Regular exercise during pregnancy can decrease your risk of complications like gestational diabetes, preeclampsia, and cesarean birth and promote a healthy weight gain. Working out can also ease common pregnancy symptoms like constipation and back pain. In addition, living an active lifestyle will improve your physical and mental health in the short and long term. This article is an overview of exercise in pregnancy including recommendations and what activities you should avoid.
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Benefits of Exercise in Pregnancy
As you can imagine, there are many benefits of exercise in pregnancy. Regular exercise can decrease your risk of complications like gestational diabetes, preeclampsia, and cesarean birth and promote a healthy weight gain. Working out can also ease common pregnancy symptoms like constipation and back pain. In addition, living an active lifestyle will improve your physical and mental health in the short and long term.
Exercise and Stress
It may seem counterintuitive that exercise can help you manage stress when the act of exercise puts physical stress on your body. Exercise can cause changes to many hormones, including those involved in your stress response. It can also help with symptoms resulting from chronic stress, like cardiovascular issues and impaired immune function. One of the challenges is that stress can impair your efforts to be physically active. The more stress you experience, the less motivated you may be to work out. One way to combat this feedback loop is to make exercise a habit. In addition to exercise, there are many evidence-based tools to manage stress in pregnancy for the health of you and your baby.
Exercise and Sleep
A systematic review suggests that sleep and exercise exert substantial positive effects on one another. Exercise will help you sleep, and high-quality sleep will also help you get more out of your exercise and recover better. A systematic review and meta-analysis of randomized controlled trials on the effects of exercise on sleep quality in pregnant women found that regularly exercising women had significantly enhanced sleep quality. The timing of your exercise does matter. To improve your sleep quality, you want to complete your workout at least 2-3 hours before bed.
Recommendations for Exercise During Pregnancy
As you are learning about aspects of pregnancy, it can be helpful to understand where your care provider is coming from and the information that is influencing their recommendations to you. This is why I often reference the American College of Obstetricians and Gynecologists. This organization sets guidelines followed by most hospitals and the vast majority of ob/gyns. While ACOG does look at evidence when creating their recommendations, they are focused on all pregnant women as a whole and tend to be conservative in their recommendations. Hopefully, you are working with a care provider who can help you navigate your questions specific to the particulars of your pregnancy, health, and goals.
The American College of Obstetricians and Gynecologists recommends pregnant women should get at least 150 minutes of moderate-intensity aerobic activity every week. They define moderate aerobic activity as one in which you move large muscles of the body in a rhythmic way enough to raise your heart rate and start sweating. You still can talk normally, but you cannot sing. Moderate-intensity aerobic activity could mean anything from a brisk walk to general gardening like raking, weeding, or digging.
ACOG does note some conditions or complications that make exercise unsafe. Their list includes certain types of lung or heart diseases, cerclage, a multiples pregnancy with risk factors for preterm labor, placenta previa after 26 weeks, preterm labor or ruptured membranes, preeclampsia, pregnancy-induced high blood pressure, and severe anemia.
Precautions for Exercise
Many of the same safety precautions you would take during pre-pregnancy can be applied during pregnancy. Some of the recommendations for pregnancy are so conservative that many expecting mothers may feel afraid to do anything with any risk.
You want to be cautious about participating in some activities, including contact sports and any activity with a risk of a high fall, crash, or injury. In a contact sport, it is possible that if you are hit in the belly, it could injure your baby or cause placental abruption or a miscarriage. If you fall or crash, your baby could also be hurt. If you injure yourself, it could put your baby at risk or limit your options for treatment. If you break a bone and need surgery, there are a lot of other concerns about surgery and medications with your baby to consider.
The American College of Obstetricians and Gynecologists has guidelines on specific activities to avoid when pregnant and specifically names activities with a risk of getting hit in the abdomen like ice hockey, boxing, soccer, and basketball. They caution against participating in activities that can result in a fall like downhill snow skiing, water skiing, surfing, off-road cycling, gymnastics, and horseback riding. They also list activities that can cause you to be overheated, like hot yoga or hot pilates.
ACOG also recommends against activities performed above 6,000 feet (if you do not already live at a high altitude), skydiving, and scuba diving. Most recreational activity companies will not allow you to participate in some activities if you are pregnant purely for liability reasons.
Warning Signs to Stop Exercising
Most of the warning signs that indicate you should stop exercising are obvious. The list from ACOG includes regular, painful contractions of the uterus, bleeding, fluid gushing, or leaking from the vagina. Other warning signs include feeling dizzy or faint, shortness of breath before starting exercise, chest pain, headache, muscle weakness, calf pain, or swelling.
Paying attention to your body and how you feel is the key to keeping your workouts within safe limits. It is safe to exercise during pregnancy for the majority of expecting mothers. If your body is too far outside its comfort zone and you feel exhausted, overly winded, or exhausted, slow down. It is excellent to maintain or start an exercise routine or practice when you are expecting a baby, but it is also essential to take it easy when you need to. Pushing yourself too far puts you at a higher probability of injury and other risks. Listen to your body, and if you feel like you may be overdoing it, you probably are.
Experience Level with Exercise Matters
There is a difference between people who are new to exercise and those who already have an active lifestyle. ACOG states that if you were very active before pregnancy, you could keep doing the same workouts with your ob-gyn’s approval. They also note that if you start to lose weight, you may need to increase the number of calories that you eat. Your care provider will weigh you at each prenatal appointment to ensure you are gaining a healthy amount of weight. If exercise is not a habit for you now, it is never too late to start. ACOG recommends beginning with as little as 5 minutes a day. Add 5 minutes each week until you can stay active for 30 minutes a day.
Physical Changes During Pregnancy that Can Impact Your Exercise
There are many symptoms and physical changes you could experience during pregnancy that can impact your motivation and ability to exercise.
Fatigue is very common during pregnancy, especially in the first and third trimesters. Fatigue is primarily due to increased levels of progesterone. In addition, your body increases blood volume, and your blood pressure is lower. You increase metabolism and lower your blood sugar. Your body is going through many changes, and all of those changes take energy. If you are tired, the best thing you can do is rest. That could mean taking a nap or going to bed earlier than usual. It could mean skipping a workout or taking a few days off.
Morning sickness is nausea that can be accompanied by vomiting during pregnancy. This does not just happen in the morning. It can be anytime or even all day. Morning sickness affects 60-80% of expecting mothers. This is most common in the first trimester, and can start as early as one to two weeks after conception. Morning sickness usually goes away after 12 weeks when you begin the second trimester. If you are not feeling well, it can impact your motivation and ability to exercise. If there is a time of day you are not experiencing symptoms, you may be able to schedule your workout around that. You may also need to take it easy and resume exercise once symptoms improve, hopefully around the start of the second trimester. See this episode for more information on morning sickness and treatments to relieve symptoms.
Weight gain during pregnancy is inevitable. The suggested healthy weight gain for someone at a normal BMI pre-pregnancy is 25-35 lbs (11-16 kg). In reality, half of all pregnant women gain more than the suggested weight. Even if you are within the recommended limits gaining weight puts additional strain on your joints and feet.
Your Center of Gravity Shifts
Most of the weight you gain during pregnancy is in your belly, and as your pregnancy progresses, this can shift your center of gravity. You may be more susceptible to falling if you lose your balance. A shift in your center of gravity can also change how you walk and distribute pressure across your feet.
Changes in Your Breasts
Your breasts may be tender, especially early on. Most women will see their breasts increase in size, beginning in the first trimester of pregnancy. This happens as the ducts and alveoli in the breast multiply rapidly in preparation for breastfeeding. Your sensitive and growing breasts may require extra support during exercise. Make sure you are wearing a supportive sports bra, and at some point, you may need to go up a size if your sports bras are too tight or uncomfortable. See this episode for more information on how your breasts change during and after pregnancy.
Changes to Your Cardiovascular System
Your blood volume increases 50% during pregnancy to support your growing baby and placenta. The additional blood requires your heart works harder. That may mean that you reach an increase in heart rate more quickly than normal during exercise. Your heart rate already tends to be higher during pregnancy. If at any point you feel like your heart rate is too high, that could be an indication that you need to slow down or take a break.
Changes to Lung Capacity
As you get further into your pregnancy and your belly grows, it pushes all of your other organs up, decreasing your lung capacity. This can make you short of breath or make breathing more challenging, especially during cardio workouts. Reduced lung capacity isn’t a reason to avoid cardio, but you should be aware of it. Your oxygen levels affect your baby’s oxygen levels. If you find yourself winded, you may need to slow down and take a break to catch your breath.
Relaxin is a hormone that relaxes your ligaments. This is necessary and will help when you are in labor and giving birth. The downside is that relaxin doesn’t only concentrate its effects on your pelvis and hips before birth. This hormone can affect your entire body throughout your whole pregnancy. This means you are at a higher risk for injury.
Changes to Your Feet
Relaxin can also relax the ligaments in your feet, which can permanently change your foot’s shape and structure. Relaxin can contribute to your arch collapsing and over-pronation. This can lead to your feet increasing a shoe size, developing bunions, and stress and inflammation on the tissue that runs along the bottom of your feet. It’s natural for your feet to flatten during pregnancy, but too much flattening can cause foot pain and increased strain on your knees, legs, and back.
A study that examined arch height changes postpartum found that pregnancy can lead to lasting changes in foot structure. This study included 49 women, 30 had an increase in foot length, and 35 had a drop in their arch height. 11 of the 49 women reported an increase in shoe size. The researchers conclude that the results of this study also suggest the need to assess whether the use of inexpensive, well-tolerated, and widely available arch-supporting orthoses during pregnancy could potentially protect the long-term musculoskeletal health of women.
Making sure you have adequate arch support can help prevent over-pronation. Hopefully, you are wearing comfortable and supportive shoes during your pregnancy. One way to ensure you support your arches and protect your feet is to wear insoles. The Mommy Steps insoles are designed to support your foot during pregnancy. (You can save 20% off Mommy Steps and Form Insoles with the promo code FEET.)
Swelling and Edema
Several physical changes can contribute to swelling during pregnancy, also called edema. You have 50% more blood and fluids in your body, which accounts for 25% of your weight gain. The second reason is that your growing uterus puts pressure on the blood vessels in your pelvis and legs. This pressure can slow down circulation and cause blood to pool in your legs, ankles, and feet. The third reason for swelling is that some elevated hormones during pregnancy can make the walls of your veins softer, which makes them not work as effectively. Swelling during pregnancy is most common in the third trimester. This can also cause numbness, tingling, or your legs and feet being achy.
You can make many easy adjustments to help prevent and reduce swelling during pregnancy. One study found that exercise in a pool helped reduce swelling. See this episode to learn more about why swelling happens, how to prevent and treat it, and when you should call your doctor or midwife.
Carpal Tunnel Syndrome
The buildup of fluid in your wrists can put pressure on a nerve that runs all down your arm into your hand and cause tingling or numbness. This can lead to carpal tunnel syndrome, which can be painful and affect your grip and strength in your hands. One study found the prevalence of carpal tunnel during pregnancy to be 34%. This tends to be more common in the second and third trimesters when swelling and edema are more common. If you are doing any type of exercise that involves grip strength or using your wrists, this can present a challenge.
Keeping Your Workouts Safe
Now that you understand the recommendations for exercise and how physical changes may impact your workouts, let’s examine some other things you should keep in mind to keep your workouts safe.
Exercise and Hydration
During pregnancy, you have increased nutrient requirements, and you need additional water for digestion and transport of those additional nutrients. You also need water to make amniotic fluid and produce additional blood. You also lose more water during pregnancy through urination and increased respiration. You also have changes to your adrenal and thyroid functions, increased metabolism, and additional blood circulation. The American College of Obstetricians and Gynecologists recommends drinking 64-96 ounces (1.9-2.8 liters) of water every day. If you are exercising, you need additional water.
Our bodies give us a lot of clues that can tell us whether we are drinking enough fluids. These may seem obvious, but these are some signs that you are not drinking enough water. The first is that your mouth is dry or you are thirsty. This is your body’s way of telling you that you need fluids. Urinating less frequently, headaches, fatigue, and dizziness can show you need to drink more water.
According to ACOG, you should call your care provider if you have the following signs and symptoms of dehydration:
- You have a small amount of urine that is dark in color.
- You are unable to urinate.
- You cannot keep down liquids.
- You are dizzy or faint when standing up.
- You have a racing or pounding heartbeat.
One way to assess whether you are hydrated is by the color of your urine. There is evidence that urine color was a valid marker of hydration in pregnant or lactating mothers. You are looking for the color of your urine to be a shade of light yellow. See this episode for more in-depth information on hydration and drinking water.
It is even more important to replace electrolytes when you exercise. Electrolytes like calcium, potassium, magnesium, chloride, and sodium play many roles in your body, including chemical reactions, your nervous system’s functioning, muscle function, regulating pH levels, and maintaining hydration. You gain electrolytes from the food and drinks you consume and lose electrolytes when you eliminate water.
I am a huge fan of adding electrolytes to my water every day, especially during or after a workout. The hydration mix from Basis is my favorite. It isn’t overly sweet and has the perfect hint of flavor. You can save 20% off with the code PREGNANCYPODCAST. Drinking water with electrolytes added has increased the amount of water I drink, made it more enjoyable to stay hydrated, and I know I am getting an adequate amount of electrolytes.
Exercise and Calorie Needs
The standard adult needs about 2,000 calories per day. This figure varies depending on many factors, including age, sex, activity level, and whether you are pregnant or breastfeeding. The American College of Obstetricians and Gynecologists states that no extra calories are needed in the first trimester if you are pregnant with a single baby. In the second trimester, you will need an additional 340 calories per day, and in the third trimester, about 450 extra calories a day. ACOG states that athletes should pay particular attention to sustaining adequate caloric intake to prevent weight loss, which may adversely affect fetal growth. Depending on your activity level, you may need to increase your calories.
Taking Your Workout Outdoors
There are two significant benefits to getting outside in natural sunlight. The first is that sunlight helps your body produce vitamin D. The second benefit is that exposure to sunlight at specific points in the day can help set your circadian clock and optimize your hormone production for hormones like estrogen. The three critical times to view natural light are within 30-60 minutes of waking up, around solar noon, and before sunset. It is also nice to get fresh air and change your surroundings.
Remember that any activity in which you use your body can count towards your exercise. Even gardening activities like raking, weeding, or digging are recognized by ACOG as exercise. If you are working out outdoors, you do need to be mindful of the temperature and sun exposure.
Exercise in Hot Weather
Both working out and being exposed to hot weather can put you at risk of overheating. When you combine the two, you need to be especially careful. When you are pregnant, there is a concern of an elevated core temperature causing neural tube defects, spontaneous abortion, and other abnormalities. If you are in an area that gets especially hot, you may need to be more cautious. Research has shown that hot weather and exposure to high temperatures can increase the risk of stillbirth. Another study linked higher temperatures to lower birth weights. If the weather is hot, you may want to plan any outdoor exercise for early mornings or in the evenings when it is cooler outside. On especially hot days, you may want to take your workout indoors, where you will be cooler and potentially have air conditioning.
Sun Exposure During Pregnancy
A review found that exposure to UV radiation in the first three months of pregnancy had beneficial effects on fetal growth and blood pressure during the pregnancy period. Sunlight will increase your levels of vitamin D and can positively affect your mood. Your skin tends to be more sensitive to everything during pregnancy, including sun exposure. There are some common skin issues during pregnancy, like melasma and stretch marks, that can get worse with exposure to the sun.
You can wear a hat to keep the sun off your face, wear clothing to protect your skin, or spend time in the shade. If you have exposed skin, you should be using sunscreen. The American Academy of Dermatology recommends an SPF of a least 30, which blocks 97% of UVB rays. You want to use a broad-spectrum sunscreen for protection against UVA rays. You should reapply every two hours or after going in the water or sweating. See this episode for more information on sun exposure during pregnancy.
Workout Clothing in Pregnancy
If this is your first pregnancy, your clothes should continue to fit until around the start of the second trimester. Week 12 or 13 is about when you will start showing and find that your clothes are getting tight and less comfortable. If this is not your first pregnancy, or you are pregnant with twins or multiples, you will likely show sooner. Depending on the clothing you wear to workout, you may want to opt for some maternity clothes, especially bottoms that may not fit as your belly grows.
If you purchase sports bras during pregnancy, avoid stocking up on multiple sports bras early on. Your breasts grow throughout your pregnancy, so you may end up needing a couple of sizes. If you need additional support, you can try wearing two sports bras. There are solutions for any budget when it comes to making clothes work for your pregnancy.
Exercise and Naturally Inducing Labor
Anything from a long walk to stair climbing theoretically has the potential to get labor initiated. When you are upright and walking, gravity may help your baby descend farther into your birth canal, which can cause your cervix to dilate through simple pressure. Stairs require you to lift your legs higher, and this position may put more pressure on your cervix than just walking on a flat surface.
There are no studies showing a direct correlation between any type of exercise and labor starting. One study asked mothers, “Did anything happen, or did you do anything that you think may have made your labor start when it did?” 32% reported physical activity (usually walking). See this episode for an examination of the evidence behind the methods thought to induce labor naturally.
Talk to Your Doctor or Midwife
One study found that more than one-half of the physicians trained in the United States received no formal education in physical activity. Even for medical professionals who are knowledgeable about exercise, it is challenging to have an in-depth discussion in a prenatal appointment that lasts fifteen minutes or less. You should be discussing your exercise and activity with your doctor or midwife in the context of your level of experience and the particulars of your pregnancy. If your care provider has reservations about workouts you feel comfortable doing, please talk through their concerns. If you are not very active and your care provider encourages you to start exercising, start with just a few minutes a day. Whether you are an athlete or are just starting out, almost any activity can be modified so that you can feel empowered to exercise during your pregnancy.
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