Pregnancy
 Locomotive
system
 Energy generating system
 Disposal system
 Endocrine system
Locomotive System
 Uterus
undergoes significant growth
 Strictly pelvic organ @ 12 weeks
 Abdominal organ: 150 fold increase in size
 1000 fold increase in capacity
 Lordosis and compensatory cervical
curvature
 Softening of the cartilage
Energy Generating Systems
 Energy
cost: 80,000 kcals, 2-300/day
 Demand is not consistent, middle quarters,
390 kcal/day
 Last quarter, 250 kcal/day
 GI tract: decline in activity
 Respiratory system: anatomic and
functional changes
 Cardiovascular System: cardiac output
↑40%, blood volume ↑50%
Disposal System
 By-products
of increased metabolism: heat
and waste
 Heat: radiation, skin
 Kidneys: clear large amounts of waste (3050% ↑ glomerular filtration rate)
Endocrine System
 Weeks
6-8 hormones sustain pregnancy
 After weeks 6-8 placenta main source of
hormone production
Pregnancy and Exercise
Myth or Fact?
 Does
repetitive jarring cause the egg to
become dislodged from the wall of the
uterus?
 Does high impact aerobics or flip turns
cause the umbilical cord to become
wrapped around the fetus’ neck?
 Does the constant jarring cause the
woman’s water to break or burst early?
 Do
strong abdominal muscles make
pushing last longer and often force a
forceps delivery?
 Is the stress of exercise associated with
early or preterm labor?
 Can a mother get too hot during
pregnancy and damage the fetus?
 Can
the mother exercise too much so
that the fetus does not get enough
nutrition?
 Does regular exercise during pregnancy
lower the fat of the mother?
 Does regular exercise during pregnancy
lower the fat of the infant?
 Does early exercise have the same
benefit as later trimester exercise?
 Does
a mother deprive the fetus of
important nutrients and oxygen during
exercise?
 Can a women begin to exercise during
pregnancy?
 Does strenuous exercise cause the
mother’s milk to dry up or taste sour (lactic
acid)? Will exercise hurt the baby?
ACOG Guidelines
 regular,
moderate intensity and duration
exercise sessions are preferable
 recommended exercises include
stretching, stationary cycling, swimming,
and walking. Other types are either
contraindicated or require modification
 avoid jerky, bouncy, and wide range of
motion movements and exercises that
involve straining, jumping, or sudden
changes in direction
 don’t
exercise lying on the back after
the fourth month
 five-minute periods of warm-up and
cool-down stretching are recommended,
but don’t stretch to the point of maximal
resistance
 women with sedentary lifestyles should
begin with short-duration, low-intensity
activity and increase gradually
 stop exercising when fatigued; stop and
consult a physician if any unusual
symptoms occur
 increase
caloric intake to cover the
demands of the exercise and take fluids
liberally before, during, and after exercise
 avoid environments with excessive heat
and humidity when you exercise
My recommendations:
 If
you’re already active, keep active
 If you‘re not active, become active
 Exercise for your baby, not yourself
 Do pelvic floor exercises
Labor and Delivery
 Every
one is different
 Have a plan, but be flexible
 Pain medication does not make you weak
Breastfeeding
 It’s
great for the baby
 Mom may not enjoy it all that much
 It can be painful, but it goes away
 Convenient
 Cheap
 Make a goal (6 months, 12 months, etc)
 Get a support team BEFORE you deliver
What’s the deal with exercise
and pregnancy?
 anecdotal
information
 exercise decreases body fat such that it
influences fertility
 women who exercise tend to miscarry
 exercise will lead to preterm labor
James Clapp, M.D. followed
250 women who exercised
throughout their pregnancy
group that were recreationally active
 group that stopped exercising during
~middle of pregnancy
 group that began exercising early in
pregnancy

Results
 those
that continued to exercise gained
less weight
 those that continued to exercise gained
less fat
 those that stopped exercising gained more
weight (~ 5#) and fat (~1-2%) than those
that never exercised
 those
that stopped exercising during their
pregnancy delivered at about the same
time as those that did not ever exercise
 those that stopped exercising did not keep
or save the benefits throughout their
pregnancy
 babies of exercisers were leaner, but not
smaller
Labor and Delivery
 those
that exercised throughout their
pregnancies had shorter (1/3), less
complicated, and easier deliveries
 35% less need for pain relief
75% decrease in maternal
exhaustion
 50%
decrease in need to artificially rupture
membranes
 50% decrease in need to induce labor
Effects of Exercise on the
Course of Labor
Control
Pain Relief
Exercise
Continued
51
78
Exercise
Stopped
81
Labor Stim.
29
58
53
Fetal Int.
13
26
12
Forceps Delivery 5
18
20
Cesarean
section
Spontaneous
Delivery
9
29
26
86
53
54
Data is %age of women in each group who required or experienced intervention or not
Clapp, 1998
Babies of Exercising Moms
8-0
Exercise
Stopped
8-8
Wt percentile 43
63
73
Length (in)
20.24
20.35
3.95
4.18
13.46
14.00
15.90
18.70
Wt (lb-oz)
Exercise
Continued
7-2
20.24
Wt/Length
3.52
ratio
Abdominal
12.44
Circ.
% Body Fat 10.70
Clapp, 1998
Control
Babies of Exercising Moms
 less
stress during pregnancy as evident by
erythropoiten levels (lower)
 also from red blood cells, lower indicating
less stress
 babies are easy keepers: respond to their
environment and self-quiet more readily
Long-term outcome
 all
aspects of growth and development
after birth in babies from exercising
mothers are equal to or better than those
observed in the control offspring
one year of age (n = 100)
 same
weight, fat, and size
 exercising
children did perform better on
standardized intelligence tests
 physical
performance is better as well
five years of age (n = 20
matched pairs)
 no
difference in height, limb lengths, or
head and chest circumferences
 offspring
of exercisers were leaner and
weighed less
 no
difference in academic readiness
 children
of exercisers scored much higher
on tests of general intelligence and oral
language skills
National Survey
 91
Women completed the survey
 Benefits
of exercise are physical
 And
emotional
 ~10
years of research to support benefit

Leiferman, 2003