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Congratulations! You're having a baby! If this is your first pregnancy—or your third—you will want to be a healthy mother for you and your baby. “Exercise in pregnancy is associated with numerous benefits, and is safe in the absence of medical or obstetric contraindications. I encourage exercise for almost all of my pregnant patients, and in my experience have found that pregnant women who exercise generally feel better, have fewer days of malaise and may even have easier deliveries. There is also good evidence that postpartum recovery is easier in women who exercise during their pregnancies, as well as a lower risk for postpartum depression. Three to five days per week should be adequate for maintaining fitness,” says Randy A. Fink, MD, an in-demand ob-gyn in Miami.

Presumably, you are taking your prenatal vitamins, watching what you are eating and drinking water. But do you know the right choices for you regarding your exercise program? “By following some commonsense guidelines, fitness can be maintained during pregnancy with a whole host of benefits,” Dr. Fink says. “I see many patients who have been told by well-meaning friends or relatives that they must stop exercising or adopt a sedentary lifestyle during pregnancy in order to protect the baby. If in doubt, ask your clinician. But in general, the opposite is true. Don’t be afraid to be active.”

Things have definitely changed in the prenatal workout world. As Dr. Fink can attest to, the general consensus among health care and fitness experts is that as long as you are having a healthy pregnancy (for example, no high blood pressure, placenta previa, preterm labor issues, vaginal bleeding or other things your doctor has discussed with you that would not allow you to exercise), you can stick with your regular exercise routine with some minor modifications. “The goal with exercise is to increase cardiorespiratory and musculoskeletal status (aerobic and resistive exercise, respectively). Most exercise is okay, but, like I said before, common sense should prevail. I recommend avoiding high-impact aerobics and activities that may put joints and balance in jeopardy. Considering the other precautions above, one should also avoid potentially dangerous activities like mountain biking, skateboarding and most roller-skating. While swimming is a great activity during pregnancy, scuba diving is not permitted,” Dr. Fink adds.

It is imperative that you talk with your doctor about the level of exercise you intend to do before you actually do it. Dr. Fink says: “Pregnancy is not a time to dramatically improve endurance and stamina, but even if a woman has never worked out before, there is a reasonable amount of exercise she can do during pregnancy. Some women prefer the organized approach of a trainer and a gym, while others will simply start their own fitness program by walking or doing pool exercises, for instance. My recommendation is similar for someone not pregnant, too: Follow a gradual progression of increasing exercise, up to an accumulation of 30 minutes per day.”

Many women also worry about when or if they should stop their exercise programs. Dr. Fink tells us that “a pregnant woman may continue to exercise as long as she feels up to it, though adjustments will be necessary as she becomes more pregnant. As pregnancy progresses, the pregnant woman’s center of gravity changes. Thus, she is more prone to falls and must take extra care to avoid this risk. A woman’s joints during pregnancy become more lax, so she is more prone to joint injury as well. Pregnant women are also more sensitive to dehydration, so keeping well-hydrated is a must. Without other risk factors, there’s been no meaningful link between exercise and preterm labor, but dehydration leads to the release of hormones that can increase uterine contractions. Exercise or working out in an environment that is temperature-controlled makes good sense.”

Some Benefits of Prenatal Exercise

There are many benefits of exercising during pregnancy. According to the American College of Obstetricians and Gynecologists, sticking to a regular exercise routine can:

• Increase your energy

• Reduce backaches, constipation, bloating and swelling

• Prevent or treat gestational diabetes

• Improve your mood

• Improve your posture

• Promote muscle tone, strength and endurance

• Help you sleep better

What You Need to Know About Prenatal Exercise

While working out during pregnancy is a wonderful thing for you to do for your body and baby, there are some key points you need to follow to stay safe. Remember: Always check with your doctor before starting an exercise routine.

With increased hormones running through your body, joints become more lax. Avoid jerky movements and high-impact motions.

You will be carrying extra pounds, and as your belly grows, your center of gravity will shift. Therefore, it is very important to be aware of and work on balance.

There are conflicting studies out there about what a safe heart rate should be for a pregnant woman while exercising. I advise my clients to exercise moderately but do so at a pace at which you can talk normally while exercising.

Avoid outdoor exercise in hot and humid weather.

Wear comfortable clothing, including a bra that fits well and gives you lots of support.

Drink a lot of water (up to half your body weight in water is recommended). Avoid dehydrating yourself and overheating. This can cause preterm labor.

A Few Words About Weight Gain

This is not the time to be exercising for weight loss. You are expected to gain weight during pregnancy—as a matter of fact, it is essential. So make sure you are still consuming extra calories for you and that baby in your belly. These 40 weeks are about the both of you. This is an amazing time in your life, so enjoy it—and enjoy the extra pounds you are supposed to put on. If you exercise safely during your pregnancy, those pounds will shed right off; you will have a quicker recovery and be back to your normal self before you know it.

Below, you will find a powerful and empowering prenatal workout that a beginner or an in-shape mama can do to stay healthy and fit during pregnancy. Beginners, especially, should start slow and not overdo it. Begin with a warm-up and end with a cool-down for five to 10 minutes on an elliptical trainer or a treadmill. This exercise will help your muscles and joints warm up and return to normal levels. It will also have residual effects by helping in your overall workout recovery, including muscle soreness. The strength-building part of your workout is very important. You want to keep those muscles toned and healthy. Remember to keep your back straight, your abdominals tight at all times and do not arch your back.

Pregnant Moms: Reduce Complications with Exercise

Submitted by Natural Baby Pros on Nov 08, 2009

By James Goodlatte and Kimberly Nelli

Would you believe that a little thing like regular exercise can minimize you and your baby’s risk of dangerous interventions? In today’s hospital world of birthing, it can seem like a pregnant mom has little control over the outcome of her pregnancy and the condition her baby enters the world. You are about to find you may have more input than you think.

Maternity wards today often seem more like a repair shop, full of devices and procedures to “help” what women have naturally been doing themselves since evolution began. You may already know some of the tools and techniques doctors often use to help a baby into the world:

• Forceps—An instrument that puts a great deal of traction on the baby’s neck and spine and often results in some bruising in order to pull the baby out.

• Vacuum Extractor—A cap-like cup that attaches to the baby’s head and suction part of the scalp into the cup. The doctor then pulls and tugs at the baby’s head.

• Episiotomy—According to The Revised Edition of Natural Childbirth the Bradley Way, the episiotomy, a 2-4 inch cut between the vagina and anus, is the most common surgical procedure done in the US today.

• C-section is most commonly used during times when the baby is breech, pre-eclampsia is present, fetal distress is occurring, non productive uterine contractions exist, failure to progress (dialate) occurs, baby’s head is too big, failure to progress during the pushing stage, or there are multiple babies.

All of these techniques pose a possible threat to you and your baby. If you could guarantee lowering your chances of these obstetric interventions would you? Both Doctor James Clapp and Certified Nurse Midwife Helen Varney, two prominent figures on pregnancy and exercise, report exercise significantly reduces your need for medical interventions in pregnancy and labor.

Doctor Clapp’s studies show mothers who exercised received an incredible 50% decrease in interventions due to fetal abnormalities. Fetal abnormalities often lead to forceps, vacuum, episiotomy, or C-section, and include low heart rate, presence of meconium in your baby’s water, and cord entanglement. Helen Varney teaches her Yale Nursing Students that these abnormalities are all reduced for the babies of women who exercise.

Doctor Clapp adds an amazing statistic, “You decrease the need for operative interventions like forceps by 75% just by exercising.” He also reports that your regular exercise habit decreases the probability that your doctor will slice the skin between your vagina and anus by 55%. Using exercise, you can save you and your baby from a highly stressful entrance into this world.

Diminish Risk of C- Section

In Varney’s Midwifery text book, a study of first time moms confirmed that exercising pregnant women are four and a half times less likely to deliver by C-section than sedentary moms (a 75% decrease). That lowers your C-section likelihood from 1 in 3 to about 1 in 12 just by exercising.

A sedentary woman may gestate longer or fatigue sooner than one who exercises, which makes your hospital staff begin to worry. As time drags out, the friendly staff will administer the drug pitocin into your IV. Pitocin will quickly override your body’s natural contractions and force harder, more intense uterine contractions that cause mom an intense amount of pain. With this additional throbbing, a birthing mom is quickly offered a pain relieving epidural. In the midst of artificially-hurried pitocin contractions and an epidural-induced numbing lack of control, an unsuspecting woman has carved her path for C-section. But Doctor Clapp reports exercise alone offers a 50% decrease in need for pitocin. You can stop the slippery slope of C-section through exercise.

Avoid Other Complications Too

Nurse Varney explains that healthy fit moms have decreased chance of hypertension, hyperinsulimia, and gestational diabetes. In addition, among exercising women, fewer pregnancies are harmfully prolonged into “post-date gestation” of 42 weeks or more. This fact helps lessen a woman’s chances of being induced and forced into C-section.
Another complication that can be avoided is preterm birth. Varney reports there is a decreased risk of spontaneous preterm birth in women who exercise, so your baby will not be kept for weeks or months without you, in Intensive Care.

How to Exercise for Decreased Interventions

Virtually regardless of the type of exercise you perform, your reward will be decreased interventions. Preparing for pregnancy and delivery can be multifaceted, including everything from breathing to “Labor Training” to “Belly Training” to strength, balance, posture, and flexibility. Start your exercise program now! It seems that pregnant women really can do something to control the outcome of their delivery.

For more information about how to reduce complications during pregnancy, contact Kim and James at You may also visit their website

About Pre- and Post-Natal Fitness

Submitted by Natural Baby Pros on Nov 06, 2009

Fitness for Pregnancy and Birth

Information provided by Kim Nelli, health coach of pregnant moms and owner of Fit For Birth in North Bay Village, Florida.

If you could increase your chances of carrying a healthy baby and delivering a smarter, stronger baby, would you? How much would it be worth to guarantee less fetal interventions and less pain during your labor? How much time would you spend each day to create less pregnancy discomfort and minimize pregnancy weight gain? Would you be excited to find out that studies have already proven all the above benefits for women who exercise during their pregnancy?

Exercise Benefits your Pregnancy and your Baby!
Exercise during early pregnancy can improve the growth of the baby, decrease maternal symptoms, including reducing physical discomfort, improve the baby's nutrient delivery and toxin removal, and decrease the risk of maternal and fetal complications. Exercise late in pregnancy helps to maintain fitness, limits weight gain, and shortens labor time.

In fact, studies have shown that mental performance and physical attributes are often significantly better in babies of women who exercised during pregnancy. Ten years of research by author Dr. Clapp (Exercising Through Your Pregnancy) reveals the following:

• Infants of exercising women do significantly better on the Bayley Scales of Infant Development (BSID) which are used to diagnose infants with delays in cognitive, motor, and behavioral development.

• Babies born of exercising women do better on standardized intelligence, general intelligence, and oral language tests at one year of age and after.

• Even five years after birth, children of women who exercised were in better shape than children of mothers who did not exercise.
Pregnant women who exercised also delivered leaner babies with fewer complications. The statistics include a:

• 75% less chance of having a c-section
• 35% less need for pain medications
• 55% less need for Pitocin, and
• 75% less chance of maternal exhaustion.

When Should You Start?

Exercise before pregnancy can make for a healthier conception and a stronger pregnancy, and is especially beneficial for fertility. Even if a woman has not done much exercise before her pregnancy, there are still things she can do to benefit her pregnancy and baby, and to prepare for birth. Exercises can be modified for beginners, as well as for certain high-risk conditions, with the approval of the attending doctor or midwife.

Four big contraindications for exercise during pregnancy are significant injury, illness and disease, persistent pain, and abnormal vaginal bleeding. If any of the above occurs, it is recommended that you have the situation checked.

Exercising Post-Partum

It is important to practice exercises that strengthen your abdomen and core after giving birth. It is just as important to take your time easing back into an exercise routine. Simple breathing exercises that strengthen the core, such as diaphragmatic breathing, can be incorporated into the daily routine just after giving birth. Once bleeding has completely stopped, and you are feeling up to it, additional exercises can be added.

Specific Types of Exercise to Try

There are many, many different forms of exercise. Some have even been modified specifically for pregnancy, birth, and the post-partum period. Examples include Yoga, Pilates, and even Belly Dancing. For more information regarding specific types of exercise for pregnancy, birth, and the post-partum period, browse through our Directory, read about each practitioner, search through our Articles and Blog sections, or post a question in our Forum.

Shed /Control Weight during Pregnancy without Harming Baby

If too much weight is gained, multiple physical problems can result, causing excessive discomfort in a woman's back and legs from the added burden of carrying those extra pounds. The extra weight can also result in elevated blood pressure and an overload of work on a pregnant woman's heart. This can lead to dangerous situations both for the mother and baby. Finally, all of those extra pounds can result in a more difficult labor and delivery, and after the baby is born they are much more difficult to lose!

Significant weight gain during pregnancy may cause changes in breast tissue that increase susceptibility to breast cancer in later life roughly equivalent to the risk of postmenopausal obesity. Gaining more than 50 pounds during pregnancy, and not losing the excess weight post-pregnancy, could triple a woman's risk of developing breast cancer after menopause.

Maternal weight gain during pregnancy is an important determinant of birth outcomes," says lead author Emily Oken, MD, MPH, instructor in the Department of Ambulatory Care and Prevention. "These findings suggest that pregnancy weight gain can influence child health even after birth and may cause the obstetric community to rethink current guidelines."

Most women who are obese can safely exercise and diet to lose weight during pregnancy, according to a small pilot study conducted by Saint Louis University researchers.

"Doctors hadn't encouraged pregnant women who were obese to limit their weight gain or have them lose weight because they were afraid it would hurt the baby," says Raul Artal, M.D., principal investigator and chair of the department of obstetrics, gynecology and women's health at Saint Louis University. "We found that obese women do not have to gain any weight, and, in fact, can lose weight and it won't hurt the baby. Pregnancy is an ideal time to start an exercise and fitness program, particularly for women who are obese.

You also may find that getting used to following a healthy diet and exercising while pregnant makes it easier to continue that pattern once your baby's born.

That said, he advised that pregnant women still talk to their doctors before taking up an exercise routine, to make sure they have no conditions that preclude physical activity. Women should also get advice from a nutritionist on how to make healthy diet changes.

Losing weight during pregnancy may improve the health of babies born to obese women with gestational diabetes. Gestational diabetes is diabetes that occurs during pregnancy in a woman who didn't have diabetes before pregnancy; it usually goes away after pregnancy.

Study suggested that women who either maintain weight in pregnancy or lose weight -- and exercise -- have fewer complications than those on diets alone," Artal tells WebMD. "We definitely see these women deliver normal-size babies, which means that this plays a role in fewer complications."


Raul Artal is the chair of the department of obstetrics, gynecology, and women's health, St. Louis University School of Medicine.

Mom and Baby Alike May Benefit From Exercise

By Dennis Thompson
HealthDay Reporter

SUNDAY, May 24 (HealthDay News) -- It's natural that a woman might be skeptical about exercising while she's pregnant. So many changes are occurring in her body, it makes sense to have second thoughts about whether exercise might harm her or her unborn child.

But it turns out that a thoughtful exercise program is good for both mother and child, according to medical experts.

"We know that women who exercise during pregnancy have less chance of developing certain conditions like gestational diabetes," said Dr. Raul Artal, chairman of obstetrics, gynecology and women's health for the Saint Louis University School of Medicine. "Not only that, exercise maintains musculoskeletal fitness. Women can cope with the anatomical and physiological changes of pregnancy better when they're in good shape. They also tolerate labor better and recover more quickly from delivery."

The baby also benefits. One study found that when an expectant mother works out, her fetus reaps cardiac benefits in the form of lower fetal heart rates.

The American College of Obstetricians and Gynecologists recommends that pregnant women do at least 30 minutes of moderate exercise a day most days of the week. First, though, all women should consult a doctor to make sure it's OK.

When choosing what sort of exercise to pursue, a woman should take into account the shape she was in before becoming pregnant, said Dr. Thomas Wang, a family practitioner for Kaiser Permanente in San Diego.

"A lot of things depend on the level of fitness they had before," Wang said. A mom-to-be should pursue activities that will provide a good level of exertion without testing the limits of her body's current conditioning. If she's just starting a fitness program to improve her health during pregnancy, she should start out slowly and be careful not to overexert herself.

But there are certain activities that should at least be undertaken with caution, if not avoided altogether. Pregnant women, for instance, should not go scuba diving, as that activity exposes the fetus to a risk of developing decompression sickness, also known as the bends.

Women also should think twice before engaging in activities where the risk of falling is higher, such as gymnastics, horseback riding, downhill skiing and high-intensity racquet sports. And they should avoid contact sports such as ice hockey, soccer and basketball.

"Anything that involves impact or the chance of abdominal trauma, they should try to avoid," Wang explained.

Exercise that's perfectly safe for expectant mothers includes Kegel exercises, swimming, walking, light dancing and yoga. Riding a stationary bicycle or working out on aerobic gym equipment -- elliptical or stair-climbing machines, for instance -- is also fairly safe, as long as care is taken to prevent a fall.

Most pregnant women also can take part in jogging, running and aerobics, especially if those were exercises they regularly performed before pregnancy.

Pregnant women who are doing weight training should emphasize improving their muscle tone, particularly in the upper body and abdominal area, according to the American Pregnancy Association. They should avoid lifting weights above their heads and performing exercises that strain the lower back muscles.

"There have been some studies that show heavy lifting causes a temporary drop in the baby's heart rate," Wang said. "It usually corrects pretty quickly, but they might want to be careful."

Other things to keep in mind if exercising while pregnant:

Avoid exercising to the point of exhaustion or breathlessness, as that could affect the oxygen supply to the fetus.

Avoid overheating, which can affect the baby's development. Don't exercise in hot weather.

During the second and third trimesters, avoid exercise that involves lying flat on your back as this decreases blood flow to the womb.
Though that might seem like a lot of cautions for something that's supposed to be safe, doctors insist that women can and should engage in a well-thought-out fitness program during their pregnancy.
"By and large, if there are no medical complications of pregnancy, women can continue engaging in the same type of activities," Artal said. "Women should be encouraged to continue living an active lifestyle."


SOURCES: Raul Artal, M.D., chairman of obstetrics, gynecology and women's health, Saint Louis University School of Medicine, St. Louis; Thomas Wang, M.D., Kaiser Permanente, San Diego; American College of Obstetricians and Gynecologists (; American Pregnancy Association (

Copyright © 2009 ScoutNews, LLC. All rights reserved.

ACOG releases new guidelines on exercise: 30 minutes per day in pregnancy

OB/GYN News, Jan 15, 2002 by Erik L. Goldman

NEW YORK -- The American College of Obstetricians and Gynecologists is encouraging healthy pregnant women to kick off the new year with moderately vigorous daily exercise.

The college's new guidelines on exercise and pregnancy issued earlier this month, recommend that healthy women engage in at least 30 minutes of moderate exercise on most, if not all, days. The guidelines were previewed by Dr. Raul Artal, chair of ob.gyn. and women's health, St. Louis University at a press briefing sponsored by ACOG.

"Often times, after she asks 'When is the baby due?' she will ask about exercise," Dr. Artal said. Many physically active women want to continue their participation in fitness activities as long as they can. And unless there is a specific concern or contraindication, there's no reason why they shouldn't.

"We believe pregnancy should not be a state of confinement. In fact, it is a unique time for lifestyle modification. A woman who is pregnant is often very open to healthy lifestyle changes," he said.

Dr. Artal stressed that active women weigh less to start, gain less weight during pregnancy and tolerate labor better than do sedentary women. While there are no studies to prove that active women have better obstetrical outcomes, there are certainly no data to show that moderate physical activity causes any adverse outcomes.

ACOG's previous guidelines on exercise were considerably more restrictive, based on observations of a higher prevalence of fetal growth restriction among women who engaged in strenuous activity But Dr. Artal contended that this reflected the combination of strenuous activity and caloric deficiency So long as a woman is eating well and compensating for the caloric loss due to exercise, there should be no problems, especially if the activity is moderate.

"I cannot overemphasize the importance of hydration, both to cool core body temperature and to reduce the risk of complications," he added.

There are a few caveats to the new ACOG position. Women with significant heart disease, restrictive lung disease, preeclampsia, hypertension, or a history of placental problems in current pregnancies and those with placenta previa at 26 weeks or third-trimester bleeding absolutely should not exercise, according to ACOG.

The choice of activity should be appropriate. Obviously pregnant women should avoid contact sports or any activities that involve extreme temperature changes or risk of trauma. While swimming is a very good option, scuba diving should be completely avoided: A fetus is at markedly increased risk for decompression sickness.

Patients should also avoid any sport that involves motionless standing for long periods of time. Likewise, some yoga practices that involve holding still positions for extended time periods should probably be avoided, as should any activity that involves long periods in a supine position, which could precipitate hypotension.

Dr. Artal urged his colleagues to drop, once and for all, the notion that a pregnant woman's maximal heart rate should not go above 140 beats per minute, This widely circulated idea originally appeared in a 1984 ACOG-produced video developed by Dr. Artal and several other ob.gyns. interested in exercise. The ACOG guidelines of 1994 did not mention this idea.

"There is no science to support this," he said, explaining that the idea came out of the fact that target heart rates were commonly used when speaking about exercise in nonpregnant women. "We had to come up with a guideline in a short period of time. Nobody had data on pregnancy so we guesstimated."

The new exercise guidelines come hot on the heels of the college's committee opinion on air travel during pregnancy, issued in mid-December. The position paper states that for healthy pregnant women, air travel is safe up to 36 weeks' gestation.

As with exercise, pregnant women with compromised cardiovascular or respiratory function should avoid flying. The cabin pressure of a plane at 39,000-4 1,000 feet is kept at the equivalent of an altitude pressure of 8,000 feet. For a pregnant woman with medical conditions, that's pushing the hypoxia envelope.

At 32,000 feet, the cabin pressure is maintained at the equivalent of the pressure at an elevation of 6,000 feet. Even at this lower altitude, oxygen consumption in a pregnant woman is about 13% lower than it would be at sea level. Among nonpregnant women, the change is only 3%. A woman with cardiovascular disease may not be able to compensate for changes in partial oxygen pressure associated with altitude.

Flying also should be avoided by women with sickle cell disease or the trait for it, pregnancy-induced hypertension, or poorly controlled diabetes. Those with histories or risk factors for premature delivery or other obstetrical complications should defer air travel until after delivery whenever possible. Women taking long flights should be advised to use support hose and to get up and move around to keep the blood circulating.

"There is no evidence that thrombotic events are more common during air travel in pregnancy, but it is a good idea to take precautions," said Dr. Artal.

COPYRIGHT 2002 International Medical News Group
COPYRIGHT 2008 Gale, Cengage Learning


Pregnant women safe to lose weight

Published: June 7, 2007 at 7:44 AM

ST. LOUIS, June 7 (UPI) -- Obese moms-to-be can safely exercise and diet to lose weight during pregnancy, found a small pilot study by Saint Louis University researchers.

"Doctors hadn't encouraged pregnant women who were obese to limit their weight gain or have them lose weight because they were afraid it would hurt the baby," principal investigator Dr. Raul Artal, of Saint Louis University, said in a statement.

"We found that obese women do not have to gain any weight, and, in fact, can lose weight and it won't hurt the baby. Pregnancy is an ideal time to start an exercise and fitness program, particularly for women who are obese."

The study flies in the face of the "eat for two" and "take it easy" advice that obstetricians gave to a past generation of pregnant women, according to Artal.

Artal examined two groups of pregnant women who were obese and had gestational diabetes -- a type of diabetes that starts during pregnancy. More women who exercised and dieted either lost or maintained their weight than women in the group that followed the standard diabetic diet.

Babies born to women who lost or maintained their weight were more likely to be of normal size, according to the study published in the journal Applied Physiology, Nutrition, and Metabolism.

© 2007 United Press International, Inc. All Rights Reserved.

Exercise urged for pregnant women

Published: Sept. 15, 2005 at 2:12 PM

ST. LOUIS, Sept. 15 (UPI) -- A St. Louis University obstetrician and nationally known exercise expert says exercise during pregnancy should be recommended.

Dr. Raul Artal says not enough obstetricians are encouraging their pregnant patients to exercise, a reluctance he finds to be old fashioned.

"With ample evidence to show that regular, moderate exercise in women with healthy pregnancies results in no adverse maternal or fetal effects, obstetricians should make exercise recommendations a top priority," he says.

Artal says pregnancy is a perfect time for women to begin exercising because they stick with the habits they adopt during pregnancy after their babies are born.

Artal recommends that pregnant women engage in moderate exercise -- such as brisk walking, which allows them to carry a normal conversation -- for about 30 minutes a day. They can combine aerobic and resistance training, but should avoid contact sports or activities that carry a high risk of falling or trauma to the abdomen.

© 2005 United Press International, Inc. All Rights Reserved.

Pregnant women need more exercise

Published: Nov. 9, 2005 at 7:44 PM

ST. LOUIS, Nov. 9 (UPI) -- A study says doctors need to do a better job of encouraging women with uncomplicated pregnancies to exercise.

Terry Leet, a study author and associate professor of community health at Saint Louis University School of Public Health, said only one of every six pregnant women is meeting the current recommendation -- 30 minutes or more of moderate physical activity on most, if not all, days of the week.

The research, funded by the Centers for Disease Control and Prevention, was published in Medicine & Science in Sports & Exercise.

The findings support a recent newsletter article by Dr. Raul Artal, lead author of the American College of Obstetrics and Gynecology's 2002 guidelines for exercise during pregnancy.

"The hesitance of obstetricians to recommend exercise to pregnant women is rooted in old-fashioned notions of pregnancy as a time of confinement," Artal wrote in the September issue of Ob.Gyn News.

Brisk walking for 30 or more minutes at least five days a week is considered moderate exercise and meets the current physical activity recommendation for pregnant and non-pregnant women.

© 2005 United Press International, Inc. All Rights Reserved.

Fitness for two

Exercise is good for pregnant women. The U.S. Department of Health and Human Services (HHS) recommends that healthy pregnant women get at least 2½ hours of moderate-intensity aerobic activity a week (1). It’s best to spread this exercise throughout the week (1). This means that pregnant women should try to do 30 minutes of an aerobic activity on most, if not all days.

Regular physical activity leads to improved fitness for pregnant women. It helps keep the heart, mind and entire body healthy. It can ease many common discomforts of pregnancy, such as constipation, backache, fatigue, sleep disturbances and varicose veins. Regular exercise also may help prevent pregnancy-related forms of diabetes and high blood pressure (1, 2, 3). Fit women may be able to cope better with labor and recover faster after birth.

Pregnant women who have not been physically active should consider gradually increasing their activities or starting a mild exercise program to gain some of these health benefits. However, all pregnant women should check with their health care provider before starting or continuing exercise.

Women who do not want to participate in a traditional exercise program can get many of the health benefits of exercise by doing something physically active, like going for a walk. Past recommendations stated that a person needed to exercise continuously for about 30 minutes at least three times a week to obtain health benefits. However, current HHS recommendations say that short bouts of physical activity (at least 10 minutes each) spread throughout the week are effective (1).

Are there any pregnant women who should not exercise?
Exercise is good for pregnant women, except in certain circumstances. Women should not exercise while pregnant if they have (2):

Heart disease that compromises blood flow
Preterm labor
Incompetent cervix, a defect of the cervix that can cause pregnancy loss or premature birth
Restrictive lung disease
Multiple gestation (twins, triplets or more), which increases the risk for preterm labor
Persistent vaginal bleeding in the second or third trimester
Ruptured membranes (bag of waters)
Preeclampsia, a pregnancy-related form of high blood pressure
Placenta previa, a low-lying placenta that covers part or all of the opening of the cervix during the third trimester
Women with a history of medical problems—such as severe anemia or poorly controlled high blood pressure, diabetes, thyroid disease or seizure disorder—should exercise only with the approval of their health care provider. Pregnant women who are obese or extremely underweight also should seek medical approval before starting an exercise routine.

Can exercise harm the baby?
There is no evidence that moderate exercise has any harmful effects on an unborn baby, or that it increases the risk of miscarriage, preterm labor or birth defects in a normal pregnancy.

In the past, providers had concerns that exercise could trigger preterm labor because it increases the levels of hormones that may stimulate uterine contractions. Recent studies have shown that moderate exercise does not increase the risk for preterm labor in low-risk pregnancies (1, 4, 5). In fact, a 2008 Danish study suggests that moderate-to-heavy leisure-time physical activity (including sports, walking and gardening) may significantly reduce the risk of premature birth (6).

Some providers also were concerned that regular exercise could slow fetal growth. Most studies have found that moderate exercise has no effect on birthweight, and a few studies suggest that moderate exercise may actually increase birthweight (4, 5). Recent studies have shown that moderate exercise in early pregnancy improves growth of the placenta (6), possibly contributing to an increase in birthweight.

Few studies are available on the effects of strenuous exercise during pregnancy. Some studies suggest that women who continue to exercise strenuously through the third trimester of pregnancy may have babies with slightly reduced birthweight (4, 5, 8). Strenuous exercise does not, however, appear to increase a woman’s risk for having a low-birthweight baby (less than 5½ pounds).

One study that followed a group of babies through age 5 found that the children of women who exercised strenuously throughout pregnancy were somewhat leaner than the children of non-exercisers, although their growth was in the normal range (3). And, for reasons that are not clear, the children of the exercisers scored significantly higher than the children of non-exercisers in tests of intelligence and language skills (3).

Does pregnancy change how a woman’s body responds to physical activity?
Yes. During pregnancy, a woman’s body changes in a number of ways that alter her response to physical activity:

Breathing: Pregnant women require more oxygen than non-pregnant women, even at rest. As pregnancy progresses, women have to work harder to breathe because the enlarging uterus crowds the diaphragm (the large muscle separating the chest and abdomen). These changes mean that there is less oxygen available for use during physical activity, making it easier to become out of breath.
Heart rate: A pregnant woman’s heart works harder and beats quicker to supply oxygen to the baby. As a result, she may have less energy for physical activity. Her cardiovascular system also responds differently to certain body positions. If a woman in her second or third trimester exercises while lying flat on her back, her expanding uterus may compress the major vein that carries blood back to the heart from the legs. This causes her heart to beat more slowly. A slow heartbeat can cause dizziness and interfere with normal blood flow to the uterus. Motionless standing also causes the heart to beat more slowly.
Body temperature: Some studies suggest that a pregnant woman’s body dissipates heat more efficiently than a non-pregnant woman’s body. A pregnant woman starts sweating at a lower body temperature than a non-pregnant woman, so her temperature actually falls slightly during exercise (5). This adaptation may help protect the baby. Pregnant women should avoid overheating, especially during the first trimester, because a sustained body temperature of 102.5 F or higher may increase the risk for certain birth defects of the brain and spine. However, studies have not shown any increase in these or other birth defects among babies of women who exercise vigorously during pregnancy (2, 5).
Balance: Pregnancy alters a woman’s sense of balance. The enlarging uterus and breasts shift her center of gravity.
Joints: High hormone levels make a pregnant woman’s connective tissues more lax, and her joints may be more susceptible to injury.
What are some guidelines for exercising safely during pregnancy?
A pregnant woman should check with her health care provider to make sure the activities she chooses are safe during pregnancy. The following precautions can help assure that an exercise program is safe for mother and baby (2, 9). A pregnant woman should:

Avoid ontact sports and any activities that can cause even mild trauma to the abdomen, such as ice hockey, kickboxing, soccer and basketball.
Avoid activities with a high risk for falling, such as gymnastics, horseback riding, downhill skiing and racquet sports.
Avoid scuba diving. This activity puts the baby at increased risk for decompression sickness and may contribute to miscarriage, birth defects, poor fetal growth and preterm labor.
Avoid exercising on her back after the first trimester. She also should avoid prolonged periods of motionless standing.
Avoid jerky, bouncing or high-impact movements that may strain joints and cause injuries.
Avoid exercising at high altitudes (more than 6,000 feet) because it can lead to reduced amounts of oxygen reaching the baby.
Avoid overheating, especially in the first trimester. She should drink plenty of fluids before, during and after exercise; wear layers of breathable clothing; not exercise on hot, humid days; and avoid hot tubs, saunas and steamrooms.
A pregnant woman should stop exercising immediately and call her health care provider if she experiences symptoms such as (2):

Vaginal bleeding
Increased shortness of breath
Chest pain
Muscle weakness
Calf pain or swelling
Uterine contractions
Leakage of amniotic fluid
Decreased fetal movement
What types of physical activities are best during pregnancy?
Most pregnant women can continue their prepregnancy exercise programs, though they may need to modify some activities or decrease the intensity of workouts as pregnancy progresses. Women who participated in strength-training programs before pregnancy often can safely continue their training during pregnancy, as long as they do so in moderation. They should check with their provider to see how much weight is safe for them to lift and avoid lifting while lying on their back.

If a pregnant woman is just starting an exercise program (with her health care provider’s OK), walking, swimming, cycling on a stationary bicycle, aerobics (low impact or a class for pregnant women) and yoga classes for pregnant women are activities that usually are safe.

When can a woman begin postpartum exercises?
Some women can resume their exercise program within days of delivery, while others may need to wait longer (9). A woman should check with her health care provider to see what is right for her.

Women who exercise regularly during pregnancy build stamina and muscle tone. After delivery, these allow them to build up to their previous level of exercise more quickly than mothers who do not exercise regularly. New mothers who resume exercise (and moms who breastfeed) lose more weight than those who do not exercise. Most exercising mothers are back to their prepregnancy weight by their baby’s first birthday.

Studies show that moderate exercise improves the mood of new mothers (1). A 1999 study shows that women who resume their exercise program within 6 weeks of delivery feel better about themselves and adjust more quickly to being a mom than women who do not exercise (10).

Pregnancy-related changes in bodily systems last for about 4 to 6 weeks after giving birth. Therefore, a woman should start or resume exercise slowly. If she feels pain or has other unusual symptoms during a specific activity, she should stop that activity (or do fewer repetitions or a shorter routine). A woman who has had a cesarean birth should not exercise strenuously until her health care provider gives her the go-ahead.


U.S. Department of Health and Human Services (HHS). 2008 Physical Activity Guidelines for Americans. Washington, D.C., October 7, 2008. American College of Obstetricians and Gynecologists (ACOG). Exercise During Pregnancy and the Postpartum Period. ACOG Committee Opinion, number 267, January 2002 (reaffirmed 2005).
American College of Sports Medicine. Roundtable Consensus Statement: Impact of Physical Activity During Pregnancy and Postpartum on Chronic Disease Risk. Medicine and Science in Sports and Exercise, 2006, pages 989-1005.
Clapp, J.F., III. Recommending Exercise during Pregnancy. Contemporary Ob/Gyn, January 2001, pages 30-49.
Morris, S.N. and Johnson, N.R. Exercise During Pregnancy: A Critical Appraisal of the Literature. Journal of Reproductive Medicine, volume 50, number 3, March 2005, pages 181-188.
Hegaard, H.K., et al. Leisure Time Physical Activity Is Associated with Reduced Risk of Preterm Delivery. American Journal of Obstetrics and Gynecology, volume 198: 180.e1-e5.
Clapp, J.F. Influence of Endurance Exercise and Diet on Human Placental Development and Fetal Growth. Placenta, June-July 2006, volume 27, pages 527-534.
Perkins, C.D., et al. Physical Activity and Fetal Growth During Pregnancy. Obstetrics and Gynecology, volume 109, number 1, January 2007, pages 81-87.
American College of Obstetricians and Gynecologists (ACOG). Exercise During Pregnancy. Educational pamphlet AP119. ACOG, Washington, D.C., June 2003.
Sampselle, C.M., et al. Physical Activity and Postpartum Well-Being. Journal of Obstetric, Gynecologic and Neonatal Nursing, January/February 1999, pages 41-49.

December 2008


Exercise during pregnancy

It used to be that pregnancy offered a good reason to sit down and put your feet up. But times have changed for pregnant women in good health.

The U.S. Department of Health and Human Services recommends that healthy pregnant women get at least 2 1/2 hours of aerobic exercise every week. This means that most pregnant women should try to get 30 minutes of aerobic exercise on most, if not all, days. Examples of aerobic exercise are walking, swimming and dancing.

Why exercise is good for you
In the short term, exercise helps all of us feel better physically and emotionally, and the calories burned help prevent excessive weight gain. People who exercise regularly develop stronger muscles, bones and joints. And over time, the benefits of regular exercise are even more impressive: lower risk of premature death, heart disease and other serious illnesses.

For pregnant women, exercise has added benefits. It can help prevent gestational diabetes, a form of diabetes that sometimes develops during pregnancy. For women who already have gestational diabetes, regular exercise and changes in diet can help control the disease.

Exercise can relieve stress and build the stamina needed for labor and delivery. It can also help women cope during the postpartum period. Exercise can help new mothers keep "baby blues" at bay, regain their energy and lose the weight they gained during pregnancy.

Before you start
Before you go out and run a marathon, talk with your health care provider. Not all pregnant women should exercise, especially if they are at risk of preterm labor or suffer from a serious ailment, such as heart or lung disease. So check with your health care provider before you start an exercise program.

Next, decide what type of exercise you will do. Pick things you think you will enjoy. You may want to try several things. For example, brisk walking for 30 minutes or more is an excellent way to get the aerobic benefits of exercise. You could also run, hike or dance, if you like. Swimming is another sport that is especially good for pregnant women. The water supports the weight of your growing body and provides resistance that helps bring your heart rate up. You can also look around for aerobics and yoga classes designed for pregnant women. You may find that a variety of activities helps keep you motivated to continue exercising throughout your pregnancy—and beyond.

Be careful when choosing a sport. Avoid any activities that put you at high risk for injury, such as horseback riding or downhill skiing. Stay away from sports in which you could get hit in the belly, such as ice hockey, kickboxing or soccer. Especially after the third month, avoid exercises that require you to lie flat on your back. Lying on your back can restrict the flow of blood to the uterus and endanger your baby. Finally, never scuba dive. This sport may lead to dangerous gas bubbles in the baby's circulatory system.

When you exercise, pay attention to your body and how you feel. Don't overdo it—try to build up your level of fitness gradually. If you have any serious problems, such as vaginal bleeding, dizziness, headaches, chest pain, decreased fetal movement or contractions, stop exercising and contact your health care provider immediately.

With a little bit of caution, you can achieve or maintain a level of fitness that would shock your grandmother. You'll feel and look better. And yes, you can still put your feet up—after you've come back from your walk.

October 2008

Exercise Found To Be Beneficial During Pregnancy

May 25, 2009 by Tanya

Filed under Baby Health, News, Pregnancy

Studies have found that an approved exercise program is beneficial for mother and baby during pregnancy.

Dr. Raul Artal, from the Saint Louis University School of Medicine said “We know that women who exercise during pregnancy have less chance of developing certain conditions like gestational diabetes,”

“Not only that, exercise maintains musculoskeletal fitness. Women can cope with the anatomical and physiological changes of pregnancy better when they’re in good shape. They also tolerate labor better and recover more quickly from delivery.”
“Women should be encouraged to continue living an active lifestyle.”

The American College of Obstetricians and Gynecologists has recommended that women aim to do at least half an hour of moderate exercise every day during pregnancy.

They reminded expectant mothers to consult with a doctor before starting any exercise program.
Benefits include lower fetal heart rates
Family practitioner, Dr. Thomas Wang in San Diego said “A lot of things depend on the level of fitness they had before,”

Certain activities should be avoided during pregnancy, such as scuba diving, skiing, horseback riding, gymnastics, and high impact sports. Weights should not be lifted above their heads, and there should be no strain to the lower back.

Pregnant women should avoid lying flat on their backs during the second and third trimesters, as this reduces the blood circulation to the fetus.
“Anything that involves impact or the chance of abdominal trauma, they should try to avoid,” Wang commented.

Approved exercises include Kegels, yoga, light dancing, swimming, walking, cycling and aerobics, as long as the woman takes care not to fall.
It is important that when exercising during pregnancy, avoid breathlessness or exhaustion. This may reduce the amount of oxygen the fetus receives.
Also, avoid exercising during hot weather or overheating, as this may affect the development of the baby.

Tags: aerobics, exercise during pregancy, fitness program, gestational diabetes, high impact sports, lower back, overheating, pre natal exercise, pregnacy exercise, Raul Artal, Saint Louis University School of Medicine, San Diego, The American College, Thomas Wang, work out program, yoga

Healthy & Safe Pregnancy

Pregnancy Fitness

Exercise your Way Through Pregnancy

By Denise Taylor, M.D.

Congratulations on making a wonderful choice for your health and your baby's health. Women who continue to exercise in pregnancy have higher self-esteem, a more positive attitude about pregnancy and easier labors. Some guidelines are important, however.

Moderation is key! Now is not the time to increase your mileage or take up a new sport. Pregnancy increases the demands on your heart and lungs. If you are a serious athlete, you'll need to cut back the intensity of your workouts halfway through pregnancy (20 weeks from your due date).

Pregnancy increases the demands on your heart and lungs.
Pregnancy loosens your joints in preparation for giving birth. You become more flexible but also more prone to sprains and strains. Be sure to warm up well before exercise. If you lift weights, cut back the weight and increase the repetitions. And never, ever hold your breath while lifting weights or grunt to help you lift more. Always exhale slowly when lifting weight.

The weight of the baby becomes an important factor around 20 weeks. Your balance is off. Sports requiring sudden movement or balance should be stopped by then. Even bicycle riding becomes dangerous in traffic, where a fall could be very serious. Consider changing to a stationary bike at this time, if you like bicycling.

Don't get overheated. Raising your body temperature is dangerous for you and Baby. Exercise doesn't actually increase your body temperature significantly, but your environment does. During the summer, try to exercise before 8 a.m. or after 6 p.m. Also, humidity makes it hard for your body to get rid of heat. This is why hot tubs are a bad idea, too — they raise your temperature very rapidly without your realizing it. If the temperature and the humidity are higher than 80 degrees, exercise indoors or in a swimming pool. If you can't afford a health club, go to the mall and start walking!

Be sure to drink lots of water – before, during and after exercise. If you get thirsty, it's too late – you're already dehydrated! Your blood volume is greater during pregnancy, and you need more fluid to keep it up. Try to drink a pint of water before exercise and a cup every 20 minutes. Sweating can cause you to lose 1 to 2 quarts of water per hour!

Contact sports should be stopped after 12 weeks. At this time, the uterus begins to rise above the pelvic bones, and your baby could be injured by a blow to the belly.

Stop exercising and call your doctor if you have any of these symptoms: pain, dizziness, shortness of breath, faintness, vaginal bleeding, rapid heartbeat while resting, difficulty walking, contractions or the baby isn't moving.

Don't exercise if you have pregnancy-induced high blood pressure, ruptured membranes, preterm labor, incompetent cervix, cerclage, vaginal bleeding after 12 weeks or fetal growth retardation (baby growing too slowly).

Original article:

Pregnancy Diet and Exercise - The Key to a Fit and Fantastic Pregnancy

By Grace Addison

One of the most pressing concerns that expecting mothers have is weight gain. And hey, this is a totally valid concern on many levels. Face it we all want to look good, and when we are pregnant a lot of us women tend to feel "fat and ugly." Pregnancy diet and exercise is the answer to this dilemma, but it is a little bit of a mystery to many pregnant women.

First of all let's clear up the word "diet." By no means am I suggesting that you go on a traditional "diet" when pregnant. You will gain weight during pregnancy; this is a good thing. I am talking about diet in the sense of what you should be eating and how much to keep yourself looking good and your baby healthy.

Diet during pregnancy really need not be that much of a mystery. Basically you want to follow the dietary guidelines of healthy eating in terms of what you should be eating. You want to make sure you are eating a wide variety of foods to get the entire appropriate nutritional intake. Folic acid is really important. You can get this by eating green, leafy vegetables. If you are concerned at all about getting the right nutritional intake make sure you are taking a good prenatal vitamin.

Now, we all know about cravings. Pregnant women can tend to get some pretty intense food cravings and they mostly are not for healthy foods. Try your best to indulge your cravings in moderation. Have a small bowl of ice cream instead of the entire half gallon of Breyer's Cookies and Cream (my personal favorite).

Exercising can be another mystery for expecting mothers. Is it safe to exercise during pregnancy? Will I injure my baby if I am physically active when pregnant? Rest assured that it is not only safe to exercise during pregnancy it is recommended. Recent studies are finding out all kinds of benefits of exercise during pregnancy. What are some of the benefits?

When you follow a fitness program in pregnancy you can help to relieve a lot of the annoying physical symptoms you may experience. Constipation, heartburn, even sleeping difficulty is relieved by exercise. Studies have shown that exercising while pregnant leads to an easier labor and delivery. It also has benefits for your baby like stronger heart rate.

When choosing the exercises you want to include in your pregnancy diet and exercise program there are a lot of options. Yoga, Pilates, Swimming, Aerobics are all examples of exercises you can do while pregnant. If you already exercise you can continue your current routing in most cases. Consult with your doctor if you want to double check if your current routine is safe.

A great place to start when you are looking for a pregnancy diet and exercise program is at the Happy Mother and Baby website. They offer a pregnancy fitness program that has all of the appropriate exercises, foods, and fitness tips a pregnant mom to be needs to have a healthy and happy pregnancy.

Eating for two, gaining too much

With more than half of women already overweight, some doctors say pregnancy guidelines should be scaled back.

August 22, 2005|Jacqueline Stenson, Special to The Times

Women who start their pregnancies at a normal weight are currently advised to gain at least 25 but no more than 35 pounds. Underweight women are told to gain more, overweight women less. But with the nation's overall waistline expanding, the guidelines that set these ranges are being criticized as too lenient.

As a result, they could be revised downward, dramatically so, if some doctors and women's health experts have their way.

"The concern is that it's almost recommending too much weight gain for an average pregnancy," says Dr. Michael Nageotte, president of the Society for Maternal-Fetal Medicine, who practices at Long Beach Memorial Medical Center.

More than half of women of childbearing age are overweight or obese even before pregnancy, federal statistics show. And some studies indicate that a third or more of women gain more than recommended during gestation.

Further, women who gain excess weight with two or three pregnancies may never get back to their starting point. Over time, those additional pounds contribute to diabetes, heart disease and other health problems.

The Institute of Medicine hopes to convene a committee later this year to explore how well the guidelines have been followed and whether there's a need to revisit them.

"Excessive weight gain in pregnancy is probably one of the biggest contributors to female obesity," says Dr. Sharon Phelan, a professor of obstetrics and gynecology at the University of New Mexico in Albuquerque.

And, Phelan adds, "It is exceptionally hard to lose that weight."

Weight gain during pregnancy is a source of growing concern for doctors. Not only does it raise the risk of gestational diabetes and high blood pressure, which could lead to a preterm delivery with complications, for example, but it also can lead to bigger babies that cause more difficult deliveries and require more C-sections.

Research also suggests babies born to overweight women may be more likely to have birth defects and become heavy themselves.

According to the current recommendations, women of normal weight should gain 25 to 35 pounds during pregnancy, underweight women should gain 28 to 40, overweight women should gain 15 to 25 and obese women should gain at least 15.

The guidelines focus on weight gain associated with healthy babies. But now that obesity is such a problem in the United States, the effect of the weight gain on the mothers needs to be addressed, says Brenda Rooney, an epidemiologist at the Gundersen Lutheran Medical Center in La Crosse, Wis. Her research has shown that women who don't lose baby fat within six months are more likely to be carrying it with them 10 or 15 years later.
Rooney says recent research on weight gain in pregnancy seems to indicate that a gain of up to 25 pounds may be appropriate for normal weight to overweight women.

But Dr. Raul Artal, professor and chairman of obstetrics, gynecology and women's health at St. Louis University School of Medicine, would like to see women gain far less -- no more than 10 to 14 pounds for a normal weight woman, up to 16 to 20 pounds for an underweight woman and "very little" for overweight women.

He says women should essentially gain only the weight accounted for directly by the pregnancy -- which includes the fetus, placenta, amniotic fluid, increased blood volume and breast enlargement -- but not additional fat that's usually included in estimates of healthy pregnancy weight gain.

"We're not bears," Artal says. "Pregnancy is not a time of hibernation."

Fat stores may be needed in times of starvation, but most women in our super-size-me nation are eating too much.

Although most doctors would never recommend dieting, per se, during pregnancy, Artal says he has no qualms about counseling overweight patients to eat less. "For them, less could still be the diet of another person for a whole week," he says.
One of his patients who recently gave birth weighed 520 pounds. The baby was so large that the mother had trouble in labor and needed a C-section, he says.

Other doctors say Artal's weight-gain recommendations are extreme, but they agree the Institute of Medicine guidelines, while a good general guide, may be too permissive and, if strictly adhered to by all women, could encourage some to gain more than they should.

"I don't want patients to feel pressure to gain weight in a healthy pregnancy," Nageotte says.
Most babies tend to do just fine whether their mothers gain within the current guidelines or several pounds outside of them, he says.

Though very low weight gain in some women may cause a baby to be underweight, even babies born to mothers who've endured famine have fared well, he says.

"The fetus, being a very efficient parasite, if you will, is able to survive and get what it needs from the mother," Nageotte says.

Several doctors, including Phelan and Nageotte, say a weight gain of 25 to 30 pounds is plenty for many women.

But even that upper limit can be too easily passed.
Gin Treadwell-Eng, a 33-year-old events coordinator, knows this firsthand. By the end of her first pregnancy, she had added 61 pounds to her 5-foot-5 frame.

Her blood pressure was normal and by all other accounts the pregnancy was healthy, but she hated the way she looked -- "I had a real hard time with it," Treadwell-Eng says.

The Santa Clarita woman ultimately delivered a healthy baby girl, but it took her more than a year and a half to lose most of the weight -- and she never regained her pre-pregnancy weight of 145. She began her second pregnancy eight pounds heavier than the first.

Linda Meyers, director of the Institute of Medicine's Food and Nutrition Board, which oversaw the 1990 guidelines, says her group thinks it's important to look into whether the guidelines need to be updated because they are 15 years old, newer research has been done on the subject and obesity rates are rising.

"I think any time there's active research in an area and new knowledge it pays to stop and take stock of whether it's time to look further," she says.

She notes that the Institute of Medicine's Board on Children, Youth and Families is in the preliminary stages of organizing a workshop to explore issues of weight gain in pregnancy.

Rosemary Chalk, director of the children's board, says that at the request of the federal Maternal and Child Health Bureau, she's working to convene the Institute of Medicine committee this fall to "begin raising questions" about pregnancy weight gain. The bureau is part of the U.S. Department of Health and Human Services, but the committee would be under the auspices of the Institute of Medicine.
Regardless of guidelines, though, many experts say what's most important is for pregnant women to focus on eating a healthy diet -- with a mere 300 additional calories per day -- than obsess about what the scales say.

"The weight gain is a proxy," Phelan says. "It's a clue to us about [a woman's] nutrient intake."
Due in November, Treadwell-Eng isn't gaining as rapidly this time. She credits less nausea during her first trimester; she hasn't eaten as much bread and crackers as before. And she's trying to walk more.

So far, she's put on 23 pounds -- about 20 pounds less than she had gained at this point in her last pregnancy.

"It's better this time," she says.

Exercising While Your Pregnant
A Pregnancy Fitness Guide

There was a time when exercise during pregnancy was discouraged-but not anymore! Times have changed and we've gotten smarter about women's health. Most experts now encourage exercise during pregnancy.

In 2002, the American College of Obstetricians and Gynecologists began recommending that pregnant women should exercise moderately for 30 minutes most days, if not every day (unless there are medical reasons prohibiting it).

Exercise benefits mom by:

Improving muscle tone and cardiovascular fitness
Reducing the risk of developing gestational diabetes
Preventing excess weight gain
Improving sleep patterns
Preparing you to hold and carry your growing child
Improving appearance and posture
Promoting circulation and stimulating the digestive processes (which help prevent hemorrhoids, constipation, varicose veins, leg cramps and swelling in the ankles)
Alleviating some of the discomforts of pregnancy, such as lower back pain
Strengthening the muscles needed for labor and delivery, which can ease delivery and labor time

Exercise benefits baby by:

Preparing the fetus to transition to the non-maternal environment
Increasing placental efficiency for blood circulation, which supplies oxygen and nutrients to fetus
Decreasing fetal fat without decreasing overall growth of the fetus
Increasing newborn's readiness to self-calm and self-quiet
Increasing fetal movement, which possibly helps develop oral language skills by age 5

The exercises you can do during pregnancy depend on two things: your current health and how active you were before you became pregnant. If you were not active before, don't use pregnancy as the time to begin a strenuous fitness regime; if you did exercise before pregnancy, you can continue your program with some slight modifications.

Before you begin (or continue) any exercise program, discuss it with your healthcare provider. Together, the two of you can plan an exercise program that is consistent with your current level of fitness and health conditions. It is mandatory that you consult a doctor first, especially if you have any of these conditions:

Heart Problems
Asthma or chronic lung problems
High Blood Pressure
Thyroid Problems
Extremely over or under weight
Muscle or joint problems
History of spontaneous miscarriages
Repeated C Sections
History of previous premature labors
Carrying multiples (e.g., twins, triplets)
Incompetent cervix
Persistent bleeding
A previously sedentary lifestyle

NOTE: If you experience problems such as bleeding, premature labor, dizziness, severe abdominal pain, or feeling unusually tired, during or after exercise, you should stop immediately and contact your healthcare provider before continuing.

Warm Up and Cool Down

When you're pregnant, extra blood flows to your uterus and unborn child as a first priority. Although there's plenty of blood to go around, exercising muscles require additional blood as well. This is why it's so important to warm-up before you work out. To help meet the muscles' increased demand for oxygen and blood, take 5 minutes to slowly build up your intensity and increase your heart rate before exercise.

Cooling down when your session is over is just as important because abruptly stopping any exercise can lead to dizziness, faintness, and increased muscle soreness. Spend another 5 minutes cooling down by slowly decreasing your intensity to return your heart rate back to its resting level.

What is a Kegel?

Your pelvic-floor muscles act as a sling for the bladder, uterus, and rectum. Kegal exercises play an important role in helping you heal and recover after labor. Kegels help keep your pelvic-floor muscles strong during pregnancy, help get them back in shape after delivery, and possibly prevent urinary incontinence.

How to do a Kegel: Exhale and tighten the muscles in the walls of your vagina, pulling upward and inward; count to 3 and inhale as you relax. Repeat for a total of 5 repetitions. Do 5 sets, 3 times per day. Gradually work up to holding each Kegel for a count of 10. (If you have difficulty with figuring out if you are doing it right, practice by stopping your flow of urine.) Once you are able to do Kegels, incorporate them into your abdominal exercises and lower body moves.

Moderate Means Moderate

In the past, experts suggested monitoring your heart rate during exercise, similarly to how you would when you are not pregnant. However, new research suggests that heart rate isn't an accurate way to measure intensity during pregnancy. Accordingly, the ACOG has lifted the restriction of the heart rate cap of 140 beats per minute.

When you're pregnant, your heart rate is already increased, and it is more sensitive to changes. For example, light walking may make you feel winded when you used to be able to jog. Experts now suggest using the Rate of Perceived Exertion (RPE) Scale, also called the Modified Borg Scale. This scale ranges from 1 to 10, and is a self-assessment. When pregnant, you should exercise between level 4 (Somewhat hard) and level 6 (Hard).

Do not overdo it. You don't want to become breathless or exhausted. In the proper range, you should be able to carry on a conversation with someone next to you. If you can sing, you may not be exercising intensely enough, but if you are too winded to speak, then slow down. Discuss your exercise intensity and get a recommendation from you healthcare provider beforehand.

Aim for three to five 30-minute exercise session each week at this moderate intensity. Click here for a full explanation of the Rate of Perceived Exertion scale.

Stay Cool and Comfortable

Be sure to wear clothing that provides comfort and keeps you cool. Comfortable, supportive shoes are necessary, especially if you experience swollen feet. Similarly, you may need to invest in a new, more sports bra to give you some extra support. Some women even prefer wearing two sports bras when exercising.

Staying cool is very important when you are pregnant. For this reason, it's a good idea to dress in layers which you can shed as you get warmer during your workout. Avoid exercising in rooms with poor ventilation and avoid outdoor exercise altogether when it's hot and humid. Remember to drink plenty of fluids to keep your body's natural cooling system functioning properly. As a guideline, your urine should be almost clear if you are properly hydrated.

This article has been reviewed by Sara Hambidge, Physical Therapist.

Obstetrics & Gynecology:
October 2009 - Volume 114 - Issue 4 - pp 770-776
doi: 10.1097/AOG.0b013e3181b6c105
Original Research
Association Between Regular Exercise and Excessive Newborn Birth Weight

Owe, Katrine Mari MSci; Nystad, Wenche PhD; Bø, Kari Prof, PhD


OBJECTIVE: To estimate the association between regular exercise before and during pregnancy and excessive newborn birth weight.

METHODS: Using data from the Norwegian Mother and Child Cohort Study, 36,869 singleton pregnancies lasting at least 37 weeks were included. Information on regular exercise was based on answers from two questionnaires distributed in pregnancy weeks 17 and 30. Linkage to the Medical Birth Registry of Norway provided data on newborn birth weight. The main outcome measure was excessive newborn birth weight, defined as birth weight at or above the 90th percentile. Logistic regression analyses were used to estimate the associations separately for nulliparous (n=16,064) and multiparous (n=20,805) women, and the results are presented as adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs).

RESULTS: Excessive newborn birth weight was observed in 4,033 (10.9%) newborns, 56.1% (n=2,263) of whom were born to multiparous women. An inverse association between regular exercise (at least three times per week) and excessive newborn birth weight in pregnancy weeks 17 and 30 was observed in nulliparous women, aOR 0.72 (95% CI 0.56-0.93) and aOR 0.77 (95% CI 0.61-0.96), respectively. Regular exercise performed before pregnancy did not affect the probability of delivering newborns with an excessive birth weight in nulliparous or multiparous women.

CONCLUSION: Regular exercise during pregnancy reduces the odds of giving birth to newborns with excessive birth weight by 23-28%.
© 2009 The American College of Obstetricians and Gynecologists


Growing Obesity Increases Perils of Childbearing

Published: June 5, 2010 - New York Times

As Americans have grown fatter over the last generation, inviting more heart disease, diabetes and premature deaths, all that extra weight has also become a burden in the maternity ward, where babies take their first breath of life.

About one in five women are obese when they become pregnant, meaning they have a body mass index of at least 30, as would a 5-foot-5 woman weighing 180 pounds, according to researchers with the federal Centers for Disease Control and Prevention. And medical evidence suggests that obesity might be contributing to record-high rates of Caesarean sections and leading to more birth defects and deaths for mothers and babies.
Hospitals, especially in poor neighborhoods, have been forced to adjust. They are buying longer surgical instruments, more sophisticated fetal testing machines and bigger beds. They are holding sensitivity training for staff members and counseling women about losing weight, or even having bariatric surgery, before they become pregnant.
At Maimonides Medical Center in Brooklyn, where 38 percent of women giving birth are obese, Patricia Garcia had to be admitted after she had a stroke, part of a constellation of illnesses related to her weight, including diabetes and weak kidneys.
At seven months pregnant, she should have been feeling the thump of tiny feet against her belly. But as she lay flat in her hospital bed, doctors buzzing about, trying to stretch out her pregnancy day by precious day, Ms. Garcia, who had recently weighed in at 261 pounds, said she was too numb from water retention to feel anything.
On May 5, 11 weeks shy of her due date, a sonogram showed that the baby’s growth was lagging, and an emergency Caesarean was ordered.
She was given general anesthesia because her bulk made it hard to feel her spine to place a local anesthetic. Dr. Betsy Lantner, the obstetrician on call, stood on a stool so she could reach over Ms. Garcia’s belly. A flap of fat covered her bikini line, so the doctor had to make a higher incision. In an operation where every minute counted, it took four or five minutes, rather than the usual one or two, to pull out a 1-pound 11-ounce baby boy.
Studies have shown that babies born to obese women are nearly three times as likely to die within the first month of birth than women of normal weight, and that obese women are almost twice as likely to have a stillbirth.
About two out of three maternal deaths in New York State from 2003 to 2005 were associated with maternal obesity, according to the state-sponsored Safe Motherhood Initiative, which is analyzing more recent data.
Obese women are also more likely to have high blood pressure, diabetes, anesthesia complications, hemorrhage, blood clots and strokes during pregnancy and childbirth, data shows.
The problem has become so acute that five New York City hospitals — Beth Israel Medical Center and Mount Sinai Medical Center in Manhattan, Maimonides in Brooklyn andMontefiore Medical Center and Bronx-Lebanon Hospital Center in the Bronx — have formed a consortium to figure out how to handle it. They are supported by their malpractice insurer and the United Hospital Fund, a research group.
One possibility is to create specialized centers for obese women. The centers would counsel them on nutrition and weight loss, and would be staffed to provide emergency Caesarean sections and intensive care for newborns, said Dr. Adam P. Buckley, an obstetrician and patient safety expert at Beth Israel Hospital North who is leading the group.
Very obese women, or those with a B.M.I. of 35 or higher, are three to four times as likely to deliver their first baby by Caesarean section as first-time mothers of normal weight, according to a study by the Consortium on Safe Labor of the National Institutes of Health.
While doctors are often on the defensive about whether Caesarean sections, which carry all the risks of surgery, are justified, Dr. Howard L. Minkoff, the chairman of obstetrics at Maimonides, said doctors must weigh those concerns against the potential complications from vaginal delivery in obese women. Typically, these include failing to progress in labor; diabetes in the mother, which can lead to birth complications; and difficulty monitoring fetal distress. “With obese women we are stuck between Scylla and Charybdis,” Dr. Minkoff said.
But even routine care, like finding a vein to take blood, can be harder through layers of fatty tissue.
And equipment can be a problem. Dr. Janice Henderson, an obstetrician for high-risk pregnancies at Johns Hopkins in Baltimore, described a recent meeting where doctors worried that the delivery room table might collapse under the weight of an obese patient.
At Maimonides, the perinatal unit threw away its old examining tables and replaced them with wider, sturdier ones. It bought ultrasound machines that make lifelike three-dimensional images early in pregnancy, when the fetus is still low in the uterus and less obscured by fat, but also less developed and thus harder to diagnose clearly. “You really need to use the best equipment, which is more expensive,” said Dr. Shoshana Haberman, the director of perinatal services.
Many experienced obstetricians complain that as Americans have grown larger, the perception of what constitutes obesity has shifted, leading to some complacency among doctors. At UMass Memorial Medical Center in Worcester, Mass., Dr. Tiffany A. Moore Simas, the associate director of the residency program in obstetrics, demands that residents calculate B.M.I. as a routine part of prenatal treatment. “It’s one of my siren songs,” Dr. Moore Simas said, “because we are very bad at eyeballing people.”
Dr. Haberman said there was obesity in her own family, and she had seen how hurtful even professionals could be. “We as a society have issues with the perception of obesity; anatomically, you get turned off,” she said.
So she was sympathetic to Ms. Garcia, making sure she got a room with a window, and calling to check on her after hours.
Ms. Garcia, 38, a former school bus dispatcher, is 5 feet tall. She said she had tried diets, weight-watching groups and joining a gym. She was 195 pounds before her pregnancy (B.M.I., 38) and ballooned to 261 pounds, which she attributed to water weight and inactivity.
“I’m the smallest one in my family,” she said. Her older brother weighed more than 700 pounds before having gastric bypass surgery.
She wiped tears away as she confessed that she worried that she might die and leave her baby without a mother.
At Ms. Garcia’s stage of pregnancy, every day in the womb was good for the baby but bad for the mother, Dr. Minkoff said. “She’s making a heroic decision to put her own self in peril for the sake of the child,” he said.
She survived, but was dismayed by the size of her son, Josiah Patrick, who had to be put on a breathing machine. At first she could see him only by remote video. But after a month, Josiah was off the ventilator, taking 15 milliliters of formula and had smiled at his mother, and doctors said he was where he should be developmentally for a preemie his age.
The hospital estimated that the cost of caring for the mother and baby would be more than $200,000, compared with $13,000 for a normal delivery.
Ms. Garcia promised Dr. Minkoff that she would lose weight and see her baby graduate from college. “I’m going on a strict, strict, strict diet,” she said. “I’m not going through this again.”

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