Exercise and Pregnancy Flashcards by William Tran

What are some endocrine changes with pregnancy?

Gonadotropin
Progesterone
Estrogens

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What are some cardiovascular system changes during pregnancy?

Uterine Blood Flow

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What are some renal changes during pregnancy?

Renal Blood Flow
Glomerular Filtration Rate

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What are some Respiration and Acid-Base Balances during pregnancy?

Increased VE
Reduced PaCO2/Respiratory Alkalosis

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What does increased estrogen during pregnancy do?

cardiovascular

Decreased peripheral vascular resistance
Decreased mean arterial pressure
Activation of the Renin-Angiotensin-Aldosterone System
Na+ Retention
Decreased Na+H2O (due to stimulataneous increase ADH and thirst)
Decreased Osmolatity
Increased Blood Volume

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What does increased Estrogen and progesterone during pregnancy lead to?

Increased drive to breathe
Increased Ventilation
Decreased PCO2

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What does a decreased osmotic threshold for thirst and AVP release lead to in pregnancy?

H2O retention
Decreased Na:H2O
Decreased Osmolality

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What changes occur to Autonomic control in pregnancy?

Altered skeletal muscle autonomic acitvity
Increased Burst Incidence

burst incidence is sympathetic activity / 100 heart beats

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Describe the Cardiovagal Baroreflex Gain in pregnacy

Baroreflex control of cardiovascular system reset:
- Reset Downward in pregnant women
- Favoring shorter R-R intervals
- No significant change to SBP

r-r interval shorter = faster HR

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Describe the central ventilatory chemoreflex in pregnancy

Response to hyperoxic hypercapnia in late pregnancy
Increase in subthreshold VE
Decrease central chemoreflex ventilatory recruitment threshold for CO2
Increase in central chemoreflex sensitivity
Chemical control of breathing altered

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Describe the increase in progesterone and estrogen effect on ventilatory control

Increase in CNS progesterone receptors
Increase Neutral drive to breathe
Increase in pulmonary ventilation

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What does the increase in pulmonary ventilation caused by the increase in estrogen and progesterone in pregnancy do?

Decreased
- H+ Blood
- Brain extracellular fluid
- Threshold of Chemoreflex
Increased
- Sensitivity of Chemoreflex

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What is the hypothesis of ventilatory control during human pregnancy?

Increased Progesterone and Estrogen
- Increase CNS Progesterone Receptor
- Increased Neutral drive to breathe
- Increase ventilation
- Increase PaO2 / Decrease PaCO2
- Decreased H+ blood / Brain extracellular fluid
- Decrease threshold / increase sensitivity of central & peripheral chemoreflex response to CO2
- Increased ventilation

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What does the mother transport and exchange with the fetus during pregnancy?

Glucose
-other Nutrients and Substrates
Hormone Precursors

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What does the Fetus exchange and transport with the mother during pregnancy?

Waste Products (CO2, Heat, and Metabolic Byproducts)

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What is affected the most by the increased metabolic demands for exercise?

The cardiovascular system

What is a major factor for the cardiovascular system being affected by the metabolic demand of exercise?

The Dissipation of the excess heat generated by exercise

What happens to heat production during pregnancy? Why?

Increases
- Basal metabolic rate increases

What is directly related to the increase in body temperature during exercise?

The exercise intensity

How fast does the core temperature of non-pregnant women rise during moderate-intensity exercise?

1.5C during first 30 minutes
Plateau’s after another 30 mins

What is critical to heat balance?

Maintenance of euhydration
Maintenance of blood volume

How does the cardiovascular system aid in heat balance?

Conductance of heat from core to periphery

What happens during very high-intensity exercise in regards to core temperature?

Core temperature continues to rise

What did a 1.5C rise in core temperature during embryogenesis in animal studies cause?

Major congenital malformations

What did human studies on hyperthermia during pregnancy suggest?

- Excess of 39C during first 45-60 days of gestation may be teratogenic in humans.

What is teratogenic?

- Disruption of the development of the embryo or fetus

During pregnancy, under what conditions should exercise not be conducted?

- Hemodynamically significant heart disease - Restrictive lung disease - Incompetent Cervix - Multiple gestation at risk for premature labour - Persistent second or third trimester bleeding - Placenta praevia after 26 weeks gestation - Premature labour during current pregnancy - Ruptured membranes - Pregnancy induced hypertension

During pregnancy, under what conditions should exercise be conducted cautiously?

- Severe Anaemia - Unevaluated maternal cardiac arrhythmia - Chronic Bronchitis - Poorly controlled type 1 diabetes - Extreme morbid obesity - Extreme underweight - History of extremely sedentary lifestyle - Intrauterine growth restriction in current pregnancy - Poorly controlled hypertension / pre-eclampsia - Orthopaedic limitations - Poorly controlled seizure disorder - Poorly controlled thyroid disease - Heavy Smoker

What are some warning signs of terminating exercise while pregnant?

- Vaginal Bleeding - Dyspnoea Before Exertion - Dizziness - Headache - Chest Pain - Muscle Weakness - Calf Pain or Swelling (thrombophlebitis) - Preterm Labour - Decreased Fetal Movement - Amniotic Fluid Leakage

What are some hypothetical risks of exercising while pregnant?

- Blood flow to the uterus leading to fetal hypoxia - Fetal hyperthermia - Reduced carbohydrate availability to the fetus - Possibility of miscarriage

Potential risk of aerobic exercise for the mother during pregnancy?

- Acute hypoglycemia - Chronic Fatigue - Musculoskeletal Injury

What are the possible benefits of aerobic exercise for the mother during pregnancy?

- Increased Energy Level - Reduced CV Stress - Prevention of Excessive Weight Gain - Facilitation of Labour - Faster Recovery from Labour - Prevention of Lower Back Pain - Prevention of Gestational Diabetes

What are some hypothetical risks of aerobic exercise for the fetus?

- Acute hypoxia - Acute hyperthermia - Reduced Glucose Availability - Miscarriage in 1st trimester - Premature Labour - Altered Fetal Development - Shortened Gestation - Reduced Birth Weight

What are the possible benefits of aerobic exercise for the fetus?

- Fewer complications of a difficult labor

What are the current guidelines for physical activity during pregnancy?

- 150min/wk - >30 mins exercise on most days if not all days

What are the guidelines for physical activity during pregnancy based on?

- Improved maternal-fetal health outcomes - Reduced risk of gestational diabetes - Caesarean sections - Large for gestational age babies

What are the altitude recommendations for physical activity during pregnancy?

- 1800m for lowlanders

Why are there guidelines for restricting physical activity at altitudes for pregnant individuals?

- Critical reductions in oxygen delivery to the fetus - increased maternal oxygen demand

What are the current deficits in understanding about physical activity at altitude for pregnant women?

- Physical activity patterns in pregnant women living at altitude - Physiological responses in pregnant women to physical activity in mountainous regions. - The linkages between physical activity patterns and pregnancy outcomes in active high-altitude natives.