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CLINICAL REVIEW
2019 Canadian Guidelines for Physical Activity Throughout Pregnancy.
Michelle F Mottola, Margie H Davenport, Stephanie-May Ruchat, Gregory A Davies, Veronica J Poitras, Casey E Gray, Alejandra Jaramillo Garcia, Nick Barrowman, Kristi B Adamo, Mary Duggan, Ruben Barakat, Phil Chilibeck, Karen Fleming, Milena Forte, Jillian Korolnek, Taniya Nagpal, Linda G Slater, Deanna Stirling, Lori Zehr.
Br J Sports Med 2018; 52: 1339-1346. doi: 10.1136/bjsports-2018-100056
By Amanda O’Reilly Fewer than fifteen percent of women will achieve the minimum recommendation of physical activity during their pregnancy despite the significant affect it has on her health as well as that of her fetus.
throughout pregnancy.
There continues to be uncertainty among some pregnant women and obstetric care providers as to whether prenatal physical exercise may increase the risk of pregnancy complications. The Guidelines Consensus Panel selected thirty-seven (20 rated critical, 17 rated important) outcomes related to maternal, fetal and neonatal health.
1: All women without contraindication should be physically active throughout pregnancy.
In the absence of contraindications (see Table. 1), following the guidelines is associated with a) fewer newborn complications (i.e., large for gestational age), and b) maternal health benefits (i.e., decreased risk of pre-eclampsia, gestational hypertension, gestational diabetes). CONTRAINDICATIONS TO PHYSICAL THROUGHOUT PREGNANCY ABSOLUTE RELATIVE
ACTIVITY
Ruptured membranes
Recurrent pregnancy loss
Premature labour
Gestational hypertension
Unexplained persistent vaginal bleeding Placenta praevia after 28 weeks’ gestation Pre-eclampsia
A history of spontaneous preterm birth Mild/moderate cardiovascular or respiratory disease Symptomatic anaemia
Incompetent cervix
Malnutrition
Intrauterine growth restriction High-order multiple pregnancy (e.g. triplets) Uncontrolled type I diabetes Uncontrolled hypertension
Eating disorder Twin pregnancy after the 28th week Other significant medical conditions
1
Contraindications
A)
Women who were previously inactive. Strong recommendation, moderate-quality evidence.
One hundred and four exercise-only randomized controlled trials (RCTs) were identified. From these studies prenatal physical activity was associated with a reduction in the odds of gestational diabetes mellitus (38%), pre-eclampsia (41%), gestational hypertension (39%), prenatal depression (67%) and macrosomia (39%) without increasing the odds of adverse outcomes such as preterm birth, low birth weight, miscarriage and perinatal mortality. Physical activity during the first trimester did not increase the odds of miscarriage or congenital anomalies however not engaging in physical activity from the first trimester increased the odds of pregnancy complications. Therefore, physical activity should be encouraged throughout pregnancy. B)
Women categorized as overweight or obese (pre-pregnancy body mass index ≥25kg/m2. Strong recommendation, low-quality evidence.
Despite low-quality evidence, there was evidence from RCTs of improvement in gestational weight gain and blood glucose in women categorized as overweight or obese. C)
Women diagnosed with gestational diabetes mellitus. Weak recommendation, low-quality evidence. This is a weak recommendation as the benefit between women who were physically active and those who did not was small.
Uncontrolled thyroid disease Other serious cardiovascular, respiratory or systematic disorder
Table.
Six specific recommendations are provided with corresponding quality and strength of recommendations.
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