title: The Impact of Symptoms of Depression and Walking on Gestational Age at Birth in African American Women.
abstract: Symptoms of depression have been related to lower gestational age and preterm birth (<37 completed weeks gestation). Leisure time physical activity may have protective effects on preterm birth; however, less has been published with regard to other domains of physical activity such as walking for a purpose (e.g., for transportation) or the pathways by which symptoms of depression impact gestational age at birth.
  
  
  
  This was a secondary analysis of available data of African American women. Women were interviewed within 3 days after birth. We proposed a model in which walking for a purpose during pregnancy mediated the effects of symptoms of depression (measured by the 20-item Center for Epidemiologic Studies-Depression [CES-D] scale) on gestational age at birth in a sample of 1,382 African American women.
  
  
  
  Using structural equation modeling, we found that the direct effect of CES-D scores of 23 or greater, which have been correlated with major depression diagnosis, on gestational age at birth was -4.23 (p < .001). These results indicate that symptoms of depression were associated with a decrease in gestational age at birth of 4.23 days. Walking for a purpose mediated the effect of CES-D scores of 23 or greater on gestational age at birth.
  
  
  
  Compared with African American women without symptoms of depression, African American women who had symptoms of depression walked less for a purpose during their pregnancy and delivered infants with lower gestational age at birth. If not medically contraindicated, clinicians should incorporate walking as part of prenatal care recommendations and reassure women about safety of walking during pregnancy.
authors.affiliation: College of Nursing, Wayne State University, Detroit, Michigan. Electronic address: carmen.giurgescu@wayne.edu.
authors.forename: Carmen
authors.initials: C
authors.lastname: Giurgescu
authors.affiliation: College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania.
authors.forename: Jaime C
authors.initials: JC
authors.lastname: Slaughter-Acey
authors.affiliation: College of Nursing, Wayne State University, Detroit, Michigan.
authors.forename: Thomas N
authors.initials: TN
authors.lastname: Templin
authors.affiliation: Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, Michigan.
authors.forename: Dawn P
authors.initials: DP
authors.lastname: Misra
mesh_terms: D000328:Adult; D001741:Black or African American; D015986:Confounding Factors, Epidemiologic; D003863:Depression; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D047928:Premature Birth / Q000503:physiopathology / Q000523:psychology; D012959:Socioeconomic Factors; D016138:Walking