To Exercise or Not When Pregnant?

A hot topic is always whether or not pregnant women should exercise or not. The American College of Obstetricians and Gynaecologists (ACOG) have published some very sensible guidelines pertaining to exercise during pregnancy.

These guidelines describe the safe limits under which the F.I.T.T. principal of exercise (i.e. Frequency, Intensity, Time (duration), and Type of exercise) should be applied during pregnancy. Their objective being to ensure a healthy birth outcome for mother and baby whilst avoiding injury and complications during the pregnancy.

From the onset, without even considering at the ACOG Guidelines, a key (and sensible approach) to exercise during pregnancy is to aim to pre-condition your body BEFORE falling pregnant.

Once you’ve fallen pregnant is not the time to embark on a hardcore training program to build fitness.

Exercise during pregnancy should be focussed on “maintaining” rather than “building” fitness and above all optimizing health for both mother and baby.

So focus on being active during your pregnancy and not on setting personal best performances!

Why not to exercise during pregnancy

Exercise during pregnancy for women at a low risk is ideal, however there are some specific conditions that can affect both the health of mother and baby and in such conditions exercise isn't safe. If you are currently unfit or inactive then a cautious approach is the most sensible approach.

ACOG guidelines recommend that women falling into any (or multiple) of the following categories avoid exercise during their pregnancies:

• Ruptured membranes.
• Premature labour(s).
• Diagnosed multiple pregnancies (i.e. Twins, triplets etc.).
• A history of 3 or more spontaneous miscarriages.
• Intrauterine growth retardation (i.e. The baby is smaller than expected) as exercise may worsen the problem.
• Placenta praevia (i.e. A portion of the placenta sits over the cervix making it more vulnerable to detachment).
• Pregnancy-induced hypertension (i.e. High blood pressure).
• Venous thrombosis or pulmonary embolism (i.e. Clots to legs or lungs).
• Known cardiac valve disease(s).
• Incompetent cervix (cervix becomes softer and more open than normal) which can lead to a spontaneous miscarriage.
• Primary pulmonary hypertension.
• Maternal heart disease.

When medical clearance is required to exercise

• Anaemic (i.e. Low blood iron stores).
• Thyroid disease.
  Hypertensive (i.e. High blood pressure).
• Extremely over or under weight.
• Diabetes.
• Extremely sedentary.
• Breech presentation in the third trimester of the pregnancy.
• History of repeated and/or heavy bleeding during the current or previous pregnancy.

Activities to avoid when pregnant

Even if you are healthy and/or cleared by your doctor to exercise during pregnancy, you should avoid the following activities due the associated risks:

• All contact sports or activities which involve a high risk of falling (e.g. horse riding, rock climbing, gymnastics, water skiing, surfing, basketball, football, netball, hockey, skiing, cycling, etc.).
• Endurance activities where over-heating and dehydration are possible outcomes.
• Exercise in the heat of the day or in hot/humid environments where thermal distress can become an issue for both mother and child

Other points to consider

• Be aware that your centre of gravity changes during pregnancy directly impacting your balance, strength, and agility, especially in the later stages. What was relatively easy prior to falling pregnant may become arduous during the pregnancy, so err on the side of caution and don’t take any unnecessary risks.
• With the release of increased volumes of the hormone “relaxin” in preparation for child birth (particularly during the later stages of the pregnancy), pregnant women are more prone to dislocation type injuries due to the increase flexibility associated with the release of the aforementioned hormone. Be aware of this and don't push yourself too hard.
• Avoid overheating or dehydrating. Exercise should never be so extreme as to elevate body temperature excessively as this can lead to foetal distress. Likewise not maintaining adequate hydration levels can lead to thermal stress. An ideal exercise modality is swimming which is; (a) body weight supported making it less arduous for the expectant mother, (b) done in a cooler environment ensuring overheating is less likely to become an issue and (c) exercising all the major muscle groups of the body.

Pregnancy is a time to be gentle with both yourself and your unborn baby.  Pushing through unnecessary exercise sessions on a regular basis is counterproductive for both mother and baby.

Above all “listen to your body”. If you don’t feel up to exercising or simply not in the mood to do so - don’t!