So it’s my honor tonight to introduce our speakers, Dr. Suzan Carmichael and Doctor Betty Shachar, and their lecture entitled, Taking Care of Yourself and Your Baby: Nutrition and Fitness Before and During Pregnancy, Research and Recommendations. Dr. Carmichael is an associate professor of pediatrics at Stanford University’s School of Medicine. She received her PhD from UC-Berkeley and spent two years at the Centers for Disease Control before joining the March of Dimes to do research on causes of birth defects. Her dissertation was on the pattern of weight gain during pregnancy and risk of preterm delivery.
Her research has focused largely on nutritional, environmental, social, and genetic contributors to structural birth defects and other perinatal outcomes, such as preterm delivery. Dr. Betty Shachar is an MD OB-GYN from Israel. She is a post-doctoral research fellow at the March of Dimes Prematurity Research Center at Stanford. Her main interest of study is risk factors for preterm birth, in particular the inter-pregnancy interval.
So please join me in welcoming our speakers tonight. [APPLAUSE]. >> Thank you all for coming tonight. So, to start out with a brief outline of what we’re going talk about as Felice said, we’re gonna talk about a recommendations, and research.
I think mine might be a little heavier on, on recommendations than actual research. But we’re going talk about maternal weight and weight gain. Diet and supplements, and then I’ll take about those and then Betty will talk about physical activity. So, before I get started I’ll just give you a little bit more background about myself.
Felice mentioned my dissertation was on weight gain and preterm delivery. Basically just want to let you know that maternal and infant nutrition has always been a passion of mine. It’s kind of been the one thing that has been constant through my different career steps. So the dissertation fit that.
I was a nutritionist for the WIC program. It’s a nutrition education and supplement program for low income women. I was a Peace Corps volunteer for a little while in Honduras, doing again maternal and infant nutrition. And then my other piece of experience is that I do have two boys.
So I’ve been through pregnancy a couple of times and I can sort of relate to the changes in your body, the changes in your weight, and the crazy changes in your appetite. So first we’ll talk about pre-pregnancy weight and basically we’re usually talking about body mass index or BMI and that’s calculated as your weight in kilograms divided by your height in meters squared. And for better or for worse we’re all familiar with the obesity epidemic I’m sure. And then this, this slide just sort of gives you a visual of that.
I’m trying to figure out where I can point from. So this is basically a heat map from the CDC of prevalence of obesity by state in 1987 versus 2008. The darker colors are obviously more prevalent, at higher prevalence of obesity. But it just shows you how striking the epidemic has been and really how recent.
It’s only been the last, you know, couple of decades this has really emerged as a big problem. And actually an interesting statistic is that for the first time, average lifespan is shorter for the first time for current generations than for previous generations. And this is attributable to the obesity epidemic. So why is pre-pregnancy weight important? Well, it is associated with a number of different adverse maternal and infant health outcomes.
And although I’m going to focus on obesity more it’s true at both extremes of the spectrum of BMI and that underweight women and obese women are at increased risk of different, somewhat different set of adverse outcomes. So things like diabetes, and hypertension, preterm delivery, growth restriction of the baby are associated with the extremes of BMI. What can we do about it? Preconception care, ideally, is very important to help people be as healthy as they can at the start of pregnancy. Unfortunately, we don’t always do a great job of that in our health care system.
And also about half of all pregnancies are not planned. So that’s a very striking figure, but it makes it kinda hard to do the preconception care and intervene before a woman gets pregnant. So I think the best we can do, you know, we need to be careful about what kind of interventions we try to implement during pregnancy. But basically knowing a woman’s pre-pregnancy weight helps a clinician know what her risks may be and then monitor her appropriately and give appropriate advice based on that.
And I’m gonna give you a little bit, a little window into some of the research that we’ve done in this area of obesity and pregnancy outcomes. Okay. So, this is a schematic that just kind of gives you an idea of how we might think about the research question of the association of obese, obesity with pregnant, adverse pregnancy outcomes. So, basically, we’re interested in what are the mechanisms and the mediators that are responsible for this association. And, as well, we’re really interested in what kind of protective factors may allow us to sort of intervene or stop this progression to an adverse outcome among obese women.
Some of the common mechanisms that we’re thinking about and working on and trying to understand that may be responsible for these associations for example, of obesity with preterm delivery are inflammation and infection because those are both higher and a bit different in obese versus non obese women. Some of the most commonly cited mediators would be the higher prevalence of diabetes and hypertension in obese women perhaps being responsible. And then some of the protective factors that can protect against the negative effects are that we study our nutrition and exercise. So, I’m gonna give you a few examples of how we’ve tried to really understand this association of obesity with in particular, neural tube defects.
Neural tube, because most of our, a lot of our research has been on, on structural birth defects. So, neural tube defects are when the neural tube does not close properly. And it may be at the top of the spine or the lower part of the spine. A couple of the most commonly, or most familiar outcomes, neural tube defects, are spina bifida and anencephaly.
So we know that neural tube defects are about twice as likely among women who are obese as women who aren’t obese. But still keep in perspective that even though it’s a two-fold increased risk, these are still relatively rare. They affect less than 1 per 1,000 deliveries. But still we wanna understand how to prevent them even when they aren’t when they’re that rare.
So if we think about obesity, it’s a pretty broad category. And one thing that we’ve tried to think about, well, what is it about obesity, not all, sometimes people refer to healthy obesity versus unhealthy obesity. And or maybe there’s a spectrum of sort of the unhealthiness of obesity depending on what else is going on. So abdominal obesity is so this is sort of the, the apple shape if you will.
Where the weight tends to be gained in the waist and then the alternative is sort of the, if you will, the pear shape, or people who tend to gain weight in their hips and the abdominal type is associated with worse endocrine milieu, including worse glycemic control, which is important to pregnancy outcomes. So, what we did is in one of our studies of neural tube defects, is we looked at the association of obesity with neural tube defects overall in our study, and here you see the 1.3 is the overall association, and when we’re doing these studies we either do odds ratios or risk ratios. But basically one means, when you compare the two groups, the ratio is one, there’s no association. And then on the y-axis will be, sort of, the fold increase or decrease in risk for your, your two groups.
So here when we looked overall we saw a slight increased risk of neural tube defects among women who were obese versus not obese, but then we asked women, we usually do telephone surveys for a lot of our birth defect studies. We asked women about when you gain weight do you tend to gain it in your waist or your hips. So trying to get at that pear versus apple phenotype and we found that women who were obese and tended to be more the abdominal type of obesity there, that’s where we were, that’s what was driving the increased risk is those women. Whereas, the women who tended to have the other body type the obesity was not associated with the increased risk.
And that sort of fit with our hypothesis of thinking that maybe that the worst glycemic control is associated with, is driving the increased risk for NTDs. And then in thinking about this in a similar way rather than type of obesity, we thought about well what other, what factors may, are the, is the association of different other risk factors with neural tube defects similar, operating similarly in women who are obese versus not obese. And again, that helps us really understand what’s driving that association. So one thing we know, is that nutrition and particularly folic acid is really important to neural tube defects and intake of certain nutrients and folic acid in particular, or folates is known to be protective.
So, if you see in my slides if you see an odds ratio or relative risk that’s less than one, that means reduced risks. So, here, for example, there are two studies that I’m illustrating. And this one was conducted by our colleague, Martha Werler. And what she did was, she looked at well, is folate intake above this amount versus less than that? Is it’s association, or it’s protective effects against neural tube defects, is that similar among women who are higher weight and lower weight.
In their study, they cut it at not obesity, but rather 70 kilograms pre-pregnancy weight, about 150 pounds. And what they found was that Folate, the usual [SOUND] oops. The usual protective effects that we see were observed for the women who were lower weight, but not for the women who were higher weight. So it seemed to be helping in the women who had the normal weight, but not the women who were higher weight.
And then another study that we did was looking at more holistically at nutrition and that we, I’ll talk more about diet quality in a little while, but basically it’s like an overall sort of score of the quality of your diet. And what we found was that among women with normal BMI there was a protective association. So, diet quality, higher diet quality was associated with lower risks. But among obese women, it wasn’t.
So basically the take home message from these studies was that, well, maybe, it may be that the ideology of what’s causing NTDs among obese women may be a little bit different than what we’ve seen in the general population with regard to nutrition and folic acid. So basically these kinds of studies I’m giving you are an example kind of like we’ll know an association and try to go the next step and try to understand it. In research your steps are often, they feel like baby steps, but it’s just kind of the nature of trying to make progress. It’s usually not a magic bullet, but each step hopefully gets us a little closer to understanding associations.
So here’s another one of those sort of interaction slides. So this one sort of is, is demonstrating, well, what about if a woman has obesity and diabetes? Are those the women who are driving the risk, again, with this sort of hypothesis about is it glycemic control that may be driving this ends increased risk. And so this study was conducted by our colleague Adolfo Correa when he was at CDC. And basically the reference group, the comparison group, was the women that we expected to be best off which was women who did not have diabetes and they had normal BMI.
And so we found out that women who had no diabetes but were obese, they weren’t at increased risk. And remember we usually are seeing, overall in the population, an increased risk there. But if we excluded the women with diabetes, they weren’t at increased risk. Women who’d had gestational diabetes and normal BMI again weren’t really at increased risk.
But then if you had gestational diabetes and obese the risk starts to pop up. If you have pregestational diabetes and normal BMI it’s again higher and the worst is if you have the pregestational diabetes and obesity. So, again, it’s kind of showing, well, if we kind of dig in a little bit deeper, is it everyone who’s obese or should we be particularly concerned about taking care of women who have multiple risk factors? So, now, I’m going to move on to my second topic which is weight gain during pregnancy. And this slide just gives you a general feel for what the pattern, the average pattern of gain looks like.
Basically in the first trimester and this is on average, in the first trimester gain tends to be pretty minimal, I mean some women gain, some women lose weight, but on average it’s pretty flat. And then after that, it tends to be rather linear if you, again, this is averaging. Everybody knows that that’s not their particular case, just like we know that we know that we don’t have 1.3 children. But that gives you a feel for the pattern of gain and how it looks.
And, then this slide just tells you a little bit more about what all that gain is going towards. So, I don’t know if all of you are already familiar with all of this, but basically half of it’s going to the baby. Half of it’s going to mom. And all the things that, that you’re building.
And again, the average increase in calories that are really needed, thought to be needed to build all of this in first trimester, it’s about null. And then in the second and third trimesters, it’s about 350 to 500 extra calories per day. But what I want to really impart is that all of these are averages and we know that we’re all over the board in what really happens. And just because one isn’t on the average doesn’t mean that they’re not going to have a good outcome.
Also it’s really amazing how much adaptability there is in the human body, especially during pregnancy. For example there were some studies like over 50 years ago that really were trying to figure out what were the metabolic requirements of pregnancy. And it was found that women who were undernourished actually had a lower actual, you know, incremental energy intake need than women who were normal weight or perhaps overweight. And, part of the explanation for that is because of the adaptability.
Somehow, your body kind of, in a lot of ways, knows what it needs, and has a really wide range of ability to adapt and to change, you know, how well, how efficiently it’s using what you’re, what you’re taking in. So, just want to point that out to put all of this, these averages in context and just really appreciate how much your body really does adapt and kind of know, it knows what to do a lot of the time. So are all of you familiar with the Institute of Medicine’s weight gain recommendations during pregnancy or not? Anybody familiar with them? Yes, no? It’s a safe way to raise your hand. [LAUGH] Okay, so, that’s interesting, cause I’m not sure how much people already know, or what kind of advice, you know, you’re given.
So, basically the Institute of Medicine came out with recommendations for weight gain. It had a thick report from 2009. The first report was in 1990. That’s when, it’s the 1990, 93 to 96 when I was doing my dissertation work.
My adviser had been on the original committee and we were trying to follow-up and fill in some of the gaps in research that they found in doing that report. But, basically a lot of research, a lot of consensus work went in, has gone into these recommendations. And they’re basically, they’re different, by BMI category. They’re ranges.
And one of the new things they did in the 09 report was to provide, excuse me, a rate of gain, as well as just a total. And, basically, during the first trimester, it’s recommended, you know, negligible weight gain, as if we can control it. But basically this shows the short of average weekly gain that is, is sort of expected to reach this, this total gain for a term, a full-term pregnancy. They also added recommendations for twins in the recent report and refined the recommendation for obese women.
And again, these are, you know, recommendations. Most women, I don’t know if it’s most exactly, but a lot of women don’t gain within the recommendation and they tend towards gaining more than the recommendation. But again, it’s just, it’s a, it’s a recommendation, it’s a gauge. And it’s, it’s important because, to monitor weight gain during pregnancy because it provides clues.
It’s like, it’s not the end all, be all on its own, but I think in the context of, you know what else is going on with a woman it can provide clues to whether, everything else is going well or not. On some people, especially when I was doing my doctoral work, there was a lot of debate about whether we should even measure weight gain during pregnancy. I mean, I can’t imagine prenatal care with actually er, er, pregnant women never actually stepping on a scale. But it’s debated I guess partly because of it’s sensitivity.
But it’s never been intended that it would be just considered in isolation, what your weight gain is. It’s more of, it’s part of the whole picture of what’s going on. So what can we do about weight gain? Again, I don’t think it’s something that we need to harshly control or anything, it basically is good to monitor and then give appropriate advice as one sees how it’s going. I’m not going to talk about research on this particular topic because I feel like well I don’t a whole lot of time to talk, and also a lot of research really went into coming up with those recommendations, so suffice it to say that research is what led to those.
And then the last topic I’m gonna talk about is nutrient intake and nutrition during pregnancy as it relates to food and nutrients rather than body mass index. So, again, this picture shows you all, to build all of these things naturally we actually need, we need an increase in energy but we also need an increase in a lot of different nutrients as well. So then the question is, how do you get that and what you should do during pregnancy and this was just a quick Amazon you know – – no, I’m sorry not Amazon, Google on books that might be on Amazon. On, you know, you put in nutrition during pregnancy advice and you get like the, I, I don’t even know what all these are [LAUGH] but it’s, you could spend your whole pregnancy trying to read up on it.
So my advice is to basically, the Public Health Service and other organizations recommend to take a multivitamin mineral supplement when you’re planning pregnancy and during pregnancy. And as far as dietary recommendations, anybody can, you know, look on the web and see what it says, see what, you know, different people are saying, but my general advice is to keep it simple. And if, if you’re reading things that are stressing you out, because they get so detailed or whatever, then, then try something else. Try another set of recommendations.
And really the recommendations for a healthy diet you know, when you’re not pregnant are very similar to when you are pregnant. And so in that vein I’ve included a couple of books here. I really like the Eat, Drink, and Be Healthy by Walter Willett at Harvard. He’s very practical.
And that just really spoke to me. It was very readable. It’s not trendy. And then I haven’t actually read Michael Pollen’s recent food rules.
But I have read other books by him, he’s at Berkley, and he gives again, it’s not like eat this particular nutrient but more general advice about how to eat and how to sort of select what you’re eating in general. And so those tend to be the kinds of advice that I think are the most helpful, the most holistic, the most perhaps easier to follow and not get obsessed about hopefully. But just to share with you a few of the food rules from, from Michael Pollan to give you a feel if you haven’t read him before. Because I think they’re true but they’re also somewhat amusing.
So eat only foods that will eventually rot. So that might exclude some of the Halloween candy that we all just got. If it came from a plant, eat it. If it was made in a plant, don’t.
And again, it would be hard to follow this strictly, but I think you get the idea. Eat the rainbow, which does not mean Skittles. Eat all the junk food you want as long as you cook it yourself. Isn’t that freeing? Eat more like the French, or the Japanese, or the Italians, or the Greeks, which, I think, means don’t eat like us in the U.S. and break the rules once in a while.
you know, to enjoy food and don’t feel like you’re married to the rules. Eating should be enjoyable. It’s something we all do together. It represents community.
There’s so much more to it than just a nutrient. He also says you know, if the ingredient list is something that a third grader can’t pronounce, then try to avoid it. But, anyway. I like, I like his stuff.
So as far as a little bit into the research we’ve done on nutrition and again, I’ll use neural tube defects as an example. So here it says there’s been a reduction in neural tube defects after fortification in 1998. And do you guys know what nutrient I’m talking about? Anybody? So, folic aid. So, basically there was a lot of research that was done showing that folic acid, which is a B vitamin comes from the word foliage.
Basically a lot of research was done showing that it was protective against neural tube defects and that led in 1998 to mandated folic acid fortification of the food supply, and that’s primarily grains. It’s all the things that were already fortified with things with thiamine, riboflavin, iron, and niacin. So now it’s also folic acid. I’ve always thought it fascinating that most people don’t even, there was so much debate in the scientific community, but the general public doesn’t even realize there was a nutrient added to the food supply at that point.
But basically it’s a huge, it’s been lauded as one of the most important public health successes in the last couple of decades because it really has substantially reduced the prevalence of neural tube defects, which is great. One of the main challenges, though, that we face in doing research on nutrition, is that naturally, nutrients co-occur. So it’s, they co-occur in a vitamin supplement, they co-occur in anything that we eat. And so that just makes it harder from a research perspective to actually isolate the effects of a particular nutrient.
Or even a particular food for that matter. So one of the things that we’ve done, we’ve done lots of single nutrient research, but one of the things we’ve done recently is take a step back and try to come at it from a different direction and study diet quality, which is more, I mentioned it recently in the context of one of the slides. But it’s been more a holistic approach. Basically it’s an overall score based on different food groups and nutrients that you’ve eaten and this approach has been used a lot in more chronic diseases like cardiovascular disease and then the cancer research world, adult mortality, and it’s been so, shown to be, if you have a better overall diet quality, you have better outcomes.
All, all different types of outcomes. But it really hasn’t been done in the field of birth defects or really not so much in reproductive outcomes in general. So, the idea is, if you look at diet quality, if your diet quality is better, does that effect outweigh the effect of any particular nutrient. So because in our bodies, I mean, as we metabolize these things, as we use them, nutrients depend on each other.
There are, you know you look at the folic acid or folate cycle and it has B12 in it, it has choline in it, it has B6 in it. All these things sort of, they all work together. So, from this perspective that’s kind of what drove thinking about diet quality rather than just single nutrients. So, one of our recent studies was on birth defects and diet quality index and basically, the diet quality index was based on USDA food pyramid, if any of you are familiar with that.
Basic food dietary food guidelines with some modifications to make it more applicable to pregnancy. Recently the food pyramid has been replaced by the my plate cartoon. But basically we saw that Diet Quality Index was protective against neural tube defects and a couple of other birth defects. And that was independent of, it didn’t matter how much folate or folic acid the woman took or whether she took multi-vitamins or not.
There was an independent effect of diet quality. So basically the message is that it’s good to take a supplement. It’s also good to try to have a generally good diet, so what you eat is still important. Just a couple more slides again to kind of in that vein of thinking about interactions and if we have, maybe we have one thing that puts us at increased risk, but is there something else we can do to lower our risk.
So we’ve done a lot of work on stress and pregnancy outcomes. And so one we did in particular, again NTDs is an example, is we looked at whether the association of stress with NTDs was similar regardless of whether a woman took a multivitamin or not, during very early pregnancy. So neural tube defects happen in the first few weeks of pregnancy before most women even know that they’re pregnant, even if they’re planning a pregnancy. And so what we saw was, that for women who did not take vitamins, if they had increased stress they had an increased risk.
But among women who did take vitamins the increased risk was much lower. So, hopefully, you know, maybe that means again, we can’t really take cause from this so it’s association and so forth, and it’s one study. But it suggests that perhaps it’s possible that nutrition can protect against these negative, other negative risk factors. And then one more, this is my last research slide.
Again, in the context of these multiple, thinking about multiple risk factors. So here we looked at well, actually, this was not our work. This was an Adolfo Corea, again from CDC, but using data from the National Birth Defects Prevention study which we’ve been part of for many years in our group. And basically this was heart defects and NTDs and clefts.
And the reference group was women who did not have diabetes or take vitamins. No, no, I’m sorry, the reference group was women who did not have diabetes and they did take vitamins. So that’s kind of what we’re thinking of as our lowest risk group. And women who, so this is the light blue group here.
Women who just… these first two bars here are women who had either one or the other. So this is the women that had no diabetes but they didn’t take vitamins. This is the risk for women who had diabetes and did take vitamins, so they had one of the two risk factors.
But as you see, it’s starkly, much more increased risk for women who had both. So hopefully this is, again, saying if you, if you take vitamins maybe it can help protect against the increased risk associated with diabetes. And some animal work has been really interesting, showing that one of the mechanisms by which diabetes may be causing birth defects, this was from animal models but it, it may be oxidative stress may be the mechanism. So that kind of ties in, that makes sense that if you’re taking a vitamin you’re getting higher doses of a lot of different antioxidants.
It could be protective for that reason. So my last slide is basically as far as all the advice and so forth avoid, try to avoid feeling this way and anything that’s making you feel that way during pregnancy or otherwise when it comes to all the dietary advice especially. I advocate for the simpler the better, the more general the better, keep it simple and that’s basically where I’ll conclude and hand it over to Betty. >> So hello again and thank you for having me here.
I’m Betty Shachar and I’ll try to keep it a little bit more simple I think about and shorter physical activity in pregnancy. Happy to answer any question in the, at the end. Did it move? Hm. Why is it that small? Okay, I’ll try to use my computer instead of this.
So the, my goal in this presentation is actually to answer the common questions of every woman. Should I do any exercise during pregnancy? What kind of activity am I allowed to do? Should I avoid some kind of activity? And what should I be aware of while exercising. I’ll start with some, background. The first US guidelines for physical activity during pregnancy were in 1985 and they were very conservative.
There wasn’t much data about physical activity during pregnancy at that time. They didn’t, they suggested to limit vigorous activity to more than, more, no more than 15 minutes and not to let maternal heart rate exceed 140 beats per minute. Also, obese women were recommended not to do any physical activity during pregnancy or women who didn’t do any physical activity before pregnancy were also recommended not to begin activity, physical activity during pregnancy. So, what have actually changed since then? The decades of research that has established a variety of health benefits of physical activity, activity for virtually everyone, regardless of age, gender, or physical capabilities.
And the landmark was the Physical Activity Guidelines for Americans in 2008 which has a specific role for the physical activity, during pregnancy and the postpartum period. So what are the benefits of physical activity during pregnancy? We all know then what is the general benefits of a healthy heart, mind and body. And what Susan explained much of they’re less likely to gain weight and we all know now about the adverse outcome of pregnancy associated with obesity. It’s also suggested to reduce stress, and stress by himself is a risk factor for adverse pregnancy outcome, in particular, preterm birth.
So there’s also a lot of data about physical activity and specific birth outcomes. For example preterm birth. There is converging evidence that’s suggesting physical activity may actually reduce the risk of preterm birth but I must stop here and say Women who feel contractions or any other signs of preterm birth or had previous preterm birth in the past should not continue to do any physical activity during pregnancy. so this is important, even though as you can see it, it has been related to reduced risk for preterm birth.
What about preeclampsia or hypertension during pregnancy? So again there is a bulk of evidence that suggests that physical activity during pregnancy may reduce the risk of preeclampsia. But there is another recent Danish study that have shown that women who reported extra physical activity of more than seven hours per week actually had a higher risk of preeclampsia. So it is still should be decided in the literature and future studies might, might help us understand the relationship between physical activity and the risk for preeclampsia. What about gestational diabetes? This is more…
there is agreement that physical activity during pregnancy has been shown to be effective in the treatment of gestational diabetes. And most studies indicate that exercise is a safe and reasonably effective therapy in gestational diabetes. What about the effects of the baby? So, early studies were, they were concerned about fetal distress. People in the literature have showed that maternal exercise may contribute to fetal distress.
But actually what we are sure now that physical exercise is not related to fetal stress. And also not related to, about birth weight. Early studies again showed decrease in mean birth weight and increase risk of low birth weight. Recent reports show that there is no relationship between physical activity during pregnancy and mean birth weight.
As with preterm birth, women that are, there is a suspicion that their baby might not grow well, for example, there is a suspect IUGR, intrauterine growth retardation, are recommended not to do any physical exercise. So what are the current guidelines? Healthy women, who are not alrerady in highly active or doing vigorous intensive activity, should get at least two and a half hours of moderate intensity aerobic activity per week. And the recommendation is for at least 30 minutes every day. So what kinds of activities can you do? There are forms of safe exercise including walking, swimming, cycling, aerobics and even running.
Activities to avoid – – you should better not do much exercise on your back. Avoid heavy lifting, and standing around for too long. Holding your breath when working out. Any exercise that can compromise your balance, there is change in balance during pregnancy so please, the recommendations are to avoid this kind of thing.
Avoid jumping and most of the sports team, that basketball, volleyball, things that might cause trauma or fall are best, are best to avoid during pregnancy. Better to avoid. What should you be aware of? Please start slowly. It has been some time, especially if it has been some time since you have exercised.
Consume extra daily calories in according with the amount of calories you think you have exercised. Avoid overheating by hydrate, by staying out of the sun. And these are the recommendations for most of the women. It’s important to understand that not all women should exercise.
There are women with specific heart problems, lung disease. As I said, signs of preterm labor or previous preterm delivery, an incompetent cervix, women with multiple pregnancy, with vaginal bleeding, with ruptured membranes or placenta previa which is when the placenta is exterior, it’s on the cervix, should not, should not exercise during pregnancy. And these are just the summary of the warning signs, when to stop, when to stop exercising. If there’s vaginal bleeding, if you feel dizziness or feeling faint.
Increased shortness of breath. Any kind of headache, headache. Muscle weakness, uterine contractions, any signs of preterm delivery as I mentioned before. Decreased fetal movements and chest pain.
If you have any of these please stop and turn to your health provider. After delivery… So a lot of time there’s the question, when exactly I can start going back to exercise after delivery. So it’s different among different women, but in general we know that the, whenever you feel ready, it’s okay.
There’s no association between a rapid going back to physical activity after delivery, and any kind of a adverse outcome. So it’s better to a gradual return to physical activity, but when you feel ready, and it’s always good to ask your health provider. It’s okay for you to go back to your usual physical activity. In conclusion, research indicates that pregnant women should be encouraged to be physically active during pregnancy.
And there, if there are, of course, no contraindication. And such participation is not harmful and in fact, may be of great benefit of the mother during pregnancy and after pregnancy. Thank you and if you have any questions please. [APPLAUSE]
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Source: Stanford Children’s Health | Lucile Packard Children’s Hospital Stanford
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