Exercise During Pregnancy and Postpartum: ACOG Guidelines Summary

ACOG Guidelines for Exercise During Pregnancy and Postpartum

  • ACOG promotes exercise during pregnancy for health; may help manage gestational diabetes.

  • Sedentary women or those with complications: exercise only after medical evaluation.

  • Contraindications exist; terminate exercise if warning signs occur.

  • Avoid contact sports and scuba diving.

  • Gradual postpartum return.

Musculoskeletal Adaptations

  • Weight gain increases joint forces.

  • Lumbar lordosis causes low back pain.

  • Balance affected, increasing fall risk.

  • Increased ligament laxity may increase strain/sprain.

  • Recommendation: Modify exercises to reduce joint stress and fall risk.

Uterine Activity & Nutrition

  • Activity may increase uterine contractions.

  • Reduce activity in 2nd/3rd trimesters with preterm labor risk.

  • Extra 300 kcal/day needed after 13th week.

  • Increased carb use during exercise.

Cardiovascular Adaptations

  • Blood volume, HR, stroke volume, and cardiac output increase.

  • Avoid supine positions after 1st trimester.

  • Recommendation: Avoid prolonged standing; be aware of decreased venous return symptoms.

Respiratory Adaptations

  • Minute ventilation increases.

  • Decreased oxygen availability during exercise.

Thermoregulatory Control

  • Increased heat production.

  • Maintain euhydration.

  • Avoid hyperthermia during first 45-60 days.

  • Recommendation: Stay hydrated; avoid hot/humid conditions.

Fetal Responses

  • Fetal injuries unlikely in uncomplicated pregnancies.

  • Fetal HR may increase.

  • Ensure adequate energy intake.

Clinical Evaluation

  • Thorough evaluation needed before recommending exercise.

Exercise Prescription

  • Include aerobic and musculoskeletal exercise.

  • Walking and cycling are useful.

  • Avoid scuba diving and supine exercises.

  • Caution with activities increasing fall risk or joint stress.

Intensity, Duration, Frequency

  • Moderate intensity (3-4 METS) recommended.

  • Use perceived exertion (12-14 on 6-20 scale).

  • Limit prolonged exercise (> 45 minutes).

  • Accumulate 30 minutes on most days.

Recreational Activities

  • Avoid high fall risk or abdominal trauma risk.

Water Exercise

  • Redistributes fluid, increasing blood volume.

  • Good for edema, thermal regulation, and buoyancy.

Competitive Athletics

  • Require close supervision; address thermoregulation.

Special Populations

  • Individualized prescriptions for diabetes, obesity, or hypertension.

Postpartum Exercise

  • Resume gradually when safe.

  • Moderate weight reduction while nursing is safe.

  • Consider feeding infants before exercising.

  • May decrease postpartum depression.