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Summary of 2019 Canadian guideline for physical activity throughout pregnancy

Summary of 2019 Canadian guideline for physical activity throughout pregnancy
  • This guideline offers evidence-based recommendations regarding physical activity throughout pregnancy in the enhancement of maternal, fetal and neonatal health
  • Without contraindications, following recommendations in this guideline help with,
    • Fewer newborn complications like large for gestational age
    • Maternal health benefits like lower risk of pre-eclampsia and gestational diabetes
  • Physical activity during pregnancy is not correlated to undesirable outcomes like miscarriage and stillbirth
  • In general, more physical activity (frequency, duration and/or volume) is related to greater benefits
     
3 min read

The objective is to provide guidance for pregnant women and obstetric care and exercise professionals on prenatal physical activity.

Summary of key recommendations

  • ALL women WITHOUT contraindication (Tables 1 and 2) should be physically active during pregnancy
  • To reach clinically meaningful reductions in pregnancy complications,
    • Pregnant women should accumulate at least 150 min of moderate-intensity physical activity per week
  • Physical activity should be accumulated over a minimum of 3 days per week, but being active daily is encouraged
  • To achieve greater benefits
    • Pregnant women should include a variety of aerobic exercise and resistance training activities
    • Yoga and/or gentle stretching may be beneficial
  • Pelvic floor muscle training (i.e. Kegel exercise) may be done daily to reduce the chance of urinary incontinence
    • Instruction on the appropriate technique is recommended for optimal benefits
  • For pregnant women who have light-headedness, nausea or feel not well when they exercise flat on their back,
    • Modification of the exercise position is needed to avoid supine position
       

Safety precautions

  • Physical activity in excessive heat, especially with high humidity should be avoided
  • Activities involving physical contact or danger of falling should be avoided
  • Scuba diving should be avoided
  • Women living below 2,500 m (i.e. lowland women) should avoid physical activities at high altitudes (i.e. > 2,500 m)
  • Pregnant women considering athletic competition or exercising significantly over the recommended guidelines should,
    • Seek supervision from an obstetric care provider who has knowledge of the influence of high-intensity physical activities on maternal and fetal outcomes
  • Adequate nutrition and hydration should be maintained,
    • Drink water before, during and after doing physical activities
  • Aware reasons (listed below) to stop doing physical activities and seek advice from healthcare providers at once if these occur,
    • Persistent excessive shortness of breath which cannot resolve on rest
    • Severe chest pain
    • Regular and painful uterine contractions
    • Vaginal bleeding
    • Persistent loss of fluid from the vagina that indicates rupture of the membranes
    • Persistent dizziness or faintness which cannot resolve on rest
       

Table 1 – Absolute contraindications to exercise

  • Ruptured membranes
  • Premature labour
  • Unexplained persistent vaginal bleeding
  • Placenta praevia after 28 weeks’ gestation
  • Pre-eclampsia
  • Incompetent cervix
  • Intrauterine growth restriction
  • High-order multiple pregnancy (i.e. triplets)
  • Uncontrolled type I diabetes
  • Uncontrolled hypertension
  • Uncontrolled thyroid disease
  • Other serious cardiovascular, respiratory or systemic disorder

 

Table 2 – Relative contraindication to exercise

  • Recurrent pregnancy loss
  • Gestational hypertension
  • A history of spontaneous preterm birth
  • Mild/moderate cardiovascular or respiratory disease
  • Symptomatic anaemia
  • Malnutrition
  • Eating disorder
  • Twin pregnancy after 28 weeks’ gestation
  • Other significant medical conditions
Reference

Mottola MF, Davenport MH, Ruchat SM, Davies GA, Poitras VJ, Gray CE, Jaramillo Garcia A, Barrowman N, Adamo KB, Duggan M, Barakat R, Chilibeck P, Fleming K, Forte M, Korolnek J, Nagpal T, Slater LG, Stirling D, Zehr L. 2019 Canadian guideline for physical activity throughout pregnancy. Br J Sports Med. 2018;52(21):1339-1346.
Link to the full article: https://bjsm.bmj.com/content/bjsports/52/21/1339.full.pdf