Exercise and PregnancyBy:Nariman GhalebMohamed MoneerLo’ayMahmoud Rabee’

Supervised by:Dr Mohamed El

Sharkawy

OverviewBenefitsSuggested ExercisesMyths DebunkingContraindicationsPostpartum

Benefits of exercise during pregnancyEnjoymentMore energyImproved postureImproved circulationWeight controlStress reliefImproved sleepStronger back muscles, which can help manage back painPreparation for the physical demands of labourFaster recuperation after labourFaster return to pre-pregnancy fitness and healthy weight

Preventing & Treating GDM

• Exercise may be beneficial in the primary prevention of GDM, especially in morbidly obese women (BMI > 33)

• Resistance training may reduce need for insulin therapy in overweight women (BMI > 25)

• ADA endorsed exercise as helpful adjunctive therapy with GDM when euglycemia is not achieved by diet alone.

LABOR AFTER ENDURANCE EXERCISE IN PREGNANCY

Exercise(n=87)

Control(n=44)

Incidence of PTL 9% 9%Length of Gestation 277 d 282 dIncidence of c-section 6% 30%Incidence of operative vaginal delivery

6% 20%

Duration of labor 264 min

382 min

Clinical evidence of fetal distress 26% 50%

Suggested exercise activities during pregnancyWalkingSwimmingCycling – outdoors or on a

stationary bicycleExercise in water (aquarobics)Yoga, stretching and other floor

exercisesDancingPilatesPregnancy exercise classes.

Myth Vs Fact

Myth or Fact: Never get your heart rate over 130 while exercising during pregnancy.

Myth

There is no one "target" heart rate that's right for every pregnant woman. 

What most experts now rely on as a guide is RPE, or rate of perceived exertion.

Myth or Fact: It's not safe to do abdominal work during pregnancy.

Myth

Abdominals and pelvic floor should be strengthened throughout pregnancy, and doing so will help not only during pregnancy, but also aid in labor and delivery

It will also help with posture problems

Myth or Fact: If you were a runner before pregnancy, you can continue to run during pregnancy.

Fact

Both ACOG and the National Academy of Sports Medicine have said that if you were running prior to pregnancy, you can continue during pregnancy, as long as you feel OK

Myth or Fact: Pregnancy can make you more prone to certain fitness injuries

Fact

During pregnancy, the body produces a hormone called relaxin. It's designed to help lubricate joints so labor is easier. When joints are too lax, risk of injury increases

Myth or Fact: Not every exercise is safe to do during pregnancy

FactExercises to avoid:Contact sports or activities that carry

a risk of fallingExercises involving balance e.g biking

or skiingCompetition sportsExercises that involve lying on your

back – the weight of the baby can slow the return of blood to the heart.

Activities that involve jumping, frequent changes of direction and excessive stretching (E.g. gymnastics).

Myth or Fact: If I exercise too much during pregnancy, I will pull nutrients from the baby

MythRegular Exercise:

Augments pregnancy associated increases in plasma volume

Increases placental volumeIncreases cardiac output

What does this suggest?Increased rate of placental blood flow at

restIncrease in 24 h glucose & oxygen delivery

Myth or Fact: If I never exercised before pregnancy, now is not the time to start

Mythit can help combat the fatigue of pregnancy

and help you sleep better at night. But better to start slow.

Myth or Fact: Any sign of trouble -- like spotting or pain -- means I should stop exercising and not do it any more during my pregnancy

MythWarning signs when exercising during pregnancy:

HeadacheDizziness or feeling

faintHeart palpitationsChest painSwelling of the face,

hands or feetCalf pain or swellingVaginal bleeding

ContractionsDeep back or pubic

painCramping in the lower

abdomenWalking difficultiesAn unusual change in

fetal movementsAmniotic fluid leakageUnusual shortness of

breath.

Absolute ContraindicationsHemodynamically significant heart diseaseRestrictive lung diseaseIncompetent cervix/cerclageMultiple gestation at risk for premature laborPersistent second- or third-trimester bleedingPlacenta previa after 26 weeksPremature labor during current pregnancyRuptured membranesPreeclampsia/pregnancy induced

hypertension

Relative Contraindications• Severe anemia• Unevaluated maternal

cardiac arrhythmia• Chronic bronchitis• Poorly controlled type

1 diabetes• Extreme morbid

obesity• Extreme underweight

(BMI < 12)• Heavy smoker

• History of extremely sedentary lifestyle

• IUGR in current pregnancy

• Poorly controlled hypertension

• Orthopedic limitations• Poorly controlled

seizure disorder• Poorly controlled

hyperthyroidism

PostpartumProbably safe to resume training within 2

weeks of delivery in competitiveNo proof of increased injury to pelvic

floor/abdominal musclesFaster regain of abdominal musclesImproved bladder controlCare with return to high impact activities such as running

Decreased post partum depressionIncreased weight loss

Postpartum breastfeeding• Overall no decrease in ability to

breastfeed when exercising• Strenuous training can decrease

milk production in breast feeding women– Feed prior to exercise• Decreased discomfort from engorged• Less chance of acidity in breast milk

Take Home PointsHealthy women should be encouraged to

exercise before, during, and after pregnancyKnowledge of theoretical risks and known

benefits are key to advising womenIndividualized exercise prescription promotes

a safe, healthy pregnancy Potential benefits typically outweigh any risksAvoid contraindicated exercises and

conditionsHeat, altitude, depth

Continue exercising postpartum

Thank you