Guidelines - Pregnancy

Guidelines - Physical Activity Throughout Pregnancy

This tool provides information to facilitate physical activity recommendations for pregnant women without contraindications.

Focused examination

1. Patient History

Absolute contraindications:

Ruptured membranes, premature labor, unexplained persistent vaginal bleeding, placenta praevia after 28 weeks gestation, pre-eclampsia, incompetent cervix, intrauterine growth restriction, high-order multiple pregnancy (e.g. triplets), uncontrolled type I diabetes, uncontrolled hypertension, uncontrolled thyroid disease, and other serious cardiovascular, respiratory or systemic disorders

Relative contraindications:

Recurrent pregnancy loss, gestational hypertension, a history of spontaneous preterm birth, mild/moderate cardiovascular or respiratory disease, symptomatic anaemia, malnutrition, eating disorder, twin pregnancy after the 28th week, and other significant medical conditions

2. Physical Examination

Determine the existence of diastasis recti.
- Women who develop diastasis recti should avoid abdominal strengthening exercises as this may worsen the condition, increasing the likelihood of requiring postnatal repair.
- Continuing aerobic exercise, such as walking, is associated with decreased odds of developing diastasis recti.
Women considering athletic competition or exercising significantly above the recommended guidelines should speak to their obstetric care provider prior to doing so.
Elite athletes who continue to train during pregnancy are advised to seek supervision from an obstetric care provider with knowledge of the impact of vigorous-intensity physical activity on maternal, fetal, and neonatal outcomes.

Diastasis Recti:

Defined as the separation of the rectus abdominis muscles by an abnormal distance. Diastasis recti might cause a bulge in the middle of the abdomen where the two muscles separate

3. Management

The Physical Activity Readiness Medical Examination for Pregnancy (PARmed-X for Pregnancy) is recommended for use as a health screening prior to participation in physical activity.
Discuss the range of physical activity recommendations with the patient and, together, select the option this is right for them.

Patient Handouts

Recommendations:

All women without contraindication should be physically active throughout pregnancy including women who were previously inactive, women diagnosed with gestational diabetes mellitus, women categorized as overweight or obese (pre-pregnancy body mass index ≥25 kg/m²)
Complete at least 150 min of moderate-intensity physical activity each week
Physical activity should be accumulated over a minimum of 3 days per week; however, being active every day is encouraged
Incorporate a variety of aerobic and resistance training activities to achieve greater benefits. Adding yoga and/or gentle stretching may also be beneficial
Pelvic floor muscle training (PFMT) (e.g., Kegel exercises) may be performed on a daily basis to reduce the risk of urinary incontinence. Instruction on the proper technique is recommended to obtain optimal benefits: instructions / video
Modify exercise position to avoid the supine position light-headedness, nausea or unwell feeling is experienced while lying flat on back

4. Reevaluation and Discharge

Outcome Measures

5. Referrals and Collaboration

Refer the patient to a physician for further evaluation at any time during their care if they develop new or worsening contraindications or psychological symptoms.