TOG - exercise in pregnancy -2015 Flashcards
Low birthweight is associated with
a period of catch-up growth in childhood, later obesity and increase cardiovascular disease risk.
What are the hypothetical risks of high intensity exercise in pregnancy?
(There is a lack of substantial evidence to prove these effects)
Low birthweight
preterm delivery,
abnormal fetal heart rate patterns
exercise generated heat stress with teratogenic effects
What are the cardiovascular changes in the first trimester?
Blood volume increases by 40%
Stroke volume by 10%
Heart rate and cardiac output by 20% - (30-40%) from the second.
Decrease in systemic vascular resistance
What is the physiological trend effect on the mean arterial pressure?
Decreases by mid second trimester by 5-10mmhg before returning to pre-pregnancy levels
What are the physiological adaptions in the respiratory system?
50% increase in minute ventilation due to increased tidal volume and oxygen tension.
Due to a rise in baseline oxygen consumption of 10-20% and increased work of breathing due to the growing fetus on the diaphragm, less O2 is available during aerobic exercise…
Maximum exercise performance is therefore decreased although in some fit women there is no evidence of reduced aerobic power.
What is the approximate additional maternal calorie requirement at the end of the first trimester
Around 300kcal
What is the theory with insulin competition?
Physical activity during pregnancy lowers insulin levels. Pregnancy induces a states of relative insulin resistance to increase glucose availability to the fetus. decreasing insulin resistance through exercise is thought to possibly leave the fetus competing withs its mother for glucose.
Does exercise affect pre-eclampsia risk?
There is conflicting evidence. Some showing benefit others suggesting negative effects.
What percentage of weight gain in pregnancy is associated with higher risk of developing complications?
10% weight gain associated with GDM, HTN, LSCS and medically indicated pre-term delivery.
Also more likely to give birth to LGA babies at greater risk of neonatal hypoglycaemia, perinatal trauma and death, obesity DM and metabolic syndromes.
How much more likely are women with GDM to develop T2DM in later life
7-8 times more likely.
What impact may GDM have on the long term risks for the infant
Higher prevalence of diabetes in infants, impaired glucose tolerance in adolescence and obesity in the first 20 years.
In GDM what effect was seen with mild walking programmes compared with standard care.
Lower glucose concentrations and required fewer units of insulin per day.
Is there an established effect of exercise on pre-term delivery?
2006 cochrane review found insufficient data.
Some studies suggest reduction or no effect, some demonstrate reduced odds.
What do NICE recommend regarding exercise frequency, length and intensity?
At least 30 minutes of moderate exercise per day.
