There is no question that getting adequate physical activity is important to general health and well-being, but what when you are pregnant? Many people question what is OK and what isn’t and if there are any risks.
If you are just starting an exercise routine in a low-risk pregnancy, you should be sure to have a thorough clinical exam prior to ensure no medical contraindications. Beginning an exercise routine while pregnant can be intimidating and challenging. You may note body changes and discomfort, a lack of time, and not having a social group or support system for exercising may make starting an exercise routine difficult. Just know that those who are able to incorporate exercise into their prenatal routine have an improvement in well-being, quality of life, and mood. You may also find that you experience fewer episodes of nausea, vomiting, and fatigue. Finally, there is a reduced odds of developing prenatal depression.
To get started, set a goal of 20 to 30 minutes daily on most days of the week, aiming to reach 150 minutes of moderate intensity aerobic activity per week during pregnancy and postpartum. A good gauge of “moderate intensity” exercise is the “Talk Test”- if you can carry on a conversation, typically this level of activity would not be associated with over-exertion.
Those with an established, regular exercise routine prior to pregnancy and who have uncomplicated pregnancies, should be able to participate in and maintain the same level of intensity during their pregnancy with no adverse effects, and monitoring your heart rate is not necessary. Be sure to listen to your body and make changes to exercise routines to accommodate the growing uterus, and pay attention to the physiologic fatigue of pregnancy and any limitations on the physical ability for more intense exercises as your pregnancy progresses.
Elite athletes are defined as having several years’ experience in a particular sport, usually training 2 times per day, at least 5 days a week. Close monitoring of body temperature, hydration status, and nutrition intake to avoid hypoglycemia during exercise and overall weight loss during pregnancy is recommended, as fetal growth can be affected. Elite athletes are at added risk for activity-related injuries in pregnancy, largely due to compensatory measures taken to counterbalance a changing anatomy, such as pelvic instability or postural changes. If you fall into this category, discuss your exercise routine with your obstetrical care provider to see if any modifications should be done or additional fetal surveillance should be initiated.
Overall, exercise is a key part of a healthy pregnancy and should be encouraged. Exercise is associated with a reduced risk of certain complications in pregnancy such as gestational diabetes, excessive weight gain, hypertensive disorders, preterm birth, and low birth weight, and may be associated with a reduced risk of cesarean section. It is also associated with a higher incidence of vaginal delivery. Additionally, exercise conveys benefits in the postpartum period by reducing recovery time and preventing postpartum depression. Keep in mind that modifications of various exercises may be necessary due to the physiologic changes of pregnancy, as well as your changing body.
Despite what some may have thought in decades past, physical activity in low risk pregnancies is not linked to miscarriage, poor fetal growth, musculoskeletal system injury, or preterm delivery.
Progressive curvature of the lower spine inward, also known as lordosis, during pregnancy leads to increased force on the joints and spine with back pain occurring in 60% of pregnancies. The good news is that abdominal and back muscle strengthening reduces this risk.
A supine position (or laying flat on your back) when you are over 20 weeks pregnant may lead to decreased venous return to your heart and a drop in your blood pressure. Be sure to use position modifications for supine activities after this point.
Because you lose both water and electrolytes when sweating, be sure to stay adequately hydrated. It can also help to avoid high heat and humidity (especially during the first trimester), and wear loose fitting clothing.
Discontinue an exercise program if you experience any of the following and talk to your ObGyn immediately:
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Shannon M. Clark, MD, MMS is a double board certified ObGyn and Maternal-Fetal Medicine Specialist, and founder of Babies After 35. In her roles as a clinician, educator and researcher at UTMB-Galveston, she focuses on the care of people with maternal and/or fetal complications of pregnancy. Dr. Clark has taken a special interest in pregnancy after the age of 35, which according to age alone, is considered a high-risk pregnancy.
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