Summary
The dual stresses of pregnancy and exercise may create conflicting physiological demands that could adversely affect pregnancy outcome. Specifically, redistribution of uterine blood flow and subsequent fetal hypoxia, hyperthermia and the risk of teratogenic effects, decreased carbohydrate availability for the fetus, and increased uterine contractility with a possible increase in risk for pre-term labour, all pose potential threats to fetal growth and development. However, despite these potential risks, literature dealing with exercise and pregnancy outcome generally shows neutral or somewhat favourable effects.
A few studies have found reduced birthweight, shortened gestation, and less gestational weight gain among women who continue vigorous exercise during pregnancy compared with those who discontinue exercise or who are sedentary. However, most studies find little, if any, association between exercise and birthweight or gestational age. In contrast, studies of occupational physical activity often show an association between heavy physical work and lower birthweight and shorter gestation, especially in women in developing societies whose nutritional status may be compromised. Standing, in particular, may be associated with increased risk of prematurity. Although other outcomes, such as length of labour, type of delivery have not been well studied, there is no indication of any negative associations with exercise.
There is limited evidence which suggests that exercise is related to shorter labour and is a useful treatment for gestational diabetes. Exercise is also associated with fewer symptoms and discomforts of pregnancy. This relationship is temporal in that exercise earlier in pregnancy is associated with fewer symptoms later in pregnancy. The lack of evidence for any harmful effects of exercise on pregnancy outcome indicates that, for healthy, well-nourished women, exercise during pregnancy is safe and subject to few restrictions. This conclusion is reflected in the revised, 1994 recommendations of the American College of Obstetricians and Gynecologists.
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References
Artal R, Gardin K. Historical perspectives. In: Artal R, Wiswell RA, editors. Exercise in pregnancy. Baltimore: Williams and Wilkins, 1986; 1–6
American College of Obstetricians and Gynecologists. Exercise during pregnancy and the postnatal period. Washington, DC: American College of Obstetricians and Gynecologists, 1985
American College of Obstetricans and Gynecologists. Exercise during pregnancy and the postpartum period. Washington, DC: American College of Obstetricians and Gynecologists, 1994
Artal R, Wiswell RA, editors. Exercise in pregnancy. Baltimore: Williams and Wilkins; 1986
Wolfe LA, Ohtake PJ, Mottola MF, et al. Physiological interactions between pregnancy and aerobic exercise. Exerc Sports Sci Rev 1989; 17:295–351
Sady SP, Carpenter MW. Aerobic exercise during pregnancy: special considerations. Sports Med 1989; 7: 357–75
Gorski J. Exercise during pregnancy: maternal and fetal responses. A brief review. Med Sci Sports Exerc 1985; 17: 407–16
McMurray RG, Mottola MF, Wolfe LA, et al. Recent advances in understanding maternal and fetal responses to exercise. Med Sci Sports Exerc 1993; 25: 1305–21
Lotgering FK, Gilbert RD, Longo LD. The interactions of exercise and pregnancy: a review. Am J Obstet Gynecol 1984; 149: 550–68
Wolfe LA, Brenner IKM, Mottola MF. Maternal exercise, fetal well-being and pregnancy outcome. Exerc Sports Sci Rev 1994; 22: 145–94
Rowell LB. Human cardiovascular adjustments to exercise and thermal stress. Physiol Rev 1974; 54: 75–159
Morris N, Osborn S, Wright H, et al. Effective uterine blood flow during exercise in normal and pre-eclamptic pregnancies. Lancet 1956; 271: 481–4
Rauramo I, Forss M. Effect of exercise on maternal hemodynamics and placental blood flow in healthy women. Act Obstet Gynecol Scand 1988; 67: 21–5
Lotgering FK, Gilbert RD, Longo LD. Exercise responses in pregnant sheep. Oxygen consumption, uterine blood flow and blood volume. J Appl Physiol 1983; 55: 834–41
Longo LD, Hewitt CW, Lorjm RHW, et al. To what extent does maternal exercise affect fetal oxygenation and uterine blood flow?. Fed Proc 1978; 37: 905
Chandler KD, Bell AW. Effects of maternal exercise on fetal and maternal respiration and nutrient metabolism in the pregnant ewe. J Dev Physiol 1981; 3: 161–76
Hohimer AR, McKean TA, Bissonnette JM, et al. Maternal exercise reduces myoendometrial blood flow in the pregnant goat. Fed Proc 1982; 41: 1490
Clapp III JF. Acute exercise stress in the pregnant ewe. Am J Obstet Gynecol 1980; 136: 489–94
Curet LB, Orr JA, Rankin JHG, et al. Effect of exercise on cardiac output and distribution of uterine blood flow in pregnant ewes. J Appl Physiol 1976; 40: 725–8
McArdle WD, Katch FI, Katch VL. Exercise physiology: energy, nutrition and human performance. Philadelphia: Lea & Febiger, 1981
Smith DW, Clarren SK, Harvey MA. Hyperthermia as a possible tertogenic agent. J Pediatr 1978; 92: 878–83
Miller P, Smith DW, Shepard TH. Maternal hyperthermia as a possible cause of anencephaly. Lancet 1978; I: 519–21
Shioto K. Induction of neural tube defects and skeletal malformations in mice following brief hyperthermia in utero. Biol Neonate 1988; 53: 86–97
Chernoff GF, Golden JA. Hyperthermia-induced exencephaly in mice: effect of multiple exposures. Teratology 1988; 37: 37–42
Little BB, Chali FE, Snell LM, et al. Is hyperthermia teratogenic in the human?. Am J Perinat 1991; 8: 185–9
Edwards MJ. Hyperthermia as a teratogen: a review of experimental studies. Teratogenesis Carcinog Mutagen 1986; 6: 563–82
Jones RL, Botti JJ, Anderson WM, et al. Thermoregulation during aerobic exercise in pregnancy. Obstet Gynecol 1985; 65: 340–5
Clapp III JF, Wesley M, Sleamaker RH. Thermoregulatory and metabolic responses to jogging prior to and during pregnancy. Med Sci Sports Exerc 1987; 19: 124–30
Clapp III JF. The changing thermal responses to endurance exercise during pregnancy. Am J Obstet Gynecol 1991; 165: 1684–9
Vitug A, Schneider SH, Ruderman NB. Exercise and type I diabetes mellitus. Exerc Sports Sci Rev 1988; 16: 285–304
Wallberg-Henriksson H. Exercise and diabetes mellitus. Exerc Sports Sci Rev 1992; 20: 339–68
Zaidise I, Artal R, Bessman SP. Fuel metabolism in pregnancy. In: Artal R, Wiswell RA, editors. Exercise in pregnancy. Baltimore: Williams & Wilkins, 1986; 6: 83–98
Falk P. Body fuel metabolism and diabetes mellitus in pregnancy. Med Clin North Am 1977; 61: 43–66
Treadway JL, Young JC. Decreased glucose uptake in the fetus after maternal exercise. Med Sci Sports Exerc 1989; 21: 140–5
Artal R. Exercise in pregnancy I. Maternal cardiovascular and metabolic responses in normal pregnancy. Am J Obstet Gynecol 1981; 140: 123–7
McMurray RG, Katz VL, Berry MJ, et al. The effect of pregnancy on metabolic responses during rest, immersion, and aerobic exercise in the water. Am J Obstet Gynecol 1988; 158: 481–6
Clapp III JF. Capeless EL. The changing glycemie response to exercise during pregnancy. Am J Obstet Gynecol 1991; 165: 1678–83
Jovanovic L, Kessler A, Peterson CM. Human maternal and fetal response to graded exercise. J Appl Physiol 1985; 58: 1719–22
Bonen A, Campagna P, Gilchrist L, et al. Substrate and endocrine responses during exercise at selected stages of pregnancy. J Appl Physiol 1992; 73: 134–42
Rosas T, Gonstantino N. Exercise as a treatment modality to maintain normoglycemia in gestational diabetes. J Perinat Neonat Nurs 1992; 6: 14–24
Bung P, Bung C, Artal R, et al. Therapeutic exercise for insulin-requiring gestational diabetics: effects on the fetus — results of a randomized prospective longitudinal study. J Perinatal Med 1993; 21: 125–37
Mulford MI, Jovanovic-Peterson L, Peterson CM. Alternative therapies for the management of gestational diabetes. Clin Perinat 1993; 20: 619–34
Rauramo I, Andersson B, Laatikainen T, et al. Stress hormones and placental steroids in physical exercise during pregnancy. Br J Obstet Gynecol 1982; 89: 921–5
Artal R. Hormonal responses to exercise in pregnancy. In: Artal R, Wiswell RA, editors. Exercise in pregnancy. Baltimore: Williams & Wilkins, 1986; 10: 139–46
Veille JC, Hohimer AR, Burry K, et al. The effect of exercise on uterine activity in the last eight weeks of pregnancy. Am J Obstet Gynecol 1985; 151: 727–30
Durak EP, Jovanovic-Peterson L, Peterson CM. Comparative evaluation of uterine response to exercise on five aerobic machines. Am J Obstet Gynecol 1990; 162: 754–6
Grisso JA, Main DM, Chiu G, et al. Effects of physical activity and life-style factors on uterine contraction frequency. Am J Perinat 1992; 9: 489–92
Mayberry LJ, Smith M, Gill P. Effect of exercise on uterine activity in the patient in preterm labour. J Perinatol 1992; XII: 354–8
Lotgering FK, Gilbert RD, Longo LD. Maternal and fetal responses to exercise during pregnancy. Physiol Rev 1985; 65: 1–36
Dewey KG, McCrory MA. Effects of dieting and physical acativity on pregnancy and lactation. Am J Clin Nutr 1994; 59 Suppl.: 446S–53S
Cohen GC, Prior JC, Vigna Y, et al. Intense exercise during the first two trimesters of unapparent pregnancy. Physician Sports Med 1989; 17: 87–94
Hutchinson PL. Metabolic and circulatory responses to running during pregnancy. Physician Sports Med 1981; 9: 55–61
Korcok M. Pregnant jogger: what arecord! JAMA 1981; 246:201
Dressendorfer RH. Physical training during pregnancy and lactation. Physician Sports Med 1978; 6: 74–80
Ruhling RO, Cameron J, Sibley L. Maintaining aerobic fitness while jogging through a pregnancy: a case study [abstract]. Med Sci Sports Exerc 1981; 13: 93
Pomerance JJ, Gluck L, Lynch VA. Physical fitness in pregnancy: its effect on pregnancy outcome. Am J Obstet Gynecol 1974; 119:867–76
Erkkola R. The physical work capacity of the expectant mother and its effect on pregnancy, labour and the newborn. Int J Gynecol Obstet 1976; 14: 153–9
Dibblee L, Graham TE. A longitudinal study of changes in aerobic fitness, body composition and energy intake in primi-gravid patients. Am J Obstet Gynecol 1983; 147: 908–14
Wong SC, McKenzie DC. Cardiorespiratory fitness during pregnancy and its effect on outcome. Int J Sports Med 1987; 8: 79–83
Beckmann CRB, Beckmann CA. Effect of a structured antepartum exercise program on pregnancy and labor outcome in primiparas. J Reprod Med 1990; 35: 704–9
Collings CA, Curet LB, Mullin JP. Maternal and fetal responses to a maternal aerobic exercise program. Am J Obstet Gynecol 1983; 145: 702–7
Hall DC, Kaufmann DA. Effects of aerobic and strength conditioning on pregnancy outcomes. Am J Obstet Gynecol 1987; 157: 1199–203
Kulpa FJ, White BM, Visscher R. Aerobic exercise in pregnancy. Am J Obstet Gynecol 1987; 156: 1395–403
Lewis RD, Yates CY, Driskell JA. Riboflavin and thiamin status and birth outcome as a function of maternal aerobic exercise. Am J Clin Nutr 1988; 48: 110–6
Varrassi G, Bazzano C, Edwards WT. Effects of physical activity on maternal plasma β-endorphin levels and perception of labour pain. Am J Obstet Gynecol 1989; 180: 707–12
Wallace AM, Boyer DB, Dan A, et al. Aerobic exercise, maternal self-esteem, and physical discomforts during pregnancy. J Nurse Midwifery 1986; 31: 255–62
Zaharieva E. Olympic participation by women. JAMA 1972; 221:992–5
Berkowitz GS, Kelsey JL, Holford TR, et al. Physical activity and the risk of spontaneous preterm delivery. J Reprod Med 1983; 28: 581–8
Botkin C, Driscoll CE. Maternal aerobic exercise: newborn effects. Fam Pract Res J 1991; 11: 387–93
Clapp III JF. The effects of maternal exercise on early pregnancy outcome. Am J Obstet Gynecol 1989; 161: 1453–7
Clapp III JF, Capeless EL. Neonatal morphometrics after endurance exercise during pregnancy. Am J Obstet Gynecol 1990; 163: 1605–11
Clapp III JF, Dickstein S. Endurance exercise and pregnancy outcome. Med Sci Sports Exerc 1984; 16: 556–62
Dale E, Mullinax KM, Bryan DH. Exercise during pregnancy: effects on the fetus. Can J Appl Sport Sci 1982; 7: 98–103
Erdelyi GJ. Gynecological survey of female athletes. J Sports Med Phys Fitness 1962; 2: 174–9
Hatch MC, Shu XO, McLean DE, et al. Maternal exercise during pregnancy, physical fitness and fetal growth. Am J Epidemiol 1993; 137: 1105–14
Jarrett JC, Spellacy WN. Jogging during pregnancy: an improved outcome?. Obstet Gynecol 1983; 61: 705–9
Marcoux S, Brisson J, Fabia J. The effect of lesiure time physical activity on the risk of pre-eclampsia and gestational hypertension. J Epidemiol Community Health 1989; 43: 147–52
Rice PL, Fort IL. The relationship of maternal exercise on labour, delivery and health of the newborn. J Sports Med Phys Fitness 1991; 31: 95–9
Rose NC, Haddow JE, Palomake GE, et al. Self-rated physical activity level during the second trimester and pregnancy outcome. Obstet Gynecol 1991; 78: 1078–80
Schramm WF, Stockbauer JW, Hoffman HJ. Exercise, employment, other daily activities, and adverse pregnancy outcomes. Am J Epidemiol 1996; 143: 211–8
Sternfeld B, Quesenberry CPJ, Eskenazi B, et al. Exercise during pregnancy and pregnancy outcome. Med Sci Sports Exerc 1995; 27: 634–40
Lokey EA, Tran ZV, Wells CL, et al. Effects of physical exercise on pregnancy outcomes: a meta-analytic review. Med Sci Sports Exerc 1991; 23: 1234–9
Chamberlain G. Pregnant women at work. Lancet 1983; I: 228–30
Gofin J. The effect on birthweight of employment during pregnancy. J Biosoc Sci 1979; 11: 259–67
Illsley R, Billewicz WZ. Prematurity and paid work during pregnancy. Br J Prev Soc Med 1953; 8: 153–6
Marbury MC, Linn S, Monson RR, et al. Work and pregnancy. J Occup Med 1984; 26: 415–21
Naeye RL, Peters EC. Working during pregnancy: effects on the fetus. Pediatrics 1982; 69: 724–9
Stengel B, Saurel-Cubizolles MJ, Kaminski M. Healthy worker effect and pregnancy: role of adverse obstetric history and social characteristics. J Epidemiol Community Health 1987; 41:312–20
Stewart A. A note on the obstetric effects of work during pregnancy. Br J Prev Soc Med 1955; 9: 159–61
Murphy JF, Dauncey M, Newcombe R. Employment in pregnancy: prevalence, maternal characteristics, perinatal outcome. Lancet 1984; I: 1163–6
McDonald AD, McDonald JC, Armstrong B, et al. Prematurity and work in pregnancy. Br J Ind Med 1988; 45: 56–62
Armstrong BG, Nolin AD, McDonald AD. Work in pregnancy and birth weight for gestational age. Br J Ind Med 1989; 46: 196–9
Saurel-Cubizolles MJ, Kaminski M. Pregnant women’s working conditions and their changes during pregnancy: a national study in France. Br J Ind Med 1987; 44: 236–43
Meyer BA, Daling JR. Activity level of mother’s usual occupation and low infant birth weight. J Occup Med 1985; 27: 841–6
Rabkin CS, Anderson HR, Bland JM, et al. Maternal activity and birthweight: a prospective, population-based study. Am J Epidemiol 1990; 131:522–31
Ramirez G, Grimes RM, Annegers JF, et al. Occupational physical activity and other risk factors for preterm birth among US army primigravidas. Am J Public Health 1990; 80: 728–9
Teitelman AM, Welch LS, Hellenbrand KG, et al. Effect of maternal work activity on preterm birth and low birth weight. Am J Epidemiol 1990; 131: 104–13
Mamelle N, Laumon B, Lazar P. Prematurity and occupational activity during pregnancy. Am J Epidemiol 1984; 119: 309–22
Mamelle N, Munoz F. Occupational working conditions and preterm birth: a reliable scoring system. Am J Epidemiol 1987; 125: 150–2
Ahlborg, Bodin L, Hogstedt C. Heavy lifting during pregnancy — a hazard to the fetus? A prospective study. Int J Epidemiol 1990; 19: 90–7
Klebanoff MA, Shiono PH, Carey JC. The effect of physical activity during pregnancy on preterm delivery and birth weight. Am J Obstet Gynecol 1990; 163: 1450–6
Klebanoff MA, Shiono PH, Roads GG. Outcomes of pregnancy in a national sample of resident physicians. N Engl J Med 1990; 323: 1040–5
Zuckerman BS, Frank DA, Hingson R, et al. Impact of maternal work outside the home during pregnancy on neonatal outcome. Pediatrics 1986; 77: 459–63
Schneider KTM, Bollinger A, Huch A, et al. The oscillating ‘vena cava syndrome’ during quiet standing: an unexpected observation in later pregnancy. Br J Obstet Gynecol 1984; 91: 766–80
Barnes DL, Adair LS, Popkin BM. Women’s physical activity and pregnancy outcome: a longitudinal analysis from the Philippines. Int J Epidemiol 1991; 20: 162–72
Kumar R, Kumar V. Effect of physical work during pregnancy on birth weight. Ind J Ped 1986; 54: 805–9
Launer LJ, Villar J, Kestler E, et al. The effect of maternal work on fetal growth and duration of pregnancy: a prospective study. Br J Obstet Gynecol 1990; 97: 62–70
Manshande JP, Eeckels R, Manshande-Desmet V, et al. Rest versus heavy work during the last weeks of pregnancy. Br J Obstet Gynecol 1987; 94: 1059–67
Tafari N, Naeye RL, Gobezie A. Effects of maternal undernutrition and heavy physical work during pregnancy on birth weight. Br J Obstet Gynecol 1980; 87: 222–6
Clapp III JF. The course of labor after endurance exercise. Am J Obstet Gynecol 1990; 163: 1799–805
Eskenazi B, Fenster L, Wright S, et al. Physical exertion as a risk factor for spontaneous abortion. Epidemiol 1994; 5:6–13
Blackburn MW, Calloway DB. Basal metabolic rate and work energy expenditure of mature, pregnant women. J Am Diet Assoc 1976; 69: 24–8
Nagy LE, King JC. Energy expenditure of pregnant women at rest or walking self-paced. Am J Clin Nutr 1983; 38: 369–76
Wolfe LA, Ohtake PJ, George KP, et al. Aerobic training effects on exercise hemodynamics during pregnancy [abstract]. Med Sci Sports Exerc 1990; 22: S28
Wolfe LA, Walker RM, Bonen A, et al. Effects of pregnancy and chronic exercise on respiratory response to graded exercise. J Appl Physiol 1994; 76: 1928–36
Brownlee S. Moms in the fast lane. Physician Sports Med 1988; 57–60
Clapp III JF, Capeless E. The VO2max of recreational athletes before and after pregnancy. Med Sci Sports Exerc 1991; 23: 1128–33
Sibley L, Ruhling RO, Cameron-Foster J, et al. Swimming and physical fitness during pregnancy. J Nurse Midwifery 1981; 26: 3–12
Wallace AM, Engstrom JL. The effects of aerobic exercise on the pregnant woman, fetus, and pregnancy outcome. J Nurse Midwifery 1987; 32: 277–90
Brown DR. Exercise, fitness and mental health. In: Bouchard C, Shephard RJ, Stephens T, et al., editors. Exercise, fitness and health: a consensus of current knowledge. Champaign (IL): Human Kinetics Books, 1990; 53: 607–26
Heckman JD, Sassard R. Musculoskeletal considerations in pregnancy. J Bone Joint Surg 1994; 76-A: 1720–30
Artal R, Friedman MJ, McNitt-Gray JL. Orthopedic problems in pregnancy. Physician Sports Med 1990; 18: 93–105
Wolfe LA. Pregnancy. In: Skinner JS, editor. Exercise testing and exercise prescription for special cases. Philadelphia: Lea & Febiger, 1993; 21: 363–85
Andrews CM, O’Neill LM. Use of pelvic tilt exercise for ligament pain relief. J Nurse Midwifery 1994; 39: 370–4
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Sternfeld, B. Physical Activity and Pregnancy Outcome. Sports Med. 23, 33–47 (1997). https://doi.org/10.2165/00007256-199723010-00004
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DOI: https://doi.org/10.2165/00007256-199723010-00004