By …
Lennox Bryson, M.D.*
Boris Petrikovsky, M.D.*
Daniel Chikvashvili, M.D.**
* Department of OB/Gyn, Nassau University Medical Center
**Department of Medicine, Nassau University Medical Center
“Recommendations from the Handbook for Prospective Mothers, published in 1913, advised pregnant women that the amount of exercise needed cannot be precisely stated, walking is the best kind of exercise and all kinds of violent exertion should be avoided,” reported M.E. Schneider in July edition of OB/GYN News.
In 1985 ACOG released its first exercise guidelines for pregnant women, which included time limits for exercise and recommended that a woman’s heart rate not exceed 140 beats per minute.
1985 ACOG recommendations were rather vague and lack scientific support for its recommendations including maximum maternal heart rate of 140 bpm. With exercise and fitness mania of the late 80′s and 90′s, pregnant women were looking for guidelines from their doctors and midwifes. There were none. As a result, non-medical guru filled in by producing Jane Fonda exercise tapes for pregnant women and creating for profit yoga and meditation / holistic classes. Until now there are no prospective well controlled studies on this topic.
In 1994, ACOG issued updated guidelines which emphasized the benefits of mild to moderate exercise at least 3 days a week.
Warning signs for halting exercise while pregnant:
• Vaginal bleeding
• Dyspnea before exertion
• Dizziness
• Headache
• Chest pain
• Muscle weakness
• Calf pain or swelling – consistent with possible put
• Previous preterm labor
• Decreased fetal movement
• Amniotic fluid leakage
Relative contradictions to aerobic exercise during pregnancy
• Severe anemia
• Unevaluated maternal cardiac arrhythmia
• Poorly controlled Type 1 Diabetes
• Morbid obesity
• Extreme underweight
• History of extremely sedentary lifestyle
• Intrauterine growth restriction in current pregnancy
• Poorly controlled hypertension/pre-clampsia
• Orthopedic limitations
• Poorly controlled seizure disorder
• Poorly controlled thyroid disease
• Heavy smoker
• Body mass index >12
Absolute contradictions to aerobic exercise during pregnancy
• Significant heart disease
• Restrictive lung disease
• Incompetent cervix
• Multiple gestation at risk for premature labor
• Persistent second or third trimester bleeding
• Placenta previa after 26 weeks gestation
• Ruptured membranes
• Pregnancy induced hypertension
Most recent ACOG recommendations on exercise in pregnancy came out in 2002. Thus women with uncomplicated pregnancies may engage in 30 minutes or more of moderate exercise per day. Pregnant athletes may continue their practices in moderation.
Recommendations for Sport Activities During Pregnancy
Activities Recommended
Walking
Stationary cycling
Low-impact aerobics
Swimming
In 2004 ACOG produced a pamphlet entitled “Woman and Exercise,” which includes a chapter on exercise during pregnancy and postpartum period. ACOG pamphlet addresses the issue of maternal positions during physical activity. After the first trimester, the supine position results in relative obstruction of venous return and, therefore, decreased cardiac output and orthostatic hypotension. For this reason, pregnant women should avoid supine positions during exercise as much as possible. Participation in sports with a high potential for contact (ice hockey, soccer, and basketball) could result in trauma to both the woman and her fetus. Similarly, recreational activities with an increased risk of falling, such as gymnastics, should be avoided. Many of the physiologic and morphologic changes of pregnancy persist 4-6 weeks postpartum. Thus, prepregnancy exercise routines may be resumed gradually as soon as it is physically and medically safe.
Suggested Reading:
- American College of Obstetricians and Gynecologists. Exercise during pregnancy and the postpartum period. ACOG Technical Bulletin 189. Washington, D.C.: American College of Obstetricians and Gynecologists, 1994.
2. Clapp JF III. Exercise in pregnancy: a brief clinical review. Fetal Med Rev 1990; 2:89-101
- Pivarnik JM, Lee W, Clark SL, et al. Cardiac output responses of primigravid women during exercise during exercise determined by the direct Flick technique. Obstet Gynecol 1990; 75:954-9.
- Pivaranik JM. Cardiovascular responses to aerobic exercise during pregnancy and postpartum. Sem n Perinatol 1996; 20:242-9.
- Artal R, Wiswell R, Romen Y, et al . Pulmonary responses to exercise in pregnancy. Am J Obstet Gyencol 1986; 154:378-83.
- E xercise during pregnancy and pregnancy outcome. Med Sci Sports Exerc . 1995 May; 27(5); 634-40.
- Artal R, O’Toole M. Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. Br J Sports Med 2003; 37:6-12.
- ACOG, “Women and Exercise”. VolumeIII, Number 3, May 2004