Preconception to postpartum accelerometry-based 24-hour movement behaviors: a prospective cohort study

TL;DR

This study tracks physical activity, sedentary behavior, and sleep patterns in women from before pregnancy through postpartum to understand how these behaviors change and affect health.

Contribution

The study provides longitudinal accelerometry data on movement behaviors across preconception, pregnancy, and postpartum phases, highlighting weekday-weekend differences.

Findings

Moderate- and vigorous-intensity physical activity decreased during pregnancy and remained low postpartum.

Light-intensity physical activity increased postpartum and could help reduce sedentary behavior.

Sleep duration declined postpartum, especially on weekdays, suggesting a need for targeted interventions.

Abstract

Changes in movement behaviors – physical activity (PA), sedentary behavior, and sleep patterns – across preconception, pregnancy, and postpartum are associated with maternal and child health but remain understudied. Longitudinal accelerometer-measured data, including weekday-weekend differences, are lacking. Understanding these patterns is essential for developing targeted interventions that account for lifestyle variations. We investigated longitudinal changes in PA, sedentary behavior, and sleep patterns throughout preconception, pregnancy, and postpartum using prospectively collected accelerometry data.

In a Singapore prospective preconception cohort, women aged 18–45 wore an accelerometer on their non-dominant wrist for seven days during preconception (within one year of planned conception), mid-pregnancy (24–28 weeks), and 12-month postpartum. Valid data required measurements at all three or at least two consecutive timepoints (preconception-pregnancy or pregnancy-postpartum). Changes in PA (vigorous-, moderate-, and light-intensity), sedentary behavior, and sleep were analyzed using generalized estimating equations.

Among 139 women (mean age: 30.8 years), most were under/normal weight (61.9%), Chinese (83.5%), had undergraduate education (59.0%), were employed (88.5%), and nulliparous (65.5%). Moderate- and vigorous-intensity PA decreased from preconception to mid-pregnancy, with vigorous-intensity PA remaining low postpartum, while moderate-intensity PA rebounded (daily mean [95% confidence interval] vigorous: 4.1 [2.8–5.4)], 1.7 [0–4.2], and 1.8 [0–5.0] min/day; moderate: 88.2 [82.8–93.5], 68.7 [58.6–78.7], and 90.2 [77.7–102.7] min/day, respectively). Light-intensity PA remained consistent from preconception to mid-pregnancy but increased postpartum (301.5 [289.6–313.5], 298.3 [273.1–323.5], and 340.1 [305.9–374.5] min/day, respectively). Sedentary behavior rose mid-pregnancy but decreased postpartum (618.2 [603.4–633.1], 639.6 [607.6–671.5], and 597.1 [553.5–640.7] min/day, respectively). Sleep duration remained stable from preconception to mid-pregnancy until postpartum, when it decreased (428.9 [420.6–437.3], 432.2 [412.2–452.1], and 408.4 [387.2–429.6] min/day, respectively). Moderate-/vigorous-intensity PA showed no weekday/weekend differences (daily percentage range, moderate: 4.7–6.6%; vigorous: 0.1–0.3%). Women engaged in less light-intensity PA on weekdays during mid-pregnancy and postpartum (weekdays: 20.5–23.2% versus weekends: 21.3–24.8%). Weekends showed lower sedentary behavior (weekdays: 42.5–45.4% versus weekends: 38.5–42.1%) and longer sleep duration (weekdays: 27.8–29.3% versus weekends: 29.8–32.0%) across all timepoints.

Sustained moderate- and vigorous-intensity PA from preconception through postpartum should be promoted, particularly vigorous-intensity PA recovery postpartum. Light-intensity PA, which increased postpartum, could be leveraged to reduce sedentary behavior, especially on weekdays. Given postpartum sleep decline, strategies to support maternal sleep, particularly on weekdays, are needed.

ClinicalTrials.gov, NCT03531658 (registered May 22, 2018).

The online version contains supplementary material available at 10.1186/s12889-025-26034-4.

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