A 32-year-old woman, gravida 4 para 3, at 8 weeks gestation comes to the office to establish prenatal care. She has had no bleeding or cramping. The patient has type 1 diabetes mellitus diagnosed at age 12 and uses an insulin pump. Her most recent hemoglobin A1c was 6.8%. Six months ago, she started a daily exercise routine of weight lifting and running on a treadmill. Her first pregnancy was a cesarean delivery at term gestation for breech presentation. The patient then had 2 painless, second-trimester deliveries consistent with cervical insufficiency. Vital signs are normal. BMI is 23 kg/m2. On pelvic examination, the cervix is closed and there is no vaginal bleeding. Transvaginal ultrasound reveals an 8-week intrauterine gestation with positive heart tones. The patient asks if she can continue her current exercise program. Which of the following is this patient's contraindication to exercise in pregnancy?
Pregnancy & exercise | |
Absolute contraindications |
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Unsafe activities |
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Exercise during pregnancy can be beneficial and is associated with decreased risks of excessive gestational weight gain, gestational diabetes mellitus, preeclampsia, and cesarean delivery. Therefore, low-risk patients who exercised regularly prior to pregnancy are encouraged to continue moderate-intensity exercise during pregnancy.
However, exercise during pregnancy may exacerbate some obstetric conditions; therefore, it is contraindicated in certain patients. Exercise should be avoided by:
Patients at high risk for preterm birth
Patients at risk for antepartum bleeding
Patients with an underlying condition that could be exacerbated by exercise
Cervical insufficiency is a cervical structural weakness associated with painless second-trimester pregnancy loss. Patients with cervical insufficiency (eg, based on a history of 2 prior losses) are at a high risk for recurrent pregnancy loss. This risk can be decreased by placing a prophylactic cerclage (a suture placed around the cervix to reinforce its stability) and avoidance of moderate- to high-intensity exercise such as running and weight lifting (Choice C).
(Choices B and E) During pregnancy, both type 1 and type 2 diabetes mellitus are associated with an increased risk of preeclampsia and abnormal fetal growth (eg, macrosomia, growth restriction), depending on placental function and maternal glycemic control. Regular exercise, along with prevention of excessive gestational weight gain, can reduce these risks. A normal BMI (eg, 23 kg/m2) is not a contraindication to exercise.
(Choice D) Prior cesarean delivery is not a contraindication to exercise.
(Choice F) Pregnant patients should avoid exercises that increase the risk of abdominal trauma and maternal injury (eg, contact sports, downhill skiing). Hot yoga is also not recommended due to the risks of hyperthermia (eg, fetal neural tube defects). Most other types of exercise, including running and moderate weight lifting, may be continued in pregnancy.
Educational objective:
Moderate-intensity exercise is recommended for most pregnant women. However, exercise is contraindicated in patients who are at high risk for preterm birth (eg, cervical insufficiency), have antepartum bleeding, or have an underlying medical condition that could be exacerbated by exercise.