Overview

Many studies demonstrate the benefits of yoga during pregnancy, from reducing time in labor to improving newborn outcomes. The American College of Obstetricians and Gynecologists states that modified yoga is one of the safest exercises for pregnant women. ACOG also cautions against specific poses and hot yoga. As with examining any activity, there is nuance to determining what activities are safe. Research is available on particular poses and practicing yoga in a heated environment. This episode examines the evidence on prenatal yoga, physical changes that can affect your yoga practice and precautions, and tips to modify yoga during pregnancy.

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Article and Resources

Exercise in Pregnancy

There is a separate episode with an overview of exercise during pregnancy. This includes general recommendations and safety tips to keep your workouts healthy for you and your baby. Plus, a breakdown of the physical changes and common pregnancy symptoms that can affect your workouts. I recommend you listen to the episode on Exercise in Pregnancy before diving into this article on yoga.

Yoga

Yoga is an ancient practice that has dramatically increased in popularity. In general, yoga is a form of exercise that involves postures and movements to build strength, flexibility, and balance. Yoga also incorporates breathing and meditation. There are many different types of yoga, ranging from practices focused on meditation and relaxation to faster-paced yoga that concentrates on strength and endurance. Within different yoga disciplines, individual instructors also have their unique teaching styles.

Benefits of Yoga

There is quite a lot of research on the benefits of yoga. Evidence shows that yogic practices enhance muscular strength and body flexibility, promote and improve respiratory and cardiovascular function, promote recovery from and treatment of addiction, reduce stress, anxiety, depression, and chronic pain, improve sleep patterns, and enhance overall well-being and quality of life.

There are also many studies demonstrating the benefits of yoga during pregnancy. A clinical trial found prenatal yoga reduced labor induction rates, preterm delivery, cesarean sections, and time in labor. It also improved newborn outcomes and APGAR scores. A study found yoga can empower pregnant women in increasing their quality of life by reducing the uncomfortable experiences, stress, anxiety, and depression pronounced during the COVID-19 pandemic. A randomized controlled trial found lower cesarean rates in the group who practiced yoga. They also had a shorter first stage of labor and a better tolerance for pain. Some research shows you can use yoga as an intervention for depression and anxiety during pregnancy.

Researchers often exclude women with high-risk pregnancies or complications from studies on exercise during pregnancy. This is not the case when examining research on prenatal yoga. Studies show that yoga is safe for high-risk mothers and has mental and physical benefits. A randomized study of yoga in high-risk pregnancies suggests that guided yogic practices and visualization can improve fetal growth and placental blood circulation. Another study found yoga as an effective therapy to reduce maternal stress levels in high-risk pregnancies.

Recommendations

The American College of Obstetricians and Gynecologists states that modified yoga is one of the safest exercises for pregnant women. ACOG notes that yoga reduces stress, improves flexibility, and encourages stretching and focused breathing. There are prenatal yoga and Pilates classes designed for pregnant women. These classes often teach modified poses that accommodate a pregnant woman’s shifting balance. ACOG does caution that you should avoid poses that require you to be still or lie on your back for long periods. The organization also advises against hot yoga, which may cause you to become overheated.

Physical Changes During Pregnancy that Can Impact Your Yoga Practice

You want to keep in mind a few things for prenatal yoga. The first consideration is that you are at a greater risk for injury when pregnant. The hormone relaxin makes your ligaments, tendons, and joints more relaxed. This is great for your growing body and birth and increases your risk of injury. Your growing belly throws off your center of balance, making advanced poses requiring a lot of balance more challenging. Plus, your core is likely not as strong because you have a baby growing, and all of the ligaments in your belly are stretched. Downward dog is a simple pose that doesn’t require much balance, but headstand is a different story. You obviously wouldn’t want to take a fall, especially on your belly when you are pregnant.

During pregnancy, your blood volume increases by 50%. This affects your heart rate and blood pressure because your heart pumps more blood volume.

The Evidence of Yoga in Pregnancy and Safety

Guidelines from the American College of Obstetricians and Gynecologists will always err on the side of caution and are blanket recommendations designed to apply to most pregnant mothers. Let’s examine the research on yoga in pregnancy regarding safety.

Specific Poses

In the past, many poses were avoided during pregnancy over safety concerns. One study looked at 26 different poses and found them safe during pregnancy. This included some poses like happy baby and child poses previously discouraged during pregnancy. See this article from Harvard University with an excellent summary of the research and a list of all poses.

Inversion Poses

There have been some questions about the safety of inversions during pregnancy. An inversion is any pose where your head is lower than your heart. This can range from a downward-facing dog to a handstand, with many poses in between. Inversion poses require your heart to work harder to deliver blood against gravity to the part of your body above your heart. From a liability standpoint, it will always be safer to advise against something during pregnancy, especially when there are unknowns or a lack of evidence.

Unfortunately, I could not locate any research on inversions during pregnancy. Like any yoga practice, you must consider your experience level and comfort. A small study looked at the effects of inversion using an inversion table, which allows you to invert by strapping your feet to a device and then hanging upside down. As the participants were inverted, their heart rate decreased, and their blood pressure increased. If you have any issues with blood pressure during pregnancy, like high blood pressure (hypertension), pre-eclampsia, or eclampsia, you should talk to your doctor or midwife before attempting any inversions.

Poses on Your Back

The American College of Obstetricians and Gynecologists cautions that you should avoid poses that require you to be still or lie on your back for long periods. This is because as your uterus grows, it puts more pressure on your vena cava. Your vena cava is the main artery that carries unoxygenated blood from the lower half of your body back to your heart. If there is a lot of pressure on this vein, it could decrease the flow of blood, which could ultimately reduce your oxygen and oxygen getting to your baby.

A systematic review to determine whether prenatal supine exercise is associated with adverse outcomes found that although many countries caution against supine exercise after 16 weeks, these recommendations are primarily based on expert opinion rather than explicit scientific evidence. The researchers concluded that supine exercise is not associated with adverse pregnancy outcomes. There is insufficient evidence to determine whether exercise in the supine position is safe or should be avoided during pregnancy.

There is a difference between spending several hours on your back and lying on your back for a few minutes during a yoga pose. You can modify some poses to be in more of an incline position rather than flat on your back. You can also alternate poses that require you to be on your back with other upright positions or reduce your time in the supine position. You always have the opportunity to skip any poses or any positions when you are uncomfortable.

Bikram and Hot Yoga

ACOG advises against hot yoga due to the possibility of you becoming overheated. There is a concern about an elevated core temperature causing neural tube defects, spontaneous abortion, and other abnormalities when you are expecting. There is evidence of an increased risk of neural tube defects among fetuses exposed to excessive heat during the first trimester. This study primarily focused on hot tubs and saunas. It is generally recommended that you limit hot tub use to less than 15 minutes or avoid it altogether. You tend to reach a higher core temperature in a hot tub than in a sauna or a hot yoga room. You sweat in a sauna or yoga studio, which can help lower your core temperature rather than submerging yourself in a hot tub where perspiration does not allow you to cool down.

Decades ago, scientists established a correlation between hyperthermia and neural tube defects. Studies in animals and humans show a strong correlation between hyperthermia and neural tube defects. Hyperthermia occurs when you have an elevated core temperature for a prolonged time.

The big question is whether hyperthermia can occur during hot yoga. An American Council on Exercise study took a group of participants who swallowed a core body temperature sensor. Researchers could remotely monitor core temperatures while participants underwent a 60-minute yoga class in a room heated to 70 °Fahrenheit (21.1 °Celsius). Then, 24 hours later, the same participants underwent a yoga class in a room heated to 92 °F (33.3 °C). The researchers did not find a difference in the core temperature increase between the two rooms. The highest recorded temperature of all participants was 102.4 F, just over the 102 °F (38.9 °C) threshold that we prefer to keep temperatures below during pregnancy. In a room heated to a temperature higher than 92 °F (33.3 °C), it is possible you could see more of an increase in core temperature.

Please discuss practicing yoga in a heated environment with your doctor or midwife. If you are comfortable and continue heated yoga during pregnancy, please remember to leave the room and cool off if you feel overheated. In addition, being in hotter temperatures and perspiration requires drinking additional fluids to stay hydrated.

Warning Signs

Most of the warning signs that indicate you should stop exercising or halt your yoga practice 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, chest pain, headache, muscle weakness, calf pain, or swelling. If you are uncomfortable at any point, skip the pose, change positions, or take a break.

Experience Level Matters

There is a big difference between someone new to yoga and someone with regular practice. Someone with a lot of experience in yoga can do more advanced poses for more extended periods with less fatigue. With regular practice, you learn the correct way to perform poses and how to regulate your breathing.

For someone new to yoga, it takes time to learn how to correctly position your body in poses or movements to get the most out of a pose and keep yourself safe from injury. A yoga class is a fantastic resource for beginners to learn yoga and get instruction and feedback on poses from an experienced teacher. There are also many prenatal yoga classes specifically geared toward pregnant mothers.

Modifying Your Yoga Practice for Pregnancy

The beauty of yoga is that you can modify any pose. You can use a block for stability or shorten the distance you need to stretch. You can use a wall to help you balance. You control how far you take each stretch and how long you hold each pose. Awareness of how you feel will go a long way in telling you whether your body agrees with a pose or if it is uncomfortable. As your body changes, your yoga practice may need to change too.

Talk to Your Doctor or Midwife

You should discuss your exercise and activity with your doctor or midwife in the context of your level of experience and the particulars of your pregnancy. Yoga is considered one of the safest exercises you can do during pregnancy. Some types of yoga or specific poses may have additional risks when you are pregnant. Whether you are an experienced yogi or are just starting, you can modify almost any pose to be safe and comfortable, even when you are nine months pregnant.

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