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

3. Locomotive System  Uterus undergoes significant growth  Strictly pelvic organ @ 12 weeks  Abdominal organ: 150 fold increase in size  1000 fold increase in capacity  Lordosis and compensatory cervical curvature  Softening of the cartilage

4. 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%

5. Disposal System  By-products of increased metabolism: heat and waste  Heat: radiation, skin  Kidneys: clear large amounts of waste (30- 50% ↑ glomerular filtration rate)

6. Endocrine System  Weeks 6-8 hormones sustain pregnancy  After weeks 6-8 placenta main source of hormone production

7. Pregnancy and Exercise

8. 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?

9.  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?

10.  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?

11.  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?

12. 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

13.  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

14.  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

15. 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

16. Labor and Delivery  Every one is different  Have a plan, but be flexible  Pain medication does not make you weak

17. 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

18. 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

19. 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

20. 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

21.  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

22. Labor and Delivery  those that exercised throughout their pregnancies had shorter ( 1/3 ), less complicated, and easier deliveries  35% less need for pain relief

23. 75% decrease in maternal exhaustion  50% decrease in need to artificially rupture membranes  50% decrease in need to induce labor

24. 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

25. Babies of Exercising Moms Clapp, 1998

26. 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

27. 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

28. 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

29. 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

30. 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