Women Exercising While Pregnant – Term Paper

This paper aims to give relevant updates on recent evidence that concerns exercising during pregnancy; this includes effects for the fetus and the mother as well as the frequency, types, duration, rate and intensity of progression depending on the exercise performed. Current research findings on exercising during pregnancy are related with the higher cardiorespiratory fitness, reduction in depression symptoms, preventing lower back pain and urinary incontinence, and cases of the gestational diabetes, subsidized number of pregnant women who needed insulin. However, there is no correlation with the reduction in the preterm birth or birth weight rate. Therefore, the kind of exercise does not show a difference on the results and its intensity must be moderate or mild for the previous sedentary pregnant women and moderate or high for the active women. The exercise suggestions are based on recent guidelines on the low-impact, moderate-intensity aerobic exercise for at least thrice a week. Nonetheless, new guidelines suggest an increment in weekly physical activities expenditure while instilling vigorous exercise as well as adding light training to an exercise routine of the healthy and fit pregnant women. However, cases of other chronic diseases such as hypertension have limited data hence more research has to be carried out to examine safety of this intervention. Nevertheless, physical exercise is advantageous for pregnant women even during their postpartum period. This is not linked with any risks for a newborn and could lead to alterations in lifestyle that show long-term advantages.

Chapter One

Introduction

There is an increased amount of women in developed countries who are overweight or obese in the early pregnancy period. This could lead to severe consequences for immediate as well as long-term health of the expectant mother as well as the fetus. Therefore, pregnancy has been prioritized for application of various interventions that target to minimize unhealthy pregnant women. Pregnancy is a period that is critical and unique in a womans life because they become more receptive to the interventions of behavior change. Promotion of physical activity is the main characteristic of interventions for weight control for pregnant women because it has advantageous effects on the glucose metabolism. Physical activity may improve the outcomes of pregnancy irrespective of weight. However, some research show that pregnant women usually possess lower levels of physical activity and these levels keep on reducing as the woman advances to the later pregnancy stages.   

Currently, the number of expectant mothers that willingly engage in strenuous exercise has increased. Both physical activity and pregnancy increase the metabolic demands of the body but physiological adaptations of the combined demands are not expensively understood. Ultimately, one could expect immense fetal or maternal effects due to the conflicting demands of acute muscle exercising and the pregnant uterus. However, nature has presented various examples whereby intense physical activity during a pregnancy could co-exist with the pregnancys favorable outcome. Hence, further investigation on adaptations to physical activity and exercise in expectant mothers is essential from a physiological viewpoint.  

Physical fitness and exercise have gained popularity dramatically for the past few decades; they have taken up significant roles in many womens lives. Reproduction and physical activity for healthy women is beneficial for a baby and the mother in several ways. Therefore, a healthy woman who has a normal pregnancy could either continue regular exercises or start a new exercise routine. According to the American College of Obstetrics and Gynecology (ACOG) and the American Society for Obstetrics and Gynecology (ASOG), pregnant women who are normal and health should carry out an exercise regimen.

Generally, swimming is seen as a suitable and safe exercise to undertake during pregnancy and the study above shows that swimming was not linked with miscarriage. It should be noted that a reduced rate of the physical activity for many women, the level of activity is usually reduced further throughout the pregnancy and exercise before pregnancy is often not retrieved six months after giving birth (Wolfe, 2008). Among the women that actively engage in exercise before pregnancy, the aspects linked with discontinuing sporting activities during the pregnancy are the same as those for inactiveness both before and after the pregnancy. Therefore, if the exercise during pregnancy is considered healthy for the fetus and the mother, knowledge on an exercise behavior with regards to predictors and pregnancy is useful when it comes to interventions of public health. Generally, there has been increased focus on exercise or physical activity hence it is important to establish guidelines that are evidence based during a pregnancy period.

Pregnancy is considered as a normal physiological form that is characterized by growth of the fetus and the mother. From the moment of conception onwards, a fetus forms into a baby while the mother experiences physiological and physical growth. All mothers desire to have good health for themselves as well as their babies, but there are some women who are concerned about the regular maternal physical activities during pregnancy because it may lead to miscarriage, poor fetal growth, musculoskeletal injury and premature delivery. However, for the normal pregnancies, such concerns have not yet been substantiated. Indeed, the participation in a regular weight-bearing exercise has revealed that it improves the maternal fitness, restricts weight gain with no effect on fetal growth, and hastens the postpartum recovery. Additionally, there are psychological advantages of exercise and this has to be nurtured by any person that cares for a pregnant women.

During a first trimester, there are major physiological alterations that take place, even though there are few maternal body changes (Frank & Cone, 2011). Therefore, during the low-level exercises, pulse responses and blood pressure are not very different from a woman who is not pregnant, but fatigue could be noticed earlier during the exercise routine. When early pregnancy proceeds, blood volume expands while the uterus keeps on enlarging; here there is minimum weight gain which could vary from zero to eleven pounds. At this time, the fetus undergoes significant growth which includes organ and limb development. Due to this fact, the mother must have balanced nutrition, exercise, rest and hydration. It should be noted that the pregnant mother has to avoid a large increase in body temperature during an exercise routine.

When well hydrated and fit pregnant women examine their main body temperatures in an efficient manner they should be able to regulate their body temperatures. The second trimester and third trimester come with dramatic changes in the pregnant womans body. The weight gain varies from 22 to 36 pounds which is normally around the pelvis and abdomen and this alters posture as well as the center of gravity. At this time, exercises that need agility and balance could become harder because of the change in weight distribution for the pregnant woman. Therefore, appropriately adjusted exercise equipment and aquatic exercises can b immensely helpful. The additional caloric demands during this period of pregnancy are greatly variable because the increment of caloric need cannot be accurately estimated.

A lot of information exists with regards to the attitudes of pregnant women towards physical activity. Nonetheless, a limited amount of studies highlight the significant limitations to the participation and this includes lack of facilities, time and physical barriers. As a matter of fact, studies show that some pregnant women view physical activity as unsafe for the fetus. Ultimately, few studies have provided elaborate insights into experiences and views of the overweight pregnant women.  

Chapter Two

Literature Review

Many studies have shown that when pregnant women exercise, the risk of acquiring various conditions is reduced. For instance, women that exercise during the first trimesters have a great chance of delivering the baby naturally and with regards to the pre-eclampsia, the time seems to be beneficial. Also, such women may seem to have a greater ability to avoid the gestational diabetes. Hence, women that regularly exercise before pregnancy through to the time of delivery are more likely to attain a health benefit. If promoting physical exercise would limit incidences of pre-clampsia, then a first half of the pregnancy is more likely to become the effective period, particularly for the first-time mothers. However, further studies must be carried out to examine the effectiveness of this kind of program.

The study will extend the findings of studies that have been done by identifying the controversy and comparing the conflicting findings. Evidence from the scientific studies shows the significant role of the physical activity particularly in the health promotion as well as quality of life. In addition, evidence of control and prevention of various diseases during pregnancy has been shown. Until almost recently, pregnant women were directed to limit their activities as well as interrupt occupational work particularly during the pregnancys final stages (Frank & Cone, 2011). However, by the 1990s, practitioners admitted a positive influence resulting from constant physical activity during the gestation period and it has been encouraged. But, this applied only if the woman did not present certain adverse conditions (Frank & Cone, 2011).

As a matter of fact, there seems to be some kind of consensus that maintenance of a light or moderate exercise during uncomplicated pregnancy gives several benefits for the health of the woman. This has been explained by evidence that proves that exercise causes thermal response as well as circulatory redistribution that shifts blood concentration from a placenta and uterus to extremities. The process assists to reduce as well as prevent lower back pains, foster lower liquid retentions, reduce cardiovascular stress, increase oxygenation capacity, decrease blood pressure, reduce risk of the gestational diabetes, prevent thrombosis and the varicose veins and assists control of gestational weight gain (Connelly, 2009).

The benefits also include the emotional aspects because exercise helps to make pregnant women more confident of themselves and satisfied with their appearance, also it raises self-esteem hence reducing chances of post-partum depression. However, the exercise during pregnancy may still raise certain controversies. According to Connelly (2009), the published guidelines and studies on exercise during pregnancy are not enough. On the other hand, Chasan-Taber et al. (n.d) state that even though they are limited, the literature recommends that practicing the moderate exercise while pregnant will not present additional risks and it does not result to unwanted outcomes for both the fetus and the mother. Both researchers still suggest that more studies have to be carried out.

The advantages of exercise or physical activity during a gestation period do not seem to be appropriately publicized and some of them consider this theme as a taboo. Most women perceive that physiological limitations presented by the pregnancy hinder them from taking part in programs which enhance regular exercise. Other women perceive that remaining relaxed and rested during pregnancy is more important as compared to exercising or maintaining the active lifestyle.

Exercising while pregnant has raised many controversies from researchers and experts but this study aims to carry out systematic reviews of scientific articles on an association between the exercising while pregnant and an occurrence of the maternal-child health results. The review will focus particularly on the aspect of physical activity for pregnant women based on the occupational and leisure-time physical activity. The former includes activities related to an individuals occupation (unpaid or paid), that is, all the activities performed within the work space which includes housework. While leisure-time physical activity refers to activities performed with an aim of promoting health or leisure.

According to World Health Organization, exercise plays an important role when it comes to the hindrance of the cardiovascular diseases, type II diabetes, stroke, breast and colon cancer as well as depression. Previously, women had to limit the physical activity once they got pregnant because of the assumed high risk of the spontaneous abortion as well as preterm birth. Pregnancy is considered as a unique condition that is characterized by the various physiologies in a mother and the concern for the developing fetus; however, this precaution is currently disregarded in general. Today, exercise is an added part of the antenatal care. For instance, the US, Great Britain, Norway, Canada and Denmark recommend that pregnant women should engage in physical activities that is equal to a women who are not pregnant. Apart from general health advantages, the physical activity is linked with favorable effects on the maternal outcomes in the gestation period like pre-clampsia and gestational diabetes (LeMoyne et al., 2012). However, Wang et al. (2015) question the assumed preventive actions on pre-clampsia. When looking at the negative and positive effects of exercise during pregnancy especially on the fetus health, the evidence is usually weak. People have always believed that physical activities may initiate labor activity as well as imminent pre-term birth hence this can only be avoided through bed rest.

However, such notions are scientifically proven but they have come up as matters of precaution particularly in the absence of proper treatment actions against the pre-term labor. Moreover, hypotheses that have been presented by Schirmer (2007) show that the physical activity could lead to reduced fetal development because of the redistribution to working muscles rather than the fetus and placenta. Therefore, there are still concerns for an unborn child with regards to a mothers exercising level, and few reviews touch on maternal exercise and the reproductive outcomes.

The initial study on the maternal physical activity was examined and the risk of a miscarriage is among the most popular adverse pregnancy results. It was found that an increased risk of a miscarriage among pregnant women who engaged in physical activity was high for the ones in their first trimester (Wang et al., 2015). It was revealed that where was a relation between the level of exercise as well as the risk of a miscarriage. Furthermore, certain kinds of exercise like jogging, racket sports and ball games were found to be closer related to a miscarriage as compared to other activities. A section of this association could be explained by the potential bias because of the retrospective exposure data collected. Nevertheless, studies on the lifestyle aspects in the beginning of pregnancy as well as early fetal loss using data that has been collected prospectively are hard to carry out hence they are rarely done.

Generally, swimming is seen as a suitable and safe exercise to undertake during pregnancy and the study above shows that swimming was not linked with miscarriage. It should be noted that a reduced rate of the physical activity for many women, the level of activity is usually reduced further throughout the pregnancy and exercise before pregnancy is often not retrieved six months after giving birth (Wolfe, 2008). Among the women that actively engage in exercise before pregnancy, the aspects linked with discontinuing sporting activities during the pregnancy are the same as those for inactiveness both before and after the pregnancy. Therefore, if the exercise during pregnancy is considered healthy for the fetus and the mother, knowledge on an exercise behavior with regards to predictors and pregnancy is useful when it comes to interventions of public health. Generally, there has been increased focus on exercise or physical activity hence it is important to establish guidelines that are evidence based during a pregnancy period.

Wolfes (2008) findings on physical activity linked with miscarriage along with a sparse knowledge of the possible effects on a fetus of the maternal physical activity came to be the main aims of the study because physical activity has been extremely focused on in the public health. However, it should be noted that just informing women about exercising while pregnant is not enough because of barriers like time and financial constraints and absence of transport and facilities. These pressures could prevent the women from organizing an exercise program. Nevertheless, if a practitioners knowledge is insufficient on whether exercise is valuable during pregnancy, then the pregnant woman may not know the health benefits it has. Hence physical exercise has the ability to enhance the outcomes of physical health during pregnancy. Wang et al. (2015) believe that exercise has to begin in the first trimester of a pregnancy or before the pregnancy in order to get the most benefit. The promotion of physical exercise at the start of the pregnancy seems to be very beneficial particularly to first time mothers.

Most of the studies that have been carried out with regards to pregnant women engaging in exercise have been prospective and observational whereby only limited studies were carried out through random trials. Furthermore, the exercises done by pregnant women are not similar in terms of intensity, frequency, duration and type of exercise because they are distinct between studies hence they are hard to compare and quantify. Therefore, fitness for maternal pre-pregnancy varies. According to Schirmer, (2007), these variables are important when it comes to determining the influence of exercise on a fetus and the woman. Moreover, these control groups utilized during the study are not consistent and they range from women that have not exercised before to women that exercised before a pregnancy but stopped exercising during the pregnancy to the women who kept on exercising during the pregnancy. This makes it difficult to compare between various studies.

According to LeMoyne et al. (2012) there are several physiological changes that take place during a pregnancy which could affect an exercising pregnant woman. They add that at the beginning of a first trimester blood volume increases, the plasma volume increases as well as the mass of red blood cells; the cardiac output also increases because of the increased stroke volume and heart rate. These changes can be seen in the early first trimester whereby by twelve weeks the increase in cardiac output is up by 35 percent above the pre-pregnancy levels. He concludes that regular exercise can also increase blood volume and cardiac output.

There are physiologic changes that can be seen in pregnant women who exercise regular and they are usually amplified. Hughes (2006) says that when comparing women that exercise before a pregnancy, an additional 40 percent increase in the cardiac output is seen in women that keep on exercising while they are pregnant as compared to the women that do not. This effect can also be seen in blood volume that expands up to 20 percent in women that keep on exercising while they are pregnant.   

Freyder (2009) believes that exercising while pregnant does not just improve fitness, but the women that exercise while pregnant have fewer pregnancy symptoms like somatic complaints, anxiety and insomnia. On the other hand, Evenson & Bradley (2010) study showed that the women that kept on exercising for 20 minutes every week have fewer pregnancy symptoms which include heartburn, nausea, lower back pain, leg cramps, ligament pain and so on during the first trimester and third trimester. Women that exercised before pregnancy still have benefits throughout the pregnancy even after they stop exercising. However, these benefits are not as good if they are compared with the women that kept on exercising during the pregnancy. The study also shows that pregnant women that exercised while pregnant but stopped later during pregnancy showed fewer symptoms but with less improvement of the symptoms but noted a subsidized improvement in the symptoms after exercise stopped.

Frank & Cone (2011) believe that exercising while pregnant improves self-image but after 2 weeks of cessation of physical activity, this positive influence begins to disappear. They prove that women that begin an exercise routine during pregnancy have immense improvement in physical health, muscular strength, body build, energy level and stamina. This information on the maternal weight increase conflict.

Various observational studies and two meta-analyses revealed no difference when it came to the maternal weight increase. However, the meta-analyses could not find a distinctiveness between intensity, exercise type, levels of pre-pregnancy fitness or duration when the results were being examined. All of these factors may impact the maternal weight increase. Various observational studies revealed that women that exercise while pregnant gained minimal weight as compared to the control group. The studies involved women that exercised before pregnancy and kept on doing so while they were pregnant.

Connelly (2009) carried out an observational study which compares the fit women who kept on exercising three times a week for an average of 30 minutes while in the #7^th week of gestation to women that halted exercising while pregnant and revealed that the weight gain rate was the same between both groups in first trimester but this was immensely lesser during the second trimester and the third trimester with regards to those women that kept on exercising. This total weight increase was around 3kgs lesser within the exercise group; hence, it was still in the suggested range of the maternal weigh increase or gain.

A study by Chasan-Taber et al. (n.d) showed that around 1.9 kg weight increases in the women that participated in the exercise routine for around 2 hours every week for almost 12 weeks. The weight gain could be due to the amount, timing and intensity of the exercise during the pregnancy. Various studies also show delivery and labor related outcomes with regards to engaging in exercise while pregnant.

Chapter Three

Methodology

The study will be conducted through a search whereby articles will be identified through the literature search of LILACS and MEDLINE databases using key words like exercise or physical activity and gestation or pregnancy. The articles will include those that have been published between the years 2005 to 2015 in English and the will refer to follow-up, case-control and cross-sectional epidemiological studies. The expected principal outcomes of these studies will be gestational diabetes, gestational hypertension, miscarriage, gestational weight increase, fetal development or growth, prematurity, mode of delivery or prematurity.

The search procedure involves a survey of references that are based on key words that finds 3,300 articles. The references will be sifted using search filters. Articles with abstracts will be read depending on other inclusion criteria that have been verified. The studies will undergo methodological quality based on the fetus and mother outcomes. The studies will be evaluated independently and assessed using Intra-Class Correlation Coefficient (ICC). Then the results will be classified based on the scale to measure the concordance between various evaluation methods.

The studies will be organized according to country of origin, publication year, study design (cross-sectional, case control, cohort), sample size, maternal-fetal health outcomes, physical activities measurements, participants age, and results in order to estimate what was used in the scoring and analysis of methodological quality. Later, the studies will be grouped in terms of the ones with similar results depending on the outcome. The objective of this is to facilitate and systematize understanding of the findings of articles that have been reviewed. Moreover, the mean of the total scores that will be assigned to these studies in every group will be calculated. No article will be rejected due to its methodological limitations, but the results will be considered much more consistent in these studies which could receive higher scores.   

References

Chasan-Taber, L, Schmidt, MD, Pekow, P, Sternfeld, B, Manson, J, & Markenson, G. (n.d.). Correlates of physical activity in pregnancy among Latina women. 353-363.) Springer New York LLC.

Connelly, F. S. (January 01, 2009). Exercising while pregnant. The Journal of Orthopaedic and Sports Physical Therapy, 10, 9, 358-65.

Evenson, K. R., & Bradley, C. B. (January 01, 2010). Beliefs about exercise and physical activity among pregnant women. Patient Education and Counseling, 79, 1, 124-9.

Frank, E., & Cone, K. (January 01, 2011). Characteristics of pregnant vs. non-pregnant women physicians: findings from the women physicians’ health study.;International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics,;69,;1, 37-46.

Freyder, S. C. (March 01, 2009). Literature Review: Exercising While Pregnant.;Journal of Orthopaedic ; Sports Physical Therapy,;10,;9, 358-365.

Hughes, H. (2006).;Watercise while you wait: A unique exercise program for pregnant women. Mesa, AZ: HH Books.

LeMoyne, Elise L, Curnier, Daniel, St-Jacques, Samuel, ; Ellemberg, Dave. (2012).;The effects of exercise during pregnancy on the newborns brain: study protocol for a randomized controlled trial. (BioMed Central Ltd.) BioMed Central Ltd.

Schirmer, J. (2007).;High-risk diabetic pregnancy and work: two hard-to-reconcile circumstances. (Revista panamericana de salud publica, 2, 6, 408-14.)

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Wang, Chen, Zhu, Weiwei, Wei, Yumei, Feng, Hui, Su, Rina, ; Yang, Huixia. (2015).Exercise intervention during pregnancy can be used to manage weight gain and improve pregnancy outcomes in women with gestational diabetes mellitus. (BioMed Central Ltd.) BioMed Central Ltd.

Wolfe, L. A. (January 01, 2008). Pregnant Women and Endurance Exercise. 531-546.

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