A BOUNCING BABY...
EXERCISE DURING PREGNANCY REVIEWED BY EMORY CLINIC FAYETTEVILLE OBSTETRICIAN

August 15, 1997

Media Contacts: Sarah Goodwin, 404/727-3366 - sgoodwi@emory.edu
Kathi Ovnic, 404/727-9371 - covnic@emory.edu
http://www.emory.edu/WHSC/

Medical research conducted over the past decade on exercising during pregnancy generally supports moderate exercise as acceptable for many pregnant women, says obstetrician/gynecologist Sujatha Reddy, M.D., of The Emory Clinic Perimeter. In fact, the American College of Obstetricians and Gynecologists (ACOG) has relaxed its guidelines for health professionals counseling expectant mothers who wish to continue or begin exercising.

"Reasonable physical activity and pregnancy can usually go hand-in-hand, providing women the usual benefits of increased physical and mental well-being," Dr. Reddy says. "But in some circumstances, exercise, particularly rigorous exercise, can be harmful to the mother, fetus or both. Therefore, any woman at any stage of pregnancy considering any type of exercise should carefully discuss this with her health care provider."

Those who receive a medical go-ahead will be pleased to know that moderate exercise has been associated with less need for medical intervention during delivery -- and reduced time in labor. According to Dr. Reddy, some of the safest physical activities during pregnancy are walking, water aerobics, swimming and bicycling. Weight lifting, water and snow skiing, and soccer are considered riskier. Contact sports, horseback riding, sky diving and scuba diving should be avoided, she says.

"Remember, pregnant women can lose their balance easily, because their center of gravity changes, Dr. Reddy says. I advise patients to use common sense. For instance, think twice about running in extremely hot, humid, cold or rainy weather. Warm-up before and after work-outs. Drink plenty of fluids. Interestingly, studies have shown that pregnant women are at higher risk for dehydration when exercising in the water."

Common sense also suggests that the duration and intensity of exercise should decrease throughout gestation. Even the most "fit" patient will have to modify her exercise regimen for pregnancy, Dr. Reddy says. Women who did not exercise prior to pregnancy can start during pregnancy, but they must remember to slowly increase duration and intensity. Walking is a great start."

FIRST TRIMESTER

Dr. Reddy says that while early pregnancy may be an optimal period to exercise for Mom, patients should remember that the relatively fragile fetus is more prone to heat, cold and other factors during the embryonic stages. Nausea, tiredness and low blood sugar common to women in the first several weeks of gestation may make exercise less appealing for some women.

SECOND TRIMESTER

No more floor (supine) exercises from here-on-out, Dr. Morris says. The weight of the enlarging uterus while lying on one's back can put pressure on the a major vein (the vena cava), dangerously decreasing circulation to the fetus and mother. Expansion of the mother's cardiovascular system also is not complete until about the 20th week of gestation. When the blood-pumping action of the calves ceases after exercising, blood may collect in the lower limbs (veins may not dilate correctly).

THIRD TRIMESTER

Throughout pregnancy, increased levels of the sex hormone progesterone cause ligaments to become more lax and more prone to musculoskeletal trauma such as sprains. One's body mass will eventually increase by one-fifth to one-third, increasing back and hip discomfort.

AFTER DELIVERY

The changes that occur with pregnancy persist for six to eight weeks after delivery -- and, accordingly, exercise schedules will need to be modified as in pregnancy, Dr. Reddy says. The type of delivery will also affect the ability of the patient to exercise.

RISKS OF OVER-EXERCISING

"With intense exercise, it is possible that blood may be shunted away from the uterus, causing fetal growth retardation," says Jean-Claude Veille, M.D., author of "Exercise During Pregnancy," a review of medical studies that was published in the March 1997 issue of Hospital Physician.

In its guidelines, ACOG advises against exercising to exhaustion. Exertion that causes heat stress (significantly elevating the body's core temperature) may increase the risk of congenital malformations, Dr. Veille says.

"Casual exercisers are advised to enroll in safe aerobics programs that are modified for pregnant patients," Dr. Veille writes. "However, careful screening of these programs by the patient is essential because many programs are marginal at best... Patients at risk for premature delivery should be advised not to enroll in any weight-bearing aerobic program."

Pregnant women with severe cardiovascular disease or who have been diagnosed with certain pregnancy-related complications including vaginal bleeding or fetal complications are usually strongly advised against exercising. Expectant mothers with the following conditions should also be careful to get detailed counseling before exercising: diabetes, anemia, sickle cell disease, thyroid disorders and even unusually underweight or overweight women, those expecting twins or those in whom the fetus is situated abnormally (breech or transverse presentations).

"It is important to exercise regularly and not sporadically to gain maximal benefit" Dr. Reddy says. "Eating enough calories to make up for what is used during exercise is important, too.

"So, if a woman burns 400 calories swimming, she needs to eat an extra 400 calories. Drink plenty of fluid -- and exercise in a well-ventilated area."

More questions on exercising while pregnant? Visit these Internet web sites: Lifematters: Medical Literature (http://lifematters.com/medrefs.html) http://lifematters.com/life.matters/medicalinfo.html.

The Emory Clinic Fayetteville is located at 1250 Highway 54 West, Suites 100-200, Fayetteville.

For more general information on The Robert W. Woodruff Health Sciences Center, call Health Sciences News and Information at 404-727-5686, or send e-mail to hsnews@emory.edu.