Pregnant Women Doing Resistance Exercise Training

Study Overview
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Brief Summary
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Despite the increase in numbers of women who engage in heavy, free-weight resistance exercise training (e.g. powerlifting, weightlifting, cross fit), the knowledge on how such exercise may affect fertility, pregnancy and birth outcomes is poor. Based on observational and associational studies of pregnant women in labour, recommendations are not to lift more than 11 kg in external load after mid-term, or to lift more than a total of 100 kg during a day. Ignoring such recommendations is associated to increased risk of miscarriage and preeclampsia, and of low birthweight and premature birth, respectively. As such, fit women who continue to exercise during pregnancy, are met with scepticism and warnings, resulting in shame and insecurity. Such attitudes may also result in physical inactivity during pregnancy, being on the contrary of what is recommended for a healthy pregnancy and delivery. Elite athletes may additionally be deprived from an early return to sport if not being able to keep exercise intensity close to pre-pregnancy period. With poor knowledge on how fit, strong women respond to high external loads during pregnancy exercise, recommendations are to follow the general guidelines. The aim of this observational study, is to explore how regular resistance exercise training may affect fertility, and how high external loads in resistance exercise training during pregnancy in resistance trained women affect; a)their pregnancy and birth outcome, and b)health of the women and their children up to 12 months post-delivery.

Detailed Description
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Pregnant women who are experienced in heavy, free-weight resistance exercise training, and who choose to continue their exercise regimes during pregnancy, are recruited in social media to regularly respond to an online questionnaire on personal health, foetus development, and the newborn child health. A reference group of pregnant women being regularly physical active (still not lifting free weights of high loads) are concurrently recruited. All will respond to questionnaire at mid-term, and week 23, 30 and 40 of pregnancy. During maternity leave the women will be asked to respond to questionnaires at 1 month, 3 months, 6 months and 12 months post-delivery.

Official Title
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Experiences by Pregnant Power Athletes, and Health Related Outcomes in Mother and Infants, After Resistance Exercise Training During Pregnancy

Conditions
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Pregnancy Related

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Being pregnant Group of interest: Being experienced with heavy, free-weight resistance exercise training, and aiming to continue exercise at comparable level during pregnancy Reference group: being regularly physical active before pregnancy (i.e. at least 2 work- outs per week), but not experienced in heavy, free-weight resistance exercise training Exclusion Criteria: Any known metabolic condition or contraindication on doing physical activity during pregnancy (i.e. miscarriages, bleedings).

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 45 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Weight lifting women<br>Experienced resistance exercise trained and pregnant women | |
| Reference women<br>Physically active pregnant women (not experienced with free weight lifting) | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Delivery week | The selfreported pregnancy week for delivery | At delivery time | 
| Delivery method | Participants report the method for delivery, choosing from natural delivery, delivery with assistance (e.g. birth forceps, vacuum delivery), caesarean section. | At delivery time | 
| Pregnancy complications at week 23 | Number of participants who report any complications during pregnancy, choosing from a list of alternatives (yes/no) (preeclampsia, nausea, fatigue, low back pain, pelvic pain, constipation, mood swings, birth anxiety, gestational depression, anemia, hypertension, pregnancy diabetes, foetus growth retardation) | During pregnancy up to week 23 | 
| Pregnancy complications at week 30 | Number of participants who report any complications during pregnancy, choosing from a list of alternatives (yes/no) (preeclampsia, nausea, fatigue, low back pain, pelvic pain, constipation, mood swings, birth anxiety, gestational depression, anemia, hypertension, pregnancy diabetes, foetus growth retardation) | Pregnancy week 23 to 30 | 
| Pregnancy complications at week 40 | Number of participants who report any complications during pregnancy, choosing from a list of alternatives (yes/no) (preeclampsia, nausea, fatigue, low back pain, pelvic pain, constipation, mood swings, birth anxiety, gestational depression, anemia, hypertension, pregnancy diabetes, foetus growth retardation) | Pregnancy week 30 to 40 | 
| Childs weight at birth | The weight of the child | At delivery time | 
| Childs length at birth | The length of the child | At delivery time | 
| Apgar score 5 minutes | The Apgar score 5 minutes post-delivery. This test checks a baby's heart rate, muscle tone, and other signs to see if extra medical care or emergency care is needed. The test is usually given twice: once at 1 minute after birth, and again at 5 minutes after birth. Scores below 4 indicates need for lifesaving measures, and higher scores indicates better health. | At delivery time (5 minutes post-delivery) | 
| Miscarriage | Number of miscarriages | Previous and up to October 2023 | 
| Urinary incontinence before pregnancy | Number of participants reporting any challenges with urinary incontinence, and if it occurs; if it is only during increased abdominal pressure (coughing, laughing), or heavy lifting (choosing from a list of always, only during increased abdominal pressure, only during lifting of heavy load) | Any experience before pregnancy | 
| Urinary incontinence during pregnancy | Number of participants reporting any urinary incontinence, and if it occurs; if it is only during increased abdominal pressure (coughing, laughing), or heavy lifting (choosing from a list of always, only during increased abdominal pressure, only during lifting of heavy load) | At pregnancy week 23, 30 and 40 | 
| Urinary incontinence after delivery | Number of participants reporting any urinary incontinence, and if it occurs; if it is only during increased abdominal pressure (coughing, laughing), or heavy lifting (choosing from a list of always, only during increased abdominal pressure, only during lifting of heavy load) | Post-delivery: 1 month-, 3months-, 6 months- and 12 months | 
| Anal insufficiency before pregnancy | Number of participants reporting any challenges with fecal incontinence | Any experience before pregnancy | 
| Anal insufficiency during pregnancy | Number of participants reporting any challenges with fecal incontinence | At pregnancy week 23, 30 and 40 | 
| Anal insufficiency after delivery | Number of participants reporting any fecal incontinence and if it has worsened after giving birth | Post-delivery: 1 month-, 3months-, 6 months- and 12 months | 
| Injuries during pregnancy up to week 23 | Number of participants reporting on any exercise related injuries occuring during pregnancy, choosing from a list of anatomical locations | During pregnancy up to week 23 | 
| Injuries during pregnancy, up to week 30 | Number of participants reporting on any exercise related injuries occuring during pregnancy, choosing from a list of anatomical locations | Pregnancy week 23 to 30 | 
| Injuries during pregnancy, up to week 40 | Number of participants reporting on any exercise related injuries occuring during pregnancy, choosing from a list of anatomical locations (yes/no) | Pregnancy week 30 to 40 | 
| Analgesic during delivery | Number of participants reporting use of analgesic during delivery, and what type of analgesic (e.g. nitrous oxide, epidural) | At delivery time | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Body weight at week 23 | Participants report on body weight changes during pregnancy | Pregnancy week 23 | 
| Body weight at week 30 | Participants report on body weight changes during pregnancy | Pregnancy week 30 | 
| Body weight at week 40 | Participants report on body weight changes during pregnancy | Pregnancy week 40 | 
| Body weight post-delivery, 1month | Participants report on body weight changes after pregnancy | Postpartum, 1 month after delivery | 
| Body weight post-delivery, 3 months | Participants report on body weight changes after pregnancy | Postpartum, 3 months after delivery | 
| Body weight post-delivery, 6 months | Participants report on body weight changes after pregnancy | Postpartum, 6 months after delivery | 
| Body weight post-delivery, 12 months | Participants report on body weight changes after pregnancy | Postpartum, 12 months after delivery | 
| Changes in external loads used in exercise training | Participants report on changes in external loads used in exercise during pregnancy (% of normal loading used pre-pregnancy) | During pregnancy | 
| Changes in external loads used in exercise training, up to week 23 | Participants report on changes in external loads used in exercise during pregnancy (% of normal loading used pre-pregnancy) | During pregnancy, week 23 | 
| Changes in external loads used in exercise training | Participants report on changes in external loads used in exercise after pregnancy (% of normal loading used pre-pregnancy) | Post-delivery: 1 month-, 3months-, 6 months- and 12 months | 
| Changes in exercise volume during pregnancy, up to week 23 | Participants report on changes in exercise volume (number of sessions per week) during pregnancy | During pregnancy, week 23 | 
| Changes in exercise volume during pregnancy, up to week 30 | Participants report on changes in exercise volume (number of sessions per week) during pregnancy | During pregnancy, week 30 | 
| Changes in exercise volume during pregnancy, up to week 40 | Participants report on changes in exercise volume (number of sessions per week) during pregnancy | During pregnancy, week 40 | 
| Changes in exercise volume after pregnancy | Participants report on changes in exercise volume (number of sessions per week) after pregnancy | Post-delivery: 1 month-, 3months-, 6 months- and 12 months | 
| Injuries from exercise during maternity leave | Reporting on any exercise related injuries occuring during maternity leave (up to 12 months post-delivery), choosing from a list of anatomical locations | Post-delivery: 1 month-, 3months-, 6 months- and 12 months | 
| Fertility | Reports on any fertility problems or use of fertility techniques in order to become pregnant | Before pregnancy | 
| Bloodpressure | Bloodpressure measures, and numbers above/below clinical cut offs (having hypo-or hypertension) | At pregnancy week 23, 30 and 40, and at 1 month-, 3months-, 6 months- and 12 months postdelivery, | 
| Symphysis-fundus measure | symphysis fundus measure during pregnancy; as a measure for growth of the fetus, evaluated according to national/international standards | At pregnancy week 23, 30 and 40 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Powerlifting, Pregnancy, Weightlifting, Female athlete, Fertility, Delivery, Maternity leave, Resistance exercise training