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Exercise During Pregnancy. Antoin M. Alexander Maj USAF MC Family Medicine Sports Fellow Adopted from Dr. Fred Brennan. Case. 24 y.o. G1P0 presents at 9 wks EGA for 1 st obstetrical visit Competes routinely in triathlons and road races - PowerPoint PPT Presentation
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Exercise During Exercise During PregnancyPregnancy
Antoin M. AlexanderAntoin M. AlexanderMaj USAF MCMaj USAF MC
Family Medicine Sports FellowFamily Medicine Sports FellowAdopted from Dr. Fred BrennanAdopted from Dr. Fred Brennan
CaseCase
• 24 y.o. G1P0 presents at 9 wks EGA for 124 y.o. G1P0 presents at 9 wks EGA for 1stst obstetrical visitobstetrical visit
• Competes routinely in triathlons and road Competes routinely in triathlons and road racesraces
• Curious about the benefits & risk of Curious about the benefits & risk of continuing to train & possibly competing continuing to train & possibly competing while pregnantwhile pregnant
• Will her performance suffer?Will her performance suffer?• Will she put her baby at risk?Will she put her baby at risk?• Can she exercise & breastfeed in the future?Can she exercise & breastfeed in the future?
OverviewOverview
• Physiology of Physiology of Exercise and Exercise and PregnancyPregnancy
• Risks and BenefitsRisks and Benefits• Guidelines for Guidelines for
Exercise in Exercise in PregnancyPregnancy
• The Pregnant AthleteThe Pregnant Athlete• Injury PatternsInjury Patterns• College athleteCollege athlete
Useful ReferencesUseful References
• ACOG CommitteeACOG Committee. Opinion no. 267: . Opinion no. 267: exercise during pregnancy and the exercise during pregnancy and the postpartum period. postpartum period. Obstet GynecolObstet Gynecol 2002;2002;9999:171–3 :171–3
• Artal RArtal R. Exercise during pregnancy. Safe . Exercise during pregnancy. Safe and beneficial for most. and beneficial for most. Phys and Sports Phys and Sports Med Med 1999;1999;2727:51–60 :51–60
Useful ReferencesUseful References
• Kelly AK. Practical exercise advice during Kelly AK. Practical exercise advice during pregnancy. Guidelines for active and inactive pregnancy. Guidelines for active and inactive women. women. Phys and Sports Med June Phys and Sports Med June 2005;33(6)2005;33(6)
• Davies GA. Joint SOGC/CSEP clinical practice Davies GA. Joint SOGC/CSEP clinical practice guideline: exercise in pregnancy and the guideline: exercise in pregnancy and the postpartum period.postpartum period. Can J Appl PhysiolCan J Appl Physiol 2003; 28(3): 2003; 28(3): 330-41330-41
• Morris SN. Exercise during pregnancy: a critical Morris SN. Exercise during pregnancy: a critical appraisal of the literature. appraisal of the literature. J Reprod MedJ Reprod Med 2005; 2005; 50(3):181-850(3):181-8
Physiologic Adaptations to Pregnancy & Interactions with Exercise
Physiology OverviewPhysiology Overview
• Significant physiologic changes occur Significant physiologic changes occur in pregnancyin pregnancy
• Objective data on the impact of Objective data on the impact of exercise on the mother, fetus, and exercise on the mother, fetus, and course of pregnancy are limitedcourse of pregnancy are limited
• Theoretical concerns must be Theoretical concerns must be understood to allow physicians to understood to allow physicians to advise women who wish to exercise in advise women who wish to exercise in pregnancypregnancy
CardiovascularCardiovascular
• Both exercise and pregnancy increase:Both exercise and pregnancy increase:– Heart rateHeart rate– Stroke volumeStroke volume– Cardiac outputCardiac output
• Theoretical risk:Theoretical risk: Competing effects on Competing effects on regional blood flow distributionregional blood flow distribution– Exercise decreases splanchnic blood flowExercise decreases splanchnic blood flow
• Doppler US not shown changes in uterine or Doppler US not shown changes in uterine or umbilical artery flowumbilical artery flow
– Both glucose and oxygen delivery to placental Both glucose and oxygen delivery to placental site is reducedsite is reduced
Fetal Response To Fetal Response To ExerciseExercise
• 45 healthy pregnany woman studied45 healthy pregnany woman studied– 15 nonexercisers, 15 regularly active,15 highly active15 nonexercisers, 15 regularly active,15 highly active– Tested 28- 33 weeks gestationTested 28- 33 weeks gestation– Treadmil #1 to volitional fatigueTreadmil #1 to volitional fatigue– Treadmill #2 to 40-59% HR reserve for 30 minTreadmill #2 to 40-59% HR reserve for 30 min– Treadmill #2 to 60-84% HR reserve for 30 minTreadmill #2 to 60-84% HR reserve for 30 min– Measure Umbilical artery Doppler, FHR tracing, Measure Umbilical artery Doppler, FHR tracing,
biophysical profilebiophysical profile
All doppler similar pre and post exerciseAll doppler similar pre and post exercise
Post exercise FHR tracing reactive < 20 minutesPost exercise FHR tracing reactive < 20 minutes
BPP scores all reassuringBPP scores all reassuringObstet Gynecol 2012; 119 (3) : 603-10Obstet Gynecol 2012; 119 (3) : 603-10
Cardiovascular IICardiovascular II
• Women who perform regular weight Women who perform regular weight bearing exercisebearing exercise– Augment pregnancy associated Augment pregnancy associated
increases in plasma volumeincreases in plasma volume– Increase placental volumeIncrease placental volume– Increase cardiac outputIncrease cardiac output
• What does this suggest?What does this suggest?– Increased rate of placental blood flow at Increased rate of placental blood flow at
restrest– Increase in 24 h glucose & oxygen Increase in 24 h glucose & oxygen
deliverydelivery
Substrate Delivery & Substrate Delivery & UtilizationUtilization
• Non-pregnant athleteNon-pregnant athlete– Wt-bearing exercise increases glucose oxidationWt-bearing exercise increases glucose oxidation– Sympathetic response mobilizes glucose stores Sympathetic response mobilizes glucose stores
& stimulates gluconeogenesis& stimulates gluconeogenesis– ResultResult: rise in glucose levels for at least the : rise in glucose levels for at least the
first hourfirst hour
• Pregnant athletePregnant athlete– Sympathetic response bluntedSympathetic response blunted– Glucose oxidation & lipogenesis are increasedGlucose oxidation & lipogenesis are increased– ResultResult: fall in glucose levels during & after : fall in glucose levels during & after
exerciseexercise
Oxygen DeliveryOxygen Delivery
• Pre-pregnancy sustained exercisePre-pregnancy sustained exercise– oxygen delivery to muscles & skinoxygen delivery to muscles & skin– oxygen delivery to most visceraoxygen delivery to most viscera
• During pregnancy oxygen delivery during During pregnancy oxygen delivery during exercise appears to be maintained byexercise appears to be maintained by– Maternal hemoconcentrationMaternal hemoconcentration– Improved perfusion at the placental Improved perfusion at the placental
interphaseinterphase– ConclusionConclusion: No evidence for compromised O: No evidence for compromised O2 2
deliverydelivery
PulmonaryPulmonary
• Both exercise and pregnancy increase Both exercise and pregnancy increase – Minute ventilationMinute ventilation– Oxygen consumptionOxygen consumption
• During pregnancyDuring pregnancy– Resting energy expenditure is increased Resting energy expenditure is increased – Augmented work of breathing during exerciseAugmented work of breathing during exercise– ResultResult: exercise requires higher VO: exercise requires higher VO22 (oxygen (oxygen
uptake) compared with that required in a uptake) compared with that required in a nonpregnancy statenonpregnancy state
• VOVO2 2 max decreases because body weight max decreases because body weight increases with pregnancyincreases with pregnancy
ThermoregulatoryThermoregulatory• Both exercise and pregnancy increase Both exercise and pregnancy increase
– Metabolic rate Metabolic rate – Increased heat productionIncreased heat production
• Theoretical concerns:Theoretical concerns:– Elevation in maternal core temperature due to Elevation in maternal core temperature due to
exercise could reduce fetal heat dissipationexercise could reduce fetal heat dissipation– Possible teratogenic effect at temp>102.6Possible teratogenic effect at temp>102.6
• Healthy, fit pregnant women have been Healthy, fit pregnant women have been shown to tolerate thermal stressshown to tolerate thermal stress
Changing Thermal Response Changing Thermal Response to Endurance Exercise in to Endurance Exercise in
PregnancyPregnancy• 18 well-trained recreational athletes18 well-trained recreational athletes• 20 minutes of cycling at room 20 minutes of cycling at room
temperature & 60-65% VOtemperature & 60-65% VO22 max max
• Maximum core temperature Maximum core temperature achieved during cycling decreased achieved during cycling decreased throughout gestationthroughout gestation
• Appear to be related to a increased Appear to be related to a increased vasodilation & increased sweatingvasodilation & increased sweating
Am J Obstet Gynecol. 1991; 165;: 1684-9.
NeuroendocrineNeuroendocrine
• Exercise increases circulating levels ofExercise increases circulating levels of– NorepinephrineNorepinephrine– EpinephrineEpinephrine
• Theoretical concernsTheoretical concerns: excess : excess catecholamines and prostanglandins will catecholamines and prostanglandins will result in contractions & preterm laborresult in contractions & preterm labor– Cochran review 2010 of 14 trials- 1014 Cochran review 2010 of 14 trials- 1014
womenwomen• No statistically significant change in gestation at No statistically significant change in gestation at
deliverydelivery
Mechanical EffectsMechanical Effects
• Altered center of Altered center of gravity gravity – growing breast, growing breast,
uterus and fetusuterus and fetus– increased lumbar increased lumbar
lordosislordosis
• Increased risk of fallIncreased risk of fall• Increased joint laxityIncreased joint laxity
– Theoretic increased Theoretic increased risk for strains/sprainsrisk for strains/sprains
Risks and Benefits
RisksRisks
• Theoretical risks:Theoretical risks:– Hypoxemia/HypoglycemiaHypoxemia/Hypoglycemia– Fetal teratogenesisFetal teratogenesis– Preterm laborPreterm labor– Low birth weightsLow birth weights– Sprains/strainsSprains/strains
• Negative outcomes have Negative outcomes have notnot been identified: been identified:– SABSAB– Pregnancy complicationsPregnancy complications– PTL/preterm birthPTL/preterm birth– Altered birth weightAltered birth weight– Higher injury ratesHigher injury rates
Sour Milk?Sour Milk?
• Neither Neither quantityquantity nor nor qualityquality of of breast milk breast milk produced appears produced appears to be affected by to be affected by moderate exercisemoderate exercise
BenefitsBenefits
• Improved cardiovascular fitnessImproved cardiovascular fitness• Control of maternal weight gainControl of maternal weight gain• Reduced subjective discomforts of pregnancyReduced subjective discomforts of pregnancy
– Swelling, leg cramps, fatigue, SOBSwelling, leg cramps, fatigue, SOB
• Positive influence of labor & delivery Positive influence of labor & delivery (Clapp et (Clapp et al)al)– Decreased risk of operative or assisted deliveriesDecreased risk of operative or assisted deliveries– Shorter active laborShorter active labor– Increased fetal tolerance of laborIncreased fetal tolerance of labor
• Possible reduced risk of preeclampsia, GDMPossible reduced risk of preeclampsia, GDM
Course of Labor after Course of Labor after Endurance Exercise in Endurance Exercise in
PregnancyPregnancyExerciExercisese(n=87)(n=87)
ContrControlol(n=44)(n=44)
Incidence of PTLIncidence of PTL 9%9% 9%9%
Length of GestationLength of Gestation 277 d277 d 282 d282 d
Incidence of c-sectionIncidence of c-section 6%6% 30%30%
Incidence of operative Incidence of operative vaginal deliveryvaginal delivery
6%6% 20%20%
Duration of laborDuration of labor 264 264 minmin
382 382 minmin
Clinical evidence of fetal Clinical evidence of fetal distressdistress
26%26% 50%50%Am J Obstet Gynecol 163: 1799-1805, 1990.
Psychological Well-BeingPsychological Well-Being
• Improved moodImproved mood• Decreased stressDecreased stress• Improved self-Improved self-
imageimage• Increased sense of Increased sense of
control and relief control and relief of tensionof tension
Semin Perinatol 20: 70-76, 1996.
Postpartum Well-BeingPostpartum Well-Being
• Improved weight lossImproved weight loss• Improved psychological well-beingImproved psychological well-being• No adverse impact on No adverse impact on
breastfeeding.breastfeeding.
Neonatal & Childhood Neonatal & Childhood BenefitsBenefits
• Clapp JF: Morphometric and Clapp JF: Morphometric and neurodevelopment outcomes at neurodevelopment outcomes at age 5 years of offspring of age 5 years of offspring of women who continued to women who continued to exercise regularly throughout exercise regularly throughout pregnancy.pregnancy.– Less body fat at birth and 5 Less body fat at birth and 5
yrsyrs– Similar motor, integrative & Similar motor, integrative &
academic readiness as control academic readiness as control groupsgroups
– Higher scores on Wechsler Higher scores on Wechsler scales and tests of oral scales and tests of oral language skills.language skills.
J. Pediatr 129: 856-863, 1996.
Preventing & Treating Preventing & Treating GDMGDM
• Exercise may be beneficial in the primary Exercise may be beneficial in the primary prevention of GDM, especially in prevention of GDM, especially in morbidly obese women (BMI > 33)morbidly obese women (BMI > 33)
• Resistance training may reduce need for Resistance training may reduce need for insulin therapy in overweight women insulin therapy in overweight women (BMI > 25)(BMI > 25)
• ADA endorsed exercise as helpful ADA endorsed exercise as helpful adjunctive therapy with GDM when adjunctive therapy with GDM when euglycemia is not achieved by diet alone.euglycemia is not achieved by diet alone.
Expert Guidance
Guidelines for Exercise in Guidelines for Exercise in PregnancyPregnancy
• ACOG in evolutionACOG in evolution– 19851985: HR : HR <<140 BPM with maximum duration 140 BPM with maximum duration
of exercise = 15 minutesof exercise = 15 minutes– 19941994: Less cautious and began to stress the : Less cautious and began to stress the
health benefits of exercisehealth benefits of exercise– 20022002: 30 minutes or more of moderate : 30 minutes or more of moderate
exercise a day recommendedexercise a day recommended
• SOGC/CSEPSOGC/CSEP– 2003: 2003: All women without contraindications All women without contraindications
should participate in aerobic & strength-should participate in aerobic & strength-conditioning exercise.conditioning exercise.
ACOG 2002ACOG 2002
• Recognition that Recognition that regular exercise is regular exercise is beneficial to even beneficial to even pregnant women pregnant women and should be and should be encouraged.encouraged.
• All women should All women should be evaluated be evaluated clinically before clinically before recommendations recommendations made.made.Obstet Gynecol 2002; 99: 171-173.
Absolute Absolute ContraindicationsContraindications
• Hemodynamically significant heart diseaseHemodynamically significant heart disease• Restrictive lung diseaseRestrictive lung disease• Incompetent cervix/cerclageIncompetent cervix/cerclage• Multiple gestation at risk for premature laborMultiple gestation at risk for premature labor• Persistent second- or third-trimester bleedingPersistent second- or third-trimester bleeding• Placenta previa after 26 weeksPlacenta previa after 26 weeks• Premature labor during current pregnancyPremature labor during current pregnancy• Ruptured membranesRuptured membranes• Preeclampsia/pregnancy induced hypertensionPreeclampsia/pregnancy induced hypertension
Obstet Gynecol 2002; 99: 171-173
Relative Relative ContraindicationsContraindications
• Severe anemiaSevere anemia• Unevaluated maternal Unevaluated maternal
cardiac arrhythmiacardiac arrhythmia• Chronic bronchitisChronic bronchitis• Poorly controlled type Poorly controlled type
1 diabetes1 diabetes• Extreme morbid Extreme morbid
obesityobesity• Extreme underweight Extreme underweight
(BMI < 12)(BMI < 12)• Heavy smokerHeavy smoker
• History of extremely History of extremely sedentary lifestylesedentary lifestyle
• IUGR in current IUGR in current pregnancypregnancy
• Poorly controlled Poorly controlled hypertensionhypertension
• Orthopedic limitationsOrthopedic limitations• Poorly controlled Poorly controlled
seizure disorderseizure disorder• Poorly controlled Poorly controlled
hyperthyroidismhyperthyroidism
Obstet Gynecol 2002; 99: 171-173
ACOG 2002ACOG 2002
• Acknowledges the potential of exercise Acknowledges the potential of exercise to prevent & treat gestational diabetes to prevent & treat gestational diabetes mellitusmellitus
• Recommends avoiding exercise Recommends avoiding exercise involving bothinvolving both– the supine position “as much as possible”the supine position “as much as possible”– prolonged periods of motionless standingprolonged periods of motionless standing
• Notes that strenuous activity has not Notes that strenuous activity has not been linked to poor fetal growth or been linked to poor fetal growth or outcomesoutcomes
Obstet Gynecol 2002; 99: 171-173
ACOG & SafetyACOG & Safety
• Safety of each sport determined by Safety of each sport determined by the “specific movements required by the “specific movements required by that sport.”that sport.”
• Scuba diving is contraindicatedScuba diving is contraindicated• Exertion above 6000 feet carries Exertion above 6000 feet carries
risks.risks.• Hyperthermia associated with Hyperthermia associated with
exercise has not be shown to be exercise has not be shown to be teratogenicteratogenic
Obstet Gynecol 2002; 99: 171-173
Higher Risk ActivitiesHigher Risk Activities
• Contact sports Contact sports with risk of with risk of abdominal traumaabdominal trauma– HockeyHockey– BasketballBasketball– SoccerSoccer
• High Risk Sports High Risk Sports with risk of both with risk of both falls and traumafalls and trauma– Gymnastics Gymnastics – Horseback ridingHorseback riding– Downhill SkiingDownhill Skiing– Vigorous racquet Vigorous racquet
sportsport
Obstet Gynecol 2002; 99: 171-173
Warning Signs to Warning Signs to Terminate ExerciseTerminate Exercise
• Vaginal bleedingVaginal bleeding• Dyspnea prior to Dyspnea prior to
exertionexertion• DizzinessDizziness• HeadacheHeadache• Chest painChest pain• Muscle weaknessMuscle weakness• Calf pain or swellingCalf pain or swelling• Preterm laborPreterm labor• Decreased fetal Decreased fetal
movementmovement• Amniotic fluid leakageAmniotic fluid leakage
Obstet Gynecol 2002; 99: 171-173
Postpartum ExercisePostpartum Exercise
• ““Prepregancy exercise routines may Prepregancy exercise routines may be resumed gradually as soon as it is be resumed gradually as soon as it is physically and medically safe.”physically and medically safe.”
• No adverse effects noted for even No adverse effects noted for even rapid return to activity.rapid return to activity.
• Moderate weight reduction while Moderate weight reduction while nursing does not compromise infant nursing does not compromise infant weight gain.weight gain.
• Associated with decreased incidence Associated with decreased incidence of postpartum depression.of postpartum depression.
Obstet Gynecol 2002; 99: 171-173
Advising the Pregnant Advising the Pregnant AthleteAthlete
• Will her athletic performance suffer?Will her athletic performance suffer?– Will she lose a significant amount of aerobic Will she lose a significant amount of aerobic
fitness?fitness?– Will her submaximal performance be affected?Will her submaximal performance be affected?
• Can she safely continue resistance Can she safely continue resistance exercises?exercises?
• Should she stop competing?Should she stop competing?• How soon can she return to competition?How soon can she return to competition?• Are breastfeeding and competitive athletics Are breastfeeding and competitive athletics
mutually exclusive?mutually exclusive?
Orthopedic Considerations for the Pregnant Athlete
Orthopedic ConcernsOrthopedic Concerns
• No injury pattern No injury pattern has been definitely has been definitely associated with associated with exercise in exercise in pregnancypregnancy
• Increased joint Increased joint laxity + weight laxity + weight gain = increased gain = increased risk of joint risk of joint discomfortdiscomfort
Common Orthopedic Common Orthopedic ConditionsConditions
• Low back painLow back pain
Common Orthopedic Common Orthopedic ConditionsConditions
• Low back painLow back pain• Pelvic/hip painPelvic/hip pain
Common Orthopedic Common Orthopedic ConditionsConditions
• Low back painLow back pain• Pelvic/hip painPelvic/hip pain• Pubic painPubic pain
Common Orthopedic Common Orthopedic ConditionsConditions
• Low back painLow back pain• Pelvic/hip painPelvic/hip pain• Pubic painPubic pain• Knee painKnee pain• Leg crampsLeg cramps
Common Orthopedic Common Orthopedic ConditionsConditions
• Low back painLow back pain• Pelvic/hip painPelvic/hip pain• Pubic painPubic pain• Knee painKnee pain• Leg crampsLeg cramps• Carpal Tunnel Carpal Tunnel
SyndromeSyndrome• DeQuervain’s DeQuervain’s
TenosynovitisTenosynovitis
Exercise PrescriptionExercise Prescription
• Goal: Maintain Goal: Maintain maternal fitness maternal fitness levels and minimize levels and minimize risk to fetus.risk to fetus.
• Points to considerPoints to consider– Current fitness levelCurrent fitness level– Goals for exerciseGoals for exercise– Job/occupational Job/occupational
requirementsrequirements– Gestational ageGestational age
• Intensity: Perceived Intensity: Perceived exertionexertion
• Safety is key!Safety is key!
Previously Sedentary Moderately Active Elite Athlete
Start with 15 min of exercise, 3 d-wk
Start with 30 min of exercise, 4 d-wk
Start with 30 min of exercise, 4 d-wk
Aerobic exercise, 65%-75% of maximum heart rate
Aerobic exercise, 65%-85% of maximum heart rate
Aerobic exercise, 75%-85% of maximum heart rate
Walking Running Continuation of previous sports should be discussed with coach/trainer/physician and should be adjusted based upon previous activity level
Swimming Cycling/Spinning Taper down or modify protocol in third trimester
Aerobics Aerobics May return to competition within 4-6 wk of delivery depending upon method
Stationary cycling Swimming Avoid trauma and avoid cutting sports after first trimester
Goal 30 min, 4 dIwkj1 Goal 30 min 5 d-wk Goal 30-40 min, 6-7 d-wk
NutritionNutrition
• Energy intake needs Energy intake needs to be sufficient to to be sufficient to meet energy meet energy expenditure and expenditure and promote weight gain.promote weight gain.
• Gestational weight Gestational weight gain (total & rate) gain (total & rate) good indicator of good indicator of adequate nutritionadequate nutrition
• Quality of diet should Quality of diet should be assessed be assessed periodicallyperiodically
Practical AdvicePractical Advice
Practical AdvicePractical Advice
• Begin discussions at the first visitBegin discussions at the first visit• Structure each regimen individuallyStructure each regimen individually
– safe upper limit of exercise will be safe upper limit of exercise will be dictated by a women’s fitness status dictated by a women’s fitness status prior to entering pregnancyprior to entering pregnancy
• Encourage rest-activity cyclesEncourage rest-activity cycles• Promote exercise as relaxationPromote exercise as relaxation
More Practical AdviceMore Practical Advice
• Assure adequate Assure adequate hydration and hydration and calories to support calories to support activityactivity
• In mid to late In mid to late pregnancy, monitor pregnancy, monitor for 2-3 fetal for 2-3 fetal movements in first 30 movements in first 30 minutes after exerciseminutes after exercise
• Do not ignore pain or Do not ignore pain or fatiguefatigue
• Routine prenatal care Routine prenatal care key!key!
Maternity Support Binder
ACOG & the Competitive ACOG & the Competitive AthleteAthlete
• First opinion statement to First opinion statement to acknowledge the competitive athlete acknowledge the competitive athlete & pregnancy& pregnancy
• Highlighted concerns:Highlighted concerns:– The potential effect of pregnancy on The potential effect of pregnancy on
competitive abilitycompetitive ability– The effects of strenuous training and The effects of strenuous training and
competition on pregnancy and the fetuscompetition on pregnancy and the fetus• ““Such athletes may require close Such athletes may require close
obstetric supervision.”obstetric supervision.”Obstet Gynecol 2002; 99: 171-173
NCAA & PregnancyNCAA & Pregnancy• Guideline published 2002Guideline published 2002• Acknowledges lack of research addressing Acknowledges lack of research addressing
intense physical exercise & pregnancyintense physical exercise & pregnancy• Cite expert opinion recommending avoid Cite expert opinion recommending avoid
participation in contact sports after 14 wks participation in contact sports after 14 wks EGAEGA
• Team physician job is to advise student-athlete:Team physician job is to advise student-athlete:– Risk, benefits, effects on competitive abilityRisk, benefits, effects on competitive ability– One-year extension of 5 yr eligibility period for One-year extension of 5 yr eligibility period for
reasons of pregnancy ??reasons of pregnancy ??
• Signed informed consent recommended if Signed informed consent recommended if athlete chooses to compete. May or may not athlete chooses to compete. May or may not protect the universityprotect the university
College athlete dilemmasCollege athlete dilemmas
• Athletes required to notify athletic Athletes required to notify athletic department when they become department when they become pregnant?pregnant?
• Allowed to play while pregnant and Allowed to play while pregnant and for how long?for how long?
• Should pregnancy be protected Should pregnancy be protected medical condition protected from medical condition protected from scholarship revocation?scholarship revocation?
• Should colleges develop programs for Should colleges develop programs for pregnant athletes?pregnant athletes?
College athlete dilemmasCollege athlete dilemmas
• Athletes may:Athletes may:– Hide pregnancyHide pregnancy– Drop out of schoolDrop out of school– Elect to have an abortionElect to have an abortion– Delay prenatal careDelay prenatal care
• Many colleges have no written policiesMany colleges have no written policies• Need safe environmentNeed safe environment• NCAA: “Stand up” to prevent NCAA: “Stand up” to prevent
revocation of scholarshipsrevocation of scholarships
Take Home PointsTake Home Points
• Healthy women should be encouraged to Healthy women should be encouraged to exercise before, during, and after pregnancyexercise before, during, and after pregnancy
• Knowledge of theoretical risks and known Knowledge of theoretical risks and known benefits are key to advising womenbenefits are key to advising women
• Individualized exercise prescription promotes Individualized exercise prescription promotes a safe, healthy pregnancy a safe, healthy pregnancy
• Potential benefits typically outweigh any risksPotential benefits typically outweigh any risks• Colleges need to adopt written “athlete Colleges need to adopt written “athlete
friendly” policies to “assist” pregnant athletesfriendly” policies to “assist” pregnant athletes
Questions?