# Exercise as it relates to Disease/Physical Activity Guidelines for obesity women during pregnancy
## Background

Worldwide, over one-third of reproductive age women are obese (body mass index (BMI) ≥ 30 kg/m2)and another 29% are overweight (BMI 25.0-29.9 kg/m2). Once a woman is pregnant, both maternal and fetal risks are increased by high maternal BMI. Pregnancy-associated morbidity and mortality are higher in obese women than in normal-weight women In addition, over 60% of overweight women gain more than recommended during pregnancy.
There are things they can do before and during pregnancy to help them to have a healthy baby. Current recommendations say that pregnant women should exercise with moderate intensity for 30 minutes or more on most, if not all, days of the week .

## Risk
### During pregnancy

* Gestational diabetes - a form of diabetes that develops during pregnancy
* Pre-eclampsia - a condition that only occurs in pregnancy, characterized by hypertension (high blood pressure) and the presence of protein in the urine
* abnormalities of the baby's growth, development and general health
* sleep apnoea - a condition that causes you to temporarily stop breathing while you are sleeping.

### During labour

* failure to progress in labour
* shoulder dystocia (the shoulders get stuck during birth)
* difficulties monitoring the baby's heart
* difficulties with providing satisfactory pain relief in labour
* increased risks with attempted vaginal birth after caesarean section
* need for an emergency caesarean section
* increased risk of complications related to caesarean section.

## Benefits of Exercise During Pregnancy

* Reduces risk of Diabetes
* Reduces stress on lower back
* Preparation of physical demands of labour
* Weight control
* Improves Constipation
* Improves posture
* Relieves Stress
* Improves quality of sleep

## Recommendation
### Workload of Exercise

During the first trimester of pregnancy, it is vital to avoid laying flat on the back or standing in a particular spot for a long period of time. This may result in blood flow restriction to the foetus. High intensity exercise should also be avoided as it will increase core body temperature, increasing temperature of the foetus. However, light walks, aqua aerobics, light strength and conditioning exercises is recommended to aid back to accommodate with weight gain during the second and third trimester.
Exercise intensity may be increased during the second and third trimester. 30 minute training sessions 3 times a week, during weeks 11 to 14 on the borg scale is said to be optimal. Heart rate is not an accurate measure of exercise intensity as basal heart rate will increase during pregnancy. Increasing intensity of the exercise will not always be beneficial to the mother or the foetus. Knowledge on optimal exercise routines and intensity for each trimester of the pregnancy should be obtained. Recent studies have shown training too often may result to giving birth to a smaller sized baby. Training at too high intensities may put too much stress on joints and pelvic floor muscles. Pelvic floor muscles supports the weight of the unborn baby and controls urination and bowl movements. Extra pressure can lead to urine being passed involuntarily because of a more relaxed pelvic floor.

### Suggested exercise activities during pregnancy

Activities that are generally safe during pregnancy, even for beginners, include:
* Walking
* Swimming
* Cycling – outdoors or on a stationary bicycle
* Exercise in water (aquarobics)
* Yoga
* Stretching
* Dancing
* Pilates
* Pregnancy exercise classes.
* Some activities are safe when done in moderation by pregnant women who had already been participating in these activities prior to pregnancy. These include:
* Running
* Strength training.

### Exercises to avoid while pregnant

During pregnancy, avoid sports and activities with increased risk of falling. include:
* Contact sports or activities that carry a risk of falling (such as trampolining, rollerblading, downhill snow skiing, horse riding and basketball)
* Competition sports – depending on the stage of pregnancy, the level of competition and your level of fitness
* After about the fourth month of pregnancy, exercises that involve lying on your back – the weight of the baby can slow the return of blood to the heart. Try to modify these exercises by lying on the side.
* In the later stages of pregnancy, activities that involve jumping, frequent changes of direction and excessive stretching (such as gymnastics).
* If you're not sure whether a particular activity is safe during pregnancy, check with your healthcare professional.

## References

* ↑ Flegal KM, Carroll MD, Ogden CL, Curtin LR JAMA. Prevalence and trends in obesity among US adults, 2010 Jan 20; 303(3):235-41.
* ↑ Flegal KM, Carroll MD, Ogden CL, Curtin LR JAMA. Prevalence and trends in obesity among US adults, 2010 Jan 20; 303(3):235-41.
* ↑ Clapp, J, Kim H, Burcui B. 2002. Continuing regular exercise during pregnancy: effect of exercise volume on fetal placental growth. American Journal of Obstetrics and Gynecology 1861:142-7 Read more: http://www.babycentre.co.uk/pregnancy/fitness/recommendedexercises/#ixzz2A6qbCzwd
* ↑ Weiss JL, Malone FD, Emig D, Ball RH, Nyberg DA, Comstock CH, et al. Obesity, obstetric complications and cesarean delivery rate — a population-based screening study. Am J Obstet Gynecol 2004;190(4):1091-7.
* ↑ Goffman D, Madden RC, Harrison EA, Merkatz IR, Chazotte C. Predictors of maternal mortality and nearmiss maternal morbidity. J Perinatol 2007;27(10):597- 601.
* ↑ Clapp, J, Kim H, Burcui B. 2002. Continuing regular exercise during pregnancy: effect of exercise volume on fetal placental growth. American Journal of Obstetrics and Gynecology 1861:142-7 Read more: http://www.babycentre.co.uk/pregnancy/fitness/recommendedexercises/#ixzz2A6qbCzwd
* ↑ Evenson K, Savitz A, Huston S. 2004. Leisure-time physical activity among pregnant women in the US. Paediatric and Perinatal Epidemiology186:400-407 Read more: http://www.babycentre.co.uk/pregnancy/fitness/recommendedexercises/#ixzz2A6rWbCR4
* ↑ Larsson L, Lindqvist P-G. 2005. Low-impact exercise during pregnancy: a study of safety. Acta Obstetricia et Gynecologica Scandinavica 84(1):34-38 Read more: http://www.babycentre.co.uk/pregnancy/fitness/recommendedexercises/#ixzz2A6rdpenJ
* ↑ Lynch AM, McDonald S, Magann, et al. 2003. Effectiveness and safety of a structured swimming program in previously sedentary women during pregnancy. The Journal of Maternal-Fetal and Neonatal Medicine 14(3):163–169 Read more: http://www.babycentre.co.uk/pregnancy/fitness/recommendedexercises/#ixzz2A6rpn6Hr
* ↑ McMurray RG, Hackney AC, Guion WK, et al. 1996. Metabolic and hormonal responses to low-impact aerobic dance during pregnancy. Clinical Sciences 28(1):41-46 Read more: http://www.babycentre.co.uk/pregnancy/fitness/recommendedexercises/#ixzz2A6rx2SNU