Page 140 - Athletic Health Handbook
P. 140
greater heat exchanges across the skin Pregnant women may adhere to must be maximized during pregnancy.
and result in smaller temperature the CDC/ACSM recommenda- Strategies to improve heat dissipation
elevations during pregnancy. Prospec- tion for moderate exercise of 30 include adequate hydration, appropri-
tive data from athletes show that minutes or more per day on most ate clothing, and optimal environmen-
during intense exercise fetal heart rates days. Intensity of activity should tal surroundings. Sauna or hot tub
remain normal.18 Additionally, be modified based on development use after exercise should be avoided.
maintaining intense exercise during of maternal warning signs (see
the third trimester up to the onset of Table 1).3 Pregnant women should Postpartum Return to
labor does not affect fetal oxygenation stop exercising when fatigued and Full Activity
as measured by cord blood and not exercise to exhaustion.
amniotic fluid erythropoietin.9 The Exercise in the supine position Many of the physiologic and morpho-
placenta plays an important role in and motionless standing should logic changes that occur during preg-
maintaining this homeostatic environ- be avoided after the first trimester. nancy persist for four to six weeks
ment for the fetus. Women who exer- During pregnancy, the supine postpartum. When returning to
cise regularly have been shown to have position results in relative obstruc- activities, athletes must be aware of
larger placentas with improved blood tion of venous return causing the detraining that occurs during
flow and gas exchange efficiency.15 decreased cardiac output and pregnancy in addition to the variations
orthostatic hypotension. Motion- in individual recovery rates postpar-
Effects of Exercise on Labor less standing is also associated tum. Thus, prepregnancy exercise
with decreased cardiac output.13 routines should be resumed gradually
Intense physical activity can induce In general, participation in a wide based on individual physical capacity.
contractions due to decreased uterine range of recreational activities appears Moderate weight reduction while
blood flow and increased cate- to be safe. Sport safety is primarily nursing has been shown to be safe
cholamines. However, moderate- to determined by the specific movements and does not compromise neonatal
high-intensity regular exercise does and potential for contact inherent in weight gain. Additionally, postpartum
not increase the pregnant athlete’s the sport. Contact sports (e.g., ice exercise is associated with a reduced
risk of premature labor and delivery.8 hockey, soccer, and basketball) should incidence of postpartum depression
Although there is no increase in rates be avoided due to the risk of abdomi- in physically active mothers.14
of preterm deliveries in exercising nal trauma and injury to both the
pregnant women, patients who exer- mother and fetus.5 Similarly, sports Contraindications to
cise regularly tend to deliver one week with an increased risk of falling (e.g., Exercise in Pregnancy
earlier than patients who do not gymnastics, running, downhill skiing,
exercise.19 Continuing moderate- to and racquet sports) should be avoided. Recommendations to exercise are
high-intensity training also decreases Additionally, scuba diving is not applicable to those without risk
labor times and the rate of medical recommended because the fetus is factors for adverse maternal or fetal
intervention, including use of pitocin, at increased risk for decompression outcome. These principles may be
forceps, and delivery by cesarean sickness due to the inability of the modified based on any potential
section. However, these trends are fetal pulmonary circulation to filter risk factors. Absolute and relative
not seen in those who begin exercise bubble formation.6 contraindications to exercise during
during pregnancy or who continue Other issues that must be consid- pregnancy should be evaluated on an
a low-intensity training regimen.8 ered during pregnancy include individual basis (see Tables 2 and 3).
altitude, adequate diet, and heat
Recommendations for dissipation. Exertion at altitudes up Conclusion
Exercise in Pregnancy to 6,000 feet appears safe; however,
engaging in physical activities at higher Exercise during pregnancy offers a
There is no evidence that exercise has altitudes carries various risks.4 Women number of potential benefits for the
a detrimental effect on pregnancy, who exercise during pregnancy must mother and fetus. Recommendations
labor, or fetal well-being. For women pay particular attention to caloric for safe exercise practices should be
without risk factors for maternal/ intake. Pregnancy requires an addi- reviewed with pregnant athletes to
perinatal complications after physician tional 300 kcal/day to maintain meta- maximize benefits and avoid possible
evaluation, the American College of bolic homeostasis. Heat dissipation complications. Risks of exercise must
Obstetricians and Gynecologists be evaluated on an individual basis
recommends the following: and exercise programs should be
modified accordingly.

THE PREGNANT ATHLETE 140
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