Pregnancy

Question 1

1. Describe the problem

Answer 1

• Should I exercise during my pregnancy?

Question 2

2. Recognize the key issues

Answer 2

Goals

• Identify boundaries
• Identify relevant information
• Become more aware
• Recognizing the information you need to “solve” this problem
• Notion of potential harm to baby
• Fear of undertaking exercise due to other physiological changes
• Uncertainty regarding which type of activity they should engage in
• Access to facilities
• Psychological state

Question 3

3. Consider the elements of the problem

Answer 3

GOAL

• Examine underlying issues
• Address: who, what, where, when, why, how?
• What concerns might a woman have exercising while pregnant?
• Or why might people be hesitant to prescribe exercise to a pregnant woman?

Question 4

Asthma Effects

Answer 4

• Increase risk of pre-eclampsia
• Poor weight gain of fetus
• Pre-term birth
• Cesarean birth

Question 5

Depression Effects

Answer 5

• Makes it difficult for woman to care for herself and her baby
• Risk factor for post-partum depression

Question 6

Eating Disorder Effects

Answer 6

• Could be exacerbated due to changes in body image during pregnancy
• Increased risk of
  
  • birth defects
  • preterm birth
• Correlated to depression

Question 7

Diabetes

Answer 7

• Harm to fetus
• Worsen pre-existing diabetes

Question 8

High Blood Pressure Effects

Answer 8

• Increased risk of
  
  • Pre-eclampsia
  • Placental abruption
  • Preterm birth
  • Low birth weight
  • Small vessel rupture

Question 9

Migraine Effects

Answer 9

• Caution with certain medications
• Symptoms generally improve during pregnancy

Question 10

Overweight/Obesity Effects

Answer 10

• Increased risk of
  
  • pre-eclampsia
  • preterm delivery
  • other complications
• Psychological stress due to rapid weight gain

Question 11

PHYSIOLOGICAL CHANGES

Cardiovascular

Answer 11

Prior to Week 12

• Cardiac output increases 20-30%
• HR increase by 15%
• Stroke volume increase by 25-30%

• Higher RPE
• HR max achieved sooner, so endurance is compromised

Question 12

PHYSIOLOGICAL CHANGES

Hematology

Answer 12

• Plasma volume increases 50%
• RBC increase 20-30%

Question 13

PHYSIOLOGICAL CHANGES

Respiratory

Answer 13

• Respiratory rate remains quite stable
• Tidal volume increases
  
  • Increases vital capacity
  • Reduces residual volume

Thus O₂consumption rises 20%

• Splinting of diaphragm
• Shortness of breath

Question 14

PHYSIOLOGICAL CHANGES

Metabolic

Answer 14

• BMR increase
• Energy increases in second and third trimester
• Active energy expenditure falls

Question 15

PHYSIOLOGICAL CHANGES

Musculoskeletal

Answer 15

• Back pain and pubic symphsis due to ligamental laxity

Question 16

SOGC Recommendations (5)

Answer 16

1. Women without contraindications encouraged to do aerobic & strength training
2. Maintain fitness, do not try to achieve peak fitness
3. Choose activities that minimize loss of balance or fetal trauma
4. Adverse pregnancy or neonatal outcomes not increased for women who exercise
5. Moderate exercise during lactation will not affect quantity of composition of breast milk

Question 17

Benefits of Exercising while Pregnant

Answer 17

1. No real evidence showing adverse effects on the baby as a result of mothers who exercise during pregnancy
2. Decreased risk of pre-eclampsia
3. Reduced risk of gestational diabetes
4. Improved posture and apperance
5. Improved sleep
6. Less water retention
7. Positive outcomes during Cesarean birth
   * reduced swelling, leg cramps, shortness of breath