Canadian Health Agencies Release Physical Activity Guidance During Pregnancy

The Society of Obstetricians and Gynaecologists of Canada and the Canadian Society for Exercise Physiology have released consensus guidelines that will provide guidance for pregnant women as well as their clinical care providers on prenatal physical activity.

The guidelines were derived following an exhaustive literature review published in 12 different databases, including MEDLINE, EMBASE, and ClinicalTrials.gov untill January 2017. Case studies were excluded from the review, as were studies published in languages other than English, Spanish, or French. Articles that discussed maternal physical activity during pregnancy that addressed maternal, fetal, or neonatal morbidity, or fetal mortality, were included. Additionally, the Guidelines Consensus Panel sought feedback from end users, which included pregnant and postpartum women, care providers, exercise professionals, and researchers.

Following these guidelines is expected to reduce complications for the newborn as well as yield maternal health benefits, such as reduced risk of pre-eclampsia, gestational diabetes or hypertension, gestational weight gain, etc. The research found that physical activity in pregnant women is not associated with miscarriage, stillbirth, neonatal death, preterm birth, preterm/prelabor rupture of membranes, neonatal hypoglycemia, low birth weight, birth defects, induction of labor, or birth complications.

Below are specific recommendations and contraindications in the 2019 Canadian Guideline for Physical Activity throughout Pregnancy.

Recommendations

1. All women without contraindication should be physically active throughout pregnancy (strong recommendation). Specific subgroups that were examined included:

• Women who were previously inactive (strong recommendation)
• Women diagnosed with gestational diabetes mellitus (weak recommendation)
• Women categorized as overweight or obese (prepregnancy body mass index ≥25 kg/m2) (strong recommendation).

2. Pregnant women should accumulate at least 150 minutes of moderate-intensity physical activity each week to achieve clinically meaningful health benefits and reductions in pregnancy complications (strong recommendation).

3. Physical activity should be accumulated over a minimum of 3 days per week; however, being active every day is encouraged (strong recommendation).

4. Pregnant women should incorporate a variety of aerobic and resistance training activities to achieve greater benefits. Adding yoga and/or gentle stretching may also be beneficial (strong recommendation).

5. Pelvic floor muscle training (eg, Kegel exercises) may be performed daily to reduce the risk of urinary incontinence. Instruction on the proper technique is recommended to obtain optimal benefits (weak recommendation).

6. Pregnant women who experience light-headedness, nausea, or feel unwell when they exercise flat on their back should modify their exercise position to avoid the supine position (weak recommendation).

Contraindications

The guidelines absolutely contraindicate exercise in women who have:

• 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 (eg, triplets)
• Uncontrolled type I diabetes
• Uncontrolled hypertension
• Uncontrolled thyroid disease
• Other serious cardiovascular, respiratory or systemic disorder

The following are relative contraindications to exercise:

• Recurrent pregnancy loss
• Gestational hypertension
• A history of spontaneous preterm birth
• Mild/moderate cardiovascular or respiratory disease
• Symptomatic anemia
• Malnutrition
• Eating disorder
• Twin pregnancy after the 28th week
• Other significant medical conditions

The article does acknowledge that evidence was lacking to identify safety or benefit of exercising at levels beyond the recommendation. Women who have been physically active are advised to continue to do so throughout pregnancy but modify the level of activity as their pregnancy progresses.

“It is critical that these Guidelines be implemented into clinical practice to achieve the significant and potentially lifelong health benefits for both the mother and the child,” the authors write.

Reference

Davenport MH, Ruchat SM, Mottola MF, et al. 2019 Canadian guideline for physical activity throughout pregnancy. Obstet Gynaecol Can. 2018;40(11):1468-1483. doi: 10.1016/j.jogc.2018.09.004.