2019 Canadian guideline for physical activity throughout pregnancy

Preamble:

These Guidelines provide evidence-based recommendations regarding physical activity throughout pregnancy in the promotion of maternal, fetal and neonatal health. In the absence of contraindications (see below for a detailed list), following these Guidelines is associated with (1) fewer newborn complications (ie, large for gestational age) and (2) maternal health benefits (ie, decreased risk of pre-eclampsia, gestational hypertension, gestational diabetes, caesarean section, instrumental delivery, urinary incontinence, excessive gestational weight gain and depression; improved blood glucose; decreased total gestational weight gain; and decreased severity of depressive symptoms and lumbopelvic pain).

Physical activity is not associated with miscarriage, stillbirth, neonatal death, preterm birth, preterm/prelabour rupture of membranes, neonatal hypoglycaemia, low birth weight, birth defects, induction of labour or birth complications. In general, more physical activity (frequency, duration and/or volume) is associated with greater benefits. However, evidence was not identified regarding the safety or additional benefit of exercising at levels significantly above the recommendations. Prenatal physical activity should be considered a front-line therapy for reducing the risk of pregnancy complications and enhancing maternal physical and mental health.

For pregnant women not currently meeting these Guidelines, a progressive adjustment towards them is recommended. Previously active women may continue physical activity throughout pregnancy. Women may need to modify physical activity as pregnancy progresses. There may be periods when following the guidelines is not possible due to fatigue and/or discomforts of pregnancy; women are encouraged to do what they can and to return to following the recommendations when they are able.

These Guidelines were informed by an extensive systematic review of the literature, expert opinion, and end user consultation and considerations of feasibility, acceptability, costs and equity.

Recommendations

The specific recommendations in the 2019 Canadian Guideline for Physical Activity throughout Pregnancy are provided below with corresponding statements indicating the quality of the evidence informing the recommendations and the strength of the recommendations (explanations follow).

1. All women without contraindication should be physically active throughout pregnancy. Strong recommendation, moderate-quality evidence.

Specific subgroups were examined:

Women who were previously inactive. Strong recommendation, moderate-quality evidence.
Women diagnosed with gestational diabetes mellitus. Weak recommendation, low-quality evidence.
Women categorised as overweight or obese (prepregnancy body mass index ≥25 kg/m²). Strong recommendation ⁱⁱ , low-quality evidence.

2. Pregnant women should accumulate at least 150 min of moderate-intensityⁱⁱⁱ physical activity each week to achieve clinically meaningful health benefits and reductions in pregnancy complications. Strong recommendation, moderate-quality evidence.

3. Physical activity should be accumulated over a minimum of 3 days per week; however, being active every day is encouraged. Strong recommendation, moderate-quality evidence.

4. Pregnant women should incorporate a variety of aerobic and resistance training activities to achieve greater benefits. Adding yoga and/or gentle stretching may also be beneficial. Strong recommendation, high-quality evidence.

5. Pelvic floor muscle training (PFMT) (eg, Kegel exercises) may be performed on a daily basis to reduce the risk of urinary incontinence. Instruction on the proper technique is recommended to obtain optimal benefits. Weak recommendation ^iv , low-quality evidence.

6. Pregnant women who experience light-headedness, nausea or feel unwell when they exercise flat on their back should modify their exercise position to avoid the supine position. Weak recommendation ^v , very-low quality evidence.

Contraindications

All pregnant women can participate in physical activity throughout pregnancy with the exception of those who have contraindications (listed below). Women with absolute contraindications may continue their usual activities of daily living but should not participate in more strenuous activities. Women with relative contraindications should discuss the advantages and disadvantages of moderate-to-vigorous intensity physical activity with their obstetric care provider prior to participation.

The following are absolute contraindications to exercise: