Maternal and Fetal Effects of Exercising During Pregnancy

Doc, what are the effects of exercising during pregnancy on the mother and her fetus?

Can I continue exercising throughout my pregnancy?

I am healthy and the work outs are part of my daily routine for past 15 years.

I am worried for my baby. This is my first pregnancy.
Doc please advise!

The Expert, Ren Chats Answers

Exercise is an essential part of our wellbeing and is equally important during pregnancy, which though an altered is yet a physiological state.

In olden days, daily chores for women involved strenuous physical work. Rest was therefore stressed for pregnant women, which has dominated our psyche for centuries. Health care providers reinforced it too, fearing that exercising would add to already increased physiological demands during pregnancy and threaten mother and baby's health.

In recent times there is tremendous change in parents' lifestyle. Women in childbearing age are engaged in sedentary work. Modern household chores also do not involve strenuous physical output. This is an important contributor to increased incidence of obesity and obesity associated diseases; metabolic syndrome, diabetes, hypertension, high cholesterol levels, ischemic heart disease and so on.

Obesity and lack of exercise has also increased pregnancy and childbirth related complications that threaten both mother and child health. Optimal exercising during pregnancy lessens the risk of prenatal complications, minimizes the chances of interventional delivery and eases normal child birth.

Recommended optimal exercises

• During a routine day, intermittently change from sitting position to standing, and find excuses to walk a little several times a day.

• Moderate intensity exercise schedule that does not cause exhaustion should be planned and maintained throughout pregnancy.

Long walks, stomach and pelvic floor strengthening exercises like stationary cycling and swimming, pelvic tilt exercises and some of the yoga mudras are commonly recommended in pregnancy.

• Women who are used to regular can plan a more intense exercise regime, but only with advise of the treating doctor.

Contraindications

• Pregnancy induced high blood pressure

• Intrauterine growth retardation

• Antenatal hemorrhage; significant/persistent bleeds

• Premature membrane rupture

• Premature child birth in previous pregnancy

• Preterm labor pains in the current pregnancy

• Incompetent cervix, even if it has been surgically treated: Cerclage

• Chronic disease in the mother that demands rest

• Relative or absolute contraindications for physical activity

Can exercising during pregnancy cause abortion?

Exercise does not increase the risk of spontaneous abortion. Nevertheless, in case of incompetent cervix abortion can be attributed to exercising. It is best to consult your doctor to determine individualized risk.

Exercising helps fetal health

• Minimizes physical challenges of birth process by strengthening the muscles involved in childbirth.

• Helps build up optimal body fat in the fetus.

• Enhances neurological development.

• Betters self-calming ability and easier consolability in infants.

• Boosts postnatal cognitive and language development.

Benefits for the mother

• Controls fat deposition

• Lessens the risk of metabolic disorder and gestational diabetes

• Relieves constipation

• Strengthens heart, back, pelvic, and abdominal muscles

• Enhances good posture and reduces backaches

• Improves sleep and eases snoring

• Builds good body image

• Minimizes hormones related mood swings

• Diminishes stress

• Alleviates depression

• Boosts the feeling of wellbeing

Concerns associated with exercising during pregnancy.

Maternal issues

• Change in center of gravity

• High altitude sports or holidays

• Trauma to abdomen

• Faulty concept of relating exercise to weight reduction.
Exercising during pregnancy is to not to lose weight, but is recommended to maintain good health through pregnancy and after.

• Sudden indulgence in strenuous exercises can endanger fetal and maternal health. The ability to do exercise is very individualized; depends on preconception health, habitual physical activity before pregnancy and pregnancy associated health issues. Exercising regime during pregnancy therefore needs to be built up gradually.
Fetal issues:

• Fetal oxygenation:
Several scientific studies show that exercising during pregnancy results in reduced uterine blood flow to meet the demands of the muscles. There has therefore been concern about optimal oxygen supply to the fetus during workouts.

Physiological adaptations, both in the mother and the fetus, effectively compensate for reduced uterine blood flow during moderate intensity exercises.

Optimal oxygen supply to fetus is maintained by increase in mother’s hemoglobin concentration, preference of blood flow through placenta compared to myometrium, musculature of the uterus and remarkably high oxygen affinity of fetal blood.

• Intrauterine growth retardation
Excessive exercising during pregnancy could compromise fetal glucose supply. Nevertheless, in event of moderate physical exercises, alternate fuel is produced by placenta to promote optimal fetal development.

With over enthusiastic workouts low blood glucose level in the mother can become a regular feature, which would then impede fetal growth and jeopardizes fetal viability. These babies have low birth weight and are prone to life threatening hypoglycaemic episodes in first week of life.

• Fetal effects of exercise related temperature rise in the mother: High body temperature of mother (above 39°C /102.2°F) threatens fetal malformation, particularly neural tube defects. And it's well known that body heat production increases in proportion to the intensity of physical activity incurred and environmental temperature.

Due to high metabolic rate during pregnancy body heat production is also high. The fetus is protected from ill effects of mother’s high core temperature by the naturally developed altered thermoregulation changes during pregnancy:

1. Increase in maternal blood volume.

2. Blood flow to the skin is significantly higher during pregnancy, because the threshold for vasodilation of the skin blood vessels is set at much lower core temperature.

3. Breathing is faster during pregnancy, which too helps to loose body heat to the environment.

4. Pregnant women perspire easily. Their threshold for sweating is also set at much lower temperature.

Moderate physical activity adds to maternal heat loss, which is crucial for fetal health. Fetus has No thermoregulatory mechanism of its own, and is very susceptible to mother’s core temperature. Therefore, maternal core temperature has to be maintained at a level that facilitates heat dissipation from fetus to mother. Heavy exercise induced temperature rise in mother can reverse this gradient, thereby pose severe threat to the fetus.

Precautions proposed

• Avoid lifting heavy objects

• Minimize bending down

• Start slowly and build up gradually to more demanding physical activity

• End the exercise session gradually; cool down adequately

• At the peak activity pulse rate should be checked to ensure appropriate range of heart rate prescribed by the health care provider. Heart rate over 140 beats per minute demands slowing down of activity.

• If a person is able to carry out conversation without any difficulty even at the peak of physical activity, the intensity of exercise is usually considered safe.

• Guard against strenuous exercise that accelerates baby's heartbeat to a dangerous level.

• Symptoms like chest pain, uterine contractions, lower abdominal pain, vaginal bleeding, labor pain – how ever mild, fluid flow from vagina, dizziness, or breathlessness demand immediate medical attention.

• Rest is equally important in pregnancy. It is therefore crucial to progressively reduce the hours of physical work as the pregnancy advances.

Hope this helps.
Take Care!

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