Pregnancy Pregnancy

Locomotive systemLocomotive system Energy generating systemEnergy generating system Disposal systemDisposal system Endocrine systemEndocrine system

Locomotive SystemLocomotive System

Uterus undergoes significant growthUterus undergoes significant growth Strictly pelvic organ @ 12 weeksStrictly pelvic organ @ 12 weeks Abdominal organ: 150 fold increase in sizeAbdominal organ: 150 fold increase in size 1000 fold increase in capacity1000 fold increase in capacity Lordosis and compensatory cervical Lordosis and compensatory cervical

curvature curvature Softening of the cartilageSoftening of the cartilage

Energy Generating SystemsEnergy Generating Systems

Energy cost: 80,000 kcals, 2-300/dayEnergy cost: 80,000 kcals, 2-300/day Demand is not consistent, middle quarters, Demand is not consistent, middle quarters,

390 kcal/day390 kcal/day Last quarter, 250 kcal/dayLast quarter, 250 kcal/day GI tract: decline in activityGI tract: decline in activity Respiratory system: anatomic and Respiratory system: anatomic and

functional changesfunctional changes Cardiovascular System: cardiac output Cardiovascular System: cardiac output

↑40%, blood volume ↑50%↑40%, blood volume ↑50%

Disposal SystemDisposal System

By-products of increased metabolism: heat By-products of increased metabolism: heat and waste and waste

Heat: radiation, skinHeat: radiation, skin Kidneys: clear large amounts of waste (30-Kidneys: clear large amounts of waste (30-

50% ↑ glomerular filtration rate)50% ↑ glomerular filtration rate)

Endocrine System Endocrine System

Weeks 6-8 hormones sustain pregnancyWeeks 6-8 hormones sustain pregnancy After weeks 6-8 placenta main source of After weeks 6-8 placenta main source of

hormone productionhormone production

Pregnancy and ExercisePregnancy and Exercise

Myth or Fact?Myth or Fact?

Does repetitive jarring cause the egg to Does repetitive jarring cause the egg to become dislodged from the wall of the become dislodged from the wall of the uterus?uterus?

Does high impact aerobics or flip turns Does high impact aerobics or flip turns cause the umbilical cord to become cause the umbilical cord to become wrapped around the fetus’ neck?wrapped around the fetus’ neck?

Does the constant jarring cause the Does the constant jarring cause the woman’s water to break or burst early?woman’s water to break or burst early?

Do strong abdominal muscles make Do strong abdominal muscles make pushing last longer and often force a pushing last longer and often force a forceps delivery?forceps delivery?

Is the stress of exercise associated with Is the stress of exercise associated with early or preterm labor?early or preterm labor?

Can a mother get too hot during Can a mother get too hot during pregnancy and damage the fetus?pregnancy and damage the fetus?

Can the mother exercise too much so Can the mother exercise too much so that the fetus does not get enough that the fetus does not get enough nutrition?nutrition?

Does regular exercise during pregnancy Does regular exercise during pregnancy lower the fat of the mother?lower the fat of the mother?

Does regular exercise during pregnancy Does regular exercise during pregnancy lower the fat of the infant?lower the fat of the infant?

Does early exercise have the same Does early exercise have the same benefit as later trimester exercise?benefit as later trimester exercise?

Does a mother deprive the fetus of Does a mother deprive the fetus of important nutrients and oxygen during important nutrients and oxygen during exercise?exercise?

Can a women begin to exercise during Can a women begin to exercise during pregnancy?pregnancy?

Does strenuous exercise cause the Does strenuous exercise cause the mother’s milk to dry up or taste sour (lactic mother’s milk to dry up or taste sour (lactic acid)? Will exercise hurt the baby?acid)? Will exercise hurt the baby?

ACOG GuidelinesACOG Guidelines

regular, moderate intensity and duration regular, moderate intensity and duration exercise sessions are preferableexercise sessions are preferable

recommended exercises include stretching, recommended exercises include stretching, stationary cycling, swimming, and walking. stationary cycling, swimming, and walking. Other types are either contraindicated or Other types are either contraindicated or require modificationrequire modification

avoid jerky, bouncy, and wide range of avoid jerky, bouncy, and wide range of motion movements and exercises that motion movements and exercises that involve straining, jumping, or sudden involve straining, jumping, or sudden changes in directionchanges in direction

don’t exercise lying on the back after the don’t exercise lying on the back after the fourth monthfourth month

five-minute periods of warm-up and cool-five-minute periods of warm-up and cool-down stretching are recommended, but down stretching are recommended, but don’t stretch to the point of maximal don’t stretch to the point of maximal resistanceresistance

women with sedentary lifestyles should women with sedentary lifestyles should begin with short-duration, low-intensity begin with short-duration, low-intensity activity and increase graduallyactivity and increase gradually

stop exercising when fatigued; stop and stop exercising when fatigued; stop and consult a physician if any unusual consult a physician if any unusual symptoms occursymptoms occur

increase caloric intake to cover the increase caloric intake to cover the demands of the exercise and take fluids demands of the exercise and take fluids liberally before, during, and after exerciseliberally before, during, and after exercise

avoid environments with excessive heat avoid environments with excessive heat and humidity when you exerciseand humidity when you exercise

My recommendations:My recommendations:

If you’re already active, keep activeIf you’re already active, keep active If you‘re not active, become activeIf you‘re not active, become active Exercise for your baby, not yourselfExercise for your baby, not yourself Do pelvic floor exercisesDo pelvic floor exercises

Labor and DeliveryLabor and Delivery

Every one is differentEvery one is different Have a plan, but be flexibleHave a plan, but be flexible Pain medication does not make you weakPain medication does not make you weak

BreastfeedingBreastfeeding

It’s great for the babyIt’s great for the baby Mom may not enjoy it all that muchMom may not enjoy it all that much It can be painful, but it goes awayIt can be painful, but it goes away ConvenientConvenient Cheap Cheap Make a goal (6 months, 12 months, etc)Make a goal (6 months, 12 months, etc) Get a support team BEFORE you deliverGet a support team BEFORE you deliver

What’s the deal with exercise What’s the deal with exercise and pregnancy?and pregnancy?

anecdotal informationanecdotal information exercise decreases body fat such that it exercise decreases body fat such that it

influences fertilityinfluences fertility women who exercise tend to miscarry women who exercise tend to miscarry exercise will lead to preterm laborexercise will lead to preterm labor

James Clapp, M.D. followed James Clapp, M.D. followed 250 women who exercised 250 women who exercised throughout their pregnancythroughout their pregnancy

group that were recreationally activegroup that were recreationally active group that stopped exercising during group that stopped exercising during

~middle of pregnancy~middle of pregnancy group that began exercising early in group that began exercising early in

pregnancypregnancy

ResultsResults

those that continued to exercise gained those that continued to exercise gained less weightless weight

those that continued to exercise gained those that continued to exercise gained less fatless fat

those that stopped exercising gained more those that stopped exercising gained more weight (~ 5#) and fat (~1-2%) than those weight (~ 5#) and fat (~1-2%) than those that never exercisedthat never exercised

those that stopped exercising during their those that stopped exercising during their pregnancy delivered at about the same pregnancy delivered at about the same time as those that did not ever exercisetime as those that did not ever exercise

those that stopped exercising did not keep those that stopped exercising did not keep or save the benefits throughout their or save the benefits throughout their pregnancypregnancy

babies of exercisers were leaner, but not babies of exercisers were leaner, but not smallersmaller

Labor and DeliveryLabor and Delivery

those that exercised throughout their those that exercised throughout their pregnancies had shorter (pregnancies had shorter (1/31/3), less ), less complicated, and easier deliveriescomplicated, and easier deliveries

35% less need for pain relief35% less need for pain relief

75% decrease in maternal 75% decrease in maternal exhaustionexhaustion

50% decrease in need to artificially rupture 50% decrease in need to artificially rupture membranesmembranes

50% decrease in need to induce labor50% decrease in need to induce labor

Effects of Exercise on the Effects of Exercise on the Course of LaborCourse of LaborExerciseContinued

Control ExerciseStopped

Pain Relief 51 78 81

Labor Stim. 29 58 53

Fetal Int. 13 26 12

Forceps Delivery 5 18 20

Cesareansection

9 29 26

SpontaneousDelivery

86 53 54

Data is %age of women in each group who required or experienced intervention or notClapp, 1998

Babies of Exercising MomsBabies of Exercising Moms

Exercise Continued

Control Exercise Stopped

Wt (lb-oz) 7-2 8-0 8-8

Wt percentile 43 63 73

Length (in) 20.24 20.24 20.35

Wt/Length ratio

3.52 3.95 4.18

Abdominal Circ.

12.44 13.46 14.00

% Body Fat 10.70 15.90 18.70

Clapp, 1998

Babies of Exercising MomsBabies of Exercising Moms

less stress during pregnancy as evident by less stress during pregnancy as evident by erythropoiten levels (lower)erythropoiten levels (lower)

also from red blood cells, lower indicating also from red blood cells, lower indicating less stressless stress

babies are easy keepers: respond to their babies are easy keepers: respond to their environment and self-quiet more readilyenvironment and self-quiet more readily

Long-term outcomeLong-term outcome

all aspects of growth and development all aspects of growth and development after birth in babies from exercising after birth in babies from exercising mothers are equal to or better than those mothers are equal to or better than those observed in the control offspringobserved in the control offspring

one year of age (n = 100)one year of age (n = 100)

same weight, fat, and sizesame weight, fat, and size exercising children did perform better on exercising children did perform better on

standardized intelligence testsstandardized intelligence tests physical performance is better as wellphysical performance is better as well

five years of age (n = 20 five years of age (n = 20 matched pairs)matched pairs)

no difference in height, limb lengths, or head no difference in height, limb lengths, or head and chest circumferencesand chest circumferences

offspring of exercisers were leaner and offspring of exercisers were leaner and weighed lessweighed less

no difference in academic readinessno difference in academic readiness children of exercisers scored much higher children of exercisers scored much higher

on tests of general intelligence and oral on tests of general intelligence and oral language skillslanguage skills

National SurveyNational Survey

91 Women completed the survey91 Women completed the survey Benefits of exercise are physicalBenefits of exercise are physical And emotionalAnd emotional ~10 years of research to support benefit~10 years of research to support benefit

Leiferman, 2003Leiferman, 2003