Exercise in Pregnancy by Dr. Soujanya Tummuru

Exercise in Pregnancy

In healthy women who don’t have any medical complications, exercise can be safe and healthy for both mom and baby! Pregnancy is also an ideal time to make positive lifestyle changes, which can include a healthy diet and increasing physical activity.

ACOG recommends at least 150 minutes of moderate-intensity physical activity weekly during pregnancy.

Benefits

-Avoidance of excessive weight gain during pregnancy

-Prevention/reduction of lower back pain or pelvic pain

-Prevention of urinary incontinence

-31% decreased risk of delivering a macrosomic or large for gestestational age newborn

-Decreased risk of developing gestational diabetes and preeclampsia

-Possible decrease in the length of labor

– 15% reduced risk of cesarean delivery

-In women with Gestational Diabetes, physical activity can lead to better glycemic control, and less need for medications during pregnancy

-No increased risk of preterm birth or miscarriage

-Infants of women who engage in physical activity while pregnant may avoid becoming overweight or developing Diabetes later in life

Risks

Hyperthermia (increased core temperature >102.2)

-unlikely during normal exercise

-increased risk during intense exercise in a “Hot” room or running outside on a very hot summer day

-avoid exercise in extreme heat (>95 degrees)

Maternal trauma (i.e. falling)

-can lead to obstetrical complications such as placental abruption if severe trauma

Contraindications

Women with any of these complications should avoid exercising during pregnancy. Always talk to your Doctor first if you are unsure!

-Persistent 2^nd or 3^rd trimester bleeding (Placenta previa )

-Cerclage

-Severe anemia

-Premature labor during the current pregnancy

-Ruptured membranes

-Hypertensive disorders of pregnancy

-Cardiovascular disease

-Restrictive lung disease

-Intrauterine Growth restriction during current pregnancy

-Extreme morbid obesity OR Extreme underweight

-Orthopedic limitations

-Unevaluated Cardiac Arrhythmia

Precautions

-Avoid contact sports, exercises with increased risk of injury/falling, jumping, inverted yoga poses, heavy weight lifting

-Avoid working out in extreme heat (>95 degrees)

-Avoid scuba diving (risk of decompression sickness in mom and baby)

-Avoid exercise in high altitudes for 3-4 days until body acclimates (increased risk of altitude sickness)

-Avoid supine positions after 1^st trimester (Laying flat on your back)

-Avoid heavy weight lifting/strength training

-Prolonged intense exercise can lead to dehydration and/or hyperthermia. Make sure to HYDRATE!!! Dehydration can lead to uterine contractions…. HYDRATE!!!!

Exercise Regimen

Frequency: 

-30 min/day, 5-7 days/week

Intensity:

-Previously sedentary women- start at low to moderate intensity and build up intensity gradually

-Previously active individuals may safely continue to engage in high intensity exercises

“Talk Test” :

-You should be able to hold a normal conversation while engaging in physical activity

Heart Rate Monitoring:

-If you don’t already have a heart rate monitor, it is a good idea to get one to monitor exertion during exercise

Target HR

Age <20 years: 140-155 bpm

Age 20-29: 135-150 bpm

Age 30-39: 130-145 bpm

Age > 40 years:  125-140 bpm

STOP EXERCISING and consult your physician if:

-vaginal bleeding, regular painful contractions, leakage of amniotic fluid,  new shortness of breath, dizziness, headache, chest pain, muscle weakness affecting balance, calf pain/swelling

FAQ:

When can I return to an exercise routine post-partum?

-After an uncomplicated delivery, you may return to light physical activity in 1-2 weeks, and gradually increase intensity.  Listen to your body and avoid any strenuous activity until cleared by a physician.

Does exercise affect breastfeeding?

-No change in breast milk production with moderate intensity exercise

-Nursing before exercising avoids discomforts of engorgement

-Adequate fluid intake is necessary with any exercise to avoid decreasing milk supply

What exercises should I avoid in pregnancy?

-contact sports (i.e. ice hockey, soccer, boxing, basketball)

-skiing, surfing, gymnastics, road cycling, horseback riding

-scuba diving

-sky diving

-hot yoga/hot pilates

Recommended weight gain in pregnancy

The amount of weight gain that is recommended during pregnancy depends on pre-pregnancy starting weight. These recommendations are based on a singleton pregnancy.  Your doctor or health care provider can help you determine your starting BMI at your initial visit.

*Increased maternal weight gain can increase risk of c-section

*Low weight gain is associated with an increased risk of low birth weights, while higher weight gain is linked to higher birth weights and increased risk of having a macrosomic infant.