January 28th, 2010 
Women benefit from light-intensity resistance exercise during pregnancy and this type of physical activity is not apt to alter the way they deliver their baby, study findings hint.
Regular exercise during pregnancy offers overall health benefits, Dr. Ruben Barakat, at Universidad Politecnica de Madrid in Spain, and colleagues note in the American Journal of Obstetrics and Gynecology. However, few investigations have focused on the effects of resistance-type exercise during pregnancy and whether this alters actual childbirth.
Therefore, they compared delivery outcomes after supervised toning and resistance exercises for shoulders, arms, pelvis, and legs, plus toning and mobilization of associated joints, in 80 women during mid to late pregnancy, compared with 80 non-exercising peers.
All of the women previously obtained less than 20 minutes of exercise on 3 or fewer days each week, a low level of exercise the “controls” maintained. By contrast, the exercise group participated in 3 weekly toning and resistance sessions of less than an hour each from pregnancy week 12 or 13 through delivery.
There were no adverse effects noted in the 72 exercising women or the 70 controls that completed the study.
And, in contrast to a previous report of increased vaginal delivery associated with regular exercise during pregnancy, Barakat’s team found no differences in delivery mode between the groups.
Fifty-one exercisers delivered vaginally, another 10 had a delivery requiring instruments, and 11 had Cesarean, compared with 50, 9, and 11, respectively, in the non-exercisers.
The groups also similarly required epidural anesthesia and had similar average durations of complete dilation and delivery, and their newborns were similarly healthy.
“Women in the training group were rather pleased with the exercise training,” Barakat and colleagues note in their report.
This finding, coupled with the exercisers desire to be physically active during future pregnancies, and the lack of exercise complications, supports the overall benefits of supervised, light-intensity exercise during pregnancy, they conclude.
Related
- Gum care smart, but it won’t curb preterm delivery
It’s been suggested that gum disease raises the risk of preterm birth in pregnant women and it was thought that getting rid of gum disease may potentially reduce the risk of preterm delivery.
Not so, according to a new study.
“(Our) study,” lead investigator Dr. Steven Offenbacher told Reuters Health, “showed that a standard dental visit to provide periodontal care during pregnancy did not impact pregnancy outcomes, nor did it stop maternal gum problems during pregnancy.”
Offenbacher of the North Carolina Oral Health Institute, Durham and colleagues draw their conclusion from a study involving 1806 pregnant women with periodontal (gum) disease, all of whom were receiving standard obstetric care.
The women were randomized to receive up to four sessions of gum care before the 24th week of pregnancy or after delivery.
According to the investigators, rates of preterm delivery were no different in the two groups. Preterm delivery rates were roughly 13 percent in the women who made the four trips to the dentist and nearly 12 percent in those that did not.
That’s not to say pregnant women should not get their teeth cleaned and treated as needed; they should, the researchers emphasize, noting that treating gum disease during pregnancy is safe.
Worsening of gum disease occurs in about 25 percent of pregnancies. The bacterial infection attacks the teeth-supporting tissues below the gum line. Left untreated, it can lead to tooth loss as well as a host of other problems.
- Natural Delivery OK in Cases of Intrauterine Growth Restriction
Waiting for natural birth is as effective as inducing labor in pregnant women with intrauterine growth restriction (IUGR), a new study shows.
IUGR, which affects about 10 percent of pregnant women, means that the fetus is much smaller than normal. At birth, these babies are more likely to have low blood sugar, an abnormally high red blood cell count and trouble maintaining their body temperature. These babies are also at increased risk for jaundice, infections and cerebral palsy.
Later in life, people who were restricted-growth babies may be more prone to behavioral disorders, obesity, heart disease, type 2 diabetes and high blood pressure.
Currently, doctors have two main approaches for women with suspected IUGR who are nearing delivery. Some doctors induce labor because they’re concerned about complications, while others await natural delivery.
This study compared the effectiveness of the two strategies among 650 women in The Netherlands. The researchers found that median birth weight was significantly lower among babies born after induced labor (2,420 grams) than among those in the spontaneous delivery group (2,560 grams). Both groups of babies had similar rates of adverse post-delivery outcomes.
The findings show that waiting for birth is equally as effective as inducing labor, the researchers concluded.
- Too Few Women Get Enough Exercise During Pregnancy
According to a study from the University of North Carolina at Chapel Hill, fewer than 1 in 4 pregnant women meet the physical activity guidelines set by the American Congress of Obstetricians and Gynecologists (ACOG) in 2002. These guidelines state that pregnant women get 30 minutes or more of moderate exercise on most days of the week if they have no medical or obstetric complications.
The study included data collected from the National Health and Nutrition Examination Survey (NHANES). Over 1,000 pregnant women aged 16 and older were interviewed between 1999 and 2006. The findings were published in the March 2010 issue of the journal Preventive Medicine.
Only about 23% of the women were active enough to meet the guidelines recommendations. Walking was the most common physical activity reported.
According to author Kelly Evenson PhD, research associate professor of epidemiology in the UNC Gillings School of Global Public Health, women in their first trimester were more likely to reach the exercise guidelines that those more advanced in their pregnancy. Women with health insurance and non-Hispanic whites were more likely to meet the guidelines than other socioeconomic groupings.
Benefits of becoming and staying active during pregnancy include helping to reduce backaches, constipation, bloating, and swelling; helping to prevent or treat gestational diabetes; increasing energy; improving mood; promoting muscle tone, strength and endurance, and helping improve sleep patterns.
Exercise during pregnancy can help prepare the body to be able to cope with labor and childbirth. Continuing an exercise program after the baby is born can help get you back in shape faster.
Women who were not following a regular exercise program prior to pregnancy, but wishing to do so as a way of improving health, should start slowly and be careful not to over exert. Start at 5 minutes a day and add 5 minutes each week until 30 continuous minutes are achieved. Never exercise to the point of exhaustion or breathlessness. Take frequent breaks, wear appropriate clothing and footwear, and drink plenty of fluids while exercising.
All pregnant women participating in an exercise program should be aware that hormones produced during pregnancy cause the ligaments that support the joints to become relaxed, which makes them more mobile and at a greater risk of injury. Avoid jerky, bouncy, or high-impact motions. Also be aware that the weight gain will shift the body’s center of gravity and may make a woman less stable or more likely to lose balance.
Most forms of exercise are safe during pregnancy. Walking, swimming, stationary cycling, and low-impact aerobics are good choices. Higher-impact sports such as running and strength training can be safe for women who were already participating in these activities before pregnancy. Potentially dangerous activities include downhill snow skiing, gymnastics, horseback riding, contact sports (soccer, basketball), and scuba diving. After the first trimester, avoid doing exercises on the back, like poses performed lying down in yoga.
Warning signs to be on the lookout for are vaginal bleeding, dizziness or feeling faint, increased shortness of breath, chest pain, headache, muscle weakness, calf pain or swelling, uterine contractions, decreased fetal movement, or fluid leaking from the vagina.
- Exercise May Lower Risk of Having Heavy Babies
For women having their first child, regular exercise during pregnancy can lower the chances of having an overweight baby, researchers say.
Working out at least three times per week reduced the odds of delivering a newborn with excessive birth weight — above 4,000 grams (8.8 pounds) — by about a quarter, Katrine Mari Owe, MS, of the Norwegian School of Sport Sciences in Oslo, and colleagues reported in the October issue of Obstetrics & Gynecology.
The associations with exercise weren’t as strong for women who have had children previously, who were more likely than first time moms to have an overweight baby.
Research has shown that regular exercise is an important part of a healthy pregnancy. But studies of the association between physical activity and mean birth weight have been inconsistent.
To clarify the issue, the researchers analyzed data from the Norwegian Mother and Child Cohort Study of 36,869 normal singleton pregnancies. They collected data on newborn birth weight from the Medical Birth Registry of Norway.
In their study, mean birth weight was 3,682 grams (8.1 pounds), and 11% of newborns were classified as being in the 90th percentile or more of birth weight, categorizing them as “excessive.”
For veteran moms, the researchers found an inverse association between regular exercise — at least three times per week — and excessive newborn birth weight.
Risk fell by 28% for those who were exercising at week 17 of their pregnancy (95% CI 0.56 to 0.93) and by 23% for those who worked out at week 30 (95% CI 0.61 to 0.96).
The risk of having an overweight baby trended downward with exercise among veteran moms, but the difference did not reach significance, the researchers said.
There was a decreased risk for excessive birth weight among veteran moms who used dance as a form of exercise in week 17 of their pregnancy (OR 0.75, 95% CI 0.63 to 0.90).
The association was even stronger for week 30 (OR 0.69, 95% CI 0.53 to 0.88), and at that time point, low-impact aerobics was associated with decreased risk as well (OR 0.68, 95% CI 0.47 to 0.97).
On the other hand, veteran moms women were more likely to have heavy babies if they trained in fitness centers during week 17 of their pregnancy (OR 1.16, 95% CI 1.00 to 1.35) or if they swam during week 30 (OR 1.16, 95% CI 1.04 to 1.30).
For first time moms, walking decreased risk at weeks 17 and 30 (OR 0.86, 95% CI 0.75 to 0.99 and OR 0.84, 95% CI 0.73 to 0.96), as did running at week 17 (OR 0.63, 95% CI 0.45 to 0.89).
One possible explanation for exercise lowering risk of excessive birth weight among newborns is the effect of aerobic exercise on glucose tolerance, the researchers said.
Research has shown that moderate physical activity during pregnancy can lower glucose levels in both disease-free women and those who have gestational diabetes.
The study also found that exercising for three months prior to pregnancy didn’t have any effect on the odds of having heavier babies for either first time moms or veteran moms, the researchers said.
The women who elected to participate had a slightly different age distribution, lower parity, were less likely to smoke and less likely to have a preterm birth.
- New study recommends pregnant women start an exercise program
Physicians should recommend low to moderate levels of exercise to their pregnant patients, even if they have not exercised prior to pregnancy, states a report published in the August 2009 issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS). According to this review article, exercise can strengthen and improve overall musculoskeletal and physiologic health as well as pregnancy related symptoms. Exercise such as aerobics, impact and nonimpact activities, resistance training and swimming:
- * eases back and other musculoskeletal pain;
- * lowers maternal blood pressure;
- * reduces swelling; and
- * improves post-partum mood, including sadness.
According to study author Capt. Marlene DeMaio, M.D., M.C., U.S.N., Research Director, Naval Medical Center, Portsmouth, Virginia, data shows that the pregnant woman’s body can compensate for the changes with no harm to the fetus during low to moderate intensity exercise.
“It is important to remember that pregnancy is a temporary condition, not a disease, and that the musculoskeletal and physiologic changes that happen are normal in the majority of patients,” she said.
Capt. DeMaio’s findings contradict what some physicians recommended in the past. As recently as the 1990s, there was concern that exercise could be detrimental to a pregnant woman and her fetus. These past concerns included a focus on normal changes related to musculoskeletal health that occur during pregnancy, such as increased ligament laxity, weight gain and change in the center of gravity. Today, some physicians continue to advise their pregnant patients to ease back on exercise or refrain from it altogether if they have not already made it a part of their lifestyle.
DeMaio, who collaborated with Capt. Everett Magann, M.D., M.C. U.S.N., Chairman in the Department of Obstetrics and Gynecology, also at the Naval Medical Center in Portsmouth, not only reports that exercise is important during pregnancy, but also believes that starting an exercise program when pregnant, is a perfect way to begin – and stick with – a fitness program.
“When a woman becomes pregnant, she often re-evaluates her lifestyle,” said Dr. DeMaio. “She is motivated in a new way to deliver a healthy baby, and be healthy herself.”
Physicians may recommend exercise for pregnant patients in the following categories:
- * Prenatal: Patients should begin or continue low to moderate exercise. The goal is to maintain fitness and adapt exercise as needed as pregnancy progresses. (For example, runners might switch to running in a swimming pool later in their pregnancy.)
- * Postnatal: Continue exercising at low to moderate levels. Lactation is not negatively affected by exercise. There are fewer reports of mothers having post-partum depression or mood changes when they are exercising.
- * Older: Exercise is even more important if the patient is older, according to Dr. DeMaio. The risk for high blood pressure and increased glucose goes up the older a patient is, but exercise can help reduce these levels.
- * Obese: Physicians should discuss pregnancy as an opportunity to improve overall health and suggest the patient start exercise for life-long health and as an example to the child when the child is older.
- * Infertile: Even if a woman is under treatment for infertility, she can exercise under the supervision of her obstetrician.
- * Athlete: For a pregnant woman wanting more strenuous exercise, or who wants to increase training from moderate to high intensity, a qualified doctor should direct her exercise program.
