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Prenatal Care 3: Exercise Guidelines In Pregnancy & Gestational Diabetes


Exercise Guidelines In Pregnancy


The American College of Obstetricians and Gynaecologists ACOG (2017) state “if you are healthy and your pregnancy is normal, it is safe to continue or start most types of exercise, but you may need to make a few changes. Physical activity does not increase your risk of miscarriage, low birth weight, or early delivery. However, it is important to discuss exercise with your obstetrician or other member of your health care team during your early prenatal visits. If your health care professional gives you the OK to exercise, you can decide together on an exercise routine that fits your needs and is safe during pregnancy.”


The Centers for Disease Control and Prevention recommend that “pregnant women get at least 150 minutes of moderate-intensity aerobic activity every week. An aerobic activity is one in which you move large muscles of the body (like those in the legs and arms) in a rhythmic way. Moderate intensity means you are moving enough to raise your heart rate and start sweating. You still can talk normally, but you cannot sing.” ACOG (2017)


With any exercise routine, if you are new – start slowly and gradually increase the level. Begin with as little as 5-10minutes each week and see how your body responds, until you reach 30mins per day. The guidelines state 150 minutes of exercise per week, so try breaking these into 5 x 30minute workouts or smaller 10-15 minute workouts throughout the day.


Moderate intensity exercise may include brisk walking, bike riding or general gardening and you can even “pace” these out and break them up during the day.


Being active prior to pregnancy definitely gives you an advantage as you can keep the same workouts with modifications.


There have been significant changes over time in relation to exercise guidelines in pregnancy. Exercise in pregnancy is now supported by the majority of health professionals. Heart rate and time restrictions have been removed by the ACOG guidelines. Previously women were told to limit their heart rate to 140bpm and exercise time to 15minutes.


Checkout more from the American College of Obstetrician and Gynaecologists (ACOG) Exercise Guidelines in Pregnancy.


Diabetes in pregnancy


Diabetes in pregnancy can be classified as either:

  • Pre-Gestation Diabetes Mellitus (Pre-GDM): A women with Type 1 or 2 Diabetes who then falls pregnant.

  • Gestational Diabetes Mellitus (GDM): A women who develops diabetes during pregnancy.

Looking closer at Gestational Diabetes Mellitus (GDM), women develop a temporary form of diabetes causing high blood sugar glucose levels due to higher than normal insulin resistance, and lower than normal insulin production. It usually doesn’t occur until late second or third trimester when the placenta is creating sufficient placental lactogen (hormone) to increase insulin resistance.. For most women they will no longer have diabetes after the baby is born, however some may continue to have high glucose levels after delivery.


Risk factors include:

  • Maternal age >40yrs

  • Family history of diabetes

  • Previous pregnancy with GDM

  • BMI>29

  • Previous stillbirth or spontaneous miscarriage

  • Ethnicity (in Australia). Chinese 13.9%, Other Asian 10.9%, Africa 9.4%, Vietnam 7.3%

  • Previous level of activity

Exercise and how physiotherapy can assist with GDM

Exercise is acknowledged now as an effective tool to manage GDM. Exercise helps to decrease insulin resistance and therefore control blood glucose levels. It has also been used to prevent GDM if it is performed through the entire pregnancy (at least 3 x per week). If women present with GDM it is safer to have them perform exercise in an environment where they can be monitored.


Women who are most likely to benefit from exercise often have contraindications including:

- Obesity

- History of sedentary lifestyle

- Poorly controlled hypertension (high blood pressure)


Prevention of GDM in pregnancy and latter pregnancies

For a large portion of women GDM can be managed and prevented. However to be preventative the exercise needs to start prior to pregnancy and in the first trimester of pregnancy.


It is important to remember that modifications to exercise routines may be necessary because of normal anatomic and physiologic changes and foetal requirements. It is best to speak to your Obstetrician, GP or health team members and find out the right exercise program for you!


You can find more information at https://www.diabetesaustralia.com.au/managing-gestational-diabetes


References:

Acog.org. (2019). Exercise During Pregnancy - ACOG. [online] Available at: https://www.acog.org/Patients/FAQs/Exercise-During-Pregnancy?IsMobileSet=false [Accessed 24 Jun. 2019].

Hallam T, (2014) An introduction to the physiotherapists role in pregnancy and early postpartum. WHTA Manual.

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