{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T05:48:56Z","timestamp":1784180936264,"version":"3.55.0"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"1-2","license":[{"start":{"date-parts":[[2024,6,29]],"date-time":"2024-06-29T00:00:00Z","timestamp":1719619200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1,16]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Pregnancy has a profound impact on physical fitness, and delivery does not allow for rapid return to peak performance levels as physiologic changes can persist for greater than 1 year postpartum. Multiple studies across all military services have documented decrements in physical performance with pregnancy among women. The purpose of this study was to determine the impact of serial pregnancies on physical fitness and body composition in a cohort of Army women. We hypothesized that a second pregnancy would be associated with increasing decrements in physical fitness in active duty soldiers beyond that seen following a first delivery.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>This retrospective cohort study screened all active duty soldiers who had delivered a singleton pregnancy of\u2009\u226532\u2009weeks gestation between January 1, 2011 and March 31, 2017 at a single military medical center. This roster of eligible women was used to extract Army Physical Fitness Test (APFT) and height\/weight data from the U.S. Army Digital Training Management System. Soldiers who delivered their first 2 pregnancies over this period were included. Select antepartum, intrapartum, and postpartum data were collected from the electronic medical record. The primary outcome variables were raw scores for push-ups, sit-ups, and run events as well as weight measures across the 2 pregnancies. The secondary outcomes were the failure rates on both the APFT events and body mass index measurements. Data were analyzed using paired t-tests to compare the means of APFT scores across the 2 pregnancies. The subjects served as their own controls. This study was approved by Regional Health Command-Pacific.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 2,103 active duty soldiers delivered singleton pregnancies at Tripler Army Medical Center between January 2011 and March 2017. Among these, 16 women delivered both their first- and second-term pregnancies and had APFT data available for analysis. Average age at time of first and second delivery was 26.1 and 28.1\u2009years, respectively. Mean time separating the first postpartum APFT from the delivery was 8.8\u2009months for the first pregnancy and 7.3\u2009months following the second.<\/jats:p>\n                  <jats:p>A significant decrease in mean sit-up score was found comparing APFT-1 with APFT-2 (72.1 vs 65.7, P\u2009=\u2009.043) and comparing APFT-1 to APFT-3 (72.1 vs 60.9, P\u2009=\u2009.002). A significant increase in mean run time was found comparing APFT-1 to APFT-3 (16.9\u2009minutes vs 17.9\u2009minutes, P\u2009=\u2009.010) and APFT-2 to APFT-3 (17.5\u2009minutes vs 17.9\u2009minutes, P\u2009=\u2009.027). Comparing APFT-1 to APFT-3 showed a significant decrease in sit-up raw scores (P\u2009=\u2009.002), run times (P\u2009=\u2009.010), and total APFT scores (P\u2009=\u2009.01). Overall, the data show a trend of decreasing performance in all APFT events across the 3 APFTs and a trend toward higher failure rates. This cohort of soldiers did not experience weight gain following the pregnancies.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The present study is the first to analyze the association of serial pregnancies on physical fitness utilizing a validated physical fitness test, and the results suggest that a second pregnancy is associated with progressive worsening of performance. This study is limited by the small sample size, and future studies could further elucidate the degree to which serial pregnancies affect physical fitness.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usae335","type":"journal-article","created":{"date-parts":[[2024,6,29]],"date-time":"2024-06-29T11:47:40Z","timestamp":1719661660000},"page":"40-46","source":"Crossref","is-referenced-by-count":2,"title":["Effect of Serial Pregnancies on Physical Fitness"],"prefix":"10.1093","volume":"190","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7719-2889","authenticated-orcid":false,"given":"Eric M","family":"Schmitt","sequence":"first","affiliation":[{"name":"Gynecologic Surgery and Obstetrics Department, Tripler Army Medical Center , Honolulu, HI 96859,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David W","family":"DeGroot","sequence":"additional","affiliation":[{"name":"Army Heat Center, Martin Army Community Hospital , Fort Moore, GA 31905,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Collin A","family":"Sitler","sequence":"additional","affiliation":[{"name":"Gynecologic Surgery and Obstetrics Department, Womack Army Medical Center , Fort Liberty, NC 28310,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Lustik","sequence":"additional","affiliation":[{"name":"Department of Clinical Investigation, Tripler Army Medical Center , Honolulu, HI 96859,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan P","family":"Gehrich","sequence":"additional","affiliation":[{"name":"Gynecologic Surgery and Obstetrics Department, Tripler Army Medical Center , Honolulu, HI 96859,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,6,29]]},"reference":[{"issue":"11","key":"2025042508420345900_R1","doi-asserted-by":"publisher","first-page":"1469","DOI":"10.1016\/s0002-9149(97)00738-8","article-title":"Cardiovascular function before, during, and after the first and subsequent pregnancies","volume":"80","author":"Clapp","year":"1997","journal-title":"Am J Cardiol"},{"issue":"7","key":"2025042508420345900_R2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0255248","article-title":"The effect of pregnancy and the duration of postpartum convalescence on the physical fitness of healthy women: a cohort study of active duty servicewomen receiving 6 weeks versus 12 weeks convalescence","volume":"16","author":"DeGroot","year":"2021","journal-title":"PLoS One"},{"issue":"1-2","key":"2025042508420345900_R3","doi-asserted-by":"publisher","first-page":"e227","DOI":"10.1093\/milmed\/usz168","article-title":"Postpartum fitness and body mass index changes in active duty navy women","volume":"185","author":"Rogers","year":"2020","journal-title":"Mil Med"},{"issue":"12","key":"2025042508420345900_R4","doi-asserted-by":"publisher","first-page":"1519","DOI":"10.7205\/milmed-d-12-00248","article-title":"Changes in Air Force fitness measurements pre- and post-childbirth","volume":"177","author":"Armitage","year":"2012","journal-title":"Mil Med"},{"issue":"8","key":"2025042508420345900_R5","doi-asserted-by":"publisher","first-page":"1433","DOI":"10.3109\/14767058.2011.639820","article-title":"Return to military weight standards after pregnancy in active duty working women: comparison of marine corps vs. navy","volume":"25","author":"Greer","year":"2012","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"6","key":"2025042508420345900_R6","doi-asserted-by":"publisher","first-page":"534","DOI":"10.7205\/milmed.171.6.534","article-title":"Effects of pregnancy on the army physical fitness test","volume":"171","author":"Weina","year":"2006","journal-title":"Mil Med"},{"key":"2025042508420345900_R7","volume-title":"Army Regulation 40\u2013501: Standards of Medical Fitness","author":"U.S. Department of the Army","year":"2019"},{"key":"2025042508420345900_R8","volume-title":"Army Regulation 600-9: The Army Body Composition Program","author":"U.S. Department of the Army","year":"2019"},{"issue":"2","key":"2025042508420345900_R9","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1136\/oemed-2016-103684","article-title":"Fitness tests and occupational tasks of military interest: a systematic review of correlations","volume":"74","author":"Hauschild","year":"2017","journal-title":"Occup Environ Med"},{"key":"2025042508420345900_R10","article-title":"FM 7\u201322 Army Physical Readiness Training: Appendix A\u2014Army Physical Fitness Test (APFT). 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