DOI: 10.1111/tog.

12228 2015;17:281–7
The Obstetrician & Gynaecologist
Review
http://onlinetog.org

Exercise in pregnancy
a b c,
Katy Kuhrt BSc, Natasha L Hezelgrave MBBS BSc, Andrew H Shennan MD FRCOG *
a
Foundation Year 1 Trainee, Division of Women’s Health, King’s College London, 10th Floor North Wing, St Thomas’ Hospital, Westminster Bridge
Road, London SE1 7EH, UK
b
NIHR Research Fellow, Division of Women’s Health, King’s College London, 10th Floor North Wing, St Thomas’ Hospital, Westminster Bridge Road,
London, SE1 7EH UK
c
Professor of Obstetrics, Division of Women’s Health, King’s College London, 10th Floor North Wing, St Thomas’ Hospital, Westminster Bridge Road,
London, SE1 7EH UK
*Correspondence: Andrew Shennan. Email: Andrew.shennan@kcl.ac.uk

Accepted on 1 June 2015

Key content  To recognise longer term benefits of exercise on maternal and

 The physiology of pregnancy and responses to exercise. fetal health.
 The benefits of exercise in pregnancy.
Ethical issues
 The potential harms related to exercise in pregnancy.
 Consider the variable national recommendations and their impact
 Guidelines and recommendations for exercise in pregnancy.
on pregnant women.
Learning objectives  Acknowledge the lack of specific research on intensity and nature
 To understand the interaction between the physiology of exercise of exercise.
and pregnancy.
Keywords: birthweight / exercise / gestational age / physiology of
 To be able to counsel women regarding the benefits and harms of
pregnancy / pregnancy
exercise in pregnancy.

Please cite this paper as: Kuhrt K, Hezelgrave NL, Shennan AH. Exercise in pregnancy. The Obstetrician & Gynaecologist 2015;17:281–7.

theoretical concerns that exercise, particularly at high

Introduction
More than two thirds of pregnant women take part in some
type of recreational physical activity.1 However, only 15% of
pregnant women exercise at a recommended level.2 Whilst
guidelines exist for minimum recommended weekly exercise
in uncomplicated pregnancies (30 minutes moderate exercise
on most, if not all, days of the week),3 there is a paucity of
advice for women who want to exercise more intensely, and
for those at risk of pregnancy-associated complications such
as gestational diabetes mellitus (GDM), pre-eclampsia and
gestational weight gain (GWG).
Evidence in the literature suggests that exercise may reduce
GWG4 and GDM,5 both of which are associated with large-
for-gestational-age (LGA) infants,6 birth trauma, neonatal
hypoglycaemia and other perinatal complications, as well as
compromised longer term health, as per the fetal origins
hypothesis.7 Exposure to GDM and maternal obesity is
thought to program a fetus for adult adiposity, type II
diabetes mellitus and cardiometabolic risk factors. Therefore
prevention of weight gain and diabetes through exercise
during pregnancy may improve both short- and long-term
infant outcomes. However, there is ‘trouble at both ends of
the birthweight spectrum’ as low birthweight is associated
with a period of catch-up growth in childhood, and later
obesity and increased cardiovascular disease risk.8 There are
intensity, could lead to low birthweight, possibly as a result
of diminished uteroplacental blood flow and reduced
substrate availability for the growing fetus.9 Other
hypothetical risks of high intensity exercise are preterm
delivery,10 abnormal fetal heart rate patterns11–13 and exercise
generated heat stress with teratogenic effects14, although
there is a lack of substantial evidence to prove these effects.
Pregnancy is a unique window of opportunity to optimise
women’s health behaviour. It is therefore important that the
risks and benefits of exercise are well understood so that
programs of physical activity can be tailored to individual
pregnant women. Some pregnant women want to exercise to
maintain fitness levels. However, exercise could act as a
crucial intervention to improve health outcomes for mother
and baby in the short and the long term, particularly for
those at risk of complications.
Physiology of pregnancy and responses to
exercise in pregnancy
Cardiovascular adaptations
Maternal haemodynamics alter during pregnancy to
adequately provide nutrients and oxygen to the mother and
fetus. Blood volume increases by 40% and stroke volume by
10%15 by the end of the first trimester. Heart rate and cardiac

ª 2015 Royal College of Obstetricians and Gynaecologists 281

 Exercise in pregnancy
output are increased by 20%16 and 30–50%17 respectively
from the second trimester. There is a corresponding decrease
in systemic vascular resistance to allow sufficient perfusion of
the placenta.18,19 Mean arterial pressure decreases by mid-
second trimester by 5–10 mmHg because of the development
of the uteroplacental circulation and reduced vascular
resistance of the skin and kidney, before returning to
prepregnancy levels.15
Sustained bouts of maternal exercise may cause acutely
reduced oxygen and nutrient delivery to the placenta as blood
is diverted to skin and exercising muscles, and as a result of
the relatively poor autoregulation of the placental circulation.
The magnitude of the decrease varies with type and intensity
of exercise, maternal fitness and the stage of pregnancy.
However, in general it is thought that regular exercise,
especially weight-bearing, optimises maternal cardiovascular
adaptations and improves placental size and function to
maintain sufficient oxygen and nutrient supply to the fetus.20
Respiratory adaptations
During pregnancy there is a 50% increase in minute
ventilation, mostly due to increased tidal volume21 and
oxygen tension (the partial pressure of oxygen in the blood).
Due to a rise in baseline oxygen consumption of 10–20% and
increased work of breathing secondary to the pressure of the
growing fetus on the diaphragm, less oxygen is available
during aerobic exercise. Maximum exercise performance is
therefore decreased although in some fit women there is no
evidence of reduced aerobic power.
Nutritional requirements
Around 300 kcal extra maternal intake is needed by the end
of the first trimester and this increases with greater energy
expenditure as a result of exercise.22 Pregnant women have
lower fasting blood glucose and use carbohydrates at a greater
rate at rest and during exercise. Physical activity during
pregnancy also lowers insulin levels. Pregnancy induces a
state of relative insulin resistance to increase glucose
availability to the fetus. Decreasing insulin resistance,
through exercise, is thought to possibly leave the fetus
competing with its mother for glucose.23
Pregnancy is associated with tissue storage of fat. Conversely
exercise induces substrate mobilisation which could, in theory,
limit fetal substrate availability,24 particularly if the woman
does not regularly maintain adequate complex carbohydrate
intake to meet her additional requirements and ensure
adequate supply of nutrients to the growing fetus.
Thermoregulatory control
During pregnancy, heat production is increased secondary to
increased basal metabolic rate. Body temperature increases in
relation to the intensity of exercise. If heat production exceeds
heat dissipation capacity (increased conductance of heat to the
282
peripheral and evaporative cooling through sweating), which is
more likely in hot, humid conditions or during very strenuous
prolonged exercise, the core temperature will continue rising.
Musculoskeletal adaptations
Weight gain in pregnancy may considerably increase forces
across the hip and knee joints during weight bearing exercises
like running, potentially resulting in discomfort and even
damage in previously unstable joints.
The growing uterus causes a shift in the centre of gravity
leading to lumbar lordosis and lower back pain in 40–50% of
pregnant women.25 Balance problems may result from these
anatomical changes, predisposing a woman to injury or even
falls. Increased estrogen and relaxin levels cause ligamentous
laxity – the pubic symphysis widens 10 mm from 10–12
weeks of gestation – and some women will experience
symptoms as a result of this.26 There is little evidence to
substantiate the risks of musculoskeletal damage during
exercise in pregnancy but, depending on the intensity of
exercise, they may cause issues for some women.
Benefits of exercise in pregnancy
Pre-eclampsia
Hypertensive disorders of pregnancy, including gestational
hypertension (new onset hypertension during pregnancy
after 20 weeks of gestation) and pre-eclampsia (gestational
hypertension with proteinuria) are amongst the leading
causes of maternal mortality worldwide.27 Pre-eclampsia is
associated with increased risk of preterm birth, neonatal
intensive care unit admissions and fetal death.28 Given that
the only effective treatment is delivery, a simple intervention
like exercise training for women at risk could have a
substantial impact as a prophylactic and adjunctive
treatment, if proven to be effective.
Case–control studies in the USA have suggested a possible
associated protective effect of physical activity in early
pregnancy against pre-eclampsia with reduced odds between
30% and 80%.29–31 However, prospective cohort studies and
small randomised controlled trials (RCTs) have largely failed
to demonstrate significant results after adjusting for
confounding factors32 and some studies have even found a
deleterious effect. The Danish National Birth Cohort study, of
83 139 women, showed that physical activity for 4–7 hours or
more than 4 hours a week significantly increased odds of
developing severe subtypes of pre-eclampsia (OR 1.6, 95% CI
1.1–2.4 and OR 1.8, 95% CI 1.1–3.0, respectively)33 suggesting
that there may be an upper limit beyond which increased
physical activity may be damaging. Despite inconclusive
evidence, several mechanisms have been suggested to explain
potential protective effects of exercise against pre-eclampsia.
A double-blinded RCT of 64 primigravid women between 16
and 20 weeks of gestation, where women were randomised to
ª 2015 Royal College of Obstetricians and Gynaecologists

either 60 minute sessions of moderate exercise three times
weekly or ‘usual physical activity’, showed significantly greater
flow-mediated endothelial dilatation in the exercise group.34
Since endothelial dysfunction is linked to pre-eclampsia,
improving flow mediated dilation might reduce the risk of
developing the disorder.
Other possible mechanisms are promotion of placental
growth by the short-lived hypoxic environment during
exercise as blood is diverted to skin and muscle,20
combating oxidative stress induced by free radicals
generated by remodelling of uterine and placental arteries
in pre-eclampsia,35 and improving deranged immune
function through reducing pro-inflammatory mediators
and increasing anti-inflammatory cytokines.
More work is needed to determine effects of exercise on
the pathophysiology and clinical presentation of pre-
eclampsia. Larger randomised trials of varying intensity of
physical activity initiated at different pregnancy gestations
would provide firmer evidence on the true effect of physical
activity on pre-eclampsia risk. Beyond exercise limiting
weight gain prepregnancy, it cannot be recommended as a
preventative strategy for pre-eclampsia.
Gestational weight gain
Overweight women who gain more than 10% of their
prepregnancy mass are at a higher risk of complications such
as GDM, hypertensive disorders of pregnancy, caesarean
section and medically indicated preterm delivery.36,37
Women who gain excessive weight during pregnancy are
more likely to give birth to LGA (OR 1.38, 95% CI 1.32–1.44)
and macrosomic babies (OR 1.43, 95% CI 1.24–1.64), at
increased risk of neonatal hypoglycaemia, perinatal trauma
and death, and obesity, diabetes and metabolic syndromes in
later life.38,39 A recent cohort study of 4145 mother/child
pairs showed that children of mothers who had gained weight
in excess of current Institute of Medicine recommendations
had a 46% increased odds of being obese or overweight at
2–5 years of age (OR 1.46; 95% CI 1.17–1.83). The effect of
GWG was increased for offspring of women who were
normal weight before pregnancy compared with those who
were overweight. This suggests that the effect is independent
of genetic predictors of obesity40 and, instead, is potentially
related to GWG and subsequent changes in maternal insulin
resistance, which permanently alter fetal systems for
programming body weight. The effects should therefore
continue into adolescence and early adulthood and this has
been shown.41 Maternal GWG is also directly associated with
postpartum weight retention. Thus, GWG is detrimental to
the mother and infant and leads to a vicious cycle of excessive
GWG and adiposity, which is passed to the offspring and to
their offspring in turn. An intervention to reduce GWG could
break this cycle and positively impact the health of current
and future generations.
ª 2015 Royal College of Obstetricians and Gynaecologists
Kuhrt et al.
Observational evidence suggests that physical activity
during pregnancy can play a significant role in preventing or
reducing excessive GWG. Mild walking programs are
associated with reduced excessive GWG.42 Beneficial effects
may extend into the long term; Rooney et al.43 showed that
women who began and continued aerobic exercise postpartum
had gained 4.5 kg on average at 10-year follow-up compared
with 6.7 kg for women who didn’t exercise; these women were
also significantly less likely to have become obese
A 2011 systematic review and meta-analysis of 12 RCTs
designed to reduce GWG also showed positive associations; a
significant reduction in GWG of –0.61 (95% CI –1.17, –0.06)
was demonstrated when comparing physical activity with a
control group.41 However, sample sizes were small in the
included studies and definitions of GWG varied.
In general, robust evidence is scarce and further
investigation is needed to quantify the amount of exercise
that is beneficial to women of different body mass indices and
which types of physical activity are most effective to
reduce GWG.
Gestational diabetes mellitus
GDM is glucose intolerance or hyperglycaemia with onset or
first diagnosis during pregnancy. It affects 1–4% of
pregnancies, depending partly on the variable definitions
worldwide, and is associated with short- and long-term risks
for mother and baby.39
Women with GDM have higher rates of labour induction,
caesarean section, and pre-eclampsia. Uterine rupture and
perineal lacerations are commoner because GDM women are
more likely to have an LGA or macrosomic (>4000 g) baby.
Babies born to mothers with GDM are more likely to suffer
perinatal trauma, including shoulder dystocia and nerve
palsies, because of their large size, and other neonatal
complications such as respiratory distress syndrome
and hypoglycaemia.39
In the long term, women with GDM are 7–8 times more
likely to develop type II diabetes in later life. Treatment in
pregnancy has not been shown to modify this risk as it may
just unmask an underlying potential for insulin resistance.
There are also long-term risks for the infant; exposure to
diabetes in utero is associated with a higher prevalence of
diabetes in infants, impaired glucose tolerance in adolescence
and with an excess of obesity especially in the first 20 years of
life. Potential mechanisms include long-term changes in fat
and lean body mass, altered appetite regulation and deranged
pancreatic structure and function.8
Recent observational studies have found physical activity
during pregnancy reduces insulin resistance and so might
help lower risk of GDM. Mild walking programs, compared
with standard care, achieved lower glucose concentrations
and required fewer units of insulin per day (walking,
0.16U/kg; standard care, 0.50U/ kg; P<0.05).5
283
 Exercise in pregnancy
Evidence from a recent meta-analysis showed that women
who exercised before and during pregnancy reduced their
risk of GDM by 55% and 24% respectively (pooled OR 0.76,
95% CI 0.70–0.83; P<0.001).44 However, the confidence
intervals were wide and the authors compared only the
highest category of exercise to the lowest. In the highest
category women commonly exercised more intensely than
current recommendations suggest, so further work is needed
to establish the minimum dose of physical activity required
to have a beneficial effect.
A 2012 Cochrane review examined five intervention trials
of 115 women and their babies and found no difference in
GDM incidence between women either receiving routine care
or exercising. No long-term outcomes were reported from
any of the studies, which were small and varied widely in
their interventions and methodologies.39
Overall larger randomised trials with standardised
interventions and long-term outcomes are needed to derive
sufficient evidence to guide practice.
Potential harms related to exercise in
pregnancy
Preterm delivery
A 2006 Cochrane review of 11 trials, including 472 women,
found insufficient data to determine the effects of exercise on
preterm delivery.32 Studies focusing on physical exercise
found either decreased or no extra risk of preterm birth (not
specified whether spontaneous or iatrogenic).44–46 Other
studies have shown a 20–50% reduction in preterm birth in
exercising women compared with those who didn’t exercise
during pregnancy.47 A 2012 prospective observational study
looked specifically at the effects of vigorous physical activity
and found reduced odds of preterm birth.23 Jukic et al.23
suggested a proposed mechanism to explain their analysis
where the frequency of vigorous activity sessions was
associated with a lower risk of preterm birth. Regular
exercise may result in improved placental function overall;
a physical activity session could be associated with a decrease
in nutrient delivery to the placenta, followed by an increase as
the woman recovers. The more frequent the exercise sessions,
the more fluctuation there will be in nutrient delivery to the
placenta. This could stimulate placental growth. However
this particular study only investigated the effects of exercise
in the first trimester. Further investigation is needed to
establish whether there is a minimum threshold for the
protective effect that has been observed and if the protective
effect of exercise against preterm birth remains if the woman
continues to exercise vigorously later in her pregnancy.
Details regarding whether the early birth is iatrogenic or
spontaneous are often lacking in the literature, and
mechanisms would be very different, that is, mediated
through placental disease or cervical pressure/uterine
284
activity, respectively. Further work is needed to clarify
these relationships.
Low birthweight
Smaller babies have increased rates of perinatal
complications, including hypoglycaemia, hypothermia,
necrotic enterocolitis, chronic lung disease and death. They
also have increased rates of long-term metabolic sequelae and
of later adult diseases, including coronary heart disease and
type II diabetes mellitus.48
A 2009 review of GWG and child adiposity highlighted the
possibility of a U-shaped association between maternal
weight and child adiposity with greater overweight risks at
low and high GWG. One study showed a significantly greater
obesity risk in 18-year-old daughters born to mothers
who gained less than 10 lb compared with those who
gained 15–19 lb (OR 1.54; 95% CI 1.02–2.34).49 It is thought
that this effect is due to the development of a ‘survival
phenotype’ where infants with poor in utero nutrition
experience catch-up growth; this is beneficial in early life
but contributes to worse health outcomes in the long term.
Exercise in pregnancy causes a temporary reduction in
oxygen and nutrient delivery to the placenta as blood is
redirected to working muscles. Maternal blood volume,
cardiac output and placental function have been found to
increase in exercising women but it is uncertain whether
these mechanisms provide adequate oxygen and nutrient
supply to the fetus.47
Clapp and colleagues50,51 conducted a series of
prospective studies attempting to establish the effects of
exercise on birthweight and found that women exercising
in pregnancy delivered healthy (including in the long term)
babies weighing 310 g lighter; this was entirely attributed
to decreased fat mass. Conversely, previously sedentary
women who began exercise in pregnancy gave birth to
babies who were 260 g heavier and both fat mass and lean
body mass was increased. They also showed that
birthweight was affected depending on the pattern of
exercise in pregnancy; women exercising early and stopping
late in pregnancy had heavier babies compared
with women exercising moderately throughout pregnancy
(460g; P<0.001).50 Women who exercised most in late
pregnancy had the lightest babies. This variation was
attributed to changes in placental function throughout
pregnancy and needs further exploration to establish
optimal exercise programs at different points in
pregnancy for different groups of women. They also
showed that the smaller babies of exercising mothers
were not disadvantaged in early life. They remained lighter
and leaner than controls (18 kg versus 19.5 kg; P = 0.01;
sum of 5 skinfolds: 37 versus 44 P<0.01) and performed
better overall in intelligence tests (115 versus 111; P<0.01)
at 5 years of age.51
ª 2015 Royal College of Obstetricians and Gynaecologists
 Kuhrt et al.

Conversely, a more recent population based observational CI 1.61–2.29)14 but there is no evidence that exercise can
study of 79 692 pregnancies showed that exercising mothers induce this level of heat stress.
had a decreased risk of SGA (hazard ratio 0.87; 95% CI
0.83–0.92) and LGA (hazard ratio 0.93; 95% CI 0.89–0.98)
Guidelines and recommendations
babies. The effect on LGA increased with more regular
exercise; five times weekly exercise was associated with a There are few specific recommendations for exercising in
27% reduction in risk (hazard ratio = 0.72; 95% CI pregnancy as robust RCTs are difficult to perform and are
0.57–0.91). The Norwegian Mother and Child Cohort lacking. Likewise observational studies are often not
Study found a similar effect where risk of LGA was sufficiently powered to derive firm conclusions about the
reduced by 23% with regular exercise (OR 0.77; 95% CI
0.61–0.96).47,52 Proposed mechanisms to explain these Table 1. A comparison of the American College of Obstetricians and
potential benefits include normalisation of maternal blood Gynecologists (ACOG)3 and National Institute for Health and Care
Excellence (NICE)56 recommendations for exercise during pregnancy.
glucose, reduced maternal insulin resistance and increased
placental surface area and volume which improves its ACOG guidelines NICE guidelines
functional capacity and nutrient delivery.20,53
More work is needed to systematically explore the effects Duration and  30 minutes or more of  At least 30 minutes of
of exercise in different women at various stages of pregnancy, intensity moderate intensity moderate exercise
exercise on most, if not per day.
including different types of exercise. Trials should be large all, days of the week,  Women who exercised
with consistent methodologies and outcomes so that their provided no medical/ regularly before
findings can be more easily compared before confident obstetric complications. pregnancy should be
 Recreational and able to continue with
recommendations can be made.
competitive athletes no adverse effects.
can remain active  Women who haven’t
Fetal Distress during pregnancy and exercised routinely
Fetal bradycardic episodes have been associated with fetal should modify their should begin with 15
exercise routines as minutes of continuous
hypoxia. Studies using Doppler monitors to estimate fetal
medically indicated. exercise three times
heart rate have previously reported prolonged fetal  Women should be weekly, increasing to
bradycardia during low-intensity maternal exercise.22 evaluated before daily 30-minute
Speculative mechanisms include a vagal reflex, cord recommendations for sessions.
physical activity are
compression or fetal head compression possibly related to made if previously
malposition.22 However, a 1988 study measuring fetal heart inactive or medical/
rate in 45 pregnant women in response to repetitive obstetric complications.
submaximal and maximal cycle tests concluded that brief Type of  Most physical activity  Most recreational
exercise bouts up to 70% of maximal aerobic power, where exercise is safe. exercise including
maternal heart rate was less than 148 beats per minute, had  Ice-hockey, soccer, swimming or brisk
basketball or walking and strength
no effect on fetal heart rate.54 A more recent investigation
gymnastics, horse conditioning exercise is
showed that fetal bradycardia occurred when women riding and downhill safe and beneficial.
exercised more than 90% of maximal maternal heart rate skiing, where the risk of  Sports that may cause
and the mean uterine artery blood flow was less than 50% of impact or falling is abdominal trauma, falls
higher, should or excessive joint stress,
the initial value.55 However, there were only six study be avoided. and scuba diving,
participants and all were Olympic level athletes. The study  Scuba diving should should be avoided.
did not examine birth outcomes due to the small sample size be avoided.
and so it is difficult to ascertain whether there were adverse Postpartum  Prepregnancy exercise  Mild exercise
consequences to the fetus as a result of the bradycardic exercise regimens can be programmes with
episodes.55 Taken together it seems that submaximal exercise resumed gradually as walking, pelvic floor
soon as physically and exercises and stretching
does not adversely affect fetal heart rate and more work is
medically safe, which can begin immediately
needed to establish the effect of more vigorous exercise on a will vary from one  High impact exercise
wider group of women. individual to another. should not begin
too soon.
 A clinician should
Heat stress and teratogenicity advise at 6–8 weeks in
Another potential fetal risk of exercise in pregnancy is the case of more
exercise-generated heat stress. A systematic review of 15 complicated deliveries.
studies found maternal hyperthermia in the first trimester
increased overall risk of neural tube defects (OR 1.92;

ª 2015 Royal College of Obstetricians and Gynaecologists 285

 Exercise in pregnancy

prescribing exercise during pregnancy could form part of a

Table 2. Absolute and relative contraindications to aerobic exercise in
pregnancy according to the American College of Obstetricians and valuable intervention to benefit many women and their
Gynecologists (ACOG)3 offspring, and improve the health of future generations. In the
Relative contraindications Absolute contraindications to
meantime, moderate or accustomed exercise in pregnancy
to aerobic exercise aerobic exercise should be encouraged.

 Severe anaemia  Haemodynamically significant Contribution to authorship

 Unevaluated maternal
cardiac arrhythmia
 Chronic bronchitis
 Poorly controlled type 1
diabetes mellitus
 Extreme morbid obesity
 Extremely underweight
(BMI <12)
 Extremely
sedentary lifestyle
 Intrauterine growth
restriction in
current pregnancy
heart disease
 Incompetent cervix/cerclage
 Multiple gestation at risk of
preterm labour
 Persistent 2nd/3rd
trimester bleeding
 Placenta praevia after 26 weeks
of gestation
 Premature labour during
current pregnancy
 Pregnancy
induced hypertension
Professor Shennan conceived the idea, wrote the outline,
supervised the writing and edited and approved the final
version. KK was principal author, and researched the
findings. NH advised on the outline, and edited and
approved the final version.
Disclosure of interests
Professor Shennan and Dr Hezelgrave are foundation
members of the parkrun research board, and have no
pecuniary or other conflicts of interest relevant to this topic.

effect of maternal exercise on important fetal and maternal
outcomes. The existing generic guidelines can provide useful
baseline information but care must be taken to tailor advice
appropriately to individual pregnant women. Current
recommendations are summarised in Table 1.3
Generally guidelines encourage exercise in pregnancy. The
American College of Obstetricians and Gynecologists provides
some additional information about certain situations where it
suggests that exercise should be avoided (Table 2).3
Conclusion
In summary, moderate exercise is encouraged in
uncomplicated pregnancies. Despite theoretical concerns,
there is no evidence to suggest that exercise can harm the
mother or her baby, although more work is needed to better
define the effects of exercise in women who exercise intensely
during pregnancy.
Some studies show women at risk of gaining excessive
weight during pregnancy and other complications like GDM
and pre-eclampsia could derive substantial benefit from
exercising in pregnancy. Physical activity has been shown to
increase flow-mediated dilatation, potentially reducing the
risk of pre-eclampsia, prevent weight gain and improve
glucose control. Improving these parameters may reduce
complications surrounding the birth for the mother and baby
but could also improve their future health.
Larger powered studies with consistent methodologies are
needed to better understand the potential benefits associated
with exercise. Of importance will be distinguishing between
different types of exercise, in more diverse groups of women
at various stages of pregnancy. Tailored exercise programs
could then be designed. Maternal obesity and GDM are rising;
Supporting Information
Additional supporting information may be found in the
online version of this article at http://wileyonlinelibrary.com/
journal/tog
Infographic S1. Exercise in pregnancy.
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