Exercise and pregnancy: what to do and when?

Engaging in moderate physical activity is highly beneficial for the expectant mother and her baby. It can contribute to the well-being of both mother and child throughout these nine months. You will of course need the agreement of your doctor, gynaecologist, or midwife. 

The Haute Autorité de Santé (HAS) indicates that exercise during pregnancy has the following benefits: 

• Improvement or maintenance of physical fitness 
• Prevention of excessive weight gain during pregnancy
• Facilitation of weight loss after delivery
• Reduction in the risk of complications: developing gestational diabetes, pre-eclampsia, excessive birth weight
• Prevention of gestational hypertension
• Relief of lower back and pelvic pain
• Reduced risk of urinary incontinence during pregnancy and after delivery
• Possible reduction in the duration of labour
• Lower likelihood of requiring a caesarean section
• Prevention and improvement of post-partum depressive symptoms

When we exercise, our brain produces endorphins. These are happiness hormones that bring about a state of euphoria. The release of endorphins in the body helps to reduce anxiety and stress. They also help to boost self-confidence and concentration. Endorphins also have analgesic effects that help reduce the sensation of pain. 

Sports recommended during pregnancy

Health professionals recommend gentle walking, light jogging (but not running), gentle gymnastics, swimming, racket sports (such as table tennis or badminton), Pilates, golf, moderate cycling, and yoga.

Swimming is by far the most popular sport. The benefits for the body are numerous: it helps you feel lighter, it is very safe, and it promotes wellbeing. It is particularly useful if you suffer from joint pain. Another notable advantage is that it can be practised from the first to the ninth month.

The prenatal yoga and Pilates are excellent physical activities. Both combine stretching and strengthening and can also improve mental wellbeing and reduce pain.

Cycling is also a great option. Using a stationary bike is preferable, as there is less risk of falling and therefore less risk of injury for the mother-to-be and baby. It can also be more comfortable than walking, which can cause pelvic tension.

How long and how often can I exercise during pregnancy? 

The French National Health Insurance (AMELI) recommends that pregnant women, in the absence of any medical contraindication, aim for 150 to 180 minutes of activity per week. This can be spread across several sessions, each lasting a maximum of 60 to 90 minutes. To get the most benefit, it is advisable to spread these sessions over at least three days, reaching a total of 2 to 3 hours per week. As pregnancy progresses, the intensity level should decrease, but continuing to walk is still encouraged.

The "talk test" is a handy way to monitor the intensity of your exercise. If you can hold a conversation while exercising, you are generally not overexerting yourself. Overexertion can lead to complications during pregnancy and should be avoided. If you are not used to exercising, don't put pressure on yourself. If you start a programme, adapt it to your fitness level. You could begin with just 5 minutes a day, then add 5 to 10 minutes each week. 

A recent meta-analysis of studies, including more than 2,000 women, showed that practising aerobic activities and moderate-intensity strength and toning exercises 3 or 4 days per week throughout pregnancy was not associated with increased risks of preterm birth or low birth weight in women with a single, uncomplicated pregnancy.

Sports not recommended during pregnancy

They fall into three main categories: endurance, contact and mountain/altitude change sports. 

Among those to avoid entirely are running, martial arts, rowing, and ice skating — they are simply too energy-demanding. Contact sports, including volleyball, basketball, football, rugby, and squash, are also too risky. Finally, mountain sports such as skiing and climbing are contraindicated.

Lying on your back should be avoided from 24 weeks of amenorrhoea. Prolonged standing still should also be avoided.

Excessive exertion and intense aerobic exercise are not recommended. They could compromise the wellbeing of the baby. This is due to the diversion of blood flow towards the mother's vital organs, to the detriment of the foetus. Weightlifting and long-distance running are also discouraged for the same reasons.

Always seek advice from your doctor or gynaecologist. For example, if you were very active before pregnancy, your recommendations will differ from those for someone who was not sporty to begin with. 

Sedentary behaviour, on the other hand, is strongly discouraged. It is associated with a higher likelihood of deep vein thrombosis. This puts the life of both the baby and the mother at risk. Sedentary behaviour can lead to obesity or, at the very least, contribute significantly to persistent obesity.

Contraindications to physical activity during pregnancy

Certain medical conditions make physical exercise formally contraindicated during pregnancy. 

According to guidelines, this should be avoided in the following cases:

• Placenta praevia after 24 weeks of gestation
• Persistent and unexplained vaginal bleeding
• Premature rupture of membranes
• Preterm labour 
• History of at least two preterm births
• Cervical incompetence or presence of a cervical cerclage
• Pre-eclampsia or severe gestational hypertension
• Suspected or confirmed intrauterine growth restriction
• Higher-order multiple pregnancy (triplets or more)
• Serious cardiac conditions (congenital or acquired)
• Severe acute or chronic pulmonary conditions
• Severe anaemia or haemoglobinopathies
• Systemic conditions (e.g. serious autoimmune diseases)
• Uncontrolled epilepsy

In these high-risk situations, gentle walking is recommended in order to reduce the risk of complications, particularly thromboembolic ones.

In certain cases, the benefit/risk balance will need to be assessed. Here are the main situations concerned: 

• History of recurrent miscarriages
• Moderate gestational arterial hypertension
• Twin pregnancy beyond 28 weeks of gestation
• Symptomatic anaemia or haemoglobin below 9 g/L
• Poorly controlled diabetes (HbA1C> 6.5%)
• Uncontrolled type 1 diabetes
• Malnutrition or eating disorders (anorexia, bulimia)
• Severe obesity (BMI above 40)
• Musculoskeletal or orthopaedic limitations (back, knees, hips) — swimming may be a gentle alternative
• Mild to moderate cardiovascular or pulmonary conditions
• Uncontrolled arterial hypertension
• Uncontrolled thyroid condition
• Heavy smoking
• Other medical conditions requiring professional advice 

In all these situations, it is essential to consult a healthcare professional (midwife, GP, obstetrician-gynaecologist) before starting or continuing any physical activity. They will provide guidance tailored to your situation and medical condition.

Above all, listen to your body! You should stop exercising immediately in the event of fatigue, chest pain, persistent uterine contractions, leaking, or severe abdominal pain. 

Warning signs or symptoms of a potential problem include regular painful contractions, vaginal bleeding, exertional dyspnoea, dizziness, headaches, chest pain, or calf pain.

The right, targeted physical activity should go hand in hand with a diet adapted to your new needs. 

You should avoid overheating. Drinking water before and during physical activity can help prevent overheating and dehydration. Hydration is essential for fighting fatigue. Aim to drink around 2 litres of water per day. 

Moreover, during periods of nausea, you more easily lose important nutrients. This is why it is even more important to pay attention to your diet. If needed, you can take a food supplement for pregnant women to help you meet your needs.

The most beneficial foods after physical activity are fresh foods. Think in particular of leafy green vegetables or fruits containing vitamin C. Nuts and seeds are also great — such as walnuts and almonds, which are rich in fibre, minerals and healthy fatty acids. Wholegrains are also recommended. It is also important not to exercise on an empty stomach. Make sure you get an optimal protein intake. 

Numerous studies have shown that exercise offers many benefits for the physical and mental health of pregnant women. 

As long as you experience no adverse effects, you can practise almost all types of exercise. Of course, this requires common sense — avoid activities that could cause falls. 

It is important to follow your doctor's guidance carefully in order to safely combine exercise and pregnancy.

It is also advisable to seek support when returning to exercise after birth.