Pregnancy  Locomotive system  Energy generating system  Disposal system  Endocrine system

Locomotive System  Uterus undergoes significant growth  Strictly pelvic 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 (30- 50% ↑ 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 Data is %age of women in each group who required or experienced intervention or not Clapp, 1998

Babies of Exercising Moms Clapp, 1998

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 Leiferman, 2003