Physical activity and pregnancy
The Canadian Guidelines for Physical Activity in Pregnancy 2019 (1,2) represent a fundamental shift in our view of prenatal physical activity: rather than being a recommended behavior to improve quality of life, it becomes a precise prescription to reduce pregnancy complications and optimize the health of two generations throughout their lives.
It is essential that these guidelines be applied to clinical practice to achieve tangible health benefits for mother and baby, potentially for life.
1. Exercise reduces the risk of some common pregnancy complications.
2. Previously inactive women can safely begin exercising with the goal of reaching the minimum recommended level. Exercise can be initiated at any time during pregnancy.
3. All types of physical activity contribute to a woman’s fitness during pregnancy. Even walking can reduce complications. Aerobic exercise and other types of exercise (for example, resistance training) contribute to good physical condition.
4. Women can achieve the activity level recommended in these guidelines in many ways, including doing activities, such as walking, that cost nothing.
5. When exercising, women should beware of activities where a fall or direct physical contact could injure them or the fetus
1. All women without contraindications should be physically active throughout pregnancy (strong recommendation, moderate quality evidence). We looked at the subgroups below:
has. Previously inactive women (strong recommendation, moderate quality evidence).
b. Women with a diagnosis of gestational diabetes (weak recommendation, low quality evidence).
vs. Overweight or obese women (prepregnancy body mass index of 25 kg/m2 or more) (strong recommendation, low-quality evidence).
2. Pregnant women should get at least 150 minutes of moderate-intensity physical activity each week to achieve clinically meaningful health benefits and reduce the risk of pregnancy-associated complications (strong recommendation, moderate-quality evidence) .
3. Physical activity should be spread over at least three days; daily activity is encouraged (strong recommendation, moderate quality evidence).
4. Pregnant women should engage in a variety of aerobic and strength-training activities to achieve greater benefits. Adding yoga or gentle stretching may also be beneficial (strong recommendation, high-quality evidence).
5. Pelvic floor muscle training (eg, Kegel exercises) can be done daily to reduce the risk of urinary incontinence. Learning the correct technique is recommended for optimal benefit (weak recommendation, low-quality evidence).
6. Pregnant women who experience dizziness, nausea, or discomfort when exercising on their back should modify their exercise position to avoid this position (weak recommendation, very low-quality evidence).
All pregnant women can do physical activity during pregnancy, except those who have contraindications. Those with absolute contraindications can continue with their usual daily activities, but should not do more vigorous activities. Those with relative contraindications should discuss the benefits and harms of moderate-to-vigorous-intensity physical activity with their obstetric care provider before participating.
– Ruptured membranes
– Premature labor
– Unexplained persistent vaginal bleeding
– Placenta previa after 28 weeks of pregnancy
– cervico-isthmic insufficiency
– Intrauterine growth retardation
– High-order multiple pregnancy (eg, triplets)
– Uncontrolled insulin-dependent diabetes
– Uncontrolled hypertension
– Uncontrolled thyroid disease
– Other serious cardiovascular, respiratory or systemic disorder
– Repeated spontaneous abortions
– Pregnancy hypertension
– History of spontaneous preterm birth
– Mild to moderate cardiovascular or respiratory disease
– Symptomatic anemia
– Eating disorders
– Twin pregnancy after the 28th week
– Other significant health issues
As we do not know if chronic high-intensity physical activity is safe and effective for the mother, fetus and newborn, it is recommended that high-intensity physical activity only be performed under supervision. Moderate-intensity physical activity is recommended throughout pregnancy.
Intensity can be gauged either through heart rate intervals or speaking ability. The woman is at a comfortable intensity if she is able to carry on a conversation during physical activity, and should reduce the intensity if she is unable.
In the absence of contraindications (see detailed list below), following these guidelines is associated with:
1) fewer complications for the newborn (eg, large for gestational age)
2) maternal health benefits (eg, reduced risk of preeclampsia, pregnancy-induced hypertension, gestational diabetes, caesarean section, operative delivery, urinary incontinence, excessive weight gain during pregnancy and depression; improved blood sugar levels; decreased total weight gain during pregnancy; and decreased severity of depressive symptoms and lumbopelvic pain).
It is important to know that physical activity is not associated with miscarriage, stillbirth, neonatal death, premature delivery, premature rupture of membranes, neonatal hypoglycemia, weight insufficient at birth, birth defects, induction of labor, or birth complications. On the other hand, in general, an increase in physical activity (frequency, duration or volume) is linked to an increase in benefits.
Prenatal physical activity should be seen as a first-line treatment to reduce the risk of pregnancy complications and improve the physical and mental health of the mother.
For pregnant women who currently do not reach the recommended level, we recommend a gradual increase to reach it. Women who are already active can continue to be active throughout pregnancy. They may need to change the type of activity as their pregnancy progresses. It may become impossible to follow the guidelines during certain periods due to fatigue or pregnancy discomforts; we encourage women to do what they can and return to recommendations when they are able.
OTHER HEALTHY LIFESTYLE HABITS DURING PREGNANCY
In addition to physical activity, it is strongly encouraged to adopt other habits characteristic of a healthy lifestyle, such as adequate nutrition and sleep, and avoiding smoking and consuming alcohol, marijuana and illicit drugs.
We care, you perform.
1. Mottola MF, Davenport MH, Ruchat S-M, Davies GA, Poitras VJ, Gray CE, et al. 2019 Canadian guideline for physical activity throughout pregnancy. Br J Sports Med. 1 nov 2018;52(21):1339‑46.
2. 4208_CSEP_Pregnancy_Guidelines_Fr_P2A.pdf [Internet]. [cité 11 mai 2020]. Disponible sur: https://csepguidelines.ca/wp-content/uploads/2018/10/4208_CSEP_Pregnancy_Guidelines_Fr_P2A.pdf