Exercise and Nutrition in
Pregnancy
Gowri Reddy Rocco, MD
Family Medicine &Women’s Health
Exercise recommendations during
Pregnancy- Introduction
• In the past, women were told to significantly
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increase their caloric intake and decrease their
physical activity during pregnancy.
Thus, pregnancy became a large contributor to
the present obesity epidemic.
Currently, experts recommend that pregnant
women continue and maintain an active lifestyle
during their pregnancy.
Exercise does not increase the risk of
miscarriage.
Exercise Regimens for Pregnant
Females
• A thorough medical exam/evaluation
should be conducted prior to
recommending an exercise program.
• This is done at routine prenatal visits and
an exercise prescription is usually
recommended at this time.
Pre-exercise medical screening
• Overall health, obstetrical history and medical risks are
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reviewed.
Considered factors include:
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Age
General physical condition
Exercise history
Risk factors for coronary heart disease
Orthopedic history and musculoskeletal risks
Medication use
History of pulmonary disease
Anticipated type of exercise
Handicaps or disabilities
Current and past obstetric history
Pre-exercise medical screening
• Women in good health should be encouraged to
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engage in regular, moderate intensity physical
activity during a normal, uncomplicated
pregnancy.
Pregnant women with diabetes, morbid obesity,
or hypertension should be counseled on an
individual basis.
Contraindications to exercise:
– Preexisting or developing medical conditions
– These women should be closely monitored.
Exercise Prescription
• Exercise intensity should start light to moderate
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and should gradually increase.
There is no data to support health benefits from
prescribing strenuous exercise to pregnant
women.
A meta-analysis of exercise and pregnancy
reported an exercise program for an average of
43 minutes 3 times a week at a
heart rate= 144 bpm was not associated with
adverse effects on maternal weight gain, birth
wt., length of gestation, length of labor, or
APGAR scores in normal pregnancies.
Benefits of Exercise
• Pregnancy usually leaves women feeling tired,
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exercise gives you more energy to make through
the day.
Exercise allows you to sleep better.
Improves your mood, lessens mood swings,
improves your self image, and gives you some
sense of control.
Prepares you for childbirth. Studies show shorter
labor, fewer medical interventions, and less
exhaustion during labor.
Easier to lose the weight after the baby is born.
Recommendations
• Both ACOG ( American College of Obstetrics and
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Gynecologists) and ACSM (American College of
Sports Medicine) recommends at least 30
minutes of physical exertion for most days of the
week.
As your pregnancy progresses, your center of
balance shifts, making falls more likely.
Participating in activities such as swimming,
walking or low impact aerobics do not put you at
additional risk to slip or fall.
Keep your heart rate under 140 bpm and avoid
overheating, especially in your first trimester and
Recommended exercises:
Kegel: women have easier births, minimize bladder
leaks and hemorrhoids. Please refer to handout.
Walking: Start slowly, stretch before you begin. Wear
good shoes to decrease risk of falling.
Swimming: safest exercise for pregnant women,
because doesn’t add extra weight or stress to your
joints.
Running and Jogging: usually if your in a habit of
running before pregnancy, you can continue running.
Make sure you’re well hydrated and avoid overheating and wear good shoes.
Bicycling and Stair climbing machines: Safe in the
beginning, but as your center of gravity is shifting,
you have a greater risk of falling.
Exercises to Avoid:
• Activities with high risk of falling or those with a
high risk of abdominal trauma are not
recommended:
Skiing
Water skiing
Horseback riding
Scuba diving
Contact sports- ice hockey, soccer,
basketball
When you exercise:
• Don’t wear tight clothes
• Wear a good sports bra
• Wear comfortable shoes that give strong ankle
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and arch support
Breathe deeply
Drink lots of water
Keep your heart rate under 140 bpm
Avoid jerking motions
Avoid laying on your back for extended periods
of time
Avoid exercise in extremely hot weather
Benefits of Exercise during
Pregnancy
• Retrospective data suggest that exercise may:
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prevent gestational diabetes
reduce the risk of developing preeclampsia
prevent excessive weight gain during pregnancy
Gaining weight at a steady rate can lower your
chances of having
• Hemorrhoids
• Varicose veins
• Stretch marks
• Backache
• Fatigue
• Indigestion
• And shortness of breath during pregnancy
Exercise in Postpartum
• May start as early as 2 weeks or at 6 weeks
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after delivery.
Modest weight reduction while nursing is safe
and does not compromise neonatal weight gain.
Nursing women should consider feeding their
infants before exercising to avoid the discomfort
of engorged breasts and also avoid the problems
associated with increased acidity of milk
secondary to any build-up of lactic acid.
Exercise postpartum is also associated with a
decreased frequency of postpartum depression.
Nutrition in Pregnancy- Intro
• Pregnancy is the one time in your life
when your eating habits directly affect
another person.
• A nutritious, well-balanced eating plan will
give your baby a strong start in life.
Nutrition in Pregnancy
• The key components of a health lifestyle during
pregnancy include:
– Appropriate weight gain
– Appropriate physical activity
– Consuming appropriate amounts of food to allow
adequate, but not excessive, maternal weight gain
– Appropriate vitamin and mineral supplementation
– Avoidance of alcohol
– Avoidance of tobacco, drug use and other harmful
substances
Avoidance of food borne
illnesses
• Food borne illness have adverse effects to
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mother and fetus, especially Toxoplasma and
Listeria.
To avoid the risk of food borne illnesses, it is
important to:
– Frequently wash hands
– Consume only meats, fish, poultry that are fully
cooked
– Avoid unpasteurized dairy products
– Thoroughly rinse fresh fruits and vegetables under
running water before eating
– Hands, food prep surfaces, cutting boards, utensils
Pregnancy weight gain
• How much weight a woman should gain all
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depends on her prepregnancy weight.
Underweight women with low weight gain
during pregnancy appear to be at higher risk for
having a low birth wt. Infant, preterm birth and
recurrent preterm birth.
Obese women are at increased risk of having a
large for gestational age infant, post term birth,
and other birthing complications.
How much total weight should I
gain?
• This all depends on your prepregnancy wt:
– 25-37 pounds for normal weight women
• BMI<19.8
– 28-40 pounds for underweight women
• BMI 19.2-26
– 15-25 pounds for overweight women
• BMI 26-29
– 15 pounds for obese women
• BMI>29
Where does the extra weight
go?
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Baby: 7-8 pds
Placenta: 1-2 pds
Amniotic Fluid: 2 pds
Uterus: 2 pds
Maternal breast tissue: 2 pds
Maternal blood: 4 pds
– Your blood volume will have increased as much as
60%
• Fluids in maternal tissue: 4 pds
• Maternal fat and nutrient stores: 7 pds
– Nutrients stored for breastfeeding the baby after
Rate of weight gain
• Also depends on prepregnancy weight and goal
should be to keep weight gain as steady as
possible
– Healthy weight before pregnancy
• 3-5 pds during the first trimester
• 1-2 pds/ week second and third trimester
– Underweight before pregnancy
• 5-6 pds or more first trimester, depending on medical eval
• 1-2 pds/week second and third trimester
– Overweight before pregnancy
• 1-2 pds first trimester
• 1 pd/week during last six months
Risks of gaining too much
weight
• These are potential medical problems with
gaining too much weight:
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Gestational diabetes- high blood sugar
Backaches
Preeclempsia- high blood pressure
Leg pain
Increased fatigue
Varicose veins
Increased risk of cesarean delivery
Recommended Daily Allowances
(RDAs)
• 3-4 servings of fruits and vegetables
• 9 servings of whole-grain or enriched
bread, cereal, rice or pasta for energy
• 3 servings of milk, yogurt and cheese for
calcium
• 3 servings of meat, poultry, fish, eggs,
nuts, dried beans and peas for protein
RDAs
• Calories- recommended intake is increase in
daily caloric intake:
– 340 kcal/day in the second trimester
– 452 kcal/day in the third trimester
• Protein- recommended intake is 75-100
grams/day.
– This means 2-3 servings of meat (3 ounces-deck of
cards)
– Animal foods are considered complete or high-quality
proteins b/c they contain all the 9 essential amino
acids.
– Plant based foods are incomplete, and can be fortified
with soy products and increase of dairy products.
Additional benefits
• Omega –3 Fish Oils, consisting of DHA
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(Docosahexaenoic acid), appear to be essential
for early brain development during gestation
and infancy.
Recommended dose is between 200-400mg/day
Offspring of mothers who took Omega-3 Fish
Oils during pregnancy and lactation scored
higher on cognitive tests.
These supplements also have been to show to:
– Improve visual acuity
– Decrease the risk of allergic disorders
– Improve neurological, immunological and physical
Dietary Restrictions
• Fish:
– 2 or more servings/week associated with
improvement with fetal brain development, however,
it is very important not to eat fish containing mercury,
which causes delayed development and brain damage
to the child and mother.
– Avoid eating any shark, king mackerel, tilefish, tuna
– Low in mercury fish are shrimp, canned light tuna,
wild Alaskan tuna, catfish. Canned albacore white
tuna has more mercury than canned light tuna.
Dietary Restrictions
• Caffeine:
– A stimulant and a diuretic, this leads to increased BP,
HR and reduction in body fluids leading to
dehydration.
– Caffeine also crosses the placenta to your baby, you
are able to metabolize it, however, your baby is not.
– Found in coffee, tea, chocolate, soda, some OTC
meds that relieve headaches.
– Studies have reported an association between high
levels of caffeine consumption and risk of
miscarriages, decreased birth weight, and late fetal
death.
– Restriction of caffeine consumption to 1-2 cups or
Breastfeeding Nutrition
• Women breastfeeding should increase
their caloric intake by 300-500kcal above
prepregnancy levels
• Should also consume 1000mg/day of
Calcium
• Caloric demand of breastfeeding is
estimated at 640kcal/day, however, this
depends on maternal weight.
THANK YOU!!!
ANY QUESTIONS?