Latest Advice on Pregnancy: Keep on Kickin'

By JANE E. BRODY

OS ANGELES — At a special gym here on the western edge of the county, a dozen or more women with bellies out to there kick up their heels, stretch and do step aerobics and other activities to stay in shape and acquire or preserve the stamina they will need to deliver their babies and care for them.

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Their instructor, Angelica Divinagracia, guided them until 10 days before she gave birth to her first child in April. She continues to work with those still pregnant, as well as a number of other postpartum women, who say their workouts at the West Hills Hospital and Medical Center PregnaGym leave them feeling better, physically and mentally.

"Labor and delivery, especially with a first baby, are like running a marathon," Ms. Divinagracia said. "Who runs a marathon without training? By the time you get to the finish line, you would have nothing left to kick. The better shape you're in, the more stamina you have at the end to push the baby out." Ms. Divinagracia's own 7-pound 2-ounce baby popped out like a Champagne cork after just five pushing contractions.

"For most of our women, their babies are bigger, their labor is shorter, and their postpartum recovery is faster than average," Ms. Divinagracia said.

According to Dr. Raul Artal, chairman of the department of obstetrics and gynecology and women's health at the St. Louis University School of Medicine, "Fit women do not necessarily have a faster labor and delivery, but they may be able to cope better with labor, and their recovery after birth may be faster and easier." A quick return to physical activity after childbirth has been linked to a reduced risk of postpartum depression, he noted.

While only anecdotal evidence supports the premise that exercise during pregnancy can aid labor and delivery, the participants at West Hills say there is no question that it relieves stress, helps them sleep and gives them a feeling of control when their bodies are otherwise out of their control.

The American College of Obstetricians and Gynecologists recommended this year that pregnant women who had no medical or obstetric complications participate in moderate exercise for "30 minutes or more a day on most, if not all, days of the week." The college's latest statement on exercise during pregnancy and the postpartum period replaces its previous advice that pregnant women can exercise with a recommendation that, barring certain situations, they should exercise.

The statement also recognizes the overall value of exercise, especially its ability to prevent gestational diabetes, a pregnancy complication now on the rise.

Dr. Artal, who was principal author of the new advisory, said that the college recognized that pregnancy "should not be a state of confinement" and that fears that exercise put pregnancies at risk were not supported by evidence for most women. Even for women who were sedentary before becoming pregnant, he said, "it's O.K. to start a safe exercise like walking or swimming."

The college is especially worried about the increase in obesity. As Dr. Artal explained: "Many women gain additional weight during pregnancy and never take it off. We recognize that pregnancy is a unique time for behavior modification." If women can be motivated to exercise during pregnancy, it may become a lifelong habit.

The West Hills Routine

Participants in the PregnaGym at West Hills must have their doctors' permission to work out. If a pregnancy is considered high-risk — for example, if a woman has had previous miscarriages or has a weak cervix — she cannot take the class.

The 90-minute class starts with a 10-minute warm-up in the form of low-impact aerobics, followed by careful stretching, then aerobic activities like steps or stationary cycling and strength-building activities using arm weights, stretch bands and exercise balls.

"We teach the women how to modify their activities to minimize the risk of injury," Ms. Divinagracia said. For example, when doing step aerobics, instead of moving their arms up and down, the women use their hands to support their bellies. Lunges are done in a more upright position and knee pulls are done with legs to one side instead of in front of the body.

After the first trimester, the women do situps while lying on their sides; lying on their backs is not safe because the expanding uterus compresses the body's main vein and can compromise the blood supply to the fetus. Likewise, the women do pelvic tilts on their hands and knees instead of on their backs.

"Even with stretching, you can overstretch because ligaments are looser during pregnancy," said Ms. Divinagracia. "The main thing is to listen to your own body; it will tell you how far to go."

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Class participants are also encouraged to drink lots of water, and their breaks are frequent, Ms. Ms. Divinagracia said, noting that pregnancy limits the bladder's capacity. In addition, women who have already delivered can bring their babies to class and may have to take care of them from time to time.

A woman unable or unwilling to take a class can exercise on her own. Nearly every book on pregnancy has a chapter on exercise, but be sure to consult one that was recently published. There is also a very helpful magazine, Fit Pregnancy, published every other month, that can guide pregnant and postpartum women to activities that are safe and effective. (A year's subscription is available for $11.97 by calling 1-800-929-1491.)

Cautionary Advice

The college strongly advises women with certain disorders to avoid aerobic exercise during pregnancy. These include heart disease that compromises blood flow, restrictive lung disease, an incompetent cervix, multiple gestation (twins or more) at risk of premature labor, persistent bleeding in the second or third trimester, placenta previa (a placenta that would precede the baby's exit from the womb after the 26th week of pregnancy), premature labor in the current pregnancy, ruptured membranes and preeclampsia (pregnancy-induced hypertension).

Certain other disorders may also preclude safe exercise by pregnant women. They include severe anemia, chronic bronchitis, intrauterine growth restriction, being extremely underweight or overweight and having orthopedic limitations. In addition, health problems that are poorly controlled may make exercise unsafe, including poorly controlled hypertension, Type 1 diabetes, an overactive thyroid and seizure disorders.

The college also cautioned against participation in recreational sports with a high risk for abdominal trauma or falls, like ice hockey, soccer, basketball, gymnastics, downhill skiing and vigorous racket sports.

Scuba diving should also be avoided throughout pregnancy because this puts the fetus at risk of decompression sickness. Also, women who exercise at altitudes above 6,000 feet must stop exercising at the first signs of altitude sickness, descend to a lower altitude and seek medical attention, the college warned.

But there is no evidence that the increase in body temperature that can accompany vigorous exercise is dangerous to the fetus, the college stated.