Absolute and relative contraindications to prenatal exercise in guidelines from around the world
| Contraindication | SOGC/CSEP1–3 | IOC7 | ACOG6 | SMA5 |
| Absolute | ||||
| Cardiovascular disorders | ||||
| Serious cardiovascular disorder | X | Haemodynamically significant | Haemodynamically significant | |
| Chronic hypertension, uncontrolled | X | X | ||
| Hypertensive disorders of pregnancy | X | |||
| Gestational hypertension | X | X | ||
| Pre-eclampsia | X | X | X | |
| Respiratory disorders | ||||
| Serious respiratory disorders | X | |||
| Restrictive lung disease | X | X | ||
| Pregnancy-specific disorders | ||||
| IUGR | X | X | Growth-restricted fetus | |
| Multiple pregnancies | High order (≥3) | Risk of PTL | Risk of PTL | High order (≥3) |
| Persistent vaginal bleeding | X | T2 or T3 | T2 or T3 | |
| Placenta previa | After 28 weeks | After 26 weeks | After 26 weeks | After 28 weeks |
| PPROMs | X | X | X | X |
| Preterm labour (including premature contractions) | X | X | X | Signs of |
| Cerclage | X | X | ||
| Incompetent cervix | X | X | X | |
| Cervical insufficiency | X | |||
| Other disorders | ||||
| Anaemia (severe) | X | X | ||
| Systemic disorder | X | |||
| Thyroid disease, uncontrolled | X | |||
| Type 1 diabetes, poorly controlled | X | |||
| Relative | ||||
| Cardiovascular disorders | ||||
| Cardiac arrhythmia, unevaluated | X | X | ||
| Cardiovascular disorders, mild/moderate | X | X | ||
| Chronic hypertension, uncontrolled | X | Hypertension (all) | ||
| Gestational hypertension | X | |||
| Respiratory disorders | ||||
| Mild/moderate respiratory disorders | X | X | X | |
| Chronic bronchitis | X | X | ||
| Smoking, heavy (>20 cigarettes/day) | Heavy smoker (all quantities) | |||
| Pregnancy-specific disorders | ||||
| IUGR | History of | X | In current pregnancy | |
| History of premature birth | X | X | X | |
| Recurrent pregnancy loss | X | History of | ||
| Previous spontaneous abortion | History of | X | ||
| Twin pregnancies >28 weeks | X | X | ||
| Cervical enlargement | X | |||
| Other disorders | ||||
| Epilepsy, poorly controlled | Seizure disorder | Seizure disorder | ||
| Thyroid disease, uncontrolled | Hyperthyroidism | Hyperthyroidism | ||
| Type 1 diabetes, poorly controlled | X | X | X | |
| Orthopaedic limitations | X | X | ||
| Other significant medical conditions | X | X | ||
| Anaemia | Symptomatic | X | Hb <100 g/L | |
| Eating disorder | X | Extreme underweight | BMI <12 kg/m2 | X |
| Malnutrition | X | Extreme underweight | BMI <12 kg/m2 | X |
| Obesity | BMI >40 kg/m2 | BMI >30 kg/m2 | ||
| History of extremely sedentary lifestyle | X | |||
Adapted from Evenson et al (2014).135
Guidance from the UK Chief Medical Officer states that exercise should be recommended to women with uncomplicated pregnancies.4 However, women with obstetric or medical complications may perform moderate intensity physical activity during pregnancy but should receive additional monitoring and/or specialist support.136
ACOG, American College of Obstetricians and Gynecologists; BMI, body mass index; CSEP, Canadian Society for Exercise Physiology; Hb, haemoglobin; IUGR, intrauterine growth restriction; PPROMs, preterm premature rupture of membrane; PTL, preterm labour; SMA, Sports Medicine Australia; SOGC, Society of Obstetricians and Gynaecologists of Canada; T2, second trimester; T3, third trimester.