Is High-Intensity Exercise in Pregnancy Taboo?

The lay press recently has reported several stories about pregnant women being criticized for intense exercise in late pregnancy. The latest of these stories involves a pregnant personal trainer who, coincidentally (or not so coincidentally), specializes in pregnancy fitness.

Exercise is a health-promoting activity, and there is no reason why healthy women with uncomplicated pregnancies, especially those who exercised routinely before pregnancy, should discontinue exercise during pregnancy, experts say. Even women who have been sedentary can begin exercising during pregnancy and may even be more motivated to stay healthy because they are pregnant. In fact, exercise in pregnancy can help women feel great, keep weight gain in check, perhaps keep gestational diabetes at bay, and keep the body strong for labor and delivery.

Most ob/gyns encourage exercise in women who want to be active during pregnancy, offering guidance in line with ACOG recommendations. For example, don’t overheat, stay hydrated, don’t lie flat on the back after the first trimester, and stop immediately if dizziness, increased shortness of breath, chest pain, bleeding, cramping, or contractions occur. Certain activities, including horseback riding, contact sports, downhill skiing, and scuba diving, are not advised.

So where does this public opinion of exercise in late pregnancy being “irresponsible” or “dangerous” come from? Some may argue these opinions are the remnants of the archaic practice of confinement, when a woman withdrew from society during pregnancy or spent the last month of her pregnancy in bed. For example, in the upper echelons of Victorian society, showing a baby bump in public (gasp!) was tantamount to social suicide. In some cultures, pregnant women are still treated as delicate flowers, perhaps a remnant of this historical practice. Others may argue that people are just projecting their own feelings about exercise in pregnancy on these women, be it fear of injury to the fetus, inferiority, or guilt, to guess a few. And there are others who are just plain uncomfortable around pregnant women in any situation.

Society seems to accept gentle exercise in pregnancy, such as yoga, walking, swimming, and light weight training, but increase the intensity, and exercise in pregnancy becomes taboo (according to the headlines and comments associated with these reports). A woman’s pre-pregnancy fitness level, as well as her personal comfort with the risks of exercise in pregnancy, probably are factors in whether she chooses to be physically active during pregnancy. However, in physically active women or athletes who correctly self-monitor, are the risks associated with intense exercise any greater than those associated with tripping on a rug or getting in a hot tub during pregnancy? And also, do some pregnant women choose to exercise less intensely or less often than they’d like because they don’t want to feel judged? I wonder…

As ob/gyns, the guardians of maternal and fetal health in pregnancy, I’d love to know what you think about this and how you advise patients when it comes to exercise in pregnancy. It seems as if there is a division between clinician advice and public acceptance.

- Do you encourage physical activity in all pregnant patients, or do you wait for the patient to bring up exercise before you discuss it?

- In your experience, are women who exercise regularly throughout pregnancy better able to handle the physical demands of labor and delivery?

Share your thoughts in the comment section below.