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Why can’t I exercise during pregnancy? Time to revisit medical ‘absolute’ and ‘relative’ contraindications: systematic review of evidence of harm and a call to action
  1. Victoria L Meah1,
  2. Gregory A Davies2,
  3. Margie H Davenport1
  1. 1Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
  2. 2Department of Obstetrics and Gynecology, Queen's University, Kingston, Ontario, Canada
  1. Correspondence to Dr Margie H Davenport, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB T6G 2R3, Canada; mdavenpo{at}ualberta.ca

Abstract

Background Clinical guidelines recommend pregnant women without contraindication engage in regular physical activity. This is based on extensive evidence demonstrating the safety and benefits of prenatal exercise. However, certain medical conditions or contraindications warrant a reduction, modification or cessation of activity due to potential health risks.

Aim To review and evaluate the evidence related to medical disorders which may warrant contraindication to prenatal exercise.

Methods Online databases were searched up to 5 April 2019. Forty-four unique studies that reported data on our Population (pregnant women with contraindication to exercise), Intervention (subjective/objective measures of acute or chronic exercise), Comparator (not essential) and Outcomes (adverse maternal or fetal outcomes) were included in the review.

Key findings We found that the majority of medical conditions listed as contraindications were based on expert opinion; there is minimal empirical evidence to demonstrate harm of exercise and benefit of activity restriction. We identified 11 complications (eg, gestational hypertension, twin pregnancy) previously classified as contraindications where women may in fact benefit from regular prenatal physical activity with or without modifications. However, the evidence suggests that severe cardiorespiratory disease, placental abruption, vasa previa, uncontrolled type 1 diabetes, intrauterine growth restriction, active preterm labour, severe pre-eclampsia and cervical insufficiency are associated with strong potential for maternal/fetal harm and warrant classification as absolute contraindications.

Conclusion Based on empirical evidence, we provide a call to re-evaluate clinical guidelines related to medical disorders that have previously been considered contraindications to prenatal exercise. Removing barriers to physical activity during pregnancy for women with certain medical conditions may in fact be beneficial for maternal–fetal health outcomes.

  • pregnancy
  • exercise
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Footnotes

  • Twitter @vtorixm, @ExercisePreg

  • Contributors MHD, GAD, VLM developed the concept; VLM wrote the first draft of the manuscript; all authors revised and reviewed the final manuscript.

  • Funding VLM is funded by generous supporters of the Lois Hole Hospital for Women through the Women and Children's Health Research Institute Postdoctoral Fellowship. MHD is funded by Heart and Stroke Foundation Canada Joint National and Alberta Improving Hearth Health for Women New Investigator award (HSFC NNIA Davenport).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval for this study was not required. The data retrieved for the systematic review is publicly available information that is legally accessible.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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