Exercise and Pregnancy: Beliefs of Medical Practitioners in South Africa

Introduction

Antenatal behaviors determine pregnancy outcomes, and thoughtful and well-informed health decisions eliminate some risks, decrease the likelihood of complications and improve mothers’-to-be quality of life. As of now, there is convincing evidence that proactive antenatal behavior should encompass reasonable exercise as the latter provides various health benefits. The idea, however, needs promotion, and one of the ways of spreading knowledge is through medical professionals.

In their study, Watson, Oddie, and Constantinou examined South African medical practitioners’ knowledge, convictions, and attitudes towards exercise and pregnancy to further evaluate their potential role in promoting the active lifestyle among their pregnant patients. The researchers conducted a survey that showed that despite the prevalence of positive attitudes towards exercise in pregnant women, there is a discrepancy between the MPs’ beliefs and medical recommendations.

Research problem

The authors clearly stated the problem of medical professionals’ awareness of the implications of a particular lifestyle during pregnancy, namely, regular exercise. The problem is practically important as MPs, be it general practitioners or obstetric gynecologists, often serve as a source of knowledge. Thus, it is fair to assume that they have a certain influence over their patients’ decisions. At that, it is crucial that they promote healthy lifestyles and are convincing in explaining their benefits.

In their study, Watson et al. aimed at providing insights into the awareness of health benefits among South African MPs and the congruence of their beliefs with recommendations. It was reasoned that MPs should be encouraging exercise in patients with uncomplicated pregnancies as an indispensable part of prenatal assistance. The authors put forward a hypothesis that South African MPs are cognizant of various advantages of exercise during pregnancy and there’s a particular alignment between an MP’s positive attitudes if such are present, and their medical advice.

Literature review

The literature review encompassed a wide array of studies conducted in the US, Europe, and South Africa. However, not all the references are recent as less than half of the studies mentioned have been carried out in the last six years. What raises doubts is the use of a South African national health survey dated 2004, for it was used by the authors to give a perspective about the current situation with obesity in SA. Another peculiarity of the literature review is its unequivocal support of exercise during pregnancy, in which physical activity is seen as inarguably beneficial and healthy. However, there are known risks of exercise even in women with uncomplicated pregnancies. The authors have not mentioned the studies proving the existence of the said dangers to balance out the review.

Design and procedures

For their study, Watson et al. conducted a cross-sectional descriptive survey among a group of South African medical practitioners. The authors elaborated a questionnaire with a total of 33 items, including yes-no, Likert-type scale, and open-ended questions. There were no preliminary studies; the research was a full-scale project from the start. Watson et al. did not refer to their study as a replica; however, they acknowledged the existence of similar studies in other countries. They mentioned a research piece by Leiferman, Gutilla, Paulson, and Pivarnik (2012), conducted in Colorado, US. The methodology of the two studies has a resemblance; however, the American researchers elaborated more questions and generated a greater outreach (p. 350). Watson et al. sent the questionnaire via the Internet to 1,520 Obstetricians/ Gynaecologists and General Practitioners across South Africa and handed it out to 100 Obstetricians/ Gynaecologists in Gauteng. The sampling was non-randomized as MPs in the public sector were not included in the study because of time limitations and the lack of access to federal healthcare facilities. The response rate was low as only 96 MPs decided to fill in the questionnaire.

As for the data processing, the main variables were the number of MPs that participated in the study and the share of the participants that picked a specific variant. The knowledge among the MPs was the operationalized variable of the study and defined as the percentage of the participants that were aware of the benefits of exercise during pregnancy and promoted such a choice. The authors calculated descriptive statistics and frequency tables for each question and used chi-squared tests to investigate if the age, focus of practice, and work experience impacted the responses. Watson et al. processed the data via Statistica version 11, with statistical significance at p < 0.05.

Data analysis and presentation

In general, findings supported the hypothesis and purpose of the study, for the data analysis showed that the overwhelming majority of health practitioners (92%) firmly believed that moderate workout implementation is advantageous. Three-thirds of them deemed active lifestyle promotion an essential element of prenatal assistance and their advice on adopting such a lifestyle was impactful. However, there has appeared to be a lack of knowledge on some benefits of exercise, e.g., not all the MPs knew that exercise helps combat incontinence in pregnant women. Authors also found that only one-fifth routinely prescribed exercise or offered individualized workout programs. Thus, it is fair to conclude that there’s a discrepancy between the MPs’ beliefs and practical recommendations.

The researchers clearly defined the study’s limitations and gave reasons as to why the results may be not precisely representative of the situation in SA. First, the response rate was rather low, and there might have been selective bias. i.e., the MPs initially conscious of the benefits and exercise were more likely to respond. Furthermore, the study targeted the MPs in the private sector which may not be reflective of the commonly held beliefs among the South African MPs on the whole. Lastly, the authors admitted that the convenience sampling design they used might not have been the most reliable option.

Conclusions and implications

The findings have only shed light on the beliefs and promotion practices among a small share of South African MPs, which did not match the study’s greater purpose. However, the authors emphasized that it was the first study of that kind in SA and its findings may be of use for health professionals and encourage them to change their prenatal care routines. The authors also claimed that their study has the potential to give a start to further research and outlined suggestions and recommendations. For instance, future research should target broader groups of participants and include those in the public healthcare sector. There is also a need for qualitative research to establish barriers and facilitators in disseminating clinical knowledge.

Overall, the study was conducted on a problem that is practically important in South Africa as well as on a global scale. Despite the presence of similar attempts to provide insights into MPs’ attitudes towards exercise during pregnancy and compliance with guidelines, the research by Watson et al. is unique for SA. In my opinion, the study’s weak points, especially inconsiderably low response rate and insufficient outreach, seem to be outweighing its strengths. The conclusions do not appear to be representative of the health care system in SA. However, the questionnaire is well-structured and comprehensive and may be further used on greater samples of participants. I also consider the authors’ recommendations on future research feasible and a way to overcome the study’s under investigation limitations. All in all, Watson et al. started a much-needed dialogue on maternal health and the benefits of exercise which may help raise awareness among South African MPs.

References

Leiferman, J., Gutilla, M., Paulson, J., & Pivarnik, J. (2012). Antenatal physical activity counseling among healthcare providers. Open Journal of Obstetrics and Gynecology, 2, 346–355.

Watson, E. D., Oddie, B., & Constantinou, D. (2015). Exercise during pregnancy: knowledge and beliefs of medical practitioners in South Africa: a survey study. BMC pregnancy and childbirth, 15(1), 245.

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