Pregnancy Advanced Sports Medicine 4134 Dr. Paulo Sanzo November 30, 2012 Jeff Ploen Jeff Ploen Jessica French Jessica French Jen Wright Jen Wright Ben MacKay Ben MacKay

Pregnancy

First,

Then,

And THEN

General Overview of Nine Months of Pregnancy From Conception to Birth

The First Trimester Lasts from conception to the twelfth week of pregnancy 3 periods during the first trimester: 3 periods during the first trimester: The Germinal Period The Germinal Period Fertilized egg travels and implants in wall of uterus Fertilized egg travels and implants in wall of uterus Implantation occurs days after conception Implantation occurs days after conception The Period of the Embryo The Period of the Embryo Lasts from third through eighth week of pregnancy Lasts from third through eighth week of pregnancy Major organs and anatomical structures begin to form Major organs and anatomical structures begin to form The Period of the Fetus The Period of the Fetus Lasts from ninth week of pregnancy until birth Lasts from ninth week of pregnancy until birth All major organs continue rapid growth and become interconnected All major organs continue rapid growth and become interconnected

The Second Trimester Fetus assumes distinct human appearance The nails harden and skin thickens, as well as the eye lashes, eye brows, and scalp hair appear during fifth and sixth months The nails harden and skin thickens, as well as the eye lashes, eye brows, and scalp hair appear during fifth and sixth months Fetus s visual and auditory senses are functional Fetus s visual and auditory senses are functional

The Third Trimester All organ systems mature rapidly Fetus prepares for birth Fetus prepares for birth Fetus reaches age of viability, the point at which the fetus can survive outside of the uterus Fetus reaches age of viability, the point at which the fetus can survive outside of the uterus Fetus shows better-organized gross motor activity, and sleepiness/ waking activity Fetus shows better-organized gross motor activity, and sleepiness/ waking activity Towards end of ninth month, fetus is positioned head-down with limbs curled up in fetal position Towards end of ninth month, fetus is positioned head-down with limbs curled up in fetal position

Teratogens External agents such as viruses, drugs, chemicals and radiation that can harm a developing embryo or fetus. External agents such as viruses, drugs, chemicals and radiation that can harm a developing embryo or fetus. Time when organ system or body part is at highest risk of effects from teratogens is known as sensitive period. Time when organ system or body part is at highest risk of effects from teratogens is known as sensitive period. Effects of teratogens on a body part or organ system are worst during the period when that structure is forming and growing most rapidly. Effects of teratogens on a body part or organ system are worst during the period when that structure is forming and growing most rapidly.

Teratogens The same defect can be caused by different teratogens. The same defect can be caused by different teratogens. A variety of defects can be caused by a single teratogen. A variety of defects can be caused by a single teratogen. The longer the exposure or the higher the dose of the teratogen, the more likely it is that serious harm will be done. The longer the exposure or the higher the dose of the teratogen, the more likely it is that serious harm will be done. The long-term effects of a teratogen often depend on the quality of the postnatal environment. The long-term effects of a teratogen often depend on the quality of the postnatal environment.

Subjective Assessment When pregnant female comes to you, the kinesiologist, you should ask: When pregnant female comes to you, the kinesiologist, you should ask: Name Name Age Age Medical history Medical history Genetic history Genetic history Previous surgeries Previous surgeries Current/past medications Current/past medications If they have ever or are using street drugs or smoking If they have ever or are using street drugs or smoking Alcohol/caffeine use Alcohol/caffeine use Occupation and current working status Occupation and current working status Marital status and children Marital status and children

Objective Assessment When observing the client, evaluate: When observing the client, evaluate: Height Height Weight Weight BMI BMI Blood Pressure Blood Pressure General alignment General alignment Range painful movement Range painful movement

Conditions During Pregnancy Constipation Constipation Affects half of pregnant women Affects half of pregnant women Causes: Causes: increase in progesterone increase in progesterone the colon absorbing more water the colon absorbing more water worse in first weeks worse in first weeks Treatment: Treatment: Drink plenty of fluids Drink plenty of fluids Eat high fiber foods Eat high fiber foods Take fiber supplements – psylium husks, Metamucil, Ex-Lax Take fiber supplements – psylium husks, Metamucil, Ex-Lax EXERCISE! EXERCISE!

Conditions During Pregnancy Fatigue Fatigue Almost all women report increased fatigue in the 1st trimester. Almost all women report increased fatigue in the 1st trimester. Causes: Causes: Body is working harder Body is working harder More levels of progesterone, More levels of progesterone, Treatment: Treatment: Take naps Take naps Drink plenty of fluids, but avoid fluids 2-3hr before bed. Lac Drink plenty of fluids, but avoid fluids 2-3hr before bed. Lac Exercise Exercise Gentle stretches before bedtime can help prevent nighttime cramping Gentle stretches before bedtime can help prevent nighttime cramping Eat foods rich in protein Eat foods rich in protein

Conditions During Pregnancy Back Ache Back Ache Many women experience back aches during 2nd and 3rd trimesters Many women experience back aches during 2nd and 3rd trimesters Causes: Causes: Poor posture Poor posture Extra weight Extra weight Change in centre of gravity Change in centre of gravity Hormones Hormones Treatment: Treatment: Pay attention to posture Pay attention to posture Exercise Exercise Swimming Swimming Pillow support in bed Pillow support in bed Ask for assistance when lifting heavy objects Ask for assistance when lifting heavy objects Heat/cold Heat/cold Massage Massage Support belt Support belt Wear supportive low heel shoes Wear supportive low heel shoes

Benefits of Exercise During Pregnancy Maintenance/improvement of maternal fitness Maintenance/improvement of maternal fitness Control of excess weight gain Control of excess weight gain Improved posture and appearance Improved posture and appearance Increased energy Increased energy Improved sleep Improved sleep Decreased incidence of back pain Decreased incidence of back pain Improved self-esteem Improved self-esteem Decreased incidence of varicose veins Decreased incidence of varicose veins Decreased water retention Decreased water retention Decreased level of tension Decreased level of tension Possible decrease in complications during labour Possible decrease in complications during labour Shortened labour Shortened labour More rapid postpartum recovery More rapid postpartum recovery

Disadvantages of Not Exercising Studies have shown that women who exercise do not experience an increase in: Studies have shown that women who exercise do not experience an increase in: Premature Rupture of Membranes (PROM) Premature Rupture of Membranes (PROM) When the membranes that hold the amniotic fluid break too early. When the membranes that hold the amniotic fluid break too early. Congenital Abnormalities Congenital Abnormalities

Risk Reduction Pre-Eclampsia (Toxemia) Pre-Eclampsia (Toxemia) Occurs only during pregnancy and the postpartum period Occurs only during pregnancy and the postpartum period Affects 5-8% of all pregnancies Affects 5-8% of all pregnancies Causes blood vessels to constrict resulting in high blood pressure and a decrease in blood flow to organs and uterus. Causes blood vessels to constrict resulting in high blood pressure and a decrease in blood flow to organs and uterus. Having high blood pressure before pregnancy puts you at risk, also having a BMI of 30 or more Having high blood pressure before pregnancy puts you at risk, also having a BMI of 30 or more Characterized by high blood pressure and presence of protein in the urine Characterized by high blood pressure and presence of protein in the urine Symptoms: excess swelling of hands and feet, headaches, changes in visions, vomiting blood, ringing in the ears Symptoms: excess swelling of hands and feet, headaches, changes in visions, vomiting blood, ringing in the ears Occurs in the 2nd or 3rd trimesters Occurs in the 2nd or 3rd trimesters

Kinesiologists Role

Exercises During Pregnancy Low impact aerobics Low impact aerobics Water aerobics Water aerobics Walking Walking Kegels Kegels Pilates Pilates Yoga Yoga Cycling Cycling Swimming Swimming

Kegels Help prepare body for labour Help prepare body for labour Kegel exercises are easy to do - can be done anywhere Kegel exercises are easy to do - can be done anywhere Kegels help strengthen the pelvic floor muscles Kegels help strengthen the pelvic floor muscles Many women do kegel exercises to prevent incontinence Many women do kegel exercises to prevent incontinence

Yoga (prenatal) Help with breathing and relaxation Help with breathing and relaxation Promote feelings of well-being Promote feelings of well-being Energizing Energizing Stress relief Stress relief Improve posture Improve posture Meet others who are facing the same challenges Meet others who are facing the same challenges Note: Avoid positions lying on the back Note: Avoid positions lying on the back

Walking Vary the intensity Vary the intensity Less impact on the knees and ankles Less impact on the knees and ankles Easy way to start exercising Easy way to start exercising Supportive shoes Supportive shoes Water bottle Water bottle Spray bottle Spray bottle Maintain good posture Maintain good posture

Swimming Uses large muscle groups of the legs and arms Uses large muscle groups of the legs and arms No strain on ligaments No strain on ligaments Feeling of weightlessness Feeling of weightlessness Improved circulation Improved circulation Water Temp °C Water Temp °C

Exercises to Avoid During Pregnancy Ball sports Ball sports Contact sports: ultimate fighting, wrestling, football Contact sports: ultimate fighting, wrestling, football Sports that involve bouncing, leaping, a sudden change of direction (increased joint laxity from hormones make joints susceptible to sprains) Sports that involve bouncing, leaping, a sudden change of direction (increased joint laxity from hormones make joints susceptible to sprains) Exercises that put you at risk for falls: rollerblading, horseback ridding, skiing Exercises that put you at risk for falls: rollerblading, horseback ridding, skiing After 1st trimester avoid exercise in the supine position After 1st trimester avoid exercise in the supine position Lying in the prone position Lying in the prone position Lifting heavy free weights Lifting heavy free weights

Contraindications to Exercise Pregnancy induced hypertension Pregnancy induced hypertension Premature rupture of membranes Premature rupture of membranes Preterm labor during the prior or current pregnancy Preterm labor during the prior or current pregnancy Persistent 2nd or 3rd trimester bleeding Persistent 2nd or 3rd trimester bleeding There should be an evaluation to determine whether an exercise program is appropriate if the woman has conditions such as: There should be an evaluation to determine whether an exercise program is appropriate if the woman has conditions such as: Cardiac disease, constrictive lung disease Cardiac disease, constrictive lung disease Chronic hypertension Chronic hypertension Severe anemia Severe anemia Chronic bronchitis Chronic bronchitis Extreme obesity Extreme obesity Extreme underweight Extreme underweight History of an extremely sedentary lifestyle History of an extremely sedentary lifestyle Orthopedic limitations Orthopedic limitations Heavy smoker Heavy smoker

CONTRAINDICATION/PRECAUTION Pregnancy (around foetus) Pregnancy (anywhe re) NON THERMAL ULTRASOUND (NON THERMAL)CI PULSED SHORTWAVECI LASER TENSCI INTERFERENTIALCI LOW FREQUENCYCI

CONTRAINDICATION/PRECAUTION Pregnancy (around feotus) Pregnancy (anywhere) HEAT INFRARED WAX SHORTWAVE (CONT/PULSED)CI MICROWAVECI HOT PACK OTHER BIOFEEDBACK (NO STIMULATION) COLD THERAPYP ULTRA VIOLET RADIATIONP see modality details

Recommendations for Exercise Beginners Beginners non weight bearing activities pose the least risk of injury non weight bearing activities pose the least risk of injury 20 – 30 minutes of activity a day at a comfortable pace 20 – 30 minutes of activity a day at a comfortable pace Previously active women Previously active women participation in aerobic activities are generally safe participation in aerobic activities are generally safe Exercise in high altitudes is not recommended Exercise in high altitudes is not recommended Running Running can be continued late into pregnancy to maintain fitness, less than 45 min can be continued late into pregnancy to maintain fitness, less than 45 min Weight training Weight training light weights and moderate reps will maintain flexibility and muscle tone and reduce the risk of joint/ligament injury light weights and moderate reps will maintain flexibility and muscle tone and reduce the risk of joint/ligament injury Should be able to converse while exercising – vigorous exercise offers no benefits during pregnancy, only more complications Should be able to converse while exercising – vigorous exercise offers no benefits during pregnancy, only more complications Listen to your body – stop if you feel breathless, nausea, dizzy, tired Listen to your body – stop if you feel breathless, nausea, dizzy, tired Pulse should NEVER exceed 140 beats per minute! Pulse should NEVER exceed 140 beats per minute!

Recommendations for Exercise Positions/Posture: Positions/Posture: Avoid lying on your back after 12th week of pregnancy Avoid lying on your back after 12th week of pregnancy Abdominal exercises Abdominal exercises Avoid standing for long periods Avoid standing for long periods Avoid back swaying (lordosis) – cat back stretch, strengthen abdominals Avoid back swaying (lordosis) – cat back stretch, strengthen abdominals Rounded upper back (kyphosis) – chest stretches, upper back strengthening Rounded upper back (kyphosis) – chest stretches, upper back strengthening Avoid valsalva maneuver – increase blood and intra-abdominal pressure Avoid valsalva maneuver – increase blood and intra-abdominal pressure Avoid lying in the prone position after the 1st trimester Avoid lying in the prone position after the 1st trimester

Pelvic Tilts

Side Leg Lifts

Alternating Arm/Leg Raise

Precautions for Exercise Dehydration and hyperthermia: Dehydration and hyperthermia: Avoid exercise in hot humid environments Avoid exercise in hot humid environments Drink plenty of liquids – prior, during, after Drink plenty of liquids – prior, during, after Appropriate clothing may help dissipate heat Appropriate clothing may help dissipate heat Hot tubs/saunas Hot tubs/saunas Poor Balance: Poor Balance: Centre of gravity shifts as pregnancy progresses Centre of gravity shifts as pregnancy progresses Exercise cautiously Exercise cautiously Pay attention to changes to terrain Pay attention to changes to terrain Muscle cramps and soreness: Muscle cramps and soreness: Stretch muscles and warm-up before exercising Stretch muscles and warm-up before exercising Wear supportive well cushioned shoes Wear supportive well cushioned shoes

Dont over do it! Watch for dizziness, blurred vision, nausea, shortness of breath Watch for dizziness, blurred vision, nausea, shortness of breath Stop or slow down Stop or slow down Heart rate should not exceed beats per minute Heart rate should not exceed beats per minute Contact doctor the following occur: vaginal bleeding, uterine contractions, leaking amniotic fluid Contact doctor the following occur: vaginal bleeding, uterine contractions, leaking amniotic fluid

And Finally…

Exam Question 1 Of the following, which are contraindications to exercise during pregnancy? A) Pregnancy induced hypertension A) Pregnancy induced hypertension B) Premature rupture of membranes B) Premature rupture of membranes C) Persistent 2nd or 3rd trimester bleeding C) Persistent 2nd or 3rd trimester bleeding D) Preterm labor during the prior or current pregnancy D) Preterm labor during the prior or current pregnancy E) All of the above E) All of the above

Exam Question 2 What is the hormone responsible for excessive joint laxity found in pregnant women. A) relaxin A) relaxin B) progesterone B) progesterone C) testosterone C) testosterone D) estrogen D) estrogen E) gonadotropin E) gonadotropin

Exam Question 3 What are some good exercises for a pregnant woman? A) Swimming A) Swimming B) Kegals B) Kegals C) Ultimate Fighting C) Ultimate Fighting D) A and C D) A and C E) A and B E) A and B