The Generalist: Exercise and Pregnancy

The Generalist: Exercise in Pregnancy

Dusty Marie Narducci, MD, and Heidi James, MD 

Exercise during uncomplicated pregnancy is safe, has many health benefits, and should be recommended by physicians. Here, Dusty Narducci discusses the many benefits—and the few caveats—of exercise in pregnancy.  

• Exercise in pregnancy decreases the risk of 
• Gestational weight gain, diabetes, hypertension, musculoskeletal discomforts
• Preeclampsia
• Macrosomia
• Instrumental delivery
• Postpartum weight retention
• Urinary incontinence
• Depressive disorders
• The PARMed-X is a useful tool to determine your patient’s readiness for exercise.
• While exercise is safe in uncomplicated pregnancies, contraindications include but are not limited to the following:
• Maternal considerations
• Preeclampsia, pregnancy-induced hypertension
• Hemodynamically significant heart disease, arrhythmia
• Severe lung disease
• Severe anemia
• Poorly controlled type 1 diabetes, hypertension, hyperthyroidism, seizure disorder
• Extremes in weight
• Obstetrical considerations (related to abnormalities during the CURRENT pregnancy, NOT previous pregnancies)
• Cervical insufficiency or cerclage
• Persistent 2nd or 3rd trimester bleeding
• Placenta previa after 26 weeks
• Premature labor during the current pregnancy 
• Ruptured membranes
• We can prescribe exercise to our patients, using the FITT acronym to provide direction: 
• Frequency
• Intensity
• Time
• Type
• What types of exercises are best? Exercises that
• Activate large muscle groups
• Maintain strength and core muscles
• Maintain flexibility
• What exercises should be avoided?
• Exercise in extremes in temperature
• Contact sports
• High-risk activities (eg, scuba diving) 
• Patients should stop exercising if they experience
• Painful contractions, vaginal bleeding, leakage of amniotic fluid
• Dyspnea, chest pain
• Dizziness, syncope, headache
• Muscle weakness affecting balance
• Deep vein thrombosis symptoms
• Exercise in postpartum period
• Should be encouraged
• Can prevent postpartum depression
• Can be continued while breastfeeding as moderate exercise does not impact breast milk quantity and composition 

References:

Exercise during pregnancy: Obstetricians' beliefs and recommendations compared to American Congress of Obstetricians and Gynecologists' 2015 Guidelines
McGee LD, Cignetti CA, Sutton A, et al. Cureus. 2018;10(8):e3204. doi: 10.7759/cureus.3204. 

The effect of supervised prenatal exercise on fetal growth: a meta-analysis
Wiebe HW, Boulé NG, Chari R, et al. Obstet Gynecol. 2015;125(5):1185-1194. doi: 10.1097/AOG.0000000000000801.

It's time to treat exercise in pregnancy as therapy
Davies G, Artal R. Br J Sports Med. 2019;53(2):81. doi: 10.1136/bjsports-2018-100360.

Exercise during pregnancy
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists, 2016. 

Exercise and pregnancy in recreational and elite athletes: 2016/2017 evidence summary from the IOC expert group meeting, Lausanne. Part 5–Recommendations for health professionals and active women.
Bø K, Artal R, Barakat R, et al. Br J Sports Med. 2018;52:1080-1085. doi: 10.1136/bjsports-2018-099351.

Exercise and pregnancy in recreational and elite athletes: 2016/17 evidence summary from the IOC expert group meeting, Lausanne. Part 4–Recommendations for future research
Bø K, Artal R, Barakat R, et al. Br J Sports Med. 2017;51(24):1724-1726. doi: 10.1136/bjsports-2017-098387.

Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 2–The effect of exercise on the fetus, labour and birth
Bø K, Artal R, Barakat R, et al. Br J Sports Med. 2016 Nov;50(21):1297-1305.
doi: 10.1136/bjsports-2016-096810.

ACOG Committee Opinion No. 804: Physical Activity and Exercise During Pregnancy and the Postpartum Period
Committee on Obstetric Practice. Obstet Gynecol. 2020;135:e178.

Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 1–Exercise in women planning pregnancy and those who are pregnant
Bø K, Artal R, Barakat R, et al. Br J Sports Med. 2016;50:571-589. doi: 10.1136/bjsports-2016-096218.

PARMed-X for pregnancy physical activity readiness medical examination
Canadian Society for Exercise Physiology. 2015. http://www.csep.ca/cmfiles/publications/parq/parmed-xpreg.pdf (Accessed on September 21, 2018).

Provider advice on physical activity and nutrition in twin pregnancies: a cross-sectional electronic survey
Whitaker KM, Baruth M, Schlaff RA, et al. BMC Pregnancy Childbirth. 2019;19:418. doi: 10.1186/s12884-019-2574-2.