Current Women's Health Reviews - Volume 11, Issue 1, 2015

Background: Regular physical activity during pregnancy has a positive effect on the psychophysical condition of the pregnant woman, pregnancy and fetal development, parturition and the postpartum period. However, its level in pregnant women is insufficient in most countries. For an exercise program to be effective it must take into account four training components: intensity, frequency, duration and its content - through a proper selection of the type of exercises and their technique. In this work we aimed to answer the question what information on the contents of prenatal exercises is provided in the current guidelines for exercise during pregnancy in different countries. Methods and Results: We have analyzed 11 documents, that were the official position of national obstetrics, gynecology, or sports medicine institutions from 7 countries. The guidelines provide little information on the contents of prenatal exercise and on the adaptation of sports activities to pregnancy. Conclusions: The guidelines for exercise in pregnancy should be updated based on high-quality research and in collaboration with practitioners in the field of prenatal physical activity, which could increase the chances of their implementation. Trustworthy and comprehensive guidelines created on the basis of international and interdisciplinary initiatives should be disseminated among all interested in prenatal physical activity: pregnant women and their families, obstetrics care providers and exercise professionals to enable them an effective cooperation and to globally promote exercise in pregnancy.

Pregnancy is a time in women’s lives that is associated with considerable physiological and psychological changes. From a scientific point of view, practically all the female body is changing for nine months, sometimes discontinuously, which can cause generate alterations, including psychological. The addition of exercise can generate, in theory, conflicts due to the requirements and reactions of the physical activity itself. Both pregnancy and exercise are biological process which involve striking many adaptations, such adaptations may be in the same or in opposite direction. Depending on the specific variable being studied. The scientific literature has not been totally conclusive regarding the coexistence of two processes: exercise and pregnancy. However there is currently sufficient empirical evidence to support the promotion of moderate prenatal physical activity for maternal health benefits. Most of the studied consulted in this review show that in the absence of obstetric contraindication during pregnancy adding physical exercise should not pose a risk to maternal and fetal well-being.

Pregnancy and especially vaginal childbirth are risk factors for pelvic floor dysfunctions such as urinary incontinence (UI). The aim of this literature review was to give an overview of how the pelvic floor may be affected by pregnancy and childbirth, and further state the current evidence on pelvic floor muscle training (PFMT) on UI. Connective tissue, peripheral nerves and muscular structures are already during pregnancy subjected to hormonal, anatomical and morphological changes. During vaginal delivery, the above mentioned structures are forcibly stretched and compressed. This may initiate changed tissue properties, which may contribute to altered pelvic floor function and increased risk of UI. Trained pelvic floor muscles (PFM) may counteract the hormonally mediated increased laxity of the pelvic floor and the increased intra-abdominal pressure during pregnancy. Further, a trained PFM may encompass a greater functional reserve so that childbirth does not cause the sufficient loss of muscle function to develop urinary leakage. Additionally, a trained PFM may recover better after childbirth as the appropriate neuromuscular motor patterns have already been learned. Evidence based guidelines recommend that pregnant women having their first child should be offered supervised PFMT, and likewise for women with persistent UI symptoms after delivery (Grade A recommendations). Conclusion: Several observational studies have demonstrated significantly higher PFM strength in continent women than in women having UI, and further that vaginal delivery weakens the PFM. Current evidence based guidelines state that PFMT can prevent and treat UI, and recommend strength training of the PFM during pregnancy and postpartum.

Maternal obesity is accelerating world-wide and may be partly due to excessive gestational weight gain (GWG) and weight retention so that women begin a subsequent pregnancy with extra weight. Excessive GWG has been linked to chronic disease risk in the mother and also to an unhealthy foetal environment with downstream consequences for offspring health with risk for childhood obesity. Weight control during pregnancy and prevention of excessive GWG is an important issue for both mother and developing child. A healthy lifestyle through healthy eating and physical activity are key to prevention. Weight management for non-pregnant individuals has been evaluated for over 30 years, and lessons learned may assist in planning interventions for preventing excessive GWG. Many systematic reviews and meta-analyses analyzing the same studies on GWG report very different results. Recently, 10 intervention trials to prevent excessive GWG were published and only 6 of them were successful. Significant association between maternal exercise and GWG guidelines were reported, however, “one size does not fit all”. The failed trials did not have extra faceto- face sessions, were educational based and adherence was <50%. Accountability, face-to-face exercise sessions, and pedometers may motivate pregnant women to increase step counts to 10,000, which, when combined with nutrition control, prevents excessive GWG. Community walking programs that include family members and children may assist pregnant women of all body mass index categories to overcome potential barriers to promote a healthy lifestyle that will benefit them and their families for weight control and prevention of future chronic disease risk.

During pregnancy, dietary energy and nutrient requirements are increased to support metabolism changes of the mother, as blood volume and red cells expansion, and the delivery of energy and nutrients to the fetus. This review aims to: i) identify and discuss maternal physiological changes during pregnancy related to nutrition; ii) clarify about the most recently nutritional recommendations for pregnant women, including special groups of pregnant women, who do not usually practice a healthy diet, those who are in high-risk categories and pregnant athletes; iii) and clarify the importance of breastfeeding, specifically for the newborn, and infant formulae, as an alternative feeding. A literature review was undertaken by electronic databases PubMed, b-on, Scielo, Medline, Web of Science and Science Direct. The most recent original articles, systematic reviews and meta-analyses were used to search information from pregnancy, newborn baby, postpartum and nutritional status. The intake of whole grains, fruit, vegetables, low-fat dairy and lean meats can be preventive for an appropriate maternal weight and infant weight. Supplements should only be used when there is a deficiency. Special groups of pregnant women who do not usually practice a healthy diet, those who are in high-risk categories and pregnant athletes should daily take a multivitamin andmineral preparation containing a variety of nutrients beginning in the second trimester. A healthy diet and an appropriate body weight are mandatory for maternal health and fetal outcomes. Breast milk is a unique source of energy and nutrients for the infant.

The purpose of this study was to analyze studies that have investigated posture and gait during pregnancy and the importance of exercise. For this purpose, a systematic literature search was conducted on the following electronic databases: Scielo, Scopus, Embase, Pubmed, and Medline. Gait biomechanics, posture, lower limb alignment, postural balance, and physical exercise studies from 1943 to 2014 were accepted as potentially relevant for inclusion in this review. In general, posture studies showed that pregnant women demonstrated pain and discomfort in the pelvis and lumbar spine during pregnancy and after childbirth. Static posture changes, such as increased lumbar and thoracic curvatures during pregnancy and up to two months after childbirth, pelvic anteversion, and stretching of the abdominal musculature resulted in reduced functional stability of the hip. The lower limb alignment studies showed hyperextension or valgus knee and decreased longitudinal arch with increased support bases and distances between the feet. Postural balance studies showed that postural stability decreased during pregnancy and after childbirth, leading to an increased risk of falls. Gait studies showed a pattern of feet rollover with greater stance phase duration, a decrease of plantar flexion and propulsion force associated with increased hip flexion, as well as extensor and abductor moments. Other changes were characterized by greater anterior-posterior and medial-lateral sway with increased plantar load over the forefoot and rearfoot areas. Gait training and resistance exercises at moderate intensity showed to be low-cost aerobic exercises with positive therapeutic effects to reduce the risk of pre-eclampsia and gestational diabetes mellitus. However, no studies were found regarding the therapeutic effects of exercise to improve the biomechanical aspects of posture, specially lumbar curvature, knee angle and plantar arch, and of gait, such as propulsion, hip angle and overload feet in pregnant women.

Diastasis recti abdominis (DRA) or the increased inter rectus distance (IRD) is described as the separation of the rectus abdominis muscles. It can occur during pregnancy and after childbirth. Mota et al. (2015) found DRA may affect up 100% of pregnant women [1], and it may persist separated in the immediate postpartum period in 35% to 60% of women [2]. Reported prevalence of DRA or increased IRD varies and may be inaccurate due to different cut off points for the diagnosis [1-7] and use of different measurement methods. To date limited studies about the normal width of the IRD in postpartum women are available [8, 9], and there is scarce information about risk factors for DRA. There are some theories stating that failure to treat DRA effectively can lead to long term sequelae [10], including abnormal posture [1], lumbo-pelvic pain and cosmetic imperfections [10]. Postnatal women are stimulated to resume abdominal exercises shortly after delivery [3] to improve trunk function and restore abdominal figure and fitness [8]. To date there is scant knowledge on the most effective abdominal exercises both during pregnancy and after childbirth. In particular there is little evidence on which exercises are most efficient in the narrowing of the recti diastasis. The aim of this article is to critically review the literature on the risk factors, functional implications and the effect of exercise on DRA. This information is expected to be relevant for physiotherapists and exercise professionals.

Women suffering from low back pain (LBP) and/or pelvic girdle pain (PGP) may be advised not to participate in physical exercises. Although LBP and PGP share similar and overlapping features, there is growing evidence that PGP comprises a distinct subgroup with a unique clinical presentation and needs specific management. There is a moderate level of evidence that PGP is related to a change in the pelvic mechanism and/or motor control. Appropriate information to reduce fear and anxiety and specific exercises are recommended. Evidence of moderate quality suggests that exercise or acupuncture during pregnancy significantly reduced LBP/PGP more than usual care alone. Even though group exercises during pregnancy do not seem to influence the prevalence of LBP/PGP, women who exercised handled their pain better. Exercises should focus coordination of the local and overall muscle system, especially addressing the dynamic control of a neutral position of the lumbopelvis, subsequently increase strength and endurance to manage the physical demands facing each individual. Additional essential points to be addressed are: restriction of the sacroiliac joint, posture, breathing, and some cognitive behavioural aspects. As there is strong evidence that stabilization exercises are not more effective than any other form of active exercise, therapeutic exercises should focus less on specific stabilizing muscles and more on behaviour and optimal dynamic control of movements. Women should be encouraged to be physically active and health care providers should help them to find exercises or physical activity optimal for each individual in her own environment.

Current scientific evidence supports the recommendation to initiate or continue the practice of physical exercise in healthy pregnant women. Group exercise programs have positive effects in improving health and well-being, as well as social support. In order to understand the scientific evidence in this field, and the outcomes in maternal health, it has generated wide interest in exploring the studies carried out with more relevant group exercise programs. The aim of this systematic review was to evaluate the available evidence on the effectiveness of group exercise programs in improving women’s and newborns health outcomes during pregnancy. Three databases were used to conduct literature searches and strict inclusion and exclusion criteria were employed. Seventeen studies were selected for analysis. All studies were randomized control trials conducted with pregnant women that evaluated the effect of group exercise programs on the health outcomes of mother and newborn. Most studies followed a supervised structured exercise program including a main aerobic part, resistance training, pelvic floor training and stretching and relaxation sections. The significant effects of the programs are related with improved maternal perception of health status, lower maternal weight gain, improved levels of maternal glucose tolerance, improved aerobic fitness and muscular strength, lower frequency of urinary incontinence, improved sick leave due to lumbopelvic pain, fewer cesarean and instrumental deliveries, higher newborn Apgar score and faster postpartum recovery. Exercise and health professionals should advise pregnant women that aerobic group exercise during pregnancy improves a wide range of health outcomes for the women and newborns.