Congratulations! You’ve just receive the expected good news that you are pregnant. You’ve been active and very fit your entire life.  You wish to remain fit during pregnancy. But, you’ve heard conflicting information on the benefits and risks of exercise during pregnancy.  The good news is we now have a body of growing evidence that supports that pregnant women can benefit from exercise without risk to the developing fetus.  Follow these guidelines for pregnancy and exercise.
First, what are the benefits of exercise in pregnancy and what are the contraindications to exercise in pregnancy?
Benefits of Exercise During Pregnancy
- Reduction in severity and frequency of back pain.
- Enhancement of prenatal weight management.
- Improved coping skills.
- Lowers levels of stress, anxiety, and depression.
- Improved energy levels.
- Improved ability to perform activities of daily living.
- Improved digestion.
- Reduced risk of gestational diabetes and pregnancy- induced hypertension.
The American College of Obstetrics and Gynecology (ACOG) has developed the following lists of absolute and relative contraindications for aerobic exercise during pregnancy. A woman with an absolute contraindication should not perform any aerobic exercise during pregnancy, and a woman with a relative contraindication should seek clearance from her physician prior to exercising.  The following lists of contraindications are modified from ACOG.
Absolute Contraindications (Pregnancy and Exercise)
- Significant coronary heart disease
- Ruptured membranes
- Incompetent cervix
- Premature labor
- Multiple gestation
- Vaginal bleeding
- Placenta previa
- History of 3 or more spontaneous abortions or miscarriages
- Restrictive lung disease
Relative Contraindications
- Severe anemia
- Cardiac arrhythmia
- Poorly controlled hypertension
- Poorly controlled diabetes
- Poorly controlled seizure disorder
- Morbid obesity
- Orthopedic restrictions
- Sedentary lifestyle
Pregnancy is associated with many physiologic changes that need to be considered in women who wish to continue to exercise. These changes include weight gain, increase in blood volume, and the upward pressure of the uterus and fetus on the abdominal organs and diaphragm. In most women it becomes necessary to adjust the intensity, frequency, and/or duration of an exercise program.
General Recommendations
The main purpose of exercising during pregnancy is to maintain your pre-pregnancy fitness level, not improve it.
Lower impact aerobic exercises are generally safer and place the women at less risk of orthopedic trauma. This becomes more important as you gain weight during pregnancy.  Low impact exercises include cycling, swimming, walking, stair climbing, etc.
But, for women who are already running when they become pregnant they can continue to run, but should run at slower pace and on level surfaces. Â Exercise sessions should b 20-30 minutes at least three times a week at a mild to moderate intensity.
Women should avoid exercising in the supine position (on the back) after the first trimester to avoid a drop in cardiac output as the growing fetus and enlarging uterus can reduce return of blood flow to the heart in the supine position.
Also, pregnancy and exercise increase a women’s need for nutrition and calories. So be sure to intake sufficient calories.
Discontinue exercise and seek medical advice if you develop any vaginal discharge, sudden swelling in the extremities, or face, persistent headaches, visual disturbances, faintness or dizziness, excessive fatigue, chest pain or palpitations, persistent contractions, or unexplained abdominal pain.
The many physiologic changes associated with pregnancy persist 4 to 6 weeks post-partum. So be sure to gradually return to your pre-pregnancy exercise program.
A woman can continue to reap the health benefits of exercise during pregnancy as she receives the joy of bringing new life into the world.
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