Mar 30, 2017

Interview Transcript

Dr. Jones: So you are the exercise queen, you can hang in there with the hard bodies in the CrossFit gym, but now you're pregnant. Here are the little Goldilocks questions. How much exercise is too much? How much is too little? And how much is just right? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health, and this is The Scope.

Announcer: Covering all aspects of women's health, this is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: For many years, in fact, many women actually had to keep working, so they didn't have a chance of laying down and they were pretty physical during their pregnancy. But how much is too much, and what isn't enough, and how do we just keep going? So, today in the Scope studio, we are joined by Dr. Amy Sullivan. She's a perinatologist, a physician who specializes in high-risk pregnancies and who also has an interest in exercise in pregnancy. Dr. Sullivan, firstly, why exercise at all? Why not just put your feet up and eat chocolates, one for you, one for the baby? You know, what are the benefits? Why bother?

Dr. Sullivan: Well, the benefits of exercise in pregnancy, of course, are the same as the benefits of exercise when you're not pregnant. So it's good for cardiac health, respiratory health, weight control, flexibility, muscle strength, bone strength. So the benefits of exercise, of course, in pregnancy are the same as in the non-pregnant state. But during pregnancy, exercise adds more benefit to pregnancy, specifically. And by that, exercise in pregnancy helps people avoid excessive weight gain.

Dr. Jones: There goes the bonbons.

Dr. Sullivan: And also, after pregnancy, it also helps patients lose their pregnancy weight. There's also a great psychological benefit for exercise in pregnancy, and people who remain active during pregnancy have reported that they have a much higher satisfaction rate with pregnancy, but also their labor and delivery.

Dr. Jones: Yeah. I heard that women who exercise have less postpartum depression.

Dr. Sullivan: That is true. It has really helped decrease the incidence of postpartum depression, regular exercise.

Dr. Jones: I also heard that women who exercise have shorter labors. Is that true?

Dr. Sullivan: Well, there is some evidence to suggest that it's shorter labors, but there are also some evidence that it helps decrease the Caesarean section rate. So, in addition, there's certainly a decrease in gestational diabetes, and also it can help with blood pressure control in pregnancy.

Dr. Jones: Well, is there such a thing as too much? What are the risks of some sports, or what's too much, then?

Dr. Sullivan: Well, again, exercise in pregnancy needs to be individualized. So you can have someone who doesn't exercise at all, all the way to an elite athlete. Now, you imagine that what is normal exercise is going to vary greatly. There's no clear limit. There's no "too much" in pregnancy, exercise in pregnancy, so it really has to be tailored to the patient. But in general, ACOG recommends that pregnant women engage in about 150 minutes, actually, is what they say, of exercise a week. So five 30-minute sessions. But it's really hard to exercise too much.

Dr. Jones: So what should your heart rate be? Because I think you're already pumping for two, so is there too much? Could your heart be going too fast if you're going uphill or running uphill with a baby, and you're like 32 weeks, waddling uphill?

Dr. Sullivan: Yeah. Well, you know, as it turns out, I think the old-fashioned news was that, you know, people would recommend a maximum heart rate of 140. And as it turns out, in pregnancy, this is not a very high heart rate. It doesn't take much to . . .

Dr. Jones: No. You can get there just, you know, eating.

Dr. Sullivan: Exactly. It does not take much to get to 140. And again, it's specific to patients, but it's not really recommended that you monitor your heart rate, but instead it's one's perceived exertion. So you can get going on a treadmill, or walking up a hill or whatever form of exercise you can do, and the idea is to be able to talk. You don't have to have a long conversation, but you shouldn't be gasping for air.

Dr. Jones: Well, are there any medical conditions where women really shouldn't exercise?

Dr. Sullivan: Pregnancy conditions that really should not exercise, one is cervical insufficiency.

Dr. Jones: So the baby's trying to come out . . .

Dr. Sullivan: Too early.

Dr. Jones: . . . too early.

Dr. Sullivan: And then, often, these patients might have a cerclage, which is a stitch in their cervix to keep the cervix shut. They should not be exercising in pregnancy. Also, if the placenta is covering the cervix, so a placenta previa, you know, after 26 weeks, if the placenta previa persists, those people probably should not exercise in pregnancy. If someone has really severe hypertension and a poor or abnormal fetal growth, that may be an indication.

Dr. Jones: Okay. Are there any sports that are not okay?

Dr. Sullivan: I get this question a lot, of course, in Utah, but I tell people that, you know, if you're comfortable with it and it's kind of second-nature, it's okay. You know, just use your judgment. Someone would say to me, "Can I ice-skate?" Now, I, of course, am not an ice-skater and, like you with skiing, I would say, "No, no." So it's all . . . use your judgment.

Dr. Jones: Horseback riding.

Dr. Sullivan: Horseback riding. I would say, "Never," but use your judgment. It's not an absolute no-no.

Dr. Jones: How about scuba diving?

Dr. Sullivan: That one, scuba diving, actually is really not recommended. It has to do with pressure changes, and the change in pressure and the likely inability of the fetal cardio respiratory system to adapt to the variations in pressure deep underwater. So scuba diving, skydiving, I wouldn't recommend those two.

Dr. Jones: No skydiving, great.

Dr. Sullivan: People who are elite athletes or marathon runners, if that's what they're used to doing, they can continue that in pregnancy. It will become more uncomfortable, just the pressure from the pregnancy. Also, you have a belly in front of you that your balance is a little bit different. But as far as getting out and putting the miles in, that's okay to do in someone who is accustomed to doing that.

The big thing about exercise in pregnancy that I do want to put in is that you want to make sure, you want to avoid overheating, okay? And overheating in pregnancy can be problematic, particularly in the first trimester. And so it kind of recommended that you don't exercise in hot weather, humid weather, greater than 90 degrees because that can be risky.

Dr. Jones: What happens if you overheat in the first trimester? Is it a risk of miscarriage, or is it the overheating or is it the dehydration?

Dr. Sullivan: Well, there is a risk of miscarriage. But more so with the overheating, there's some evidence saying that the elevation of the maternal core body temperature in the first trimester may lead to neural tube defects or spina bifida in the fetus.

Dr. Jones: Right. So there's been that evidence, also, about women who had long febrile illnesses or hot tubs. So hot tubs after you've exercised, heating up your total body isn't such a great thing for the baby to be . . . We'd say we're cooking a bun in the oven, but we don't want to overcook our bun.

Dr. Sullivan: Exactly. And this is particularly in, you know, the first eight weeks of pregnancy.

Dr. Jones: Right. Well, after that, as you get bigger, if you get really hot, your blood pressure comes down in the second part of pregnancy. And if that happens, then you could stand up and pass out. So people often get pretty dizzy in pregnancy just because their blood pressure is low.

Dr. Sullivan: Right. So, again, that has to do not necessarily with body temperature, but also staying well-hydrated. So that's a big thing. Drink, drink, drink, drink, drink.

Dr. Jones: Good. Well, drink water. We're talking about water here, so there you go. And hopefully, if you're pregnant, you're going to keep going. And thanks, Dr. Sullivan, for joining us today, and thanks to you for joining us on The Scope.

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