Pregnancy and Sports - Part 3
Exercise Precautions
The adolescent should be cautioned to stop exercising and contact her health care provider if any of the following occur:
- Dizziness
- Muscle weakness
- Shortness of breath
- Chest pain or tightness
- Vaginal bleeding or fluid loss
- Uterine contractions
- Headache
- Abdominal pain
- Absent fetal movement
Contraindications to Exercise
Adolescents with any of the following conditions should be advised not to exercise during pregnancy:
- Pregnancy-induced hypertension
- Preterm rupture of membranes
- Preterm labor (current or previous)
- Incompetent cervix/cerclage
- Persistent second or third trimester bleeding
- Intrauterine growth retardation
- Severe anemia
- Placenta previa
Adolescents with chronic hypertension or active thyroid, cardiac, vascular or pulmonary disease should be evaluated individually to determine if exercise is advisable.
Assessment
Obtaining the following information at the initial visit will be helpful in providing guidance to the adolescent who exercises during pregnancy.
- Prepregnancy exercise program, including:
- Types of exercise such as competitive and recreational sports activities, strength training, other school or leisure-related activities (e.g., cheerleading, walking, swimming, cycling, exercise/dance classes)
- Frequency of exercise
- Duration of exercise
- Intensity of exercise
- Current exercise patterns (assess as above)
- Goals and expectations for continuing or beginning physical activity during pregnancy
Counseling
The following information should be provided to adolescents who wish to begin or remain physically active during pregnancy:
- Potential benefits of exercise during pregnancy
- Physiologic changes associated with pregnancy that affect exercise comfort and safety
- Guidelines for exercise during pregnancy and the postpartum period
- Nutrition guidelines for exercise during pregnancy
- Advice to avoid or discontinue exercise if any of the above contraindications are present
- Warning signs that exercise sessions should be stopped
Postpartum Exercise Considerations
- Musculoskeletal and cardiovascular changes associated with pregnancy gradually reverse during the postpartum period and continue to affect the safety and comfort of exercise.
- Ligaments and joints remain softened and at increased risk of injury for up to 12 weeks after delivery.
- Cardiovascular changes may continue to affect exercise tolerance for 4-6 weeks postpartum.
- The adolescent should be advised to gradually return to her prepregnancy exercise level as tolerated.