Studies show that exercise in pregnancy make for healthier Mums and healthier babies (and it’s never too late to start!)

freestanding-handstandabetes Mellitus is one of the most common complications in pregnancy and I’m sure it’s happened to you or maybe someone you know. It can be associated with many unhappy outcomes in the offspring and the mother due to the abnormality in carbohydrate metabolism and glycemic control. Prevalence is thought to be as high as 14% of all pregnancys. The risks of undergoing C-section, induction of labor and of developing type 2 diabetes in later life are all augmented. Infants born to mothers with GDM are more likely to experience being overweight or be obese, develop type 1 or 2 diabetes and may have impaired intellectual achievement. Risk factors for development are varied and include advanced maternal age, ethnic background, large birth weight and a history of previous GDM, these are all not within our control however. Fortunately, since GDM is a consequence of glycemic control, it can be modified by exercise and dietary interventions. The American College of Obstetricians and Gynecologists (ACOG) recommend that a healthy pregnant women exercise at moderate intensity for at least 30 minutes, on most days of the week. This level of activity is associated with lower risk for developing GDM. It would appear from the studies available that the most effective time to decrease the risk of developing this condition is to be in great condition prior to pregnancy and to maintain that level during the first trimester. There was not robust evidence in this anaylsis that would suggest that starting an exercise program in the second or third trimester would be advisable or produce the desired effect (Yin et al., 2013), however in a trial performed in a hospital setting, previously sedentary women that exercised 3 times a week during the last 2 trimesters of their pregnancy were able to significantly lower their risk and the development of GDM (Barakat et al., 2013). Therefore, it seems that again the exercise effect is going to be beneficial and it is always better to be active than inactive.

 

Before preparing a program for a healthy women during pregnancy, there are certain things that should be taken into consideration.

Firstly, is there good evidence that exercise in pregnancy is beneficial? 

Research suggests that self rated measures for quality of life show marked improvement with the addition of aerobic or resistance exercise, even in previously sedentary women. During pregnancy, symptoms are an important contributor to poor health status, while in the postpartum period a lack of social support is the most consistent predictor of poor health outcomes.

Following recommended levels of physical activity are positively associated with one or more domains of health-related quality of life. In particular, physical functioning, general health, vitality, social functioning, and mental health are critically affected (Montoya Arizabaleta et al., 2010).

Low back pain occurs frequently during pregnancy. Studies on the topic have been conducted on three different continents, and depending on the method and definition used, the prevalence varies from 50 to 70% of all pregnant women. Exercise is a proven tool to decrease back pain (Backhausen et al., 2014).

In addition, Regular moderate-intensity exercise performed over the second-third trimesters of pregnancy can be used to decrease gestational diabetes mellitus-incidiece (Barakat et al., 2013), however this is most not likely related to introduction of exercise alone and therefore other lifestyle related interventions should be considered (Yin et al., 2013).

To follow……contraindications to exercise in pregnancy and how to know if you should stop

 

So the question becomes, “What are the contraindications (relative and absolute) to exercise in pregnancy?” 

We’ve determined through evaluating the available evidence that yes, exercise in pregnancy is not only beneficial, but absolutely the right thing to do for your health and that of your child. If you missed it, see part 1 and part 2.

Is there any reason not to exercise? Well, there are some established guidelines which I have listed below. These are taken from the best available information and I would stand behind this 100%

From Wadsworth, (2007)

Based on the recommendations from the American College of Obstetricians and Gynecologists

Contraindications to Exercise In Pregnancy

  1. Haemodynamically significant heart disease
  2. Restrictive Lung Disease
  3. Incompetent Cervix or cerciage
  4. Multiple gestation at risk of premature laour
  5. Persistent second or third trimester bleeding
  6. Placenta previa after 26 weeks of gestation
  7. Premature labor during the current pregnancy
  8. Ruptured membranes
  9. Preeclampsia or pregnancy induced hypertension

Relative Contraindications to Aerobic Exercise During Pregnancy

  1. Severe anaemia
  2. Unevaluated maternal cardiac arrhythmia
  3. Chronic bronchitis
  4. Poorly controlled type 1 diabetes
  5. Extreme morbid obesity
  6. Extreme underweight (body mass <12)
  7. History of extremely sedentary lifestyle
  8. Intrauterine growth restriction in current pregnancy
  9. Poorly controlled hypertension
  10. Orthopedic limitations
  11. Poorly controlled seizure disorder
  12. Poorly controlled hyperthryoirdsiom
  13. Heavy smoker

 

What are the warning signs that you should make be aware of during exercise that should make you stop exercising? 

What about if you’re cleared for exercise? There’s some good and obvious signs and symptoms to be wary of, mostly based on common sense. The list is not exhaustive but clearly most of these merit investigation and for sure would prohibit any further exertion until you got to the bottom of the problem.

Warning Signs to Terminate Exercise While Pregnant

  1. Vaginal Bleeding
  2. Dyspnea before exertion
  3. Dizziness
  4. Headache
  5. Chest pain
  6. Muscle weakness
  7. Calf pain or swelling (rule out thrombophlebitis)
  8. Preterm labor
  9. Decreased fetal movement
  10. Amniotic fluid leackage

 

THAT CONCLUDES THIS SHORT 3 PART SERIES ON EXERCISE AND PREGNANCY. ANY QUESTIONS, LET ME KNOW VIA COMMENT, MESSAGE OR THROUGH FACEBOOK

References

Backhausen, M., Katballe, M., Hansson, H., Tabor, A., Damm, P. and Hegaard, H. (2014). A standardised individual unsupervised water exercise intervention for healthy pregnant women. A qualitative feasibility study. Sexual & Reproductive Healthcare.

 

Barakat, R., Cordero, Y., Coteron, J., Luaces, M. and Montejo, R. (2011). Exercise during pregnancy improves maternal glucose screen at 24-28 weeks: a randomised controlled trial. British Journal of Sports Medicine, 46(9), pp.656-661.

 

Barakat, R., Pelaez, M., Lopez, C., Lucia, A. and Ruiz, J. (2013). Exercise during pregnancy and gestational diabetes-related adverse effects: a randomised controlled trial. British Journal of Sports Medicine, 47(10), pp.630-636.

 

Barakat, R., Ruiz, J. and Lucia, A. (2009). Exercise during pregnancy and risk of maternal anaemia: a randomised controlled trial. British Journal of Sports Medicine, 43(12), pp.954-956.

 

Bo, K., Hilde, G., Staer-Jensen, J., Siafarikas, F., Tennfjord, M. and Engh, M. (2014). Does general exercise training before and during pregnancy influence the pelvic floor “opening” and delivery outcome? A 3D/4D ultrasound study following nulliparous pregnant women from mid-pregnancy to childbirth. British Journal of Sports Medicine.

 

Clapp, J., Kim, H., Burciu, B. and Lopez, B. (2000). Beginning regular exercise in early pregnancy: Effect on fetoplacental growth. American Journal of Obstetrics and Gynecology, 183(6), pp.1484-1488.

 

Clapp, J., Kim, H., Burciu, B., Schmidt, S., Petry, K. and Lopez, B. (2002). Continuing regular exercise during pregnancy: Effect of exercise volume on fetoplacental growth. American Journal of Obstetrics and Gynecology, 186(1), pp.142-147.

 

Kim, K., Chung, E., Kim, C. and Lee, S. (2012). Swimming exercise during pregnancy alleviates pregnancy-associated long-term memory impairment. Physiology & Behavior, 107(1), pp.82-86.

 

Montoya Arizabaleta, A., Orozco Buitrago, L., Aguilar de Plata, A., Mosquera Escudero, M. and Ramírez-Vélez, R. (2010). Aerobic exercise during pregnancy improves health-related quality of life: a randomised trial. Journal of Physiotherapy, 56(4), pp.253-258.

 

Salvesen, K., Hem, E. and Sundgot-Borgen, J. (2012). Fetal wellbeing may be compromised during strenuous exercise among pregnant elite athletes. British Journal of Sports Medicine, 46(4), pp.279-283.

 

Szymanski, L. and Satin, A. (2012). Strenuous exercise during pregnancy: is there a limit?. American Journal of Obstetrics and Gynecology, 207(3), pp.179.e1-179.e6.

Tinloy, J., Chuang, C., Zhu, J., Pauli, J., Kraschnewski, J. and Kjerulff, K. (2014). Exercise during Pregnancy and Risk of Late Preterm Birth, Cesarean Delivery, and Hospitalizations. Women’s Health Issues, 24(1), pp.e99-e104.

 

Wadsworth, P. (2007). The Benefits of Exercise in Pregnancy. The Journal for Nurse Practitioners, 3(5), pp.333-339.

 

Yin, Y., Li, X., Tao, T., Luo, B. and Liao, S. (2013). Physical activity during pregnancy and the risk of gestational diabetes mellitus: a systematic review and meta-analysis of randomised controlled trials. British Journal of Sports Medicine, 48(4), pp.290-295.

References

Backhausen, M., Katballe, M., Hansson, H., Tabor, A., Damm, P. and Hegaard, H. (2014). A standardised individual unsupervised water exercise intervention for healthy pregnant women. A qualitative feasibility study. Sexual & Reproductive Healthcare.

 

Barakat, R., Cordero, Y., Coteron, J., Luaces, M. and Montejo, R. (2011). Exercise during pregnancy improves maternal glucose screen at 24-28 weeks: a randomised controlled trial. British Journal of Sports Medicine, 46(9), pp.656-661.

 

Barakat, R., Pelaez, M., Lopez, C., Lucia, A. and Ruiz, J. (2013). Exercise during pregnancy and gestational diabetes-related adverse effects: a randomised controlled trial. British Journal of Sports Medicine, 47(10), pp.630-636.

 

Barakat, R., Ruiz, J. and Lucia, A. (2009). Exercise during pregnancy and risk of maternal anaemia: a randomised controlled trial. British Journal of Sports Medicine, 43(12), pp.954-956.

 

Bo, K., Hilde, G., Staer-Jensen, J., Siafarikas, F., Tennfjord, M. and Engh, M. (2014). Does general exercise training before and during pregnancy influence the pelvic floor “opening” and delivery outcome? A 3D/4D ultrasound study following nulliparous pregnant women from mid-pregnancy to childbirth. British Journal of Sports Medicine.

 

Clapp, J., Kim, H., Burciu, B. and Lopez, B. (2000). Beginning regular exercise in early pregnancy: Effect on fetoplacental growth. American Journal of Obstetrics and Gynecology, 183(6), pp.1484-1488.

 

Clapp, J., Kim, H., Burciu, B., Schmidt, S., Petry, K. and Lopez, B. (2002). Continuing regular exercise during pregnancy: Effect of exercise volume on fetoplacental growth. American Journal of Obstetrics and Gynecology, 186(1), pp.142-147.

 

Kim, K., Chung, E., Kim, C. and Lee, S. (2012). Swimming exercise during pregnancy alleviates pregnancy-associated long-term memory impairment. Physiology & Behavior, 107(1), pp.82-86.

 

Montoya Arizabaleta, A., Orozco Buitrago, L., Aguilar de Plata, A., Mosquera Escudero, M. and Ramírez-Vélez, R. (2010). Aerobic exercise during pregnancy improves health-related quality of life: a randomised trial. Journal of Physiotherapy, 56(4), pp.253-258.

 

Salvesen, K., Hem, E. and Sundgot-Borgen, J. (2012). Fetal wellbeing may be compromised during strenuous exercise among pregnant elite athletes. British Journal of Sports Medicine, 46(4), pp.279-283.

 

Szymanski, L. and Satin, A. (2012). Strenuous exercise during pregnancy: is there a limit?. American Journal of Obstetrics and Gynecology, 207(3), pp.179.e1-179.e6.

Tinloy, J., Chuang, C., Zhu, J., Pauli, J., Kraschnewski, J. and Kjerulff, K. (2014). Exercise during Pregnancy and Risk of Late Preterm Birth, Cesarean Delivery, and Hospitalizations. Women’s Health Issues, 24(1), pp.e99-e104.

 

Wadsworth, P. (2007). The Benefits of Exercise in Pregnancy. The Journal for Nurse Practitioners, 3(5), pp.333-339.

 

Yin, Y., Li, X., Tao, T., Luo, B. and Liao, S. (2013). Physical activity during pregnancy and the risk of gestational diabetes mellitus: a systematic review and meta-analysis of randomised controlled trials. British Journal of Sports Medicine, 48(4), pp.290-295.

 

References

Barakat, R., Pelaez, M., Lopez, C., Lucia, A. and Ruiz, J. (2013). Exercise during pregnancy and gestational diabetes-related adverse effects: a randomised controlled trial.

Yin, Y., Li, X., Tao, T., Luo, B. and Liao, S. (2013). Physical activity during pregnancy and the risk of gestational diabetes mellitus: a systematic review and meta-analysis of randomised controlled trials. British Journal of Sports Medicine, [online] 48(4), pp.290-295. Available at: http://www.bjsm.com [Accessed 12 Nov. 2014].

2018-02-12T21:51:49+00:00 November 12th, 2014|Sports Medicine|