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Alexis M. Lacewell
Dr. Bret Zawilski
RC 2001-410
8 December 2015
Exercise and Pregnancy
Pregnancy is a vital time of growth, development, and change for both mothers and their
unborn children. Mothers are particularly subject to experience significant changes in their
anatomy and physiology that stem from accommodating the needs of their growing fetuses.
Despite the accommodations the body makes during pregnancy, there are still a variety of health
complications that may arise and pose risks for both mothers and fetuses. Pregnant women may
become susceptible to cardiovascular disease and/or its associated risks, gestational diabetes,
preeclampsia, depression, specifically post-partum, and more. Exercise is a critical behavior that
can be modified to accompany pregnant women in order to sustain the increased demand on their
bodies, to maximize potential health benefits, and to minimize potential health complications.
Aerobic exercise and resistance training are two types of exercise that, despite being ill-advised
at one point, have been shown to have positive physiological, maternal, and fetal outcomes.
The first United States guidelines for exercise during pregnancy were published in 1985
by the American College of Obstetricians and Gynecologists (ACOG). Until this time, only a
variety of cultural beliefs and practices influenced whether or not women participated in exercise
during pregnancy. For example, a commonly held belief that continues to persist among some
African American women is that if a pregnant woman raised her arms above the head, this
would lead to the umbilical cord getting wrapped around the fetal neck, and risk strangling the

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fetus (Krans and Chang 1184). Cultural myths such as these inhibited and continue to inhibitalong with other factors-women from exercising during pregnancy. When ACOG published the
1985 guidelines, the research revolving around exercise during pregnancy was in its beginning
phases; therefore, the guidelines were sparse and included more caution surrounding the issue.
Traditionally, pregnant women have been advised to restrict exercise due to concerns for the
health of the mother and her fetus, including risks of overheating; impaired delivery of oxygen
and nutrients to the fetus; and premature labour (qtd in Duncombe et al.). Exercise causes an
increase in body temperature which requires the body to work to regulate that temperature, or
maintain homeostasis. Increased temperatures that are unable to be regulated, or overheating, can
cause an extremely high temperature environment for a growing fetus that can negatively affect
growth and development, particularly that of the central nervous system.
Exercise also requires a source of oxygen and nutrients; the muscles and bones involved
require minerals, such as calcium, to enable and assist with movement. These same nutrients
needed for exercise are also necessary for developing fetuses, so it is thought that there may be a
competition for resources. However, this does not take into account the mothers diet, potential
nutrient reserves, or the ability for some nutrients to be recycled. Concerns such as overheating
and impaired delivery or nutrients and oxygen often lead to preterm labor, which is a fear of
expecting mothers that often ends in fetus mortality if the age of viability has not been reached.
Exercise and pregnancy have gained more recognition and research has progressed, and while
these concerns remain valid in some cases, the research has leaned some in the opposite
direction.
Despite earlier perceptions, more recent research has deemed exercise during pregnancy
safe and beneficial for both mothers and fetuses. Most sources, including ACOG, continuously

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update their guidelines to include the type, intensity, frequency, and duration of exercise that
pregnant women should be participating in as more research becomes available. Even though
there are sources that discuss exercise during pregnancy, it is specifically tailored to the
individual needs of the mother and should be discussed with and cleared and monitored by a
physician. During pregnancy, the goals are to maintain/increase fitness and avoid exertion that
could be harmful to mother or fetus (May 3). Understanding the goals of exercise during
pregnancy and following the guidelines and recommendations of the physician can allow
mothers and fetuses to maximize the health benefits associated with exercise.
Aerobic exercises are typically prescribed for women during pregnancy. The American
College of Sports Medicine refers to aerobic exercise as an activity that uses the large muscles of
the body in a continuous, rhythmical fashion, and that is relatively easy to maintain at a
consistent intensity (Franklin et al.). Aerobic exercises include, but are not limited to, walking,
biking, swimming and dancing. In general, aerobic exercises can reduce cardiovascular stress
caused by pregnancy (Genti et al.). Cardiovascular health is a significant component of
physiological well-being, yet cardiovascular disease is the most frequent cause of death during
pregnancy in the industrialized world (Tennant 31). Todays technology has allowed many
women to conceive later in life when their cardiovascular risk factors could potentially be
increasing.
Aside from conception age, when women become pregnant, the demands on their heart
increase to accommodate the needs of the growing fetuses. It is important for women to be able
to sustain the increased demand on their heart from pregnancy, and aerobic exercise is a critical
behavior that can be modified to accompany women to sustaining the increased demand on their
heart. These exercises decrease resting heart rate and blood pressure, which allow the heart to

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function without overworking itself. Resting heart rate and blood pressure indicate the hearts
workload while a person is inactive. Having a low resting heart rate and blood pressure implies
that your heart is functioning normally based off of the pressure in the walls of your veins and
arteries without overcompensating. On the other hand, a high resting heart rate and blood
pressure implies that your heart is functioning normally, but may be working too hard at rest.
This extra work could potentially be indicative of pre-hypertension or hypertension, which are
risk factors for cardiovascular disease. Pregnant women have to accommodate their heart rate
and blood pressure to that of their fetus, so their resting heart rates and blood pressures may
become higher. The increase in heart rate and blood pressure are normal as long as they do not
exceed a certain threshold. Aerobic exercise during pregnancy allows women to maintain a
relatively safe, stable resting heart rate and blood pressure, which decreases the risk for
hypertension and related cardiovascular risks and diseases.
Along with improving cardiovascular health and related risks, aerobic exercises is also
correlated with other pregnancy related benefits. Studies have demonstrated that
well-trained women managed the birth better, had a higher rate of vaginal deliveries or a
lower rate of caesarean sections and had more aerobic tness, muscular strength, reduced
time for the birth and reduced risk of childbirth complications. Moreover, trained women
recovered faster postpartum and had better prole of pregnancy-related medical
conditions such as high blood pressure and blood sugar than the women who did not
train (qtd in Kader and Naim-Shuchana 5).
Mothers pregnancy related benefits are connected to infants. In particular, the reduced risk of
childbirth complications and postpartum recovery are two areas where infants receive a
substantial amount of benefits. Childbirth complications can range from being breeched to

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experiencing anoxia-an absence of oxygen-but overall, minimizing complications correlates with
better initial assessment scores. The Apgar score is an assessment performed on newborns to
assess their appearance, pulse, grimace, activity, and respiration. Each category is rated either a
zero, one, or two, and a high total score indicates fewer concerns about babies initial overall
health. Altogether, babies with minimal birth complications and higher Apgar scores tend to have
more positive initial health outcomes that stem from their mothers participation in aerobic
exercise.
Infants also benefit from their mothers postpartum recovery. A major concern after
pregnancy involves mothers emotional and psychological well-being. It is common for women
to experience the baby blues, but more persistent feelings of sadness are associated with
postpartum depression. Postpartum depression may directly affect mothers ability to care for
their children, and proper care during infancy is essential to positive continued development.
Mothers who exercise may recover quickly from the baby blues and have a reduced risk of
developing postpartum depression because exercise has been known to improve mood. Reduced
risk of postpartum depression due to aerobic exercise reduces the risk of infants receiving
insufficient care that may negatively impact their development.
Aerobic exercise is not the only type of exercise that has been researched and seen as a
having a positive effect on pregnancy and related outcomes. Resistance training or exercise is
becoming more common among researchers and being assessed to further discover its benefits
for pregnant women and fetuses. Resistance training is a form of physical activity that is
designed to improve muscular fitness by exercising a muscle or a muscle group against external
resistance (Resistance Training). Resistance exercises typically require individuals to
utilize instruments, such as weights, medicine balls, elastic tubing, and more. People perform

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resistance training to help maintain and combat the loss of muscle mass by increasing muscular
fitness (Resistance Training . . . ). While resistance training has been associated with a variety
of health benefits, it, like aerobic exercise, has been ill-advised during pregnancy because of
risks. Examples of such risks are hyperthermia and a redistribution of blood flow away from the
fetus potentially depriving it of necessary oxygen and nutrients; however, human studies have
not confirmed these potential risks (White, et al 1141). Unconfirmed potential risks have led
professionals to research the potential benefits of resistance training, and a number of them have
been discovered.
The American College of Sports Medicines Information on Resistance Training for
Health and Fitness identifies decreased risk of heart disease by lowering body fat, decreasing
blood pressure, improving cholesterol, and lowering the stress placed on the heart while lifting a
particular load as benefits of regular resistance training. Along with these benefits, researchers
have also identified an inverse relationship between gestational diabetes and resistance exercise.
Gestational diabetes occurs in 1 to 14 percent of all pregnancies (Chapman-Novakofsk and
Montvilo). When women become pregnant, the sustainable nutrients extracted from their diet
also have to accommodate the nutritional needs of their growing fetuses. This is not problematic
if mothers maintain their normal balanced diet or a diet plan prescribed by their physician.
However, pregnancy is often considered a time where women can eat for two.
Eating for two can cause an increase in caloric and carbohydrate intake, which
pregnant womens bodies may or may not be able to handle. If their bodies cannot break down
the extra calories and carbohydrates using insulin, their blood glucose levels may exceed the
normal range causing gestational diabetes. While gestational diabetes is usually temporary, it can
create a variety of health issues for mothers unborn fetuses.

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The most common complication is fetal macrosomia, or having a birth weight greater
than or equal to 4.5 kilograms. Infants this large may require a cesarean section for birth,
which itself has greater health risks than a vaginal birth. Additionally, higher maternal
glucose levels lead to poorer placental functioning at an earlier point in pregnancy. While
the placenta is designed to work as a filtering mechanism for thirty-eight to forty-two
weeks, in gestational diabetics, the placenta often begins to malfunction by thirty-seven
weeks. Therefore, infants of diabetic mothers are delivered early to avoid placental
malfunction (Chapman-Novakofsk and Montvilo).
Pregnant womens participation in resistance training can lower the possibility and prevalence of
gestational diabetes by improving glycemic control; in turn, the negative outcomes associated
with gestational diabetes can also be reduced.
In addition to the correlated blood glucose and fetal outcome improvements from
resistance exercise, mothers and fetuses also benefit from the qualitative aspects of resistance
exercise. As mentioned earlier, infants are directly affected by their mothers emotional and
psychological well-being post-partum. Exercise in general has been known to be a contributing
factor of a better mood, and multiple studies concerning the various aspects of regular resistance
training recount several pregnant womens positive emotions associated with resistance training.
Several of the women experienced that resistance training resulted in some kind of
immediate positive physical or psychological feedback. Using ones muscles led to a
sense of satisfaction and physical well-being. In addition, exercise was described as
enjoyable and to generate a sense of mental well-being, both during and after the
performance (Fieril, et al 1139).

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The feelings of satisfaction and enjoyment that accompany resistance training are likely to carry
over in the womens post-partum routine because people often repeat the actions that generate
the positive feelings and emotions that they experienced. With that being said, mothers
experiencing pleasant emotions can combat the baby blues, reduce the risk of post-partum
depression, and better care for their infants from participating in resistance training. Also,
mothers continuing resistance training beyond the post-partum period will be able to influence
the overall health and well-being of their children as they age, which will relate to healthier
outcomes throughout childhood and adolescence.
Altogether, pregnancy is a sensitive period for both women and their unborn infants.
There are a number of activities that women have to be concerned about as they may affect their
health and that of their unborn children. Despite some past and current misconceptions, exercise
can actually be beneficial for mothers and fetuses if safely completed with a physicians
guidance and approval and with the proper goal(s) in mind. Aerobic and resistance exercises
have been thoroughly researched to determine the benefits that they may have for pregnant
women and their fetuses. So far, aerobic exercise has been heavily correlated to positive
cardiovascular health, better infant assessment, and post-partum recovery; resistance training has
been connected to maintained gestational blood glucose, positive fetal outcomes, and long-term
health and well-being of mothers and infants. Research on the effects of aerobic and resistance
exercises individually and combined is continuously being conducted. For now, medical
professionals are utilizing all of the current research and ACOGs guidelines to advise and
encourage pregnant women to partake in exercise because if done properly, exercise during
pregnancy minimizes common pregnancy complications and maximizes health benefits for both
mothers and fetuses.

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Works Cited
Resistance Training for Health and Fitness. American College of Sports Medicine. ACSM, n.d.
Web.
Chapman-Novakofsk, Karen, and Robin Kaienny Montvilo. Gestational diabetes. Magills
Medical Guide (Online Edition). (2013): n.p. Web.
Duncombe, Dianne, et al. Factors Related to Exercise Over the Course of Pregnancy Including
Women's Beliefs about the Safety of Exercise during Pregnancy. Midwifery. 25.4
(2009): 430-438. Web.
Fieril, Karolina Petrov, Monika Fagevik Olsn, Anna Glantz, and Maria Larsson. Experience of
Exercise During Pregnancy Among Women Who Perform Regular Resistance Training: A
Qualitative Study. Physical Therapy. 94.8 (2014): 1135-1143. Web.
Franklin, Barry A., Gary J. Balady, Kathy Berra, Neil F. Gordon, and Michael L. Pollock.
ACSM Current Comment: Exercise for Persons with Cardiovascular Disease.
American College of Sports Medicine. ACSM, n.d. Web.
Genti, Maria, Vasilios Serbezis, and Georgios Mavridis. Aerobics and Pregnancy. Studies in
Physical Culture and Tourism. 16.4 (2009): 355-359. Web.
Kader, Manzur, and Saira Naim-Shuchana. Physical Activity and Exercise during Pregnancy.
European of Physiotherapy. 16.1 (2014): 2-9. Web.
Krans, Elizabeth E., and Judy C. Chang. Low-Income African American Womens Beliefs
Regarding Exercise during Pregnancy. Maternal and Child Health Journal. 16.6 (2012):
1180-1187. Web.

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May, Linda E. Exercise During Pregnancy and Post-Partum. ACSM Fit Society Page. 16.3
(2014): 3-4. Web.
Tennant, Gisle. Exercise and Womens Health. International Journal of Childbirth Education.
29.2 (2014): 31-36. Web.
White, Erin, Jim Pivarnik, and Karin Pfieffer. Resistance Training During Pregnancy and
Perinatal Outcome. Journal of Physical Activity and Health. 11.6 (2014). 1141-1148.
Web.