Changing recommendations for pregnancy exercise.

Many doctors and organizations are moving toward actively encouraging exercise during pregnancy. In its latest guidelines, the Society of Obstetricians and Gynecologists of Canada (SOGC) suggests that failure to exercise during pregnancy may be associated with some risks.

The SOGC's newly released guidelines, "Exercise in Pregnancy and the Postpartum Period," are the organization's first-ever document on the subject and were developed in conjunction with the Canadian Society for Exercise Physiology (CSEP). The two organizations claim this is the world's first example of obstetricians and exercise physiologists collaborating on advice that should be given to the general public. The joint effort is testament to the medical shift from restrictive to permissive when it comes to pregnancy and exercise.

Dr. Davies, one of the principal authors, says the Canadian guidelines give physically fit patients more freedom to maintain appropriate exercise intensity and frequency during pregnancy, but the guidelines also encourage previously inactive women to start an exercise program. The goal is to stress that if the patients are not exercising, they need to start. That message has never been said before. The guidelines point out that physicians are concerned that there is a small but growing amount of evidence that not exercising in pregnancy may be associated with some risks.

The document states that "Women and their care providers should consider the risks of not participating in exercise activities during pregnancy, including loss of muscular and cardiovascular fitness, excessive maternal weight gain, higher risk of gestational diabetes and pregnancy-induced hypertension, development of varicose veins and deep vein thrombosis, a higher incidence of physical complaints such as dyspnea or low back pain, and poor psychological adjustment to the physical changes of pregnancy."

Although the American College of Obstetrics and Gynecology (ACOG) has similar opinions on encouraging exercise in pregnancy, the Canadian document is more detailed and offers more specifics on the level of exercise. The ACOG document is also less pointed about the risks associated with inactivity.

The document indicates the quality of evidence assessment for each of its recommendations. Its basic recommendations are: All pregnant women without contraindications should be encouraged to participate in aerobic and strength-conditioning exercises; their goals should be to maintain a good fitness level throughout their pregnancy, without trying to reach peak fitness, or train for competition; they should choose activities with the least risk of loss of balance or fetal trauma; they should be advised that adverse outcomes are not increased with exercise; they should be advised that pelvic floor exercises initiated immediately postpartum may reduce the risk of future urinary incontinence; and they should be advised that moderate exercise during lactation does not adversely affect breast milk. Specific suggestions are included on how to start an exercise program and how to determine target heart rate zones and exercise intensity.

Researchers regard the encouragement of exercise as an essential tool in combating the growing problem of obesity. Being sedentary during pregnancy makes the problem of obesity worse. Obesity is a problem in pregnancy, increasing the risk of complications and the risk of cesarean.

--OB/GYN Practice Today, Medscape, September, 2003