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Exercise in pregnancy – risky business or risk reducing?

Lyz Evans

Lyz Evans

Lyz is the founder of Women In Focus Physiotherapy. An industry leading pelvic health clinic in Sydney. She has her Masters in Women’s health and Continence Physiotherapy and is also a mum of two herself.
Created on Oct 10, 2023 · 3 mins read

Historically women have been encouraged to stick to walking or very light exercise such as yoga or swimming when it comes to exercising during pregnancy. Interestingly, pregnancy complications such as GDB, pre-eclampsia, Gestational HT and newborn macrosomia have risen dramatically over the last 3 decades – likely due to increasing rates of maternal obesity. Less than 15% of pregnant women meet the recommended level of weekly activity during pregnancy. Concerns as to whether exercise may increase miscarriage, growth restrictions, preterm birth, fatigue and harm to the foetus – have all served as barriers to exercise in pregnancy. Interesting, this is not even backed up by research! NOT exercising during pregnancy may pose a bigger risk to the health of the mother and her unborn child. 

What are the benefits of exercise during pregnancy?

Exercising during your pregnancy has HUGE benefits, including reduced risk of gestational diabetes, maintenance of fitness and strength, management of weight gain, reduced risk of preeclampsia, reduced rates of back pain, improved mental health and many more.

Regular exercise has also been correlated to shorter and less complicated labours (huge plus!) and fewer neonatal complications. If that’s not a reason to exercise then I’m really not sure what is.

I would argue that not exercising in an uncomplicated pregnancy is actually risk-reducing rather than risk increasing, so it is seriously important that we get the evidence-based information out there and ensure pregnant mamas are moving.

When is exercise not advised?

Of course, there are situations when exercise is advised against. This is why it’s important to ensure you have discussed exercise with your medical professional to ensure you are not a “high risk” pregnancy and safe to get moving. These will include:

Absolute contraindication = NO

  • Placenta previa
  • Persistent vaginal bleedingPre-eclampsia after 28 weeks
  • Incompetent cervix
  • Ruptured membranes
  • High order multiple pregnancy (triplets)
  • Uncontrolled diabetes type II
  • Uncontrolled hypertension or thyroid
  • Serious cardiovascular, respiratory or systemic disorder.

Relative contraindications = proceed with caution and close monitoring

  • Recurrent pregnancy loss
  • History of spontaneous pre-term birthGestational hypertension
  • Symptomatic anaemia
  • Malnutrition or eating disorder
  • Twin pregnancy after 28th week
  • Mild to mod cardiovascular or respiratory diseasePoorly controlled seizure disorder
  • Morbid obesity
  • Other serious medical conditions

If the following symptoms occur during exercise, you absolutely need to stop:

  • Persistent excessive shortness of breath that does not resolve when resting
  • Severe chest pain
  • Regular painful uterine contractions
  • Vaginal bleeding
  • Fluid loss indicating rupture of membranes’Dizziness or faintness that does not resolve on rest.

The most recent Australian pregnancy guidelines state that all women without complications participate in regular aerobic and strength conditioning exercise during pregnancy. There is no evidence that regular exercise during an uncomplicated pregnancy is detrimental to the woman or fetus.

The Australian 2016 RANZCOG guidelines say that:

  • Women are recommended to spend 150 – 300 minutes doing moderate intensity physical activity each week, ideally by being active most days for at least 30 mins.
  • ‘Moderate intensity’ will vary from person to person which given that everyone has a different level of fitness and a different response to pregnancy so monitoring this with the Borg scale or the talk test is important and something all pregnant women should be aware of (see below)
  • Don’t exceed 60 minutes to each workout session
  • Exercise should be a combination of aerobic style such as brisk walking, running, bike, cross trainer. (Note if you are walking it must be brisk)
  • Dedicate two days per week to strength-based training that includes weights, body weight or resistance bands to maintain and improve muscle mass.

Overall, stay active and consider your levels of exercise and risk before pregnancy to gauge how much might be necessary. If you overly push yourself, you risk putting far too much pressure on your body and the foetus. On the other hand, if exercise is not intense enough the benefits may not be achieved.

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