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Meah VL, Davies GA, Davenport MH. Why can't I exercise during pregnancy? Time to revisit medical 'absolute' and 'relative' contraindications: systematic review of evidence of harm and a call to action. Br J Sports Med 2020; 54:1395-1404. [PMID: 32513676 DOI: 10.1136/bjsports-2020-102042] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Clinical guidelines recommend pregnant women without contraindication engage in regular physical activity. This is based on extensive evidence demonstrating the safety and benefits of prenatal exercise. However, certain medical conditions or contraindications warrant a reduction, modification or cessation of activity due to potential health risks. AIM To review and evaluate the evidence related to medical disorders which may warrant contraindication to prenatal exercise. METHODS Online databases were searched up to 5 April 2019. Forty-four unique studies that reported data on our Population (pregnant women with contraindication to exercise), Intervention (subjective/objective measures of acute or chronic exercise), Comparator (not essential) and Outcomes (adverse maternal or fetal outcomes) were included in the review. KEY FINDINGS We found that the majority of medical conditions listed as contraindications were based on expert opinion; there is minimal empirical evidence to demonstrate harm of exercise and benefit of activity restriction. We identified 11 complications (eg, gestational hypertension, twin pregnancy) previously classified as contraindications where women may in fact benefit from regular prenatal physical activity with or without modifications. However, the evidence suggests that severe cardiorespiratory disease, placental abruption, vasa previa, uncontrolled type 1 diabetes, intrauterine growth restriction, active preterm labour, severe pre-eclampsia and cervical insufficiency are associated with strong potential for maternal/fetal harm and warrant classification as absolute contraindications. CONCLUSION Based on empirical evidence, we provide a call to re-evaluate clinical guidelines related to medical disorders that have previously been considered contraindications to prenatal exercise. Removing barriers to physical activity during pregnancy for women with certain medical conditions may in fact be beneficial for maternal-fetal health outcomes.
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Affiliation(s)
- Victoria L Meah
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Gregory A Davies
- Department of Obstetrics and Gynecology, Queen's University, Kingston, Ontario, Canada
| | - Margie H Davenport
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
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Skow RJ, Davenport MH, Mottola MF, Davies GA, Poitras VJ, Gray CE, Jaramillo Garcia A, Barrowman N, Meah VL, Slater LG, Adamo KB, Barakat R, Ruchat SM. Effects of prenatal exercise on fetal heart rate, umbilical and uterine blood flow: a systematic review and meta-analysis. Br J Sports Med 2018; 53:124-133. [PMID: 30337345 DOI: 10.1136/bjsports-2018-099822] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To perform a systematic review and meta-analysis examining the influence of acute and chronic prenatal exercise on fetal heart rate (FHR) and umbilical and uterine blood flow metrics. DESIGN Systematic review with random-effects meta-analysis and meta-regression. DATA SOURCES Online databases were searched up to 6 January 2017. STUDY ELIGIBILITY CRITERIA Studies of all designs were included (except case studies) if published in English, Spanish or French, and contained information on the population (pregnant women without contraindication to exercise), intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise, alone ["exercise-only"] or in combination with other intervention components [eg, dietary; "exercise + co-intervention"]), comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and outcomes (FHR, beats per minute (bpm); uterine and umbilical blood flow metrics (systolic:diastolic (S/D) ratio; Pulsatility Index (PI); Resistance Index (RI); blood flow, mL/min; and blood velocity, cm/s)). RESULTS 'Very low' to 'moderate' quality evidence from 91 unique studies (n=4641 women) were included. Overall, FHR increased during (mean difference (MD)=6.35bpm; 95% CI 2.30 to 10.41, I2=95%, p=0.002) and following acute exercise (MD=4.05; 95% CI 2.98 to 5.12, I2=83%, p<0.00001). The incidence of fetal bradycardia was low at rest and unchanged with acute exercise. There were no significant changes in umbilical or uterine S/D, PI, RI, blood flow or blood velocity during or following acute exercise sessions. Chronic exercise decreased resting FHR and the umbilical artery S/D, PI and RI at rest. CONCLUSION Acute and chronic prenatal exercise do not adversely impact FHR or uteroplacental blood flow metrics.
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Affiliation(s)
- Rachel J Skow
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Margie H Davenport
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Michelle F Mottola
- R. Samuel McLaughlin Foundation-Exercise and Pregnancy Laboratory, School of Kinesiology, Faculty of Health Sciences, Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Children's Health Research Institute, The University of Western Ontario, London, Ontario, Canada
| | - Gregory A Davies
- Department of Obstetrics and Gynecology, Queen's University, Kingston, Ontario, Canada
| | | | - Casey E Gray
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | | | - Nick Barrowman
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Victoria L Meah
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Linda G Slater
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
| | - Kristi B Adamo
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Ruben Barakat
- Facultad de Ciencias de la Actividad Física y del Deporte-INEF, Universidad Politécnica de Madrid, Madrid, Spain
| | - Stephanie-May Ruchat
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivieres, Quebec, Canada
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Reyes LM, Davenport MH. Exercise as a therapeutic intervention to optimize fetal weight. Pharmacol Res 2018; 132:160-167. [PMID: 29684673 DOI: 10.1016/j.phrs.2018.04.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/16/2018] [Accepted: 04/18/2018] [Indexed: 12/29/2022]
Abstract
The Developmental Origins of Health and Disease suggest the in utero environment programs offspring obesity and cardiovascular disease. Therefore, there is a need to implement safe therapeutic interventions that do not involve the intake of medications or biological products during pregnancy that can improve maternal and fetal health. Prenatal exercise is established to promote maternal and fetal health. It is generally recommended that women accumulate at least 150 min per week of moderate-intensity exercise. It has been demonstrated that prenatal exercise maintains healthy weight gain and improves maternal glucose control, maternal cardiac autonomic control, placental efficiency (increases angiogenesis, downregulates genes involved in fatty acid transport and insulin transport across the placenta, and upregulates genes involved in amino acid transport across the placenta), and oxidative stress. These adaptations following exercise improve maternal metabolism and provide adequate uteroplacental perfusion. In this review, we will focus on exercise as a therapeutic intervention to optimize fetal weight. It has been established that prenatal exercise does not increase the risk of having a small for gestational age baby. To the contrary, prenatal exercise has been associated with the prevention of excessive fat accumulation in the newborn and the maintenance of fetal muscle mass.
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Affiliation(s)
- Laura M Reyes
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport and Recreation, 1-052 Li Ka Shing Centre for Health Research Innovation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, T6G 2E1, Alberta, Canada.
| | - Margie H Davenport
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport and Recreation, 1-052 Li Ka Shing Centre for Health Research Innovation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, T6G 2E1, Alberta, Canada.
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Chaddha V, Simchen MJ, Hornberger LK, Allen VM, Fallah S, Coates AL, Roberts A, Wilkes DL, Schneiderman-Walker J, Jaeggi E, Kingdom JCP. Fetal response to maternal exercise in pregnancies with uteroplacental insufficiency. Am J Obstet Gynecol 2005; 193:995-9. [PMID: 16157100 DOI: 10.1016/j.ajog.2005.06.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2005] [Revised: 05/27/2005] [Accepted: 06/07/2005] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the fetal response to submaximal maternal exercise at 22 to 26 weeks in pregnancies with abnormal uterine artery Doppler. STUDY DESIGN This was a prospective comparison of singleton pregnancies with uteroplacental vascular insufficiency (UPVI) (mean uterine pulsatility index [PI] values >1.45 [n = 12]) and those with normal uterine artery Doppler (n = 23). Maternal and fetal cardiovascular responses to 5 minutes of steady state cycling at 10% and at 15% of predicted work rate maximum were studied. RESULTS Umbilical artery Doppler deteriorated after exercise in patients with UPVI (pre PI 1.4 [0.35-2.14], post PI 1.64 [0.45-2.18]). Three (25%) had transient absent-end diastolic flow (AEDF) in umbilical artery, 2 of which developed early-onset intrauterine growth restriction (IUGR) with AEDF. Fetal cardiac output studies remained stable during the examinations. CONCLUSION Submaximal steady state exercise had a transient deleterious effect in a subset of women with uteroplacental vascular insufficiency destined to develop early-onset IUGR.
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Affiliation(s)
- Vandana Chaddha
- Division of Maternal-Fetal Medicine, Mount Sinai Hospital, Canada
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