Fetal response to physical activity of the mother

Most studies on fetal responses to maternal exercise have focused on changes in fetal heart rate and birth weight. Studies have shown a minimal to moderate increase in fetal heart rate of 10-30 beats per minute compared to baseline levels during or after exercise. Three meta-analyses concluded that differences in birth weight were minimal or absent in women who exercised during pregnancy compared to controls. However, women who continued to exercise intensely during the third trimester were more likely to give birth to children weighing 200-400 g less than in comparable control groups, although there was no increased risk of fetal growth restriction. A cohort study that evaluated blood flow in the umbilical cord artery, fetal heart rate, and biophysical profiles before and after strenuous exercise in the second trimester found that 30 minutes of strenuous exercise is well tolerated by women and fetuses in active and inactive pregnant women.

For pregnant athletes, individual exercise protocols can be justified to establish whether there is a threshold (absolute level of intensity or duration, or both) beyond which fetal well-being may be compromised.

Purpose of an individual exercise program

The principles for prescribing exercise for pregnant women do not differ from the principles for prescribing exercise for the General population. Before recommending an exercise program, a thorough clinical evaluation should be performed to make sure that the patient has no medical reason to avoid exercise. An exercise program that leads to the ultimate goal of moderate intensity exercise for at least 20-30 minutes a day on most or all days of the week should be developed with the patient and adjusted according to medical indications. Pregnant women who were sedentary before pregnancy should follow a more gradual progression of exercise.

Although no upper level of safe exercise intensity has been established, women who regularly exercised before pregnancy and who have an uncomplicated, healthy pregnancy should be able to participate in high-intensity exercise programs such as Jogging and aerobics without any side effects. High intensity or prolonged physical activity over 45 minutes can lead to hypoglycemia; therefore, adequate caloric intake before exercise, or limiting the intensity or duration of an exercise session, is essential to minimize this risk.

Long-term physical exercise should be performed in a thermoneutral environment or in controlled environmental conditions (air-conditioned rooms), and pregnant women should avoid prolonged exposure to heat and pay close attention to proper drinking habits and caloric intake.

In studies of pregnant women engaged in physical exercise, in which physical activity was self-sustaining under controlled temperature conditions, the body temperature increased by less than 1.5°C for 30 minutes and remained within safe limits.

Although physical activity and dehydration during pregnancy were associated with a small increase in uterine contractions, a systematic review and meta-analysis involving normal-weight pregnant women with a single uncomplicated pregnancy showed that exercise of 35-90 minutes 3-4 times a week was not associated with an increased risk of preterm birth or a reduction in the average gestational age at the time of delivery.

Women with uncomplicated pregnancies should be encouraged to engage in aerobic and strength exercises before, during, and after pregnancy. Contact actions with a high risk of abdominal injury or imbalance should be avoided.

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