Pregnancy Flashcards
1
Q
What CV changes are made during pregnancy?
A
Heart adapts to the increased demands via enlarging the uterus and foetus
2
Q
How much does the resting HR increase by?
A
25%
3
Q
How much does the HR increase at each trimester?
A
5-10 bpm first trimester
15 bpm second and third trimester
4
Q
What happens in the 2nd and 3rd trimester
A
- increased oestrogen and chronic gonadotropin stimulates the HR increase
- SNS activation sedentary to maintain BP
5
Q
how much does Oestrogen and progesterone decrease peripheral vascular
A
20%, and thus must increase to maintain BP
6
Q
How much does SV increase?
A
25%
7
Q
Why does the increase in blood volume occur?
A
progesterone increase production if Renin –> sodium reabsorbed –> kidneys reabsorb fluid to the plasma volume
8
Q
Why is there a LV size increase due to maternal hormones?
A
- Oestrogen stimulates the myocardial hypertrophy, increasing contractility
- increase blood volume stimulates some myocardial hypertrophy
- growth is eccentric vs. concentric
9
Q
What is the percentage the SV increase by in the 1st trimester?
A
10%
10
Q
What percentage does blood volume increase in?
A
35-50%
11
Q
what is the offset of BP?
A
increased volume offset by an increase in venous capacitance = blood pressure is not increased
12
Q
What does the offset of BP cause
A
problems with postural hypertension
13
Q
What helps to prevent hyperthermia during exercise?
A
increase in vasodilation at the skin which increases heat loss
14
Q
Why can pregnant women become anaemic?
A
> increase in plasma volume vs red blood cells (increases 20%)
15
Q
What is the Hb in pre-pregnancy and in the 3rd trimester
A
150g. L-1
120g. L-1
16
Q
Why may blood clotting increase
A
relaxation of the blood vessel walls with hormonal changes (to keep BP normal after increase in blood volume) from the pressure of the uterus of the interior vena cava
17
Q
Why may pregnant women develop varicose veins?
A
exercise assists the blood flow in the legs and feet and helps prevent or minimise these problems
18
Q
What are the pulmonary adaptations when pregnant?
A
- elevation of the diaphragm
- uterine enlargement elevated the diaphragm up to 4cm
19
Q
How much does this reduce reserve volume
A
25%
20
Q
why does the rib cage flair outwards?
A
as it reduces the filling effectiveness
21
Q
Why is the work of breathing increase at rate and during exercise?
A
due to the diaphragm resistance
22
Q
What happens to the respiratory physiological when one is pregnant?
A
- reduction in total lung capacity occurs
- inspirational capacity remains the same
- reserve volume gets squeezed as a consequence
23
Q
What does an increased plasma progesterone mean?
A
stimulate respiratory centre to be more sensitive to CO2
24
Q
What occurs with hyperventilation?
A
–> resting hypocapnia (decrease PCO2) –> maternal alkalosis and increased PO2
25
What does the maternal alkalosis do?
protect against foetal acidosis
26
when does increase in performance in endurance activities occur?
first 12-15week, before the increase in BW and uterine size reduces or stops involvement in competitive athletics
27
What does the increase in performance result from
increased blood volume and RBC mass
28
After the 2nd trimester what happens to the PVO2
- increase O2 demand of foetus
| - increase BM
29
How much does resting O2 increase by?
15-30%
30
What are the reasons behind this?
- enlarging uterus and growing foetus
- increased breathing rate
- Uterine contents are subtracted maternal increased by ~ 4%
31
Why is there an major increase in CHO usage?
foetal demands of glucose is large
32
Why is there an increase in maternal insulin productions
- increase oestrogen causes B-cells hyperplasia in the pancreas
33
What does increased insulin production cause?
hyperinsulinemia
34
what increases the fat deposition within the mother?
stimulation of lipogenesis
35
what percentage of women have gestational diabetes (GDM)
2-3%
36
what does human placental lactose do?
counters insulin effects
37
reduces CHO use by mother....
leaves more CHO for foetus
38
what does mum have to rely on more?
Body fat --> lipolysis --> resulting in reduced adiposity
39
what percentage of mums with GDM become type II diabetic post 4yrs delivery
60%
40
Why is there increased birth weight?
CHO foetus increases birth weight (mores fat)
41
What can cause birthing problems?
disproportionate growth of head and shoulders
42
If the baby has increased insulin production to counter mothers high glucose, what does this mean?
- insulin is the growth promoter
| - baby at risk of low blood glucose post partum
43
What can maternal exercise help with?
lower blood glucose (less insulin required) and increase insulin sensitivity
44
What is the incidence rate of preeclampsia
3-7%
45
What preeclampsia associated with?
- hypertriglyceridemia
- insulin resistance
- SNS overactivity
- Atherosclerotic lesions in placenta
- increased leptin
- increases risk of becoming hypertensive (20% vs. 2%)
46
is it true that preeclampsia is reported in active women?
Yes
47
By what percentage?
35-70%
48
Why can exercise help preeclampsia?
- reduced levels of C-reactive PRO --> stops endothelium producing NO (nitric oxide) ---> less vasodilation
49
What does an increase rate of NO production cause
vasodilation
50
What is the relationship between decreased leptin and hypertension?
leptin can contribute to hypertension because of its role of stimulating the body to burn fat
51
How can leptin lead to hypertension?
stimulates SNS to burn fat- but this increases BP and leads to hypertension
52
What can increase progesterone (smooth muscle relaxant) and increase uterine size lead to?
- constipation
- slowing of gastrointestinal motility
- relaxation of the lower oesophageal sphincter
53
what can the relaxation of the oesophageal sphincter lead to?
increased gastric reflex --> heartburn
54
what happens to the anterior displacement of enlarging uterus during pregnancy?
- change in CoG
| - exaggerates normal lumber lordosis
55
What can the increase in hormone levels more so progesterone do?
- ligament and joint laxity
| - pelvic area susceptible
56
What occurs when the breasts enlarge?
- CoG moves interiorly and anteriorly
| - increased weight contributes to upper back and shoulder pain
57
What is diastatic recti?
separation of abdominal muscles from the midline point
58
why does diastatic recti occur?
enlarging uterus
59
What is the incidence rate for diastasis recti?
~20-90%
60
what is the average weight gain for a pregnant women?
~ 12kg
61
What elements does this weight gain full under and by how much?
- Fetus 3.5kg
- Uterus 1kg
- placenta 0.5kg
- Amniotic fluid 0.8kg
- breast enlargement 1.5kg
- maternal fluid gain 2.0kg
- maternal fat 2.5kg
62
what are the effect on the foetus during acute exercise?
placental blood flow
63
How can the uteroplacental blood flow change with exercise?
flow to the placenta remains unchanged, but flow of blood in the uterus is reduced
64
Why might foetal O2 supply not be changed or slightly reduced?
increased placental a-vo2 difference --> where the baby extracts more
65
How quickly does the effects of acute exercise on a pregnant women return back to baseline?
20 minutes
66
What does Foetal Tachycardia at >160bpm mean?
The foetal HR increases when the mum is exercises, and circulating maternal catecholamines during exercise
67
What other effect can foetal tachycardia have?
increase maternal core temperature
68
What is the HR for the classification of foetal bradycardia
<120bpm
69
when in foetal bradycardia, what is the response to hypoxia?
reduce foetal O2 demands
70
When is hypoxia and foetal bradycardia seen?
in long duration exercise and post exercise
71
What is another effect on the foetus during acute exercise?
hyperthermia
72
What is the foetal temperature?
5 degrees (F)
73
Why is it higher than maternal temperature?
baby loses heat via this gradient
74
What is there no evidence for due to as increased sweating, enhanced peripheral vasodilation col the mothers core temperature
increased maternal temp during exercise reduce heat gradient, plus reduced uterine blood flow meaning less blood is available to moreve heat, causing foetal hyperthermia and damage
75
Why have birth weight findings for effects of chronic exercise been inconsistent?
feotoplacental growth is higher and lower in active mothers
76
What did Clapp et al 2002, find with chronic exercise and foetal effects?
mothers who continue to perform a high volume of exercise in mid to late pregnancy, have thinner and lighter babies
77
What can increase norepinephrine and prostaglandin output during exercise stimulate?
uterine activity and premature labour --> however no real evidence to support this
78
What did the American College State with absolute contraindications to exercise prior to starting?
- sig. heart disease
- restrictive lung disease
- incompetent cervis
- known risk of premature labour
- persistent 2nd or 3rd trimester bleeding
- Placenta preview after 26 weeks
- ruptured membranes
- preeclampsia
79
What should occur if women with certain other medical or obstetric conditions do?
evaluated carefully in order to ermine whether an exercise program is appropriate
80
What did the American College find with relative contractions to exercise prior to starting?
- severe anemia
- unevaluated maternal cardiac dysrhythmias
- chronic bronchitis
- poor controlled type I diabetes
- extreme morbid obesity
- extreme underweight
- history of sedentary lifestyle
81
What other relative contradictions to exercise prior to starting involve?
- growth restriction
- poorly controlled hypertension
- Orthopaedic libations
- poorly controlled seizures
- poorly controlled hyperthyroidism
- heavy smoker
82
If a pregnant individual wants to do exercise what consent form do they need to fill out?
PARmed - X for pregnancy
83
Under what circumstances must the individual stop exercise and seek help?
- excessive shortness of breath
- chest pain or palpitations
- presynoscpe or dizziness
- painful uterine contractions or preterm labour
- leakage of amniotic fluid
- vaginal bleeding
- excessive fatigue
- Abdominal pain, particularly in back or pubic area
- pelvic girdle pain
- reduced foetal movement
- dyspnoea before exertion
- headache
- muscle weakness
- calf pain or swelling
84
Do exercise capabilities decline in pregnancy?
Yes
85
How can they decline?
Hyperthermia and BP
86
What can be addressed if suffering with hyperthermia?
- adequate hydration
- appropriate clothing
- environmental temperature
87
What temperature should a pregnant women no exceed to?
37.8 degree/C
88
What temperature should swimming pool water not exceed to?
32 degree/ C
89
What can be done to facilitate the high BP better?
rise from the flow gradually to avoid an abrupt drop in BP
90
What specific considerations should be taken in the 1st trimester?
overheating can impart development of the baby CNS --> neural tube defects in first 28 days of pregnancy
91
What should be considered in the 2nd and 3rd trimester?
avoid exercise in supine position or right side
92
Why must women avoid exercise in supine position or right side?
decreased Q in most pregnant women, and the position compresses the vena cava --> effect on the venous return
93
What sports should be avoided incase risk of mild abdominal trauma occurs?
horseback riding, skiing, water skiing etc.
94
What other two things should be avioded?
- hyperbaric (diving)
| - hyperthermia environments
95
What are the PA recommendations by the ACOG, 2002 & RCOG, 2006?
moderate exercise for > 30min days/week
96
is participants in competitive sports acceptable and up till which time period?
- Yes
| - first 15 weeks
97
At which trimester should the intensity and volume be maintained if not reduced?
3rd
98
what occurs in a weight supported exercise e.g. cycling
O2 count is the same
99
What happens in a weight bearing exercise e.g. jogging
increase in O2 cost proportional to increase BM
100
is blood pH higher than PCO2 lower opposed to non pregnant?
Yes
101
why is CHO delivery to muscles reduced?
- reduced liver glycogen stores
- reduced sympathodrenl activation reduces catecholamine production reducing delivery of CHO to muscles
- foetal demands CHO
102
What can exercise help control?
blood glucose levels in those with gestational diabetes
103
How much aerobic (low impact activities, stationary cycling, swimming, walking and low impact aerobics) can be done?
minimum of 3, but preferably all days of the week --> must avoid possibly muscloskeletal injury risk i.e plyometric
104
How much moderate aerobic activity should be achieved per week?
150mins
105
At what intensity should they work at?
HR 120-160, 40-60-90% HRmax, RPE 12-14
106
Why are the modified HR target zones for mod-intensity aerobic exercise in pregnancy?
<20yrs --> 140-155
20-29 --> 135 - 150
30-39 --> 130 - 145
>40 ---> 125 - 140
107
What loads can be done with resistance training?
light to moderate
108
What should be focused on the greatest?
muscle endurace (12-15reps)
109
What RT exercises should be avoided, especially in 3rd trimester?
ones requiring vaxsalva's manoeuvre e.g. weight lifting
110
what stretches should be done?
ones that are not taken to the max ROM
111
why is it important not to choose exercises that don't require too much balance?
as the CoG and co-ordination has changed
112
what can cause damage to the connective tissue?
jumping, jarring motions, rapid changes of direction
113
what method of cool-down should be done?
- gentle stationary stretching
| - low intensity exercise (walking)
114
How many additional kcal have to be increase at each trimester?
100kcal. d 1st
300kcal. d 2nd
450kcal. d 3rd
115
What is a solution if the weight gain is not sufficient?
reduce time of intensity of exercise
116
What does training induce and help with hypothetically?
beta-endorphins
117
How many week postpartum does the physiological and morphologic changes persist?
2-6 weeks
118
if delivery was complications, a medical caregiver should be consulted before resuming PA, usually after how many weeks the first postpartum?
6-8 weeks
119
how long does it take to return to pre-pregnancy routines if it was a caesarean birth?
10-12 weeks
120
How long does it take for changes of ligaments to rectify?
3 months
121
why exercise post pregnancy?
- return to pre-pregnancy body mass
| - Women who breastfeed and exercise don't loos excess fat more quickly as they increase EI
122
What RPE scale does not increase breast milk La accumulation?
12 RPE
123
How much does Peak VO2 increase after giving back and back to training?
10-25%
124
What recommendation of exercise did (CDC-ASCM) in sports medicine (Artal et al., 2003)?
accumulation of 30minutes or more over moderate intensity PA - preferably on all days of the week
125
How did Artal et al (2003) define moderate intensity on the METS?
3-5
126
What did CDC-ASCM recognise in intense exercise performed 20-60min 3-5 days/wk?
results in higher levels of physical fitness
127
What musculoskeletal changes occur during pregnancy?
potential to effect musculoskeletal system to rest and during exercise - most obvious weight gain.
128
What can increase in weight gain cause?
increased forces across joints such as hips and knees by up to 100% during weight bearing exercises such as running
129
What can large forces cause to the normal joints?
discomfort and increase damage to arthritic or previously unstable joints
130
What causes the low back pain in pregnant women and at what percentage?
lumber lordosis - contributes to high prevalence (50%)
131
what can the increase in ligament laxity be linked with?
influence of increased levels of oestrogen and relaxin
132
What was found with the interaction of uterine activity in exercising pregnant women?
minimal or no changes during last 8-wks of pregnancy
133
What has PA been associated with, with the uterine?
increase in uterine contractions
134
In non-weight bearing exercises during pregnancy what is there a preferable intake for anaerobic components of this activity type?
carbohydrates (CHO)
135
What are the profound alternates in maternal haemodynamics
increase blood volume, HR, SV and Q
| decrease in systemic vascular resistance
136
what's the percentage of Q during mid-pregnancy?
30-50%
137
How much does most studies show SV increases by the end of the 1st trimester?
10%
138
How much does the HR increase by in the 2nd and 3rd trimester?
20%
139
how much does mean arterial pressure decrease by in the 2nd trimester?
5-10mmHg
140
what is the decreased mean arterial pressure a result of?
increased uterine vasculature, uteroplacental circulation
| decrease in vascular restriction from skin and kidneys
141
Haemodynamic changes appear to establish circulatory reserve to provide....
Nurtrients and O2 to both mother and foetus at rest and during moderate exercise
142
during the 1st trimester, what happens to the supine position?
relative obstruction to venous return decreasing Q
143
What responses have been found in non weight bearing and weight bearing exercises?
Blunted and normal response
144
Why does the minute ventilation increase to ~ 50% in pregnant women?
due to increase in tidal volume
145
How much does arterial O2 increase by?
106-108mmHg increase in arterial O2
146
How much does the arterial O2 mean decrease by for the 3rd trimester?
101-106 mmHg
147
What happens to the physiological dead space in pregnant women?
remains unchanged
148
What happens to the O2 during treadmill aerobic exercise performance?
decreased O2 availability
149
What happens with the workload and maximum performance during o2 treadmill aerobic exercise?
decreases
150
What was found in pregnant women that are already classified as fit with their workload, maximum performance and acid base balance?
No change
151
What is the CV most effected by in thermoregulation control?
increased metabolic demands of exercise
152
What thermoregulation factors are elevated above baseline in pregnant women?
basal metabolic rate --> heat production
153
What is the body temperature directly related to when exercising?
intensity
154
during moderate exercise in a non-pregnant women, how much does the temperate increase in 30 minutes?
1. 5 degree (Celsius)
| - reaches plateau if exercise is continued > than 30 minutes
155
Humid conditions, or during very high intensity exercise what happens to the core?
continues to rise
156
What is critical to control the heat balance?
blood volume
157
How much is the foetal body core temperature then the maternal temperature?
~ 1 degrees (celcius)
158
How is hyperthermia defined within pregnant women?
excess of 39 degrees (Celsius) during the first 45-60 days
159
What was suggested to be an ideal exercise for pregnant women during immersion and shifting blood volume?
swimming
160
What can occur during obstetric events, transient hypoxia to the foetus? and what do these act as?
fetal tachycardia and increase in blood pressure
| - acting as a protective mechanism --> allowing foetus to facilitate transfer of O2 and decrease CO2 across the placenta
161
What have most studies shown for a minimum of moderate intensity exercise, how does this effect the foetal HR?
increase by 10-30 bpm over baseline during or after maternal exercise
162
When will bradycardia occur with the foetal HR?
reported to occur at a frequency of 8.9%
163
However, what are the mechanisms leading to foetal bradycardia?
vagal reflex, cord compression or fetal head mal-position
164
What has it been found for mothers who have occupations requiring strains or repetitive and strenous actions?
deliver earlier and have a tendency to have small for gestational age infants
- however, other reports have failed to confirm this
165
What was found between physical active and fit pregnant women compared to sedentary?
weight is not effect by exercise in women who have adequate energy intake
166
What exercises should be avoided when pregnant?
- scuba diving (decompression)
- supine positioning
- exercises at risk of falling
167
in addition to aerobic activities, activities that promote musculoskeletal fitness should be....?
part of the overall exercise prescription
168
What happened in a study in the Artal paper, where multiple muscle groups were strength trained, and the occurrence of the foetal HR from 28 and 38 weeks gestation?
remained unchanged
169
What is the recommended intensity and max HR by ACSM?
- 60-90%
| - 50-85%
170
What is the recommended intensity and max HR by ACSM for those that don't do regular exercise?
- 60-70%
| - 50-60%
171
In the royal college of obsteririans and gynaecologist, what can hormonal changes occur?
joint laxity and hyper mobility
172
Why should exercise at altitudes over 2500m until 4-5days of exposure take place?
lowers uterine blood flow
173
what is reduced in those that exercise?
fatigue, varicosities, swelling of extremities
174
What can active women experience?
less insomnia, stress, anxiety and depression
175
What is exercise good for in pregnant women?
- improving glycemic control (those with gestational diabetes)
- coronary heart disease
- osteoporosis
- hypertension
reduced risks of
- colon cancer
- breast cancer
- reduced body fat
176
what should women with gestational diabetes do when exercising?
- monitoring blood glucose
- regulating meal times
- scheduling rest periods
- tracking fetal activity
- and uterine contractions
