{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,4]],"date-time":"2026-01-04T06:04:49Z","timestamp":1767506689236},"reference-count":64,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2023,2,20]],"date-time":"2023-02-20T00:00:00Z","timestamp":1676851200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005423","name":"Akademiska Sjukhuset","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005423","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005423","name":"Akademiska Sjukhuset","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005423","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Investigate associations between pre\u2010pregnancy participation and performance in a demanding cross\u2010country ski race (proxy for exercise volume and fitness) and perinatal outcomes. Pre\u2010registered protocol: osf.io\/aywg2.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Prospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Based on entire overlap between the Vasaloppet registry and the population\u2010based Swedish Pregnancy Register.<\/jats:p><\/jats:sec><jats:sec><jats:title>Sample<\/jats:title><jats:p>All female Vasaloppet participants 1991\u20132017 with subsequent singleton delivery (skiers), and age\u2010 and county\u2010matched non\u2010skiers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We calculated odds ratios (ORs) for non\u2010skiers versus skiers (model 1) and, among skiers, by performance (model 2), in Bayesian logistic regressions adjusted for socio\u2010demographics, lifestyle factors, and comorbidities. We repeated calculations adjusting for early pregnancy body mass index (potential mediator) and explored robustness (selection\/exposure settings; multiple comparisons correction).<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Twenty\u2010nine important perinatal outcomes, predefined based on existing expert consensus.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Non\u2010skiers (<jats:italic>n<\/jats:italic>\u00a0=\u00a0194\u2009384) versus skiers (<jats:italic>n<\/jats:italic>\u00a0=\u00a015\u2009377) (and slower versus faster performance, not shown) consistently had higher odds of gestational diabetes mellitus (GDM) (OR 1.70, 95% highest density interval: 1.40\u20132.09), excessive gestational weight gain (GWG) (1.28, 1.22\u20131.38), psychiatric morbidity (1.60, 1.49\u20131.72), any caesarean section (CS) (1.34, 1.28\u20131.40), elective CS (1.39, 1.29\u20131.49), and large\u2010for\u2010gestational\u2010age babies (&gt;90th percentile, 1.11, 1.04\u20131.18); lower odds of inadequate GWG (0.83, 0.79\u20130.88); and no associations with fetal\/neonatal complications (e.g. preterm birth [1.09, 0.98\u20131.20], small for gestational age [SGA] [1.23, 1.05\u20131.45]). Adjustment for body mass index attenuated associations with excessive (1.20, 1.14\u20131.30) and inadequate GWG (0.87, 0.83\u20130.92) and large for gestational age (1.07, 1.00\u20131.13).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Non\u2010skiers compared with skiers, and slower versus faster performance, consistently displayed higher odds of GDM, excessive GWG, psychiatric morbidity, CS and large\u2010for\u2010gestational\u2010age babies; and lower odds of inadequate GWG, after adjustment for socio\u2010demographic and lifestyle factors and comorbidities. There were no associations with fetal\/neonatal complications.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17414","type":"journal-article","created":{"date-parts":[[2023,1,30]],"date-time":"2023-01-30T14:15:56Z","timestamp":1675088156000},"page":"891-901","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Pre\u2010pregnancy participation and performance in world's largest cross\u2010country ski race as a proxy for physical exercise and fitness, and perinatal outcomes: Prospective registry\u2010based cohort study"],"prefix":"10.1111","volume":"130","author":[{"given":"Cathrine","family":"Axfors","sequence":"first","affiliation":[{"name":"Department for Women's and Children's Health Uppsala University  Uppsala Sweden"},{"name":"Meta\u2010Research Innovation Center at Stanford (METRICS) Stanford University  Stanford California 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