Feature Article

Maternal Moves: Staying Fit while Pregnant

by Robin Warshaw

Pregnancy brings many changes to your body, some of which may leave you feeling exhausted and out of shape. It's tempting to just put your feet up and move as little as possible.

Indeed, for decades that's exactly what women were advised to do for a safe and healthy pregnancy.

"Physicians' traditional attitude was not to harm—which at that time was translated into 'don't move,'" says Raul Artal, MD, professor and chair of Obstetrics, Gynecology and Women's Health at Saint Louis University School of Medicine, St. Louis, MO. "It took us many years to realize that in the absence of medical or obstetrical complications, there's no reason why pregnant women should be confined."

Activity helps—before and during pregnancy

Fitness and strength usually decline during pregnancy, so it's important to be physically active to sustain your body as it changes.

Getting up and moving while pregnant offers a world of benefits to you and your growing baby. Regular, moderate exercise—favorites include walking and water aerobics—can help reduce the risk of developing gestational diabetes for some women; lessen pregnancy-related woes such as backache, bloating and constipation; increase energy; and improve mood.

Even if you rarely were active before becoming pregnant, you can start during pregnancy. All pregnant women should check with their health care providers to make sure there are no medical or obstetrical reasons (called a contraindication) to avoid exercise.

"I don't think there's any contraindication to start walking," says Dr. Artal. "We know that there are some physiological restrictions that preclude pregnant women from engaging in strenuous activities [those in which you can't exercise and talk at the same time], but for deriving health benefits, there is really no need to engage in strenuous activities."

Exercising before you become pregnant pays off by helping your pregnancy and delivery go more easily. Both vigorous activity and brisk walking prior to pregnancy lower gestational diabetes risk during pregnancy. And if you're overweight, increasing your physical activity and improving nutrition before pregnancy also may help lower your risk for high blood pressure and diabetes later on.

Just don't overdo it if you've had trouble becoming pregnant: women who exercised four or more hours per week for a year or more before undergoing in vitro fertilization were less likely to have a successful pregnancy.

Your changing body

As your pregnancy advances, the growing uterus puts force on your spine that increases curvature. The result: back pain. If you've had back pain in pregnancy before, have had multiple births or are an older mother, you have an increased chance of suffering back pain while pregnant.

"Back pain is the most common painful condition women have when they're pregnant," says Sheila A. Dugan, MD, assistant professor of physical medicine and rehabilitation at Rush Medical College, Rush University Medical Center, Chicago. "Maintaining flexibility and core muscle strength [through exercise] while you're pregnant can help fight that by stabilizing against forces in your low back."

The growing uterus also puts pressure on pelvic floor muscles, which can promote urinary incontinence. Dr. Dugan advises exercising those muscles before, during and after pregnancy. (When pregnant, do pelvic floor exercises that use your muscles alone; do not place a probe or other device in the vagina.)

Physical activity strengthens your body against spine curvature and muscle weakening. It also helps you adjust to your ever-changing center of gravity. That's important so you can maintain your balance better and avoid injury from falls.

Monitor your moves

Hormonal changes during pregnancy cause your ligaments to move easily and become looser. This helps, especially in the third trimester, as your baby grows down into your pelvis and your joints need to adapt and become more mobile.

Yet the influence of that rise in a hormone called relaxin also sets you up for potential injury during exercise. "It can increase your risk of rotator cuff problems and wrist pain," says Dr. Dugan, "because it doesn't just loosen ligaments in the pelvis."

Consider the story of one pregnant patient who came to see Dr. Dugan recently after developing pain during a pregnancy yoga class. The woman's problem began after performing a yoga movement that had her lift a rod up and behind her head and then hold the position for two minutes.

"She had this raging shoulder tendonitis. She had exceeded the normal movement of her joint because she was so lax," Dr. Dugan says.

"It's important when you're doing exercise classes that you don't try to exceed a comfortable threshold in how your joints feel," she adds. "Your body will oftentimes give you feedback when it's stretched to a comfortable limit."

What works

• Aim for 30 minutes of mild to moderate physical activity most days of the week. Women who have been inactive should start off slowly, with just a few minutes a day, and add five minutes a week until reaching the 30-minute level. Be sure to warm up, cool down and stretch as well.
• If you've been exercising before pregnancy, you probably can continue the same activity for awhile (check with your health care provider first). "Runners run during pregnancy," Dr. Dugan says, noting that they usually stop when they become uncomfortable. "It's not the same for everybody."
• Moderate strength training helps your muscles and is safe for women who were doing such training before becoming pregnant.
• Low-impact exercises are best if you weren't exercising regularly pre-pregnancy. Walking, riding a stationary bicycle, using an elliptical machine, swimming or taking a water aerobics class are great ways to be active while pregnant.
• Avoid contact sports or those in which you jump, change direction quickly or have a higher risk of falling: soccer, basketball, tennis, racquetball, downhill or water skiing, hockey and horseback riding. Do not scuba dive because the water pressure can harm your baby. "Even among professional athletes or recreational athletes, pregnancy brings changes, and one has to adapt to these changes," says Dr. Artal.
• Other safety tips: After the first trimester, don't do exercises for which you must lie on your back. Exercise in the cooler parts of the day to protect yourself from overheating. Drink plenty of fluids.
• If you feel faint or dizzy, have vaginal bleeding or fluid leakage, shortness of breath or chest pain, decreased fetal movement or any other unusual physical symptoms, stop exercising and call your health care provider.

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