Are you expecting and a bit of a fitness fanatic? Not sure how much is too much with a bun in the oven? BlackDoctor.org recently caught up with Dr. Jamil Abdur-Rahman of Twin Doctors TV, who answered some of the most common questions about pregnancy and exercise.
BDO: What are the worst exercises you can do while pregnant? Why?
Dr. Jamil: High-impact exercise should be avoided during pregnancy. Heavy lifting should also be avoided. We also advise that pregnant women avoid exercise/physical activity that increases their risk for abdominal trauma (e.g., martial arts, water skiing, gymnastics, horseback riding, etc.) to reduce the risk of injury to the uterus. While the uterus is protected by the pelvic bones during the first 12-14 weeks of pregnancy, once a woman is 14+ weeks pregnant, her uterus is not protected by the pelvis and is therefore more vulnerable to traumatic injury should there be any abdominal trauma.
We also advise against doing sit-ups and planks while pregnant. This is because most pregnant women are at increased risk for a condition called diastasis recti. Diastasis recti is when the rectus muscles (the two strap-like "turtle shell muscles" or the "six pack" muscles along the front of the abdomen) separate in the midline as the uterus gets larger causing them to split. Any exercise that requires a pregnant woman to increase her intra-abdominal pressure or to place strain on the midline that causes the belly to bulge outwards is very likely to make diastasis recti worse.
BDO: What are the best exercises you can do while pregnant (and why)?
Dr. Jamil: Typically, I advise that pregnant patients stick to low impact aerobic exercise instead of high impact exercise and/or heavy lifting. Firstly, when pregnant women engage in regular aerobic exercise research has revealed that they have a lower risk of gestational diabetes, are happier (as they release more "feel good" neurotransmitters), sleep better, have less constipation, shorter labors on average and quicker postpartum recoveries.
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Low impact aerobic exercise (e.g., a brisk walk/very light jog, swimming, yoga, exercise bike, elliptical, etc.) is the best type of exercise for pregnant women because it helps to keep the heart rate up and the circulation optimal (which helps to eliminate a lot of the swelling that pregnant women suffer) but it is not traumatic on the joints.
This is key, because pregnant women release lots of a hormone called relaxin. Relaxin is important in that it causes the joints throughout the body to become quite lax or "relaxed." This is necessary because, as a pregnancy progresses, the joints in the pelvis need to relax to allow the pelvis to stretch and expand to accommodate the enlarging baby and enlarging uterus.
Additionally, the pelvis needs to be able to expand and mold so that the baby can navigate the pelvis during labor and delivery. Unfortunately, relaxin affects all the body's joints. With excessively lax joints pregnant women are at greater risk for musculoskeletal injury during exercise. They therefore should avoid any exercise that isn't low impact or that requires heavy lifting as that puts them at increased risk for injury.
BDO: What is the biggest misconception you've heard about exercising while pregnant?
Dr. Jamil: The biggest misconception that I've heard is that exercise during pregnancy can increase a woman's...risk for preterm labor or miscarriage. Neither of these assertions has been found to be true. One caveat however is that extreme exercise without proper hydration can increase a woman's risk of dehydration. Dehydration does cause the pituitary gland to release a hormone called ADH (anti-diuretic hormone) that helps to prevent further water loss in the urine of someone who is dehydrated.
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ADH however is structurally almost identical to oxytocin, the hormone that the pituitary gland creates to cause the uterus to contract during labor. So when a pregnant woman becomes dehydrated and her pituitary glands produce high level of ADH, the uterus can become "confused," interpreting the elevated ADH levels as oxytocin and causing preterm labor. Preterm labor caused by dehydration, if not properly addressed, can obviously lead to preterm delivery. I've also had some patients express concern that exercises that require them to lift their arms over their heads increase the risk of a nuchal cord (i.e. the umbilical cord wrapping around the neck). This is also not true.
BDO: When should you shy away from exercise while pregnant?
Dr. Jamil: For the most part exercise during pregnancy is ok. However, if a woman has a preexisting medical condition, exercise may not be safe for her and she should consult with her doctor first. Women with asthma and with certain cardiovascular diseases (e.g., irregular heart rate, heart disease, etc.) should probably avoid exercise. This is in part because various hormones of pregnancy like estrogen, progesterone, etc. cause changes in both the respiratory and the cardiovascular system. These changes, especially when the respiratory and cardiovascular systems are being stressed during exercise can increase a pregnant woman's risk for exercise related respiratory or cardiovascular morbidity.
For example, 33 percent of pregnant women with asthma will have worsening of their asthma during pregnancy. This is because progesterone in particular causes the smooth muscles around the airways to relax. With these muscles less active the airways can't conduct air into and out of the lungs as effectively as they were prior to pregnancy. This will cause 33 percent of pregnant women to have a more poorly controlled asthma during pregnancy that obviously puts them and their unborn babies at increased risk for problems that result from suboptimal oxygenation during exercise.
BDO: For those who don't exercise regularly (or at all), what are some simple ways to implement fitness into their daily regimen while pregnant?
Dr. Jamil: That's a tough one. I will frequently encourage pregnant women who are beginners and who are looking to implement fitness into their life to join other groups of pregnant women doing the same thing. For example, my local YMCA has a "Pregnancy Yoga Class" that is open to all pregnant women. Doing something like this provides a nice support structure that makes it easier for a beginner to remain committed to the new regimen. I also encourage pregnant women to consider doing simple things like taking the stairs rather than the elevator at work, or to consider walking to work if they don't work far from home.
