birthweight, g 3146.77 ± 390.50 1.00(1.00, 1.00) 0.0801 Birthhight, cm 48.92 ± 3.72 1.07(0.93, 1.22) 0.3516 Birthhead, cm 33.23 ± 1.26 1.63(1.28, 2.08) <0.0001 Advanced maternal age No 194(89.40%) 1.0 Yes 23(1060%) 6.64(2.49, 17.70) 0.0002 Educational Level High School and Below 24(11.06%) 1.0 Associate's or Bachelor's Degree 168(77.42%) 0.88(0.36, 2.13) 0.7749 Graduate Degree and Above 25(11.52%) 0.78(0.24, 2.55) 0.6862 Profession Unemployed 34(15.67%) 1.0 Corporate Employee 153(70.51%) 1.00(0.46, 2.18) 1.0000 Government Employee 30(13.82%) 0.79(0.27, 2.25) 0.6529 Average Monthly Household Income Per Capita (Yuan) < 10000 62(28.57%) 1.0 10000 ~ 20000 93(42.86%) 0.98(0.49, 1.93) 0.9446 ≥ 20000 62(28.57%) 1.15(0.55, 2.40) 0.7075 Anticoagulant No 200(92.17%) 1.0 Yes 17(7.83%) 2.28(0.84, 6.19) 0.1044 pregnancy with Hypothyroidism No 200(92.17%) 1.0 Yes 17(7.83%) 0.77(0.26, 2.29) 0.6426 Pregnancy Complicated by COVID-19 No 22(10.14%) 1.0 Yes 195(89.86%) 1.15(0.45, 2.95) 0.7754 Pregnancy Intention Planned Pregnancy 165(76.04%) 1.0 Unplanned Pregnancy 52(23.96%) 0.90(0.46, 1.74) 0.7451 Number of pregnancy 1 155(71.43%) 1.0 2 38(17.51%) 2.18(1.05, 4.52) 0.0369 ≥ 3 24(11.06%) 5.38(2.15, 13.50) 0.0003 Oxytocin No 137(63.13%) 1.0 Yes 80(36.87%) 0.00(0.00, 0.00) 0.9869 Epidural No 25(11.52%) 1.0 Yes 192(88.48%) 0.00(0.00, 0.00) 0.9827 Newborn Gender Male 119(54.84%) 1.0 Female 98(45.16%) 0.79(0.45, 1.39) 0.4106 Anemia No 83(38.25%) 1.0 Mild 65(29.95%) 0.84(0.42, 1.67) 0.6261 Moderate 69(31.80%) 0.94(0.48, 1.84) 0.8613 Table 3 : Univariate analysis of delivery way 3.5Relationship Between Physical Activity and Mode of Delivery Three models were employed to assess the relationship between physical activity during pregnancy and the mode of delivery (Table 4 ). In the unadjusted model, no linear relationship between physical activity during pregnancy and the mode of delivery was observed (P = 0.3415). However, it was found that the group meeting the recommended physical activity levels had a 54% lower likelihood of cesarean delivery compared to the group not meeting the recommended levels (OR: 0.46, 95% CI: 0.25 to 0.84, P = 0.0117). Table 4 Relationship between Physical Activity and delivery way in different models Variable Non-adjusted M, P Value Adjusted MI, P Value Adjusted MII, P Value Physical Activity 1.00(0.99, 1.00)0.3415 1.00(0.99, 1.00)0.2494 1.00(0.99, 1.00)0.3326 Physical Activity Inadequate 1.0 1.0 1.0 Adequate 0.46(0.25, 0.84)0.0117 0.46(0.24, 0.86)0.0151 0.40(0.20, 0.83)0.0130 Physical Activity Trisection Low Physical Activity level 1.0 1.0 1.0 Moderate Physical Activity level 0.57(0.28, 1.15)0.1150 0.62(0.30, 1.28)0.1950 0.75(0.34, 1.65)0.4732 High Physical Activity level 0.82(0.42, 1.61)0.5632 0.73(0.36, 1.49)0.3907 0.85(0.39, 1.85)0.6846 P for trend 0.5593 0.3896 0.6958 Non-adjusted M ( Non-adjusted model): No adjustment. Adjusted MI (adjusted model I): adjustment for age, education, profession, percapita monthly household income. Adjusted MII (adjusted model II): adjustment for age, education level, occupation, average monthly family income, number of pregnancies, anemia, BMI (kg/m2), GA weeks at delivery, Labor Abdominal Circumference, Birthhead, Advanced maternal age This association persisted in Model I, where the odds ratio remained at 0.46 (95% CI: 0.24 to 0.86, P = 0.0151). In Model II, the group that met the recommended levels of physical activity exhibited a 60% lower risk of cesarean delivery compared to the group that did not meet the recommended levels (OR: 0.40, 95% CI: 0.20 to 0.83, P = 0.0130). For sensitivity analysis, physical activity during pregnancy was transformed into a categorical variable based on tertiles, and P-values for the trend test were calculated. The results indicated no statistical significance (all P < 0.05). Table 4 : Relationship between Physical Activity and delivery way in different models 4. Discussion This study analyzed data from 217 primiparous women who delivered at the Department of Obstetrics in Shenzhen Second People's Hospital. After adjusting for confounding factors, it was found that those who met the recommended levels of physical activity during pregnancy had a 60% lower risk of cesarean delivery compared to those who did not (OR: 0.40, 95% CI: 0.20 to 0.83, P = 0.0130). This suggests that physical activity during pregnancy serves as a protective factor against cesarean delivery, underscoring the importance of enhancing health education on exercise during pregnancy. Currently, there is considerable controversy regarding the relationship between physical activity during pregnancy and the mode of delivery. Our study found that women who met the recommended levels of physical activity during pregnancy had a 60% lower risk of cesarean delivery, consistent with the findings of Veisy et al. [ 30 ] . An epidemiological study by Meander et al. using data from the NorthPop study and the Swedish National Pregnancy Registry found that higher levels of physical activity were associated with a reduced risk of emergency cesarean sections and better self-reported health during pregnancy, while higher sedentary time was associated with poorer self-reported health during pregnancy [ 31 ] . A meta-analysis by Teede et al. of 117 randomized controlled trials showed that physical activity during pregnancy significantly reduced the cesarean section rate (OR = 0.85, 95% CI: 0.75, 0.95) [ 32 ] . This may be due to physical activity's benefits, including improved maximum oxygen uptake (VO2max), lower heart rate, reduced systolic and diastolic blood pressure, and enhanced cardiovascular health, which support the physical demands of vaginal delivery [ 33 – 35 ] . A cohort study from Taiwan involving 150 pregnant women found that for each unit increase in physical activity during late pregnancy, the risk of cesarean delivery decreased by 36% (OR = 0.64, 95% CI: 0.43, 0.97), while physical activity levels in early and mid-pregnancy were not associated with the cesarean section rate [ 36 ] . This may be because physical activity during pregnancy optimizes placental angiogenesis and endothelial function, reducing ischemic placental diseases such as preeclampsia. Through endothelial shear stress, it increases the expression of endothelial nitric oxide synthase (eNOS) and nitric oxide (NO) production in the placenta while reducing the production of reactive oxygen species (ROS). These changes benefit the vascular and antioxidant systems, lowering the risk of hypertensive disorders and diabetes during pregnancy, and improved placental function ensures adequate oxygen supply and acid-base balance during labor, reducing fetal distress and thus the cesarean section rate [ 37 , 38 ] . However, several studies have drawn opposite conclusions. Laura et al.'s study did not find any differences in physical activity levels during pregnancy between different modes of delivery [ 39 ] . A study from Denmark showed that increased physical activity levels in early and mid-pregnancy could reduce the risk of cesarean delivery, but increased physical activity levels in late pregnancy were not associated with cesarean delivery risk [ 40 ] . We speculate that the differences in results may be due to the different study populations. Our study focused on the Chinese population, and unlike Laura et al., our study was a prospective cohort study. The scope of physical activity assessment also differed, as the aforementioned studies were limited to specific forms of exercise such as yoga and Pilates, whereas our study included all possible physical activities, including household chores, occupational activities, and commuting. Previous research has shown that the cesarean section rate has a U-shaped relationship with adverse perinatal outcomes, where an increase in the cesarean section rate within a certain range is associated with increased risks of poor maternal and neonatal outcomes, such as postpartum hemorrhage, amniotic fluid embolism, and reduced neonatal immune function [ 41 , 42 ] . For nearly 30 years, China's cesarean section rate has remained high, topping the list of Asian countries [ 43 ] . In our study, the cesarean section rate was 39.63%, significantly higher than the ideal cesarean section rate of 5%-15% recommended by the World Health Organization (WHO). The persistently high cesarean section rate has become an urgent global public health issue that needs to be addressed. Our findings suggest that physical activity during pregnancy is an important determinant of the mode of delivery, and promoting physical activity during pregnancy could be adopted as a simple and cost-effective intervention to reduce the cesarean section rate. Healthcare providers should develop physical activity plans for pregnant women, guide them in safe types and frequencies of physical activity, and regularly assess and discuss these activities during prenatal check-ups. Implementing these measures will help increase the vaginal delivery rate, reduce maternal and neonatal complications, and lessen the healthcare economic burden. This study has several strengths. First, the assessment of physical activity during pregnancy covered the daily activities of pregnant women, not limited to specific forms of exercise. Second, the study included only primiparous women, which helped avoid confounding factors and better reflect the relationship between physical activity during pregnancy and mode of delivery. Healthcare providers should guide pregnant women in engaging in appropriate and correct physical activities to promote maternal and neonatal health. However, this study also has some limitations. First, as an observational study, it is inevitably subject to confounding factors, despite our rigorous adjustments. Second, the data were collected from only one hospital, and the sample size was relatively small. Therefore, future studies should involve multicenter and larger sample sizes. Given these limitations, conducting higher-level clinical studies in more diverse populations is necessary to validate our findings. 5. Conclusion This study concluded that pregnant women who met the recommended levels of physical activity had a 60% lower risk of cesarean delivery compared to those who did not meet the recommendations. Our findings suggest that everyday activities, such as cleaning, shopping, and walking to and from work, are effective ways to increase energy expenditure and help achieve the recommended levels of physical activity. By incorporating household chores and other daily activities into the scope of physical activity, pregnant women can more easily adopt a healthy lifestyle without overly relying on structured exercise programs. This diversified approach to physical activity not only helps maintain physical vitality but also reduces stress during pregnancy and improves overall quality of life. Future research can further explore the quantitative relationship between different types and intensities of physical activity and delivery outcomes, especially for mothers with pregnancy complications. Additionally, studies could investigate the use of wearable devices to accurately monitor the intensity and patterns of physical activity in pregnant women. Declarations Ethics approval and consent to participate This study has obtained approval from the Ethics Committee of the Second People’s Hospital of Shenzhen (Approval No: 202301502PJ) and the protocol was registered with ClinicalTrials.gov (registration number: ChiCTR2300078381, registration date: December 7, 2023). This study was conducted in accordance with the principles of the Declaration of Helsinki. The participants provided their written informed consent to participate in this study. Consent for publication Not Applicable. Availability of data and materials The datasets generated during and/or analyzed during the current study are not publicly available, but are available from the corresponding author on reasonable request. Competing interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Funding This study was not funded. Authors’ contributions Shu-Qun Ren: Formal analysis, Methodology, Writing– original draft, Writing – review & editing. Xiao-Ming Zhang: Writing – review & editing. Liyin Luo: Investigation, Writing – review & editing. Qian Zhao: Resources, Validation, Writing – review & editing. Lei-E Li: Funding acquisition, Methodology, Resources, Writing – review & editing. Acknowledgments We would like to express our sincere gratitude to Dr Linlin Jiang for their valuable guidance and assistance with study design and content. We would also like to acknowledge the financial support provided by Shenzhen Second People’s Hospital for this study. Their contributions were essential to the successful completion of this research project. References Massoth C, Helmer P, Pecks U, et al. [Postpartum Hemorrhage][J]. Anasthesiol Intensivmed Notfallmed Schmerzther. 2023;58(10):583–97. Li P, Li Y, Zhang Y, et al. Incidence, temporal trends and risk factors of puerperal infection in Mainland China: a meta-analysis of epidemiological studies from recent decade (2010–2020)[J]. BMC Pregnancy Childbirth. 2023;23(1):815. Liu CN, Yu FB, Xu YZ, et al. Prevalence and risk factors of severe postpartum hemorrhage: a retrospective cohort study[J]. BMC Pregnancy Childbirth. 2021;21(1):332. Sun J, Shi J, Guo X, et al. Postpartum pulmonary embolism after cesarean section[J]. Asian J Surg. 2024;47(1):598–9. Zhao XH, Zhang ZH. Risk factors for postpartum depression: An evidence-based systematic review of systematic reviews and meta-analyses[J]. Asian J Psychiatr. 2020;53:102353. Papadopoulou SK, Pavlidou E, Dakanalis A et al. Postpartum Depression Is Associated with Maternal Sociodemographic and Anthropometric Characteristics, Perinatal Outcomes, Breastfeeding Practices, and Mediterranean Diet Adherence[J]. Nutrients, 2023,15(17). Sandall J, Tribe RM, Avery L, et al. Short-term and long-term effects of caesarean section on the health of women and children[J]. Lancet. 2018;392(10155):1349–57. Mueller NT, Differding MK, Sun H, et al. Maternal Bacterial Engraftment in Multiple Body Sites of Cesarean Section Born Neonates after Vaginal Seeding-a Randomized Controlled Trial[J]. mBio. 2023;14(3):e49123. Gurdeniz G, Ernst M, Rago D et al. Neonatal metabolome of caesarean section and risk of childhood asthma[J]. Eur Respir J, 2022,59(6). Li HT, Hellerstein S, Zhou YB, et al. Trends in Cesarean Delivery Rates in China, 2008–2018[J]. JAMA. 2020;323(1):89–91. Appropriate technology for birth[J]. Lancet. 1985;2(8452):436–7. Bull FC, Al-Ansari SS, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour[J]. Br J Sports Med. 2020;54(24):1451–62. Barakat R, Pelaez M, Cordero Y, et al. Exercise during pregnancy protects against hypertension and macrosomia: randomized clinical trial[J]. Am J Obstet Gynecol. 2016;214(5):641–9. Ribeiro MM, Andrade A, Nunes I. Physical exercise in pregnancy: benefits, risks and prescription[J]. J Perinat Med. 2022;50(1):4–17. Davenport MH, Ruchat SM, Poitras VJ, et al. Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: a systematic review and meta-analysis[J]. Br J Sports Med. 2018;52(21):1367–75. Weng YM, Green J, Yu JJ, et al. The relationship between incidence of cesarean section and physical activity during pregnancy among pregnant women of diverse age groups: Dose–response meta-analysis[J]. Int J Gynecol Obstet. 2024;164(2):504–15. Physical Activity and Exercise During Pregnancy and the Postpartum Period. ACOG Committee Opinion, Number 804[J]. Obstet Gynecol. 2020;135(4):e178–88. Weng SS, Lee YH, Chien LY. Physical activity, sitting time and sleep duration before and during pregnancy and pregnancy outcomes: A prospective panel study[J]. J Clin Nurs. 2020;29(17–18):3494–505. Babili MG, Amerikanou C, Papada E, et al. The effect of prenatal maternal physical activity and lifestyle in perinatal outcome: results from a Greek study[J]. Eur J Public Health. 2020;30(2):328–32. Haakstad L, Bo K. The marathon of labour-Does regular exercise training influence course of labour and mode of delivery? Secondary analysis from a randomized controlled trial[J]. Eur J Obstet Gynecol Reprod Biol. 2020;251:8–13. Morales-Suarez-Varela M, Marcos PB, Peraita-Costa I, et al. [Sedentary lifestyle in pregnancy: Effects on the mother and the newborn][J]. Semergen. 2023;49(7):102025. Watkins VY, O'Donnell CM, Perez M, et al. The impact of physical activity during pregnancy on labor and delivery[J]. Am J Obstet Gynecol. 2021;225(4):431–7. Charkamyani F, Hosseinkhani A, Neisani SL, et al. Reducing the Adverse Maternal and Fetal Outcomes in IVF Women by Exercise Interventions During Pregnancy[J]. Res Q Exerc Sport. 2019;90(4):589–99. Wadhwa Y, Alghadir AH, Iqbal ZA. Effect of Antenatal Exercises, Including Yoga, on the Course of Labor, Delivery and Pregnancy: A Retrospective Study[J]. Int J Environ Res Public Health, 2020,17(15). Fournier D, Feeney G, Mathieu ME. Outcomes of Exercise Training Following the Use of a Birthing Ball During Pregnancy and Delivery[J]. J Strength Cond Res. 2017;31(7):1941–7. Bolanthakodi C, Raghunandan C, Saili A, et al. Prenatal Yoga: Effects on Alleviation of Labor Pain and Birth Outcomes[J]. J Altern Complement Med. 2018;24(12):1181–8. Mottola MF, Davenport MH, Ruchat SM, et al. 2019 Canadian guideline for physical activity throughout pregnancy[J]. Br J Sports Med. 2018;52(21):1339–46. 张燕 赵岳, 董胜雯 等. 中文版孕期身体活动问卷信效度评定[J] 中华护理杂志. 2013;48(09):825–7. Chasan-Taber L, Park S, Marcotte RT, et al. Update and Novel Validation of a Pregnancy Physical Activity Questionnaire[J]. Am J Epidemiol. 2023;192(10):1743–53. Veisy A, Mohammad ACS, Hematzadeh S, et al. Effect of prenatal aerobic exercises on maternal and neonatal outcomes: A systematic review and meta-analysis[J]. Nurs Open. 2021;8(5):2301–17. Meander L, Lindqvist M, Mogren I, et al. Physical activity and sedentary time during pregnancy and associations with maternal and fetal health outcomes: an epidemiological study[J]. BMC Pregnancy Childbirth. 2021;21(1):166. Teede HJ, Bailey C, Moran LJ, et al. Association of Antenatal Diet and Physical Activity-Based Interventions With Gestational Weight Gain and Pregnancy Outcomes: A Systematic Review and Meta-analysis[J]. JAMA Intern Med. 2022;182(2):106–14. Altinayak SO, Ozkan H. The effects of conventional, warm and cold acupressure on the pain perceptions and beta-endorphin plasma levels of primiparous women in labor: A randomized controlled trial[J]. Explore (NY). 2022;18(5):545–50. Perales M, Santos-Lozano A, Ruiz JR, et al. Benefits of aerobic or resistance training during pregnancy on maternal health and perinatal outcomes: A systematic review[J]. Early Hum Dev. 2016;94:43–8. Seneviratne SN, Jiang Y, Derraik J, et al. Effects of antenatal exercise in overweight and obese pregnant women on maternal and perinatal outcomes: a randomised controlled trial[J]. BJOG. 2016;123(4):588–97. Yang Y, Li W, Yang W, et al. Physical activity and sleep duration during pregnancy have interactive effects on caesarean delivery: a population-based cohort study in Tianjin, China[J]. BMC Pregnancy Childbirth. 2021;21(1):406. Ramirez-Velez R, Bustamante J, Czerniczyniec A, et al. Effect of exercise training on eNOS expression, NO production and oxygen metabolism in human placenta[J]. PLoS ONE. 2013;8(11):e80225. Owe KM, Nystad W, Stigum H, et al. Exercise during pregnancy and risk of cesarean delivery in nulliparous women: a large population-based cohort study[J]. Am J Obstet Gynecol. 2016;215(6):791. Baena-Garcia L, de la Flor-Alemany M, Coll-Risco I, et al. A concurrent prenatal exercise program increases neonatal and placental weight and shortens labor: The GESTAFIT project[J]. Scand J Med Sci Sports. 2023;33(4):465–74. Schulpis KH, Vlachos GD, Papakonstantinou ED, et al. Maternal-neonatal amino acid blood levels in relation to the mode of delivery[J]. Acta Obstet Gynecol Scand. 2009;88(1):71–6. Wang E. Requests for cesarean deliveries: The politics of labor pain and pain relief in Shanghai, China[J]. Soc Sci Med. 2017;173:1–8. Fawcus S, Moodley J. Postpartum haemorrhage associated with caesarean section and caesarean hysterectomy[J]. Best Pract Res Clin Obstet Gynaecol. 2013;27(2):233–49. Lumbiganon P, Laopaiboon M, Gulmezoglu AM, et al. Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007-08[J]. Lancet. 2010;375(9713):490–9. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4929053","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":355691787,"identity":"dee62991-2a15-4a4a-b252-4523a23ac4aa","order_by":0,"name":"Shu-Qun Ren","email":"","orcid":"","institution":"The First Affiliated Hospital of Shenzhen University","correspondingAuthor":false,"prefix":"","firstName":"Shu-Qun","middleName":"","lastName":"Ren","suffix":""},{"id":355691788,"identity":"807f3f3b-3bfd-4944-b672-ce9a3ed55423","order_by":1,"name":"Xiao-Ming Zhang","email":"","orcid":"","institution":"the People’s Hospital of Baoan Shenzhen","correspondingAuthor":false,"prefix":"","firstName":"Xiao-Ming","middleName":"","lastName":"Zhang","suffix":""},{"id":355691789,"identity":"77dc749c-4e77-45f2-ad04-4a103e2f6585","order_by":2,"name":"Qian Zhao","email":"","orcid":"","institution":"The First Affiliated Hospital of Shenzhen University","correspondingAuthor":false,"prefix":"","firstName":"Qian","middleName":"","lastName":"Zhao","suffix":""},{"id":355691790,"identity":"76a042ef-6988-4055-8bd5-9b44724890ae","order_by":3,"name":"Lei-E Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyUlEQVRIiWNgGAWjYBAC+8PMhx98qLCRY2NvIFbP8bY0wxln0oz5eA4Qq+XMGQNp3rbDifMkEojUwTgjx8BwBltaYpvk4403GGpsoglqYZZIK3jwgcfGuE06rdiC4VhabgMhLWwSyRsMZ0ikybZJ55hJMDYcJqyFRyLBQJrH4DBjm+QZIrVI8BwBakk4rNgmwUOkFgN2UCAfSDNm4wH6JYEYvxgwA6Py4z8bOfn2wxtvfKixIawFRTvRUYOkhVQdo2AUjIJRMDIAAJgvP1MRfGpXAAAAAElFTkSuQmCC","orcid":"","institution":"The First Affiliated Hospital of Shenzhen University","correspondingAuthor":true,"prefix":"","firstName":"Lei-E","middleName":"","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2024-08-17 09:26:52","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4929053/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4929053/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":66643412,"identity":"f2f8e7d9-c26b-41df-adff-917c4d144193","added_by":"auto","created_at":"2024-10-15 06:35:10","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":33536,"visible":true,"origin":"","legend":"\u003cp\u003eDescription of the study cohort.\u003c/p\u003e","description":"","filename":"floatimage141.png","url":"https://assets-eu.researchsquare.com/files/rs-4929053/v1/5adcf962583def581d4f2727.png"},{"id":85239306,"identity":"2ccb2f1e-623a-4d26-a69e-7004c6071bb4","added_by":"auto","created_at":"2025-06-23 18:01:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1128607,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4929053/v1/10b46220-496c-47ce-85fc-ed0a5d024370.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Study on the Correlation Between Physical Activity During Pregnancy and Delivery Mode in Nulliparous Patients：A prospective cohort study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eMedically indicated cesarean section (CS) is a vital medical procedure that ensures the safety of both mother and child, thereby enhancing maternal and neonatal outcomes. However, the surge in non-indicated CS rates has precipitated a heightened risk of postpartum hemorrhage\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e, infection\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e, increased maternal mortality\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e, pulmonary embolism\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e, and depression\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Furthermore, infants born via CS may encounter adverse outcomes, including elevated perinatal mortality and diminished neonatal immune function and stress response\u003csup\u003e[\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Current survey data indicate that the CS rate in China escalated from 28.8% in 2008 to 34.9% in 2014, and reached 36.7% in 2018\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e, significantly surpassing the ideal CS rate of 5%-15% recommended by the World Health Organization (WHO)\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003ePhysical activity is defined as any movement produced by skeletal muscles resulting in energy expenditure, encompassing planned and structured exercise, household chores, occupational activities, and transportation-related activities\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. Physical activity during pregnancy has been advocated as a beneficial behavioral approach to ameliorate pregnancy outcomes, owing to its potential to mitigate the risk of pregnancy complications and adverse birth outcomes\u003csup\u003e[\u003cspan additionalcitationids=\"CR14 CR15\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. In 2020, the American College of Obstetricians and Gynecologists (ACOG) updated its guidelines on physical activity during pregnancy, recommending that, in the absence of contraindications, pregnant women should engage in moderate-intensity physical activity for 20\u0026ndash;30 minutes daily\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSome studies suggest that physical activity during pregnancy is a modifiable factor associated with CS\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. Physical activity may influence metabolic and hormonal changes, enhance uterine contractility, and improve maternal endurance, thereby indirectly affecting the labor process and mode of delivery. Nevertheless, the evidence remains insufficient and contentious. Haakstad et al. found that regular exercise during pregnancy increased the rate of vaginal delivery\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. Morales et al. also reported similar findings\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. Conversely, several studies have found no association between physical activity and mode of delivery\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. Most existing studies focus on specific prenatal exercise programs, such as yoga, birthing balls, and resistance training, and their impact on delivery outcomes\u003csup\u003e[\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e, overlooking daily activities such as household chores, occupational tasks, and commuting. These activities, although distinct from structured exercise programs, are also moderate-intensity activities that can influence the mode of delivery.\u003c/p\u003e \u003cp\u003eGiven China's large population and the paucity of evidence from Chinese pregnant women compared to Western countries, and considering that previous studies have seldom included assessments of daily physical activities, this study aims to observe the relationship between physical activity during pregnancy and mode of delivery among Chinese primiparas. This research seeks to provide scientific evidence to reduce the CS rate and improve maternal and neonatal outcomes in China.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1Study Design and Participants\u003c/h2\u003e \u003cp\u003eThis prospective cohort study was conducted by collecting data from nulliparous patients who regularly attended prenatal check-ups at the obstetrics outpatient clinic of Shenzhen Second People's Hospital between May and October 2023 and subsequently gave birth in the obstetrics ward. The women were enrolled in the prospective cohort during their mid-pregnancy (14\u0026ndash;27 weeks) prenatal check-ups and signed an informed consent form. They were then followed up in late pregnancy (28\u003csup\u003e+\u0026thinsp;6\u003c/sup\u003e weeks to 32 weeks) until delivery. Inclusion criteria were: age\u0026thinsp;\u0026ge;\u0026thinsp;20 years; singleton pregnancy with no previous childbirth experience; no mental or cognitive impairments, enabling effective communication with researchers or independent completion of questionnaires; voluntary participation in the study and signing of an informed consent form; and being healthy prior to pregnancy, without conditions such as diabetes, hypertension, heart disease, or other physical defects. Exclusion criteria included adverse complications during pregnancy, such as placenta previa or threatened abortion; serious comorbidities during pregnancy, such as peripartum cardiomyopathy, liver diseases, and hematologic disorders; and a history of psychological or psychiatric illnesses\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e. Drop-out criteria included participants with logical errors in questionnaire completion and those with incomplete data affecting the analysis of study results. This study was approved by the Ethics Review Committee of Shenzhen Second People's Hospital (Ethics Approval Number: 2023-015-02PJ).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2Exposure\u003c/h2\u003e \u003cp\u003eThe exposure variable in this study is physical activity during late pregnancy. The Pregnancy Physical Activity Questionnaire (PPAQ) was utilized to assess physical activity levels, recorded as a continuous variable. The PPAQ, originally developed by American scholars and localized into Chinese in 2012, exhibits a test-retest reliability of 0.944 and a content validity of 0.940, indicating robust reliability and validity, with a correlation with energy expenditure (r\u0026thinsp;=\u0026thinsp;0.768, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e. The PPAQ categorizes physical activity by type and intensity, effectively addressing the limitations of differentiating various types of physical activity and has been extensively employed to assess physical activity levels during pregnancy. The Chinese version of the PPAQ comprises four dimensions with 31 items: 13 items for household activities, 5 items for transportation, 8 items for recreational exercise, and 5 items for occupational activities. Based on the intensity of the activity, the energy expenditure value, or metabolic equivalent (MET), is calculated. Each item includes six options, each corresponding to a different weight coefficient, multiplied by the corresponding energy expenditure value to derive the weekly energy expenditure (MET-h\u0026middot;wk⁻\u0026sup1;). According to ACOG guidelines, achieving\u0026thinsp;\u0026ge;\u0026thinsp;7.5 MET-h\u0026middot;wk⁻\u0026sup1; per week is considered meeting the recommended physical activity level during pregnancy, while\u0026thinsp;\u0026lt;\u0026thinsp;7.5 MET-h\u0026middot;wk⁻\u0026sup1; is considered not meeting the recommended level\u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3Outcomes\u003c/h2\u003e \u003cp\u003eThe primary outcome was the mode of delivery, categorized into vaginal delivery and cesarean section.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4Statistical Analysis\u003c/h2\u003e \u003cp\u003eContinuous variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (for normal distribution) or median (interquartile range) (for skewed distribution), and categorical variables were expressed as frequencies or percentages. One-way analysis of variance (ANOVA) (for normal distribution), Kruskal-Wallis H test (for skewed distribution), and chi-square test (for categorical variables) were used to determine significant differences among the groups in terms of physical activity during pregnancy. According to ACOG guidelines, participants with weekly metabolic equivalent\u0026thinsp;\u0026ge;\u0026thinsp;7.5 MET-h\u0026middot;wk⁻\u0026sup1; were classified as meeting the recommended physical activity levels, while those with \u0026lt;\u0026thinsp;7.5 MET-h\u0026middot;wk⁻\u0026sup1; were classified as not meeting the recommended levels. Baseline characteristics were compared between these two groups.\u003c/p\u003e \u003cp\u003eSubsequently, univariate logistic regression was used to evaluate the association between variables and mode of delivery. Results were expressed as odds ratios (OR) and 95% confidence intervals (CI). For binary outcome variables, logistic regression models were employed. Both univariate and multivariate binary logistic regression models were constructed. Three different models were created: an unadjusted model (with no covariate adjustments), a minimally adjusted model (adjusting for sociodemographic variables only), and a fully adjusted model. Variables with variance inflation factors\u0026thinsp;\u0026gt;\u0026thinsp;10 were excluded from the fully adjusted model.\u003c/p\u003e \u003cp\u003eAnalyses were conducted using the statistical software packages R (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.R-project.org\u003c/span\u003e\u003cspan address=\"http://www.R-project.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e, The R Foundation) and EmpowerStats (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.empowerstats.com\u003c/span\u003e\u003cspan address=\"http://www.empowerstats.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e, X\u0026amp;Y Solutions, Inc, Boston, MA, USA). P values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 (two-sided) were considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.1Baseline Characteristics of Nulliparous Patients\u003c/h2\u003e \u003cp\u003eA total of 239 participants were initially enrolled in the study. Four participants were excluded due to placenta previa, an absolute contraindication to physical activity. Five participants were excluded due to hypertensive disorders of pregnancy, and two were excluded due to pregnancy-related arrhythmias. Additionally, 11 participants were excluded due to loss to follow-up or missing physical activity data during pregnancy. Ultimately, 217 participants completed the survey, resulting in a follow-up completion rate of 91.21%. Details are provided in the flowchart (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/strong\u003e \u003cp\u003eDescription of participant inclusion and exclusion process.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e3.2 Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the baseline characteristics of primiparous women with varying levels of physical activity during pregnancy. The mean age of the participants was 30.20\u0026thinsp;\u0026plusmn;\u0026thinsp;3.71 years. Of the 217 primiparous women, 131 (60.37%) experienced vaginal deliveries, while 86 (39.63%) underwent cesarean sections.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e Baseline Data of nulliparous patients with adequate and inadequate of physical activity during pregnancy\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaternal demographics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInadequate Physical activity (n\u0026thinsp;=\u0026thinsp;131)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdequate Physical activity\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;86)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaternal age, y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.31\u0026thinsp;\u0026plusmn;\u0026thinsp;3.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.02\u0026thinsp;\u0026plusmn;\u0026thinsp;3.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.459\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.89\u0026thinsp;\u0026plusmn;\u0026thinsp;2.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.20\u0026thinsp;\u0026plusmn;\u0026thinsp;2.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.299\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGA weeks at delivery (wk)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39.30\u0026thinsp;\u0026plusmn;\u0026thinsp;1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight gain, g\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.22\u0026thinsp;\u0026plusmn;\u0026thinsp;11.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.47\u0026thinsp;\u0026plusmn;\u0026thinsp;13.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.145\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLabor Fundal Height (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34.82\u0026thinsp;\u0026plusmn;\u0026thinsp;4.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.94\u0026thinsp;\u0026plusmn;\u0026thinsp;2.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.219\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLabor Abdominal Circumference (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e97.42\u0026thinsp;\u0026plusmn;\u0026thinsp;5.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99.06\u0026thinsp;\u0026plusmn;\u0026thinsp;6.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirthweight, g\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3118.82\u0026thinsp;\u0026plusmn;\u0026thinsp;376.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3189.36\u0026thinsp;\u0026plusmn;\u0026thinsp;409.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.240\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirthhight, cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48.62\u0026thinsp;\u0026plusmn;\u0026thinsp;4.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49.37\u0026thinsp;\u0026plusmn;\u0026thinsp;1.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.147\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirthhead, cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.08\u0026thinsp;\u0026plusmn;\u0026thinsp;1.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.197\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdvanced maternal age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.340\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e115(87.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79(91.86%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16(12.21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(8.14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.670\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh School and Below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15(11.45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(10.47%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssociate's or Bachelor's Degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e99(75.57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69(80.23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGraduate Degree and Above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17(12.98%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(9.30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfession\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.585\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22(16.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12(13.95%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCorporate Employee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e89(67.94%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64(74.42%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGovernment Employee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20(15.27%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(11.63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage Monthly Household Income Per Capita (Yuan)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.231\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;10000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43(32.28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19(22.09%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10000\u0026thinsp;~\u0026thinsp;20000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53(40.46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40(46.51%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;20000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35(26.72%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27(31.40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnticoagulant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.370\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e119(90.84%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81(94.19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12(9.16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(5.81%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epregnancy with Hypothyroidism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.054\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e117(89.31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83(96.51%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14(10.69%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(3.49%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePregnancy Complicated by COVID-19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.131\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(7.63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12(13.95%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e121(92.37%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74(86.05%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePregnancy Intention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlanned Pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e107(81.68%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58(67.44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnplanned Pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24(18.32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28(32.56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.333\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90(68.70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65(75.58%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27(20.61%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(12.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14(10.69%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(11.63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOxytocin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.128\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88(67.18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49(56.98%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43(32.82%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37(32.02%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEpidural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.179\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12(9.16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13(15.12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e119(90.84%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73(84.88%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNewborn Gender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.547\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e74(56.49%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45(52.33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57(43.51%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41(47.67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.994\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50(38.17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33(38.37%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39(29.77%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26(30.23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42(32.06%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27(31.40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e: Baseline Data of nulliparous patients with adequate and inadequate of physical activity during pregnancy\u003c/p\u003e \u003cp\u003e3.3 Among the cohort of 217 primiparous women, those who experienced vaginal deliveries exhibited a significantly higher adherence to the recommended levels of physical activity during pregnancy compared to those who underwent cesarean sections. Additionally, they demonstrated a correspondingly lower incidence of failing to meet these recommended levels, with the observed differences achieving statistical significance (P\u0026thinsp;=\u0026thinsp;0.011). In terms of activity type and intensity, women with vaginal deliveries participated more frequently in household activities, recreational exercises, occupational tasks, moderate-intensity activities, and exhibited greater overall energy expenditure than their counterparts with cesarean sections; however, these variances did not reach statistical significance (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Physical Activity Levels During Pregnancy Between Vaginal Delivery and Cesarean Section Groups (n\u0026thinsp;=\u0026thinsp;217)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVaginal Delivery\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;142)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCesarean Section(n\u0026thinsp;=\u0026thinsp;75)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003cem\u003e/ Z\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeeting recommended physical activity levels during pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.481\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMet recommended levels\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e77(54.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21(28.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDid not meet recommended levels\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e65(45.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54(72.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eType of activity [M(P25, P75), MET-h\u0026bull;wk\u0026thinsp;\u003csup\u003e\u0026minus;\u0026thinsp;1\u003c/sup\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold activities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48.04(31.30, 74.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47.78(31.50, 71.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.909\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransportation activities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.13(0.00, 14.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.13(2.19, 14.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.948\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecreational exercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5.38(1.13, 12.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.63(0.88, 8.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;1.846\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.065\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccupational activities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33.25(0.00, 73.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.25(0.00, 66.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.781\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.435\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOccupational activities [M(P25, P75), MET-h\u0026bull;wk\u0026thinsp;\u003csup\u003e\u0026minus;\u0026thinsp;1\u003c/sup\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSedentary activities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19.25(10.50, 21.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21.00(17.50, 21.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;1.394\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.163\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow-intensity activities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e68.08(35.88, 89.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70.88(33.08, 116.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;1.104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.270\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate-intensity activities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20.51(9.75.36.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.00(5.69, 31.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;1.736\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.083\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh-intensity activities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.00(0.00, 0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.00(0.00, 0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.820\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.412\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal energy expenditure\u003c/p\u003e \u003cp\u003e[M(P25, P75), MET-h\u0026bull;wk\u0026thinsp;\u003csup\u003e\u0026minus;\u0026thinsp;1\u003c/sup\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e109.75(61.90, 149.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100.63(54.78, 153.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.789\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.430\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003c/strong\u003e \u003cp\u003eComparison of Physical Activity Levels During Pregnancy Between Vaginal Delivery and Cesarean Section Groups\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Univariate Analysis of Mode of Delivery\u003c/h2\u003e \u003cp\u003eThe univariate analysis reveals significant associations between the mode of delivery and several maternal and neonatal factors, including maternal age, gestational age at delivery, abdominal circumference at delivery, neonatal head circumference, advanced maternal age, and the number of pregnancies (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e Univariate analysis of delivery way\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaternal demographics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStatistics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaternal age, y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.20\u0026thinsp;\u0026plusmn;\u0026thinsp;3.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.20(1.10, 1.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.01\u0026thinsp;\u0026plusmn;\u0026thinsp;2.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.04(0.94, 1.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.4426\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGA weeks at delivery (wk)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39.07\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.71(0.54, 0.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0111\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight gain, g\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.11\u0026thinsp;\u0026plusmn;\u0026thinsp;12.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.03(1.00, 1.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0657\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLabor Fundal Height (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34.87\u0026thinsp;\u0026plusmn;\u0026thinsp;4.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.11(0.98, 1.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0892\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLabor Abdominal Circumference (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e98.07\u0026thinsp;\u0026plusmn;\u0026thinsp;6.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.06(1.01, 1.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0216\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirthweight, g\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3146.77\u0026thinsp;\u0026plusmn;\u0026thinsp;390.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00(1.00, 1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0801\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirthhight, cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48.92\u0026thinsp;\u0026plusmn;\u0026thinsp;3.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.07(0.93, 1.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.3516\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirthhead, cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33.23\u0026thinsp;\u0026plusmn;\u0026thinsp;1.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.63(1.28, 2.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdvanced maternal age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e194(89.40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23(1060%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.64(2.49, 17.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh School and Below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24(11.06%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssociate's or Bachelor's Degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e168(77.42%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.88(0.36, 2.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.7749\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGraduate Degree and Above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25(11.52%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.78(0.24, 2.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.6862\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfession\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34(15.67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCorporate Employee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e153(70.51%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00(0.46, 2.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGovernment Employee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30(13.82%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.79(0.27, 2.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.6529\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage Monthly Household Income Per Capita (Yuan)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;10000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62(28.57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10000\u0026thinsp;~\u0026thinsp;20000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e93(42.86%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.98(0.49, 1.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.9446\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;20000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62(28.57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.15(0.55, 2.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.7075\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnticoagulant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e200(92.17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17(7.83%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.28(0.84, 6.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.1044\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epregnancy with Hypothyroidism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e200(92.17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17(7.83%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.77(0.26, 2.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.6426\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePregnancy Complicated by COVID-19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22(10.14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e195(89.86%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.15(0.45, 2.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.7754\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePregnancy Intention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlanned Pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e165(76.04%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnplanned Pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52(23.96%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.90(0.46, 1.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.7451\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e155(71.43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38(17.51%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.18(1.05, 4.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0369\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24(11.06%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.38(2.15, 13.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOxytocin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e137(63.13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80(36.87%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.00(0.00, 0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.9869\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEpidural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25(11.52%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e192(88.48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.00(0.00, 0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.9827\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNewborn Gender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e119(54.84%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e98(45.16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.79(0.45, 1.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.4106\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83(38.25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65(29.95%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.84(0.42, 1.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.6261\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69(31.80%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.94(0.48, 1.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.8613\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e : Univariate analysis of delivery way\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.5Relationship Between Physical Activity and Mode of Delivery\u003c/h2\u003e \u003cp\u003eThree models were employed to assess the relationship between physical activity during pregnancy and the mode of delivery (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). In the unadjusted model, no linear relationship between physical activity during pregnancy and the mode of delivery was observed (P\u0026thinsp;=\u0026thinsp;0.3415). However, it was found that the group meeting the recommended physical activity levels had a 54% lower likelihood of cesarean delivery compared to the group not meeting the recommended levels (OR: 0.46, 95% CI: 0.25 to 0.84, P\u0026thinsp;=\u0026thinsp;0.0117).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e Relationship between Physical Activity and delivery way in different models\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-adjusted M, \u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdjusted MI, \u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAdjusted MII, \u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical Activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00(0.99, 1.00)0.3415\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.00(0.99, 1.00)0.2494\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00(0.99, 1.00)0.3326\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical Activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInadequate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdequate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.46(0.25, 0.84)0.0117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.46(0.24, 0.86)0.0151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.40(0.20, 0.83)0.0130\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical Activity Trisection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow Physical Activity level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate Physical Activity level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.57(0.28, 1.15)0.1150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.62(0.30, 1.28)0.1950\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.75(0.34, 1.65)0.4732\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh Physical Activity level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.82(0.42, 1.61)0.5632\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.73(0.36, 1.49)0.3907\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.85(0.39, 1.85)0.6846\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e for trend\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.5593\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.3896\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6958\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eNon-adjusted M ( Non-adjusted model): No adjustment.\u003c/p\u003e \u003cp\u003eAdjusted MI (adjusted model I): adjustment for age, education, profession, percapita monthly household income.\u003c/p\u003e \u003cp\u003eAdjusted MII (adjusted model II): adjustment for age, education level, occupation, average monthly family income, number of pregnancies, anemia, BMI (kg/m2), GA weeks at delivery, Labor Abdominal Circumference, Birthhead, Advanced maternal age\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThis association persisted in Model I, where the odds ratio remained at 0.46 (95% CI: 0.24 to 0.86, P\u0026thinsp;=\u0026thinsp;0.0151). In Model II, the group that met the recommended levels of physical activity exhibited a 60% lower risk of cesarean delivery compared to the group that did not meet the recommended levels (OR: 0.40, 95% CI: 0.20 to 0.83, P\u0026thinsp;=\u0026thinsp;0.0130).\u003c/p\u003e \u003cp\u003eFor sensitivity analysis, physical activity during pregnancy was transformed into a categorical variable based on tertiles, and P-values for the trend test were calculated. The results indicated no statistical significance (all P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e: Relationship between Physical Activity and delivery way in different models\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study analyzed data from 217 primiparous women who delivered at the Department of Obstetrics in Shenzhen Second People's Hospital. After adjusting for confounding factors, it was found that those who met the recommended levels of physical activity during pregnancy had a 60% lower risk of cesarean delivery compared to those who did not (OR: 0.40, 95% CI: 0.20 to 0.83, P = 0.0130). This suggests that physical activity during pregnancy serves as a protective factor against cesarean delivery, underscoring the importance of enhancing health education on exercise during pregnancy.\u003c/p\u003e \u003cp\u003eCurrently, there is considerable controversy regarding the relationship between physical activity during pregnancy and the mode of delivery. Our study found that women who met the recommended levels of physical activity during pregnancy had a 60% lower risk of cesarean delivery, consistent with the findings of Veisy et al. \u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e. An epidemiological study by Meander et al. using data from the NorthPop study and the Swedish National Pregnancy Registry found that higher levels of physical activity were associated with a reduced risk of emergency cesarean sections and better self-reported health during pregnancy, while higher sedentary time was associated with poorer self-reported health during pregnancy\u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e. A meta-analysis by Teede et al. of 117 randomized controlled trials showed that physical activity during pregnancy significantly reduced the cesarean section rate (OR = 0.85, 95% CI: 0.75, 0.95)\u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e. This may be due to physical activity's benefits, including improved maximum oxygen uptake (VO2max), lower heart rate, reduced systolic and diastolic blood pressure, and enhanced cardiovascular health, which support the physical demands of vaginal delivery\u003csup\u003e[\u003cspan additionalcitationids=\"CR34\" citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e–\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e. A cohort study from Taiwan involving 150 pregnant women found that for each unit increase in physical activity during late pregnancy, the risk of cesarean delivery decreased by 36% (OR = 0.64, 95% CI: 0.43, 0.97), while physical activity levels in early and mid-pregnancy were not associated with the cesarean section rate\u003csup\u003e[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/sup\u003e. This may be because physical activity during pregnancy optimizes placental angiogenesis and endothelial function, reducing ischemic placental diseases such as preeclampsia. Through endothelial shear stress, it increases the expression of endothelial nitric oxide synthase (eNOS) and nitric oxide (NO) production in the placenta while reducing the production of reactive oxygen species (ROS). These changes benefit the vascular and antioxidant systems, lowering the risk of hypertensive disorders and diabetes during pregnancy, and improved placental function ensures adequate oxygen supply and acid-base balance during labor, reducing fetal distress and thus the cesarean section rate\u003csup\u003e[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eHowever, several studies have drawn opposite conclusions. Laura et al.'s study did not find any differences in physical activity levels during pregnancy between different modes of delivery\u003csup\u003e[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]\u003c/sup\u003e. A study from Denmark showed that increased physical activity levels in early and mid-pregnancy could reduce the risk of cesarean delivery, but increased physical activity levels in late pregnancy were not associated with cesarean delivery risk\u003csup\u003e[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]\u003c/sup\u003e. We speculate that the differences in results may be due to the different study populations. Our study focused on the Chinese population, and unlike Laura et al., our study was a prospective cohort study. The scope of physical activity assessment also differed, as the aforementioned studies were limited to specific forms of exercise such as yoga and Pilates, whereas our study included all possible physical activities, including household chores, occupational activities, and commuting.\u003c/p\u003e \u003cp\u003ePrevious research has shown that the cesarean section rate has a U-shaped relationship with adverse perinatal outcomes, where an increase in the cesarean section rate within a certain range is associated with increased risks of poor maternal and neonatal outcomes, such as postpartum hemorrhage, amniotic fluid embolism, and reduced neonatal immune function\u003csup\u003e[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]\u003c/sup\u003e. For nearly 30 years, China's cesarean section rate has remained high, topping the list of Asian countries\u003csup\u003e[\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]\u003c/sup\u003e. In our study, the cesarean section rate was 39.63%, significantly higher than the ideal cesarean section rate of 5%-15% recommended by the World Health Organization (WHO). The persistently high cesarean section rate has become an urgent global public health issue that needs to be addressed. Our findings suggest that physical activity during pregnancy is an important determinant of the mode of delivery, and promoting physical activity during pregnancy could be adopted as a simple and cost-effective intervention to reduce the cesarean section rate. Healthcare providers should develop physical activity plans for pregnant women, guide them in safe types and frequencies of physical activity, and regularly assess and discuss these activities during prenatal check-ups. Implementing these measures will help increase the vaginal delivery rate, reduce maternal and neonatal complications, and lessen the healthcare economic burden.\u003c/p\u003e \u003cp\u003eThis study has several strengths. First, the assessment of physical activity during pregnancy covered the daily activities of pregnant women, not limited to specific forms of exercise. Second, the study included only primiparous women, which helped avoid confounding factors and better reflect the relationship between physical activity during pregnancy and mode of delivery. Healthcare providers should guide pregnant women in engaging in appropriate and correct physical activities to promote maternal and neonatal health.\u003c/p\u003e \u003cp\u003eHowever, this study also has some limitations. First, as an observational study, it is inevitably subject to confounding factors, despite our rigorous adjustments. Second, the data were collected from only one hospital, and the sample size was relatively small. Therefore, future studies should involve multicenter and larger sample sizes. Given these limitations, conducting higher-level clinical studies in more diverse populations is necessary to validate our findings.\u003c/p\u003e "},{"header":"5. Conclusion","content":"\u003cp\u003eThis study concluded that pregnant women who met the recommended levels of physical activity had a 60% lower risk of cesarean delivery compared to those who did not meet the recommendations. Our findings suggest that everyday activities, such as cleaning, shopping, and walking to and from work, are effective ways to increase energy expenditure and help achieve the recommended levels of physical activity. By incorporating household chores and other daily activities into the scope of physical activity, pregnant women can more easily adopt a healthy lifestyle without overly relying on structured exercise programs. This diversified approach to physical activity not only helps maintain physical vitality but also reduces stress during pregnancy and improves overall quality of life. Future research can further explore the quantitative relationship between different types and intensities of physical activity and delivery outcomes, especially for mothers with pregnancy complications. Additionally, studies could investigate the use of wearable devices to accurately monitor the intensity and patterns of physical activity in pregnant women.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has obtained approval from the Ethics Committee of the Second People\u0026rsquo;s Hospital of Shenzhen (Approval No: 202301502PJ) and the protocol was registered with ClinicalTrials.gov (registration number: ChiCTR2300078381, registration date: December 7, 2023). This study was conducted in accordance with the principles of the Declaration of Helsinki. The participants provided their written informed consent to participate in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data \u0026nbsp;and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analyzed during the current study are not publicly available, but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be\u0026nbsp;construed as a potential conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was not funded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eShu-Qun Ren: Formal analysis, Methodology, Writing\u0026ndash; original draft, Writing \u0026ndash; review \u0026amp; editing. Xiao-Ming Zhang: Writing \u0026ndash; review \u0026amp; editing. Liyin Luo: Investigation, Writing \u0026ndash; review \u0026amp; editing. Qian Zhao: Resources, Validation, Writing \u0026ndash; review \u0026amp; editing. Lei-E Li: Funding acquisition, Methodology, Resources, Writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express our sincere gratitude to \u0026nbsp; Dr Linlin Jiang for their valuable guidance and assistance with study design and content. We would also like to acknowledge the financial support provided by Shenzhen Second People\u0026rsquo;s Hospital for this study. Their contributions were essential to the successful completion of this research project.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMassoth C, Helmer P, Pecks U, et al. [Postpartum Hemorrhage][J]. Anasthesiol Intensivmed Notfallmed Schmerzther. 2023;58(10):583\u0026ndash;97.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi P, Li Y, Zhang Y, et al. Incidence, temporal trends and risk factors of puerperal infection in Mainland China: a meta-analysis of epidemiological studies from recent decade (2010\u0026ndash;2020)[J]. BMC Pregnancy Childbirth. 2023;23(1):815.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu CN, Yu FB, Xu YZ, et al. Prevalence and risk factors of severe postpartum hemorrhage: a retrospective cohort study[J]. BMC Pregnancy Childbirth. 2021;21(1):332.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSun J, Shi J, Guo X, et al. Postpartum pulmonary embolism after cesarean section[J]. Asian J Surg. 2024;47(1):598\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhao XH, Zhang ZH. Risk factors for postpartum depression: An evidence-based systematic review of systematic reviews and meta-analyses[J]. Asian J Psychiatr. 2020;53:102353.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePapadopoulou SK, Pavlidou E, Dakanalis A et al. Postpartum Depression Is Associated with Maternal Sociodemographic and Anthropometric Characteristics, Perinatal Outcomes, Breastfeeding Practices, and Mediterranean Diet Adherence[J]. Nutrients, 2023,15(17).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSandall J, Tribe RM, Avery L, et al. Short-term and long-term effects of caesarean section on the health of women and children[J]. Lancet. 2018;392(10155):1349\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMueller NT, Differding MK, Sun H, et al. Maternal Bacterial Engraftment in Multiple Body Sites of Cesarean Section Born Neonates after Vaginal Seeding-a Randomized Controlled Trial[J]. mBio. 2023;14(3):e49123.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGurdeniz G, Ernst M, Rago D et al. Neonatal metabolome of caesarean section and risk of childhood asthma[J]. Eur Respir J, 2022,59(6).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi HT, Hellerstein S, Zhou YB, et al. Trends in Cesarean Delivery Rates in China, 2008\u0026ndash;2018[J]. JAMA. 2020;323(1):89\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAppropriate technology for birth[J]. Lancet. 1985;2(8452):436\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBull FC, Al-Ansari SS, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour[J]. Br J Sports Med. 2020;54(24):1451\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarakat R, Pelaez M, Cordero Y, et al. Exercise during pregnancy protects against hypertension and macrosomia: randomized clinical trial[J]. Am J Obstet Gynecol. 2016;214(5):641\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRibeiro MM, Andrade A, Nunes I. Physical exercise in pregnancy: benefits, risks and prescription[J]. J Perinat Med. 2022;50(1):4\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDavenport MH, Ruchat SM, Poitras VJ, et al. Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: a systematic review and meta-analysis[J]. Br J Sports Med. 2018;52(21):1367\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeng YM, Green J, Yu JJ, et al. The relationship between incidence of cesarean section and physical activity during pregnancy among pregnant women of diverse age groups: Dose\u0026ndash;response meta-analysis[J]. Int J Gynecol Obstet. 2024;164(2):504\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePhysical Activity and Exercise During Pregnancy and the Postpartum Period. ACOG Committee Opinion, Number 804[J]. Obstet Gynecol. 2020;135(4):e178\u0026ndash;88.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeng SS, Lee YH, Chien LY. Physical activity, sitting time and sleep duration before and during pregnancy and pregnancy outcomes: A prospective panel study[J]. J Clin Nurs. 2020;29(17\u0026ndash;18):3494\u0026ndash;505.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBabili MG, Amerikanou C, Papada E, et al. The effect of prenatal maternal physical activity and lifestyle in perinatal outcome: results from a Greek study[J]. Eur J Public Health. 2020;30(2):328\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaakstad L, Bo K. The marathon of labour-Does regular exercise training influence course of labour and mode of delivery? Secondary analysis from a randomized controlled trial[J]. Eur J Obstet Gynecol Reprod Biol. 2020;251:8\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorales-Suarez-Varela M, Marcos PB, Peraita-Costa I, et al. [Sedentary lifestyle in pregnancy: Effects on the mother and the newborn][J]. Semergen. 2023;49(7):102025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWatkins VY, O'Donnell CM, Perez M, et al. The impact of physical activity during pregnancy on labor and delivery[J]. Am J Obstet Gynecol. 2021;225(4):431\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCharkamyani F, Hosseinkhani A, Neisani SL, et al. Reducing the Adverse Maternal and Fetal Outcomes in IVF Women by Exercise Interventions During Pregnancy[J]. Res Q Exerc Sport. 2019;90(4):589\u0026ndash;99.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWadhwa Y, Alghadir AH, Iqbal ZA. Effect of Antenatal Exercises, Including Yoga, on the Course of Labor, Delivery and Pregnancy: A Retrospective Study[J]. Int J Environ Res Public Health, 2020,17(15).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFournier D, Feeney G, Mathieu ME. Outcomes of Exercise Training Following the Use of a Birthing Ball During Pregnancy and Delivery[J]. J Strength Cond Res. 2017;31(7):1941\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBolanthakodi C, Raghunandan C, Saili A, et al. Prenatal Yoga: Effects on Alleviation of Labor Pain and Birth Outcomes[J]. J Altern Complement Med. 2018;24(12):1181\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMottola MF, Davenport MH, Ruchat SM, et al. 2019 Canadian guideline for physical activity throughout pregnancy[J]. Br J Sports Med. 2018;52(21):1339\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e张燕 赵岳, 董胜雯 等. 中文版孕期身体活动问卷信效度评定[J] 中华护理杂志. 2013;48(09):825\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChasan-Taber L, Park S, Marcotte RT, et al. Update and Novel Validation of a Pregnancy Physical Activity Questionnaire[J]. Am J Epidemiol. 2023;192(10):1743\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVeisy A, Mohammad ACS, Hematzadeh S, et al. Effect of prenatal aerobic exercises on maternal and neonatal outcomes: A systematic review and meta-analysis[J]. Nurs Open. 2021;8(5):2301\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeander L, Lindqvist M, Mogren I, et al. Physical activity and sedentary time during pregnancy and associations with maternal and fetal health outcomes: an epidemiological study[J]. BMC Pregnancy Childbirth. 2021;21(1):166.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTeede HJ, Bailey C, Moran LJ, et al. Association of Antenatal Diet and Physical Activity-Based Interventions With Gestational Weight Gain and Pregnancy Outcomes: A Systematic Review and Meta-analysis[J]. JAMA Intern Med. 2022;182(2):106\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAltinayak SO, Ozkan H. The effects of conventional, warm and cold acupressure on the pain perceptions and beta-endorphin plasma levels of primiparous women in labor: A randomized controlled trial[J]. Explore (NY). 2022;18(5):545\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePerales M, Santos-Lozano A, Ruiz JR, et al. Benefits of aerobic or resistance training during pregnancy on maternal health and perinatal outcomes: A systematic review[J]. Early Hum Dev. 2016;94:43\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSeneviratne SN, Jiang Y, Derraik J, et al. Effects of antenatal exercise in overweight and obese pregnant women on maternal and perinatal outcomes: a randomised controlled trial[J]. BJOG. 2016;123(4):588\u0026ndash;97.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang Y, Li W, Yang W, et al. Physical activity and sleep duration during pregnancy have interactive effects on caesarean delivery: a population-based cohort study in Tianjin, China[J]. BMC Pregnancy Childbirth. 2021;21(1):406.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRamirez-Velez R, Bustamante J, Czerniczyniec A, et al. Effect of exercise training on eNOS expression, NO production and oxygen metabolism in human placenta[J]. PLoS ONE. 2013;8(11):e80225.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOwe KM, Nystad W, Stigum H, et al. Exercise during pregnancy and risk of cesarean delivery in nulliparous women: a large population-based cohort study[J]. Am J Obstet Gynecol. 2016;215(6):791.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaena-Garcia L, de la Flor-Alemany M, Coll-Risco I, et al. A concurrent prenatal exercise program increases neonatal and placental weight and shortens labor: The GESTAFIT project[J]. Scand J Med Sci Sports. 2023;33(4):465\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchulpis KH, Vlachos GD, Papakonstantinou ED, et al. Maternal-neonatal amino acid blood levels in relation to the mode of delivery[J]. Acta Obstet Gynecol Scand. 2009;88(1):71\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang E. Requests for cesarean deliveries: The politics of labor pain and pain relief in Shanghai, China[J]. Soc Sci Med. 2017;173:1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFawcus S, Moodley J. Postpartum haemorrhage associated with caesarean section and caesarean hysterectomy[J]. Best Pract Res Clin Obstet Gynaecol. 2013;27(2):233\u0026ndash;49.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLumbiganon P, Laopaiboon M, Gulmezoglu AM, et al. Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007-08[J]. Lancet. 2010;375(9713):490\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Physical Activity, Pregnancy, Delivery way, Caesarean section, Nulliparous patients","lastPublishedDoi":"10.21203/rs.3.rs-4929053/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4929053/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBACKGROUND:\u003c/strong\u003e Physical activity during pregnancy is a beneficial behavioral intervention aimed at enhancing pregnancy outcomes. Nevertheless, the association between prenatal physical activity and mode of delivery remains contentious. This study seeks to investigate whether physical activity during pregnancy correlates with the mode of delivery, with the ultimate objective of bolstering pregnant women's self-efficacy regarding physical activity and ameliorating pregnancy outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOBJECTIVE:\u003c/strong\u003e This study aims to test the hypothesis that physical activity during pregnancy is associated with a reduced risk of cesarean delivery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSTUDY DESIGN:\u003c/strong\u003e This prospective cohort study surveyed women with singleton pregnancies, free from contraindications to physical activity, utilizing the Chinese version of the Pregnancy Physical Activity Questionnaire. This instrument categorizes and quantifies physical activity by type and intensity. The primary outcome of interest is the mode of delivery. Univariate and multivariate binary logistic regression models were employed to ascertain the relationship between prenatal physical activity and mode of delivery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRESULTS:\u003c/strong\u003e A total of 217 women participated in the physical activity survey during pregnancy and subsequently gave birth at our hospital. The median energy expenditure from physical activity during pregnancy was 145.70 (111.92, 181.69) MET-h·wk⁻¹. The mean age of the participants was 30.20±3.71 years. Among the 217 primiparas, 131 experienced vaginal deliveries, while 86 underwent cesarean sections. After comprehensive adjustment for covariates, the risk of cesarean delivery was found to be reduced by 60% in the group that adhered to the recommended levels of physical activity during pregnancy compared to the group that did not (OR: 0.40, 95% CI: 0.20 to 0.83, P=0.0130).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONCLUSION:\u003c/strong\u003e Elevated levels of physical activity during pregnancy are associated with a reduced risk of cesarean delivery. Physical activity need not be confined to structured exercise programs; routine activities such as cleaning, shopping, and commuting on foot are effective means of increasing energy expenditure and achieving recommended physical activity levels.\u003c/p\u003e","manuscriptTitle":"Study on the Correlation Between Physical Activity During Pregnancy and Delivery Mode in Nulliparous Patients：A prospective cohort study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-15 06:35:06","doi":"10.21203/rs.3.rs-4929053/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b0bbd124-a702-4898-a92c-6b35e6d0b2b4","owner":[],"postedDate":"October 15th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-23T17:53:28+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-15 06:35:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4929053","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4929053","identity":"rs-4929053","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}