Supplemental Material on Maternal Physical Activity and Infant Birth Size

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Supplemental Material

Maternal leisure time physical activity and infant birth size

Sylvia E Badon, Pandora L Wander, Chunfang Qiu, Raymond Miller, Michelle A Williams, Daniel A Enquobahrie

List of content

eTable 1. Characteristics of Omega participants by early pregnancy activity status

eTable 2. Ten most common leisure time physical activities reported in pre-pregnancy and early pregancy

eTable 3. Associations between pre-pregnancy and early pregnancy physical activity and measures of infant birth size by infant sex

eTable 4. Associations between pre-pregnancy physical activity and measures of infant birth size by pre-pregnancy BMI category

eTable 5. Association of pre-pregnancy leisure time physical activity with categorical measures of birthweight overall, by infant sex, and by pre-pregnancy BMI

eTable 6. Association of early pregnancy leisure time physical activity with categorical measures of birthweight overall, by infant sex, and by pre-pregnancy BMI

eTable 7. Joint effect of pre-pregnancy and early pregnancy physical activity in the association with measures of infant birth size overall, by infant sex, and by pre-pregnancy BMI

eAppendix. Omega study questionnaires

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eTable 1. Characteristics of Omega participants by early pregnancy activity status Active^a

early pregnancy (N=2470)

Not active early pregnancy

(N=840) Maternal characteristics and behaviors

N (%) N (%)

Non-Hispanic white race 2183 (88) 676 (81)

At least high school education 2422 (98) 768 (91)

Married 2298 (93) 727 (87)

Nulliparous 1610 (65) 468 (56)

Pre-pregnancy BMI category

Underweight (<18.5 kg/m²) 104 (4) 35 (4) Normal weight (18.5-24.9 kg/m²) 1799 (73) 547 (65) Overweight (25-29.9 kg/m²) 390 (16) 153 (18)

Obese (≥30 kg/m²) 177 (7) 105 (13)

Active* pre-pregnancy 2376 (96) 652 (78)

Smoked during pregnancy 121 (5) 76 (9)

Gestational diabetes mellitus 108 (4) 60 (7)

Preeclampsia 64 (3) 34 (4)

Severe hyperemesis gravidarum 39 (2) 33 (4)

IOM category of total GWG

Excessive 1346 (55) 498 (59)

Adequate 847 (34) 247 (30)

Inadequate 268 (11) 93 (11)

Infant characteristics

Preterm birth (<37 weeks) 199 (8) 70 (8)

Size at birth

Large for gestational age 297 (12) 122 (15)

Appropriate for gestational age 2089 (85) 698 (83)

Small for gestational age 77 (3) 18 (2)

Infant sex

Male 1249 (51) 434 (52)

Female 1221 (49) 406 (48)

Abbreviations: body mass index (BMI), gestational weight gain (GWG), Institute of Medicine (IOM)

aReporting any LTPA

bStatistics presented are median (IQR) due to skewness of the distribution.

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eTable 2. Ten most common leisure time physical activities reported in pre-pregnancy and early pregnancy

Pre-pregnancy Early pregnancy

Activity N % Activity N %

Walking, dog walking 1733 18 Walking, dog walking 1010 18

Jogging, running, general 953 10 Walking, 3.0 mph, level, firm surface 608 11

Weight lifting, weight training 868 9 Treadmill, walking 287 5

Gardening, general 603 6 Stretching, hatha yoga, physical therapy 286 5

Treadmill, walking 583 6 Gardening, general 214 4

Walking, hiking, cross country 537 6 Walking, 2.0 mph level, firm surface 211 4

Bicycling 519 5 Weight lifting, weight training 184 3

Swimming 475 5 Weight lifting, light or moderate effort 165 3

Stretching, hatha yoga, physical therapy 431 5 Jogging, running, general 124 2

Cardio workout 367 4 Swimming 99 2

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eTable 3. Associations between pre-pregnancy and early pregnancy physical activity and measures of infant birth size by infant sex

Pre-pregnancy Early pregnancy

Males Females Males Females

N Adjusted Model^a

β^b (95% CI) N Adjusted Model^a

β^b (95% CI) N Adjusted Model^a β^b (95% CI)

Head Circumference (cm) Head Circumference (cm)

LTPA duration

(hours per week) 1637 0.14 (0.046, 0.24) 1567 0.0017 (-0.082, 0.086) LTPA duration

(hours per week) 1631 -0.0064 (-0.10, 0.091) 1562 -0.0088 (-0.092, 0.074)

Q1 (0-1.89) 400 Reference 397 Reference Q1 (0) 421 Reference 392 Reference

Q2 (1.90-3.92) 418 0.11 (-0.20, 0.42) 375 -0.15 (-0.41, 0.10) Q2 (0.10-2.50) 388 0.11 (-0.20, 0.41) 400 -0.11 (-0.37, 0.15) Q3 (3.93-6.66) 398 0.25 (-0.062, 0.56) 416 0.020 (-0.24, 0.28) Q3 (2.51-5.42) 412 0.17 (-0.14, 0.47) 388 -0.12 (-0.38, 0.14) Q4 (6.67-32.51) 421 0.43 (0.12, 0.75) 379 -0.054 (-0.32, 0.21) Q4 (5.43-35.00) 410 -0.039 (-0.35, 0.27) 382 -0.027 (-0.29, 0.24)

p-value for trend: 0.004 0.97 p-value for trend: 0.90 0.83

p-value for interaction: per quartile=0.02, quartiles=0.11 p-value for interaction: per quartile=0.78, quartiles=0.28 LTPA energy

expenditure (MET-

hours per week) 1637 0.12 (0.019, 0.22) 1567 -0.015 (-0.10, 0.069)

LTPA energy expenditure (MET-

hours per week) 1631 0.0057 (-0.092, 0.10) 1562 -0.033 (-0.12, 0.050)

Q2 (8.49-18.99) 421 0.10 (-0.20, 0.41) 387 0.053 (-0.21, 0.31) Q2 (0.01-10.62) 388 0.14 (-0.17, 0.44) 392 -0.099 (-0.36, 0.16) Q3 (19.00-32.50) 400 0.086 (-0.23, 0.40) 407 0.12 (-0.14, 0.38) Q3 (10.63-24.00) 403 0.15 (-0.15, 0.46) 413 -0.011 (-0.27, 0.24) Q4 (32.51-289.8) 414 0.39 (0.081, 0.71) 387 -0.073 (-0.34, 0.19) Q4 (24.01-220.0) 416 0.016 (-0.29, 0.32) 364 -0.15 (-0.41, 0.12)

p-value for interaction: per quartile=0.03, quartiles=0.04 p-value for interaction: per quartile=0.39, quartiles=0.57

Birthweight (g) Birthweight (g)

LTPA duration

(hours per week) 1675 5.4 (-13, 24) 1617 -23 (-42, -4.5) LTPA duration

(hours per week) 1669 -1.7 (-20, 17) 1612 -21 (-39, -2.1)

Q2 (1.90-3.92) 428 -0.11 (-58, 58) 389 -5.7 (-63, 52) Q2 (0.10-2.50) 396 -38 (-96, 20) 414 -14 (-71, 44)

Q3 (3.93-6.66) 404 0.042 (-59, 59) 425 -19 (-76, 38) Q3 (2.51-5.42) 420 19 (-39, 77) 397 -22 (-80, 36)

Q4 (6.67-32.51) 431 17 (-42, 77) 392 -73 (-130, -14) Q4 (5.43-35.00) 422 -24 (-82, 34) 396 -66 (-120, -7.2)

expenditure (MET-

hours per week) 1675 1.9 (-175, 2100) 1617 -22 (-40, -2.8)

hours per week) 1669 -3.4 (-22, 15) 1612 -23 (-41, -3.8)

Q2 (8.49-18.99) 432 3.5 (-54, 61) 398 14 (-43, 72) Q2 (0.01-10.62) 395 -14 (-72, 44) 407 -9.1 (-67, 48) Q3 (19.00-32.50) 408 -14 (-74, 45) 415 29 (-29, 86) Q3 (10.63-24.00) 411 -7.5 (-66, 51) 421 -21 (-78, 37) Q4 (32.51-289.8) 421 12 (-48, 72) 402 -76 (-140, -17) Q4 (24.01-220.0) 429 -13 (-71, 44) 378 -72 (-130, -13)

p-value for interaction: per quartile=0.08, quartiles=0.01 p-value for interaction: per quartile=0.09, quartiles=0.32 Abbreviations: leisure time physical activity (LTPA), metabolic equivalent (MET), quartile (Q)

aModel is adjusted for gestational age at delivery, severe hyperemesis gravidarum (Y/N), maternal age, pre-pregnancy BMI category, race (white/non-white), education (HS or more/less than HS), smoking during pregnancy (Y/N), and marital status (married/not married).

bMean differences for quartiles of measures of LTPA are presented.

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eTable 4. Associations between pre-pregnancy physical activity and measures of infant birth size by pre-pregnancy BMI category^a

Pre-pregnancy Early pregnancy

Normal weight

(18.5-24.9 kg/m²) Overweight/obese

(≥25 kg/m²) Normal weight

(18.5-24.9 kg/m²) Overweight/obese (≥25 kg/m²) N Adjusted Model^b

β^c (95% CI) N Adjusted Model^b

β^c (95% CI) N Adjusted Model^b β^c (95% CI)

Head Circumference (cm) Head Circumference (cm)

LTPA duration

(hours per week) 2268 0.079 (-0.00035, 0.16) 802 0.072 (-0.05, 0.20) LTPA duration

(hours per week) 2262 -0.0073 (-0.085, 0.070) 799 -0.0077 (-0.13, 0.12)

Q2 (1.90-3.92) 543 0.036 (-0.22, 0.29) 218 -0.040 (-0.39, 0.31) Q2 (0.10-2.50) 538 -0.076 (-0.33, 0.18) 215 0.15 (-0.21, 0.51) Q3 (3.93-6.66) 613 0.089 (-0.16, 0.34) 166 0.37 (-0.0092, 0.75) Q3 (2.51-5.42) 581 0.025 (-0.22, 0.27) 183 -0.0053 (-0.38, 0.37) Q4 (6.67-32.51) 638 0.24 (-0.016, 0.49) 134 0.076 (-0.33, 0.48) Q4 (5.43-35.00) 615 -0.058 (-0.30, 0.19) 151 0.015 (-0.39, 0.42)

expenditure (MET-

hours per week) 2268 0.036 (-0.043, 0.12) 802 0.096 (-0.032, 0.22) LTPA energy expenditure (MET-

hours per week) 2262 -0.018 (-0.10, 0.060) 799 -0.0028 (-0.13, 0.12)

Q2 (8.49-18.99) 542 0.054 (-0.20, 0.31) 230 0.20 (-0.15, 0.54) Q2 (0.01-10.62) 532 -0.0046 (-0.30, 0.21) 217 0.16 (-0.20, 0.51) Q3 (19.00-32.50) 614 0.039 (-0.21, 0.29) 164 0.34 (-0.037, 0.72) Q3 (10.63-24.00) 590 0.11 (-0.14, 0.36) 189 -0.049 (-0.42, 0.33) Q4 (32.51-289.8) 642 0.13 (-0.13, 0.38) 127 0.22 (-0.20, 0.64) Q4 (24.01-220.0) 608 -0.10 (-0.35, 0.14) 143 0.059 (-0.35, 0.47)

p-value for interaction: per quartile=0.62, quartiles=0.62 p-value for interaction: per quartile=0.74, quartiles=0.74

Birthweight (g) Birthweight (g)

LTPA duration

(hours per week) 2333 -17 (-32, -1.7) 820 7.4 (-22, 37) LTPA duration

(hours per week) 2327 -18 (-33, -2.9) 817 13 (-16, 42)

Q2 (1.90-3.92) 562 -14 (-63, 35) 221 21 (-60, 100) Q2 (0.10-2.50) 553 -46 (-94, 2.5) 220 36 (-48, 120)

Q3 (3.93-6.66) 626 -38 (-86, 9.9) 168 38 (-51, 130) Q3 (2.51-5.42) 592 -32 (-80, 16) 187 92 (5.0, 180)

Q4 (6.67-32.51) 657 -48 (-96, 0.27) 137 12 (-83, 110) Q4 (5.43-35.00) 639 -64 (-110, -17) 152 10.1 (-83, 100)

expenditure (MET-

hours per week) 2333 -18 (-33, -3.1) 820 7.6 (-22, 38) LTPA energy expenditure (MET-

hours per week) 2327 -21 (-36, -5.9) 817 14 (-16, 43)

Q2 (8.49-18.99) 561 -9.9 (-59, 39) 231 48 (-33, 130) Q2 (0.01-10.62) 545 -26 (-74, 23) 224 41 (-43, 124)

Q3 (19.00-32.50) 625 -10 (-59, 38) 169 23 (-66, 110) Q3 (10.63-24.00) 604 -44 (-91, 3.8) 190 78 (-9.4, 170) Q4 (32.51-289.8) 662 -58 (-110, -9.8) 128 26 (-72, 124) Q4 (24.01-220.0) 631 -64 (-110, -16) 145 19 (-76, 110)

p-value for interaction: per quartile=0.09, quartiles=0.09 p-value for interaction: per quartile=0.01, quartiles=0.02 Abbreviations: leisure time physical activity (LTPA), metabolic equivalent (MET), quartile (Q)

aUnderweight women are excluded from this analysis.

bModel is adjusted for gestational age at delivery, severe hyperemesis gravidarum (Y/N), infant sex, maternal age, race (white/non-white), education (HS or more/less than HS), smoking during pregnancy (Y/N), and marital status (married/not married).

cMean differences for quartiles of measures of LTPA are presented.

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eTable 5. Association of pre-pregnancy leisure time physical activity with categorical measures of birthweight overall, by infant sex, and by pre-pregnancy BMI

Overall Males Females Normal weight^a

N Adjusted Model^b

OR (95% CI) N Adjusted Model^b

OR (95% CI) N Adjusted Model^b OR (95% CI) Large for gestational age

LTPA duration (hours

per week) 414/3283 0.96 (0.87, 1.1) 220/1669 1.0 (0.89, 1.2) 194/1614 0.89 (0.77, 1.0) 252/2326 0.92 (0.82, 1.0)

Quartile 1 124/822 Reference 62/411 Reference 62/411 Reference 67/488 Reference

Quartile 2 101/816 0.87 (0.65, 1.2) 52/428 0.87 (0.58, 1.3) 49/388 0.83 (0.55, 1.3) ^57/561 0.75 (0.51, 1.1) Quartile 3 99/827 0.89 (0.67, 1.2) 52/403 0.97 (0.64, 1.5) 47/424 0.80 (0.53, 1.2) ^64/624 0.76 (0.53, 1.1) Quartile 4 694/818 0.86 (0.64, 1.2) 54/427 1.00 (0.66, 1.5) 36/391 0.69 (0.44, 1.1) 64/653 0.76 (0.52, 1.1)

p-value for trend 0.38 0.87 0.11 0.20

p-value for interaction per quartile=0.33

hours per week) 414/3283 0.95 (0.86, 1.1) 220/1669 1.0 (0.88, 1.2) 194/1614 0.88 (0.76, 1.0) 252/2326 0.92 (0.81, 1.0)

Quartile 2 114/828 1.0 (0.77, 1.4) 53/431 0.84 (0.56, 1.3) 61/397 1.2 (0.82, 1.9) 65/559 0.94 (0.65, 1.4) Quartile 3 99/821 0.95 (0.70, 1.3) 52/408 0.94 (0.62, 1.4) 47/413 0.93 (0.60, 1.4) 66/623 0.88 (0.60, 1.3) Quartile 4 84/819 0.87 (0.63, 1.2) 52/417 0.98 (0.65, 1.5) 32/402 0.69 (0.43, 1.1) ^59/659 0.76 (0.52, 1.1)

p-value for trend 0.32 0.93 0.09 0.16

Small for gestational age LTPA duration (hours

per week) 93/3283 1.2 (0.99, 1.5) 40/1669 0.9 (0.68, 1.2) 53/1614 1.5 (1.2, 2.0) 66/2326 1.4 (1.1, 1.8)

Quartile 2 16/816 0.75 (0.38, 1.5) 10/428 0.78 (0.33, 1.9) 6/388 0.71 (0.24, 2.1) ^11/561 1.1 (0.46, 2.8) Quartile 3 22/827 1.0 (0.55, 1.9) 7/403 0.60 (0.23, 1.6) 15/424 1.6 (0.67, 4.0) 19/624 1.9 (0.81, 4.2) Quartile 4 34/818 1.6 (0.87, 2.8) 10/427 0.80 (0.33, 1.9) 24/391 2.7 (1.2, 6.4) 27/653 2.5 (1.1, 5.4)

p-value for trend 0.06 0.52 0.003 0.008

LTPA energy expenditure (MET- hours per week)

93/3283 1.2 (0.98, 1.5) 40/1669 0.91 (0.68, 1.2) 53/1614 1.5 (1.1, 2.0) 66/2326 1.4 (1.1, 1.8)

Quartile 2 17/828 0.79 (0.41, 1.5) 8/431 0.61 (0.24, 1.5) 9/397 1.1 (0.43, 3.0) ^12/559 1.3 (0.52, 3.0) Quartile 3 20/821 0.92 (0.49, 1.7) 11/408 0.95 (0.40, 2.2) 9/413 0.96 (0.36, 2.6) 16/623 1.5 (0.63, 3.4)

Quartile 4 35/819 1.6 (0.87, 2.8) 8/417 0.64 (0.25, 1.6) 27/402 2.9 (1.2, 6.7) 29/659 2.5 (1.1, 5.4)

p-value for trend 0.09 0.54 0.006 0.01

Abbreviations: odds ratio (OR), confidence interval (CI), leisure time physical activity (LTPA), metabolic equivalent (MET)

aRegression models in the overweight/obese strata did not converge.

bModel is adjusted for gestational age at delivery, infant sex, severe hyperemesis gravidarum (Y/N), maternal age, pre-pregnancy BMI category, race (white/non-white), education (HS or more/less than HS), smoking during pregnancy (Y/N), and marital status (married/not married).

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eTable 6. Association of early pregnancy leisure time physical activity with categorical measures of birthweight overall, by infant sex, and by pre-pregnancy BMI

Overall Males Females Normal weight^a

N Adjusted Model^b

OR (95% CI) N Adjusted Model^b

OR (95% CI) N Adjusted Model^b OR (95% CI) Large for gestational age

LTPA duration (hours

per week) 412/3272 0.95 (0.86, 1.1) 217/1663 1.0 (0.88, 1.1) 195/1609 0.90 (0.78, 1.0) 251/2320 0.85 (0.75, 0.96)

Quartile 2 _96/809 0.83 (0.62, 1.1) 40/395 0.69 (0.44, 1.1) 56/414 0.99 (0.66, 1.5) ^54/553 0.65 (0.45, 0.95) Quartile 3 _109/815 1.0 (0.76, 1.4) 63/419 1.2 (0.78, 1.7) 46/396 0.87 (0.56, 1.3) ^68/591 0.80 (0.56, 1.2) Quartile 4 85/814 0.79 (0.58, 1.1) 49/419 0.85 (0.56, 1.3) 36/395 0.72 (0.45, 1.1) 50/635 0.54 (0.37, 0.79)

p-value for trend 0.30 0.98 0.13 0.007

hours per week) 412/3272 0.94 (0.85, 1.0) 217/1663 0.97 (0.85, 1.1) 195/1609 0.90 (0.78, 1.0) ^251/2320 0.83 (0.73, 0.93)

Quartile 1 122/838 Reference 65/433 Reference 57/405 Reference ^79/545 ^Reference

Quartile 2 _99/801 0.87 (0.65, 1.2) 46/394 0.80 (0.53, 1.2) 53/407 0.94 (0.62, 1.4) 57/545 0.71 (0.49, 1.0) Quartile 3 111/830 1.0 (0.77, 1.4) 58/410 1.1 (0.73, 1.6) 53/420 0.96 (0.63, 1.5) 69/603 0.82 (0.57, 1.2) Quartile 4 80/803 0.76 (0.56, 1.0) 48/426 0.82 (0.54, 1.3) 32/377 0.67 (0.42, 1.1) 46/627 0.50 (0.34, 0.74)

p-value for trend 0.20 0.65 0.15 ^0.002

Small for gestational age LTPA duration (hours

per week) 93/3272 1.1 (0.94, 1.4) 39/1663 0.97 (0.72, 1.3) 54/1609 1.3 (0.99, 1.7) 65/2320 1.2 (0.92, 1.5)

Quartile 2 _21/809 1.2 (0.64, 2.4) 10/395 1.2 (0.47, 2.9) 11/414 1.4 (0.53, 3.5) ^15/553 1.6 (0.68, 3.6) Quartile 3 _28/815 1.6 (0.88, 3.0) 12/419 1.4 (0.58, 3.5) 16/396 2.0 (0.81, 4.7) 21/591 2.2 (1.0, 4.9) Quartile 4 26/814 1.4 (0.77, 2.7) 7/419 0.81 (0.29, 2.2) 19/395 2.2 (0.92, 5.1) 19/635 1.6 (0.7, 3.6)

p-value for trend 0.19 0.85 0.05 0.21

Energy expenditure

(pre-early) 93/3272 1.2 (0.96, 1.4) 39/1663 0.96 (0.72, 1.3) 54/1609 1.4 (1.1, 1.8) 65/2320 1.2 (0.94, 1.5)

Quartile 2 17/801 1.0 (0.51, 2.0) 9/394 1.1 (0.42, 2.8) 8/407 0.99 (0.36, 2.7) 11/545 1.2 (0.48, 2.8)

Quartile 3 _33/830 2.0 (1.1, 3.6) 14/410 1.7 (0.73, 4.1) 19/420 2.3 (0.97, 5.4) ^28/603 2.9 (1.4, 6.3)

Quartile 4 _25/803 1.4 (0.74, 2.6) 6/426 0.68 (0.23, 2.0) 19/377 2.2 (0.94, 5.3) 16/627 1.4 (0.61, 3.2)

p-value for trend 0.11 0.80 0.02 0.16

Abbreviations: odds ratio (OR), leisure time physical activity (LTPA), metabolic equivalent (MET)

aRegression models in the overweight/obese strata did not converge.

bModel is adjusted for gestational age at delivery, infant sex, severe hyperemesis gravidarum (Y/N), maternal age, pre-pregnancy BMI category, race (white/non-white), education (HS or more/less than HS), smoking during pregnancy (Y/N), and marital status (married/not married).

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eTable 7. Joint effect of pre-pregnancy and early pregnancy physical activity in the association with measures of infant birth size overall, by infant sex, and by pre-pregnancy BMI

Overall Males Females Normal weight Overweight/obese

N Adjusted Model^a

β^b (95% CI) N Adjusted Model^a

β^b (95% CI) N Adjusted Model^a β^b (95% CI) Head Circumference (cm)

Any physical activity

(pre-early) 3221 1644 1577 2280 807

No-no 2315 Reference 104 Reference 76 Reference 108 Reference 62 Reference

No-yes 637 -0.036 (-0.55, 0.48) 36 -0.11 (-0.94, 0.73) 53 -0.069 (-0.70, 0.57) 53 -0.093 (-0.77, 0.59) 33 0.21 (-0.62, 1.03) Yes-no 89 0.13 (-0.21, 0.47) 320 0.23 (-2.6, 0.72) 317 -0.044 (-0.50, 0.41) 424 0.097 (-0.34, 0.54) 188 0.33 (-0.24, 0.89) Yes-yes 180 0.12 (-0.20, 0.43) 1184 0.29 (-0.16, 0.75) 1131 -0.14 (-0.57, 0.30) 1695 0.059 (-0.35, 0.47) 524 0.30 (-0.23, 0.83)

Duration (pre-early)^c 3176 1624 1552 2250 794

Low-low 1965 Reference 989 Reference 976 Reference 1305 Reference 568 Reference

Low-high 423 -0.12 (-0.33, 0.094) 220 -0.18 (-0.51, 0.14) 203 -0.061 (-0.34, 0.21) 315 -0.13 (-0.39, 0.12) 96 -0.13 (-0.55, 0.30) High-low 426 0.16 (-0.051, 0.38) 228 0.43 (0.11, 0.75) 198 -0.14 (-0.42, 0.14) 336 0.20 (-0.046, 0.45) 76 -0.14 (-0.61, 0.33) High-high 362 0.097 (-0.13, 0.33) 187 0.091 (-0.26, 0.44) 175 0.12 (-0.18, 0.42) 294 0.13 (-0.13, 0.40) 54 0.058 (-0.49, 0.61) Energy expenditure

(pre-early)^c 3176 1624 1552 2250 794

Low-high 419 -0.092 (-0.31, 0.12) 229 -0.085 (-0.40, 0.23) 190 -0.11 (-0.40, 0.17) 313 -0.13 (-0.39, 0.12) 92 -0.069 (-0.50, 0.37) High-low 438 0.18 (-0.035, 0.39) 225 0.47 (0.15, 0.79) 213 -0.14 (-0.41, 0.14) 348 0.18 (-0.071, 0.42) 73 -0.081 (-0.56, 0.40) High-high 354 -0.032 (-0.27, 0.20) 184 0.11 (-0.24, 0.47) 170 -0.18 (-0.48, 0.12) 289 -0.065 (-0.33, 0.20) 50 0.15 (-0.42, 0.72) Birthweight (g)

Any physical activity

(pre-early) 3310 1683 1627 2346 825

No-no 188 Reference 108 Reference 80 Reference 113 Reference 65 Reference

No-yes 94 -28 (-130, 76) 38 -22 (-180, 130) 56 -44 (-190, 98) 54 -76 (-210, 55) 36 95 (-93, 280)

Yes-no 652 37 (-31, 110) 326 64 (-29, 160) 326 -3.4 (-110, 99) 434 56 (-28, 140) 193 37 (-94, 170)

Yes-yes 2376 12 (-52, 75) 1211 42 (-44, 130) 1165 -34 (-130, 63) 1745 2.9 (-75, 81) 531 80 (-43, 200)

Duration (pre-early)^c 3263 1661 1602 2314 812

Low-high 436 -33 (-76, 11) 225 -39 (-100, 22) 211 -28 (-88, 33) 327 -50 (-98, -1.2) 96 -1.5 (-100, 98)

High-low 437 -20 (-63, 24) 232 3.0 (-58, 64) 205 -43 (-110, 19) 344 -36 (-84, 11) 78 15 (-94, 120)

High-high 374 -42 (-88, 4.7) 193 5.2 (-60, 71) 181 -94 (-160, -28) 305 -36 (-86, 15) 55 -76 (-200, 52)

Energy expenditure

(pre-early)^c 3263 1661 1602 2314 812

Low-high 432 -25 (-68, 18) 236 -28 (-88, 32) 196 -22 (-85, 41) 323 -37 (-86, 12) 94 -13 (-110, 89)

High-low 447 -36 (-.9, 7.2) 227 -3.7 (-65, 58) 220 -70 (-130, -9.7) 356 -52 (-99, -4.8) 74 -7.3 (-120, 110)

High-high 367 -53 (-100, -6.2) 189 18 (-48, 85) 178 -130 (-200, -63) 301 -61 (-110, -10) 50 -31 (-170, 100)

aModel is adjusted for gestational age at delivery, infant sex (for overall only), severe hyperemesis gravidarum (Y/N), maternal age, pre-pregnancy BMI category, race (white/non-white), education (HS or more/less than HS), smoking during pregnancy (Y/N), and marital status (married/not married).

bMean differences for quartiles of measures of LTPA are presented.

cHigh duration or energy expenditure is reported LTPA duration or energy expenditure in the highest quartile (quartile 4). Low duration or energy expenditure is reported LTPA duration or energy expenditure in quartile 1, 2, or 3 (not in the highest quartile).

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H:\OMEGA PA\SDC\omega1_questionnaire.DOC 1 8/2/00

Appendix. Questionnaires

OMEGA STUDY

QUESTIONNAIRE CODING MANUAL

Q by Q INSTRUCTIONS

FOR OMEGA STUDY QUESTIONNAIRE

Document history: First draft dated 8/26/98 Second draft dated 9/23/98 Third draft dated 9/29/98 Fourth draft dated 10/13/98 Fifth draft dated 10/27/98 Sixth draft dated 11/20/98

PURPOSE OF THE CODING MANUAL

This document is designed primarily to be a Coding Manual for the OMEGA Study participant interview. In addition, it serves as a training aid for research interviewers. The document is

formatted in question-by-question directions for both interviewers and coders. Accompanying each question are directions specifically for interviewers and coders.

Separate introductions are included for research interviewers and coders. These introductions include descriptions of the scope of work and General Rules to be followed during interviewing and coding.

INTRODUCTION FOR INTERVIEWERS

The intent of the interviews is to gather information objectively and transcribe this information to the questionnaire as accurately as possible. The interviewer can facilitate this by following two rules.

First, read all questions exactly as they are written. Second, record or transcribe all answers/replies verbatim.

However, we do not expect every question to be perfect, and we know not all interviews will occur without incident. The interviewer should provide feedback to the study coordinator about difficulty with questions and suggestions about how best to phrase study questions. This will result in the best questionnaire and the most accurate data collection.

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The interview or the interaction between interviewer and respondent is not intended to change or influence the respondent’s answers. In order to maintain an objective information-gathering atmosphere, the respondent must find satisfaction in talking to a receptive and understanding person without fear of appearing inadequate. The interviewer can achieve this by establishing and maintaining a professional demeanor during the interview.

Probing for clarification. Often a respondent will provide an incomplete answer or an answer that does not clearly indicate one of the provided answers. For closed-ended questions (where the respondent chooses one answer from a provided list, e.g., multiple choice), if the respondent fails to provide an answer, you should repeat the question, provide the response categories, and advise the respondent to choose the answer that best describes her response. If this fails to elicit a usable response, write the answer provided in space next to the question. The study coordinator has established rules for editing/coding to account for ranges, and the answer will be entered during editing and coding.

For open-ended questions (where any response is acceptable), record the respondent’s reply verbatim. If the answer provided seems illogical, please repeat the question and record any reply verbatim.

Recording ranges. Open-ended questions often are used to collect continuous data, data that can assume any value. These are normally numerical answers such as age, weight, height, etc.

Occasionally a respondent will not be able to provide a specific numerical answer and will provide a range. For example, when answering a question about average length of menstrual cycle, a respondent will say “about 27 to 29 days”. Record this answer verbatim to the side of the answer space provided. Try to probe for a more precise answer. Repeat the question emphasizing the need for a single number and ask them to provide an answer in that format. If this does not elicit a more accurate answer, record the second response verbatim and leave the answer blank.

The study coordinator has established rules for editing/coding to account for ranges, and the answer will be entered during editing and coding.

INTRODUCTION FOR CODERS

Coding refers to the process of preparing raw data for computer analysis. Specifically, it entails transcribing data from the primary collection form, questionnaire, and abstraction forms in the OMEGA study to a coded form for entry into the computer. This manual provides coding directions for the OMEGA Study Questionnaire.

The majority of the questions on the OMEGA questionnaire are designed to be “self-coded”. Self- coded questions incorporate codes directly within the structure of the questions. The codes clearly correlate a specific answer to a code that can be entered into the computer. In the interview setting, the interviewer marks the subject’s response by circling the codes associated with specific answers. In this manual, the self-coded questions will be listed, but no coding instructions are provided. The accuracy and legibility of these answers were confirmed during the editing. While you are coding, please take time to confirm that the response to each question is legible. The answer circled or the number recorded should be entered in the database using the computer data entry program.

If you have any questions or are uncertain about assigning specific codes, please mark the page with a yellow post-it note and record your impression of the problem. These questions will be reviewed by the study coordinator.

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Rounding rule.

 Continuous data (e.g., weight and height) need to be rounded to the nearest unit. For weight, use pounds; for height, use inches. Units for other questions will be specified in the question.

 “Weeks pregnant” should not be rounded up. For example, if a woman is “13-6/7 weeks”

pregnant, she is only 13 weeks pregnant (not 14 weeks).

If you are unsure of the unit to round, ask the study coordinator.

Range rule. If a range is entered, use the midpoint of the range. When a response to an open-ended question has been entered as a range, it is necessary to specify that answer so that it is suitable for data entry. If a range is entered, for example, when answering a question about average length of menstrual cycle, a respondent may say “about 27 to 29 days”. This type of answer is not suitable for data entry, and needs to be specified.

For example:

 When a range is an odd number in length (27-29), use the midpoint of the range (28).

 When a range is an even number in length (25-28), use the midpoint of the range plus 0.5 (26.5 plus 0.5 for 27).

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SECTION A. BACKGROUND INFORMATION

A1.

“First, I would like to ask you some questions about your background.” No coding is needed for this item.

A2.

“What is your date of birth?” Enter the date in MM/DD/YY format.

__ __/__ __/__ __(MM/DD/YY)

A3.

^“How old were you at the time of your last normal menstrual period?” (REFERENCE DATE) Enter the LMP date in the MM/DD/YY format. Coders: If the age is not entered, use the date of birth, item A2, and the LMP to calculate the age at LMP.

(AGE) / / (MM/DD/YY) LMP

A4.

“What is your highest level of education?” Only one answer is acceptable. Confirm that only one answer is circled. The codes are indicated to the right of the answers provided.

NONE OR KINDERGARTEN ... 01

GRADE SCHOOL ... 02

SOME HIGH SCHOOL ... 03

HIGH SCHOOL GRADUATE OR GED ... 04

VOCATIONAL OR TECHNICAL SCHOOL ... 05

SOME COLLEGE ... 06

GRADUATED FROM COLLEGE ... 07

POST GRADUATE ... 08

OTHER (SPECIFY______________________) ... 09

DK ... 99

A5.

What is your current marital status? Only one answer is acceptable. Confirm that only one answer is circled. The codes are indicated to the right of the answers provided. If the code is difficult to interpret (e.g., if 2 answers are circled), flag the question for the study coordinator. SINGLE (NEVER MARRIED) ... 1

MARRIED ... 2

LIVING AS MARRIED ... 3

REGULAR PARTNER (6+ MONTHS) ... 4

SEPARATED ... 5

DIVORCED ... 6

WIDOWED ... 7

OTHER (SPECIFY______________________) ... 8

(13)

SECTION A.

^Continued

A6.

What is your partner’s highest level of education? Only one answer is acceptable. Confirm that only one answer is circled. The codes are indicated to the right of the answers provided.

NONE OR KINDERGARTEN ... 01

GRADE SCHOOL ... 02

SOME HIGH SCHOOL ... 03

HIGH SCHOOL GRADUATE OR GED ... 04

VOCATIONAL OR TECHNICAL SCHOOL ... 05

SOME COLLEGE ... 06

GRADUATED FROM COLLEGE ... 07

POST GRADUATE ... 08

OTHER (SPECIFY_____________________) ... 09

DK ... 99

A7.

“What is your country of birth?” Write the name of the country of origin in the available space.

Identify the Country Code using the alphabetic “Country Codes List” (Section 4) and enter the number in the code spaces provided. NOTE: All codes are 3 digits long. If the name of the country does not appear on the “Country Code List”, inform the Study Coordinator so that a new code can be created.

___________________________ ___ ___ ___

COUNTRY CODE

End of

Section A

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SECTION E. MEDICAL HISTORY

“I would now like to ask you about certain tests, disorders and conditions you may have had.”

E1.

“Before this pregnancy, about how long had it been since your last routine checkup by a doctor or other health professional (nurse practitioner, etc.)?” Only one answer is acceptable. Confirm that only one answer is circled. The codes are indicated to the right of the answers provided.

NEVER ... 1

LESS THAN ONE YEAR ... 2

AT LEAST 1 YEAR, BUT LESS THAN 2 YEARS ... 3

AT LEAST 2 YEARS, BUT LESS THAN 3 YEARS ... 4

AT LEAST 3 YEARS, BUT LESS THAN 4 YEARS ... 5

4 OR MORE YEARS ... 6

DK ... 9

E2.

“In the year before you became pregnant, did you have a Pap smear?” Only one answer is acceptable. Confirm that only one answer is circled. The codes are indicated to the right of the answers provided. YES... 1

NO ... 2

Directions for E3 and E4 (Medical Conditions). Question E3: On some questionnaires, this question does not have the corresponding codes listed. The codes corresponding to “Yes”, “No”, and

“DK” (Don’t Know) for each condition are “Yes” = “1”, “No” = “2”, and “DK” = “9”. Only one answer is acceptable. Confirm that only one answer is circled. The codes are indicated to the right of the answers provided. Question E4: Enter the age at the time the participant was notified of the condition. Coders: If a range has been entered, use the midpoint of the range.

MEDICAL CONDITIONS

(Ask about one condition at a time, going though E3 and E4 for each one)

E3.

“Has a doctor ever told you that you have/had any of the following medical conditions?”

E4.

“How old were you when the doctor told you that you had the condition?”

a. Hypertension or high blood pressure?

1=YES 2=NO 9=DK

__ __

AGE b. Heart disease?

1=YES 2=NO 9=DK

__ __

AGE c. High cholesterol?

1=YES 2=NO 9=DK

__ __

AGE

(15)

SECTION E.

^Continued

MEDICAL CONDITIONS (continued)

E3.

(continued)

“Has a doctor ever told you that you have/had any of the following medical conditions?”

E4.

(continued)

“How old were you when the doctor told you that you had the condition?”

d. Migraine headaches?

1=YES 2=NO 9=DK

__ __

AGE e. Arthritis?

1=YES 2=NO 9=DK

__ __

AGE f. Ovarian cysts?

1=YES 2=NO 9=DK

__ __

AGE g. Endometriosis?

1=YES 2=NO 9=DK

__ __

AGE h. Uterine fibroids?

1=YES 2=NO 9=DK

__ __

AGE i. Renal disease / kidney disease?

1=YES 2=NO 9=DK

__ __

AGE j. Liver problems (hepatitis or jaundice)?

1=YES 2=NO 9=DK

__ __

AGE k. Asthma?

1=YES 2=NO 9=DK

__ __

AGE l. Polycystic ovarian syndrome/polycystic

ovaries?

1=YES 2=NO 9=DK

__ __

AGE m. Periodontal disease (gum disease/

gingivitis)?

1=YES 2=NO 9=DK

__ __

AGE

E5.

“Has a doctor or other health professional ever told you that you have had a thyroid problem or any thyroid condition requiring thyroid medication or treatment?” Only one answer is acceptable.

Confirm that only one answer is circled. The codes are indicated to the right of the answers provided.

YES... 1

NO ... 2  GO TO E10 DK ... 9

(16)

SECTION E.

^Continued

E6.

“What type of condition was it?” [CODE AS MANY AS APPLY] The codes are indicated to the right of the answers provided.

GRAVES’ DISEASE ... 01

HASHIMOTO’S DISEASE (CHRONIC THYROIDITIS) ... 02

OVERACTIVE ... 03

UNDERACTIVE ... 04

GOITER ... 05

NODULES ... 06

CANCER ... 07

LOW METABOLISM ... 08

OVERWEIGHT ... 09

OTHER (SPECIFY____________________________) ... 10

DK ... 99

E7.

“How old were you when a doctor first told you of this/these disorders/conditions?” Enter the age at the time the participant was notified of the condition. Coders: If a range has been entered, use the midpoint of the range. ___ ___ (AGE)

E8.

“Which, if any of these medications did you ever receive for this problem or condition?” Only one answer is acceptable, confirm that only one answer is circled. The codes are indicated to the right of the answers provided. NONE ... 01

THYROID USP OR EQUIVALENT (SPECIFY______________) 02 SYNTHROID OR EQUIVALENT (SPECIFY________________)03 THYROID GLAND INHIBITOR (SPECIFY_________________)04 OTHER (SPECIFY_____________________________________) 05 UNKNOWN THYROID MEDICATION ... 90

UNKNOWN MEDICATION, UNKNOWN IF FOR THYROID ... 95

E9.

“Which, if any, of the following procedures did you ever have for this problem or condition?” Only one answer is acceptable. Confirm that only one answer is circled. The codes are indicated to the right of the answers provided. NONE ... 1

THYROID SURGERY ... 2

RADIOACTIVE IODINE TREATMENT ... 3

X-RAY OR RADIATION TREATMENT ... 4

OTHER (SPECIFY_____________________) ... 5

DK ... 9

(17)

SECTION E.

^Continued

E10.

“Did a doctor ever tell you that you have diabetes, or high sugar in your blood or urine?” Only one answer is acceptable. Confirm that only one answer is circled. The codes are indicated to the right of the answers provided.

YES... 1

NO ... 2  GO TO E15 DK ... 9

E11.

“Did you have diabetes?” Only one answer is acceptable. Confirm that only one answer is circled.

The codes are indicated to the right of the answers provided.

ONLY DURING PREGNANCY ... 1  GO TO E13 AT OTHER TIMES ... 2

BOTH DURING PREGNANCY AND AT OTHER TIMES ... 3 DK ... 9

E12.

“How old were you, when a doctor first told you that you had diabetes other than during

pregnancy?” Enter the age at the time the participant was notified of the condition. Coders: If a range has been entered, use the midpoint of the range.

___ ___ (AGE)

E13.

“What type of medicine did you take for diabetes?” Only one answer is acceptable. Confirm that only one answer is circled. The codes are indicated to the right of the answers provided.

PILLS ALONE ... 1 INSULIN ALONE ... 2 INSULIN AND PILLS ... 3

NO MEDICATION ... 4  GO TO E15 OTHER (SPECIFY____________________) ... 5

DK ... 9

E14.

“How old were you when you started taking medicine for diabetes”? Enter the age at the time the participant was notified of the condition. Coders: If a range has been entered, use the midpoint of the range.

___ ___ (AGE)

E15.

“Did a doctor ever tell you that you have hypertension, or high blood pressure?” Only one answer is acceptable. Confirm that only one answer is circled. The codes are indicated to the right of the answers provided.

YES... 1

NO ... 2  GO TO E22 DK ... 9

(18)

SECTION E.

^Continued

E16.

“Did you have hypertension?” Only one answer is acceptable. Confirm that only one answer is circled. The codes are indicated to the right of the answers provided.

ONLY DURING PREGNANCY ... 1  GO TO E18 AT OTHER TIMES ... 2

BOTH DURING PREGNANCY AND AT OTHER TIMES .... 3 DK ... 9

E17.

“How old were you when a doctor first told you that you had hypertension other than during pregnancy?” Enter the age at the time the participant was notified of the condition.

Coders: If a range has been entered, use the midpoint of the range.

___ ___ (AGE)

E18.

“Did a doctor ever prescribe medicine for your hypertension?” Only one answer is acceptable, confirm that only one answer is circled. The codes are indicated to the right of the answers provided.

YES... 1

NO ... 2  GO TO E22 DK ... 9

(19)

SECTION E.

^Continued

Directions for Questions E19, E20, and E21 (Blood Pressure Medication). Question E19: Enter the code of the blood pressure medication taken. Find the name of the medication on the alphabetized

“Hypertension Medications” list (Section 8) and enter the corresponding code in the space provided.

Question E20: Enter the date (month and year) the patient began taking the medication. Coders: If a range has been entered, use the midpoint of the range. If any part of the date has been left blank, see the

“Date Rule” (in Rules and Conversions, Section 3). Question E21: Enter the number of weeks, months, or years the medication has been taken. Also indicate unit reported -- weeks, months or years. If medication was taken 1 time only, enter “77.”

BLOOD PRESSURE MEDICATION

E19.

“Please tell me the name of the medication you took at least once a week for at least one month.”

E20.

“When did you start taking the medication regularly?”

E21.

“For how many weeks, months, or years did you take the medication on a regular basis?”

1^STMed Drug name_________________

CODE ___ ___ ___ ___

__ __/ __ __

MM YY

__ __

# OF WEEKS...1

MONTHS...2

YEARS...3

DK...9

2^ND Med Drug name_________________ CODE ___ ___ ___ ___ __ __/ __ __ MM YY __ __ # OF WEEKS...1

MONTHS...2

YEARS...3

DK...9

3^RD Med Drug name_________________ CODE ___ ___ ___ ___ __ __/ __ __ MM YY __ __ # OF WEEKS...1

MONTHS...2

YEARS...3

DK...9

4^TH Med Drug name_________________ CODE ___ ___ ___ ___ __ __/ __ __ MM YY __ __ # OF WEEKS...1

MONTHS...2

YEARS...3

DK...9

5^THMed Drug name_________________ CODE ___ ___ ___ ___ __ __/ __ __ MM YY __ __ # OF WEEKS...1

MONTHS...2

YEARS...3

DK...9

(20)

SECTION E.

^Continued

E22.

“Has a doctor ever told you that you have cancer?” Only one answer is acceptable. Confirm that only one answer is circled. The codes are indicated to the right of the answers provided.

YES... 1

NO ... 2  GO TO E25 DK ... 9

E23.

“How old were you when you were diagnosed?” Enter the age at the time the participant was notified of the condition. Coders: If a range has been entered, use the midpoint of the range.

___ ___ (AGE)

E24.

“In what part of your body was the cancer located?” Enter the code of the site/type of cancer that was diagnosed. Find the site/type of cancer diagnosed on the alphabetized “Cancer Codes (ICD-O)” list (Section 15) and enter the corresponding code in the space provided.

___ ___ (CODE)

E25.

“Have you ever had a blood transfusion?” Only one answer is acceptable. Confirm that only one answer is circled. The codes are indicated to the right of the answers provided.

YES... 1

NO ... 2  TO SECT. F DK ... 9

E26.

“How many blood transfusions have you had?” Enter the number of blood transfusions the patient has had. Coders: If a range has been entered, use the midpoint of the range.

___ ___ (NUMBER)

End of

Section E

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SECTION H. PHYSICAL ACTIVITY HISTORY

“The following set of questions pertains to exercise and other recreational or physical activities you may have done throughout your life. This includes both individual activities and organized sports.”

H1.

“Beginning at age 13 to the present, in which sports and other physical activities have you participated?” No coding is needed for this item. Answer each of the questions below for each physical activity listed in history.

Directions for Questions H2 through H6

 Question H2: Identify the activity on the alphabetic “Physical Activity Codes” list (Section 11) and enter the code. If the code does not appear on the list, flag the questionnaire so that the study coordinator can create a new code.

 Question H3: Enter the age at which the participant began the physical activity. Coders: If a range is given, use the midpoint of the range. If the age reported in H3 is younger than 13, change this to 13 and recalculate number of years (in H5) the participant performed the activity.

 Question H4: Enter the age at which the participant stopped doing the physical activity. Coders: If a range is given, use the midpoint of the range.

 Question H5: Enter the number of years and the number of months per year the participant regularly participated in the physical activity. Coders: If a range has been entered, use the midpoint of the range.

This may also be calculated using the information given in H4 and H5 (see Rules and Conversions in Section 3).

 Question H6: Enter the average number of hours per week the participant engaged in the activity during the period. Coders: If a range has been entered, use the midpoint of the range. If activity was

performed <1 hr/wk over a period of 52 weeks, enter “88:88” (e.g., seasonal activities).

ASK QUESTION H2-H6 FOR ONE SPORT/ACTIVITY BEFORE ASKING ABOUT THE NEXT.

H2.

“In what activity did you(first/next) participate on a regular basis?”

H3.

“At what age did you start this activity regularly?”

H4.

“At what age did you stop this activity?”

H5.

“For how many years did you regularly participate in this activity?”

H6.

“On avg., about how many hours per week did you do this activity?”

1^ST Activity

___________

NAME

__ __ __CODE

__ __

AGE

__ __

AGE

YEARS MO/YR

__ __: __ __

HRS:MIN/WK 2^ND

Activity

___________

NAME

__ __ __CODE

__ __

AGE

__ __

AGE

__ __YEARS __ __MO/YR

__ __: __ __

HRS:MIN/WK 3^RD

Activity

___________

NAME

__ __ __CODE

__ __

AGE

__ __

AGE

__ __: __ __

HRS:MIN/WK 4^TH

Activity

___________

NAME

__ __ __CODE

__ __

AGE

__ __

AGE

__ __: __ __

HRS:MIN/WK 5^TH

Activity

___________

NAME

__ __ __CODE

__ __

AGE

__ __

AGE

YEARS MO/YR

__ __: __ __

HRS:MIN/WK

(22)

SECTION H.

^Continued

H2 through H6 Continued . . .

H2.

“In what activity did you(first/next) participate on a regular basis?”

H3.

“At what age did you start this activity regularly?”

H4.

“At what age did you stop this activity?”

H5.

“For how many years did you regularly participate in this activity?”

H6.

“On avg., about how many hours per week did you do this activity?”

6^TH Activity

___________

NAME

__ __ __CODE

__ __

AGE

__ __

AGE

YEARS MO/YR

__ __: __ __

HRS:MIN/WK 7^TH

Activity

___________

NAME

__ __ __CODE

__ __

AGE

__ __

AGE

__ __: __ __

HRS:MIN/WK 8^TH

Activity

___________

NAME

__ __ __CODE

__ __

AGE

__ __

AGE

__ __: __ __

HRS:MIN/WK 9^TH

Activity

___________

NAME

__ __ __CODE

__ __

AGE

__ __

AGE

__ __: __ __

HRS:MIN/WK 10^TH

Activity

___________

NAME

__ __ __CODE

__ __

AGE

__ __

AGE

YEARS MO/YR

__ __: __ __

HRS:MIN/WK

“Now I would like to know about your physical activity during the 12 months before you became pregnant.”

H7.

“How many miles do you regularly walk each day (at home and work, including indoors)?” Enter the miles walked per day. Coders: If a range is entered, use the midpoint of the range. Also enter the number of blocks walked per day, using the “Converting Miles to Blocks” table (Rules and Conversions in Section 3).

Caveat: In some cases, you may find that H7 is reported in units of time. Convert this to hours.

Then, using this hours figure, find the walking pace in Question H8, and use the “Walking Pace”

table (Rules and Conversions in Section 3) to determine “Miles/Day” walked in Question H7.

__ __ MILES/DAY [CODE # of BLOCKS __ __/DAY]

H8.

“What is your usual pace of walking?” Only one answer is acceptable. Confirm that only one answer is circled. The codes are indicated to the right of the answers provided.

CASUAL OR STROLLING (less than 2 mph) ... 1 AVERAGE OR NORMAL (2-3 mph) ... 2 FAIRLY BRISK (3-4 mph) ... 3 BRISK OR STRIDING (4 mph or more) ... 4

H9.

“How many flights of stairs do you climb each day?” Enter the number of flights climbed each day. Coders: If a range is entered, use the midpoint of the range.

__ __ (FLIGHTS) (10 STEPS = 1 FLIGHT)

(23)

SECTION H.

^Continued

“During the past year, in what sports or recreation have you actively participated?” [Please remember seasonal sports or events, including gardening and landscaping activities.]

Directions for Questions H10, H11, H12, and H13.

Question H10: Identify the activity on the alphabetic “Physical Activities Codes” list (Section 11) and enter the code. If the code does not appear on the list, notify the study coordinator and a new code will be created.

Question H11: Enter the number of times per week the participant engaged in the physical activity.

Coders: If a range is given, use the midpoint of the range. NEW CODES: If an activity took place

<1 time in 1 month, code as “77.” If it took place 1-2 times in 1 month, code as “78.” If it took place 3-4 times in 1 month, code as “01.” Some examples (taken from actual questionnaires):

2 x mo = 78 1 q 3 mos = 77

1 time month = 78 1 q 2 wks / 1 q 3 wks / 1 q 4 wks = ALL are 78 2 wk out of year = 77 3 out of 4 wks/mo = 01

Question H12: Enter the number of months of the year that the participant regularly engaged in the physical activity. Coders: If a range is given, use the midpoint of the range.

Question H13: Enter the number of hours the participant spent on the physical activity per episode.

Coders: If a range has been entered, use the midpoint of the range.

H10.

“Which activity did you participate in on a regular basis during the year before you became pregnant?”

H11.

“How many times per week?”

H12.

“How many months did you regularly participate in this activity?”

H13.

“How much time did you spend at the ACTIVITY per episode?”

1^ST Activity ___________NAME __ __ __CODE

TIMES MONTHS :

HRS: MIN 2^ND Activity ___________NAME

__ __ __CODE __ __ TIMES __ __MONTHS __ __: __ __

HRS: MIN 3^RD Activity ___________NAME

__ __ __CODE __ __TIMES __ __MONTHS __ __: __ __

HRS: MIN 4^TH Activity ___________NAME

__ __ __CODE

TIMES MONTHS :

HRS:MIN 10^TH

Activity ___________NAME

HRS:MIN

(24)

SECTION H.

^Continued

H14.

“When you are exercising in your usual fashion, how would you rate your level of exertion (degree of effort)?” Enter the two digit score. If the score is less than two digits enter a zero before the number, for example “0X”, if not enter the number as is. If the number is not entered, look at the scale and enter the circled number in the space provided.

__ __ (SCORE)

|_________________________________________________________________________________________|

0 0.5 1 2 3 4 5 6 7 8 9 10

VERY WEAK MODERATE STRENUOUS EXTREMELY MAXIMAL

WEAK STRENUOUS

H15.

“Which of these statements best expresses your view?” Only one answer is acceptable. Confirm that only one answer is circled. The codes are indicated to the right of the answers provided.

I EXERCISE ENOUGH TO MAINTAIN GOOD HEALTH... 1 I EXERCISE MORE THAN I NEED TO ... 2 I SHOULD EXERCISE MORE ... 3 DK ... 9

“Now I would like to know about your physical activity during the past 7 days. First I would like to ask about your sleep habits.”

H16.

“On average, how many hours did you sleep each night during the last 5 weekday nights (Sunday through Thursday)?” Enter the number of hours the participant slept. Coders: If a range is entered, use the midpoint of the range.

__ __ HOURS

H17.

“On average, how many hours did you sleep each night last Friday and Saturday nights?” Enter the number of hours the participant slept. Coders: If a range is entered, use the midpoint of the range.

__ __ HOURS

(25)

SECTION H.

^Continued

“Now I am going to ask you about your physical activity during the past 7 days, that is the last 5 weekdays, and the last weekend, Saturday and Sunday. We are not going to talk about light activities such as slow walking, light housework, or un-strenuous sports such as bowling, archery, or softball. We are going to talk about moderate activities, such as delivering mail, house painting, lifting and carrying light objects, raking the lawn, sweeping, playing volleyball, brisk walking, and calisthenics exercise. We will also talk about strenuous activities such as heavy carpentry, scrubbing floors, square-dancing or folk-dancing; and we will talk about very strenuous activities such as, jogging, swimming, and playing soccer.”

“Let’s first consider moderate activities.”

Answer questions a, b, and c for moderate activities, strenuous activities and very strenuous activities listed below. Part a: Identify the activity on the “Physical Activity Alphabetic Index” list (Section 12) and enter the code. If the code does not appear on the list, contact the study coordinator and a new code will be created or be classified. Part b: Enter the number of hours per weekday the participant engaged in the physical activity. Coders: If a range is given, use the midpoint of the range. If activity was performed.

Part c. Enter the number of hours per weekend day that the participant regularly engaged in the physical activity. Coders: If a range is given, use the midpoint of the range.

H18.

What activities did you do during the last 7 days?

MODERATE ACTIVITY

a) ACTIVITY NAME? b) HOURS PER WEEKDAY?

c) HOURS PER WEEKEND DAY?

1^ST Activity ___________NAME

__ __ __CODE __ __: __ __HRS:MIN __ __: __ __HRS:MIN 2^ND Activity ___________NAME

__ __ __CODE __ __: __ __HRS:MIN __ __: __ __HRS:MIN 3^RD Activity ___________NAME

__ __ __CODE __ __: __ __HRS:MIN __ __: __ __HRS:MIN 4^TH Activity ___________NAME

__ __ __CODE __ __: __ __HRS:MIN __ __: __ __HRS:MIN 5^TH Activity ___________NAME

CODE : HRS:MIN : __HRS:MIN

(26)

SECTION H.

^Continued

STRENUOUS ACTIVITY

a) ACTIVITY NAME? b) HOURS PER

WEEKDAY? c) HOURS PER

WEEKEND DAY?

1^ST Activity ___________NAME

__ __ __CODE __ __: __ __HRS:MIN __ __: __ __HRS:MIN 2^ND Activity ___________NAME

__ __ __CODE __ __: __ __HRS:MIN __ __: __ __HRS:MIN 3^RDActivity ___________NAME

Supplemental Material on Maternal Physical Activity and Infant Birth Size