Pregnancy

1. Physiology
a. Skin Changes
 Hyperpigmentation (Oestrogen and Progesterone increase)
 Linea Nigra (Line on the Abdo)
 Melasma (Brown
patches on nose, check
chin)
 Spider Naevi (Central
red spot)
 Striae Gravidarum
( Stretch Marks)
 Palmar Erythema (Red
in the pam dt high
oestrogen)
2. MSK Problems
 Abdo Muscles become
stretch - Linea alba splits (Diastasis Recti)
o What is Diastasis
What is the Predendal nerve
 Gap between rectus abdo and why is it important?
 Separation of >15mm from
?? Pelvic floor drop
Xiphoid – >22mm 3cm above
umbilicus and >16mm 2cm
below umbilicus
 Ligaments become lax dt Relaxin and
Oestrogen
 Weight Gain – increase on joint stress
 Oedema – Water retention
 Hyperlordosis – Centre of gravity shift
 Foot drop – Arch drops
 Hip Pain
o Uncommon
o Begins 4weeks into Preg
o AVN can occur
 De Quervains Tenosynovitis
 o Inflam of Abductor Pollicis
Longus and Extensor Pollicis
Brevis
o Hormonal changes results in
fluid retention
o P @ thumb movement to
radial aspect to wrist
o Resolves after birth
o Splinting may help
o Finkelstein will help
3. Exercise During Preg
YES IT IS SAFE
 Physiological effects
o Exercise – acutely decrease oxygen and nutrients to placenta
 Should exercise from 1 to 2 trimester
 Avoid 3rd Trimester
o Ligamentous laxity – Balance Prob 60 Min x 3/week
o Increase body temp = Usual Exercise
o Increase force on joint at hip and knee
 Always check their health throughout preg and advise
 Baby puts pressure on lung therefore reduced
oxygen Kegal is important
2-3times a day
 CONTRAINDICATIONS
o Preg induced hypertension
o Premature labour during preg

4. NUTRITION and how to advise your patient

Last Trimester of Preg – fetus store iron supply for first 3-6months
Often lack B7 – Cheese, nuts, liver, milk etc (more important with
breastfeeding)

Calcium Absorption is increased during preg. Take calcium tabs as soon as

possible even starting in 2nd Trimester is ok. Else Will absorb from the
bones.
 Vit D – Recommend 10mg/day. Decrease can cause preeclampsia, low birth
weight, weak bones, auto-immue etc. TOO much can cause hypercalcemia.

Fats – Needs more. Monosaturated is better.

WHAT TO AVOID
Alcohol – Crosses the placenta and can cause feotal alcohol syndrome
Drugs also cross the placenta
Fish – King Macorol Fish
Caffeine – Can cross placenta, affect Baby heart rate (Coffee, tea, cooldrink)
Delhi Meats – Linked to listeriosis in Preg (Processed and uncooked meats
eg Salami, HotDogs etc)
Liver – High dose of Vit A
Raw Milk and Unpasteurized Cheese – Can cause early labour and
poisoning

Vegetarians: Protein can come from soymilk, cheese, eggs, and iron rich
food (beans, legumes). Eat with VIT C (orange etc) for better absorption of
Fe foods. Calcium rich food good.

What Meds Safe during Preg

Tylenol – is OK
Actifed – OK
Paracetamol – OK in very small amount. Don’t recommend.
Amoxilin – Safe within small quantity

EXERCISE IN PREGNANCY
1. Decrease Gestational Hypertension
Studies evaluating prescribed moderate-intensity aerobic exercise compared with maintenance of
normal activity during pregnancy found no significant difference in the development of
preeclampsia between the exercise group and the non-exercising group
A Cochrane review of diet and exercise interventions during pregnancy found no difference in the
development of preeclampsia when comparing women who exercised with those who did not.
However, in that review, women who participated in an exercise program during pregnancy were
less likely to have hypertension during pregnancy. Reduced chances of Preeclampsia.
 2. Shorten Labor
Reduction in first stage of labour along women who follow prescribed exercise.
3. Reduce risk of C-Section
Less likely to have C-section.

PHYSIOLOGICAL CHANGES
1. Maternal Cardiovascular Physiology changes in excer
Improves foetus well-being. Lowers maternal heart rate and increased heart rate variability.
2. Maternal Glucose Metabolism During Exercise
Glucose homeostasis improved in 3rd trimester opposed to those who did not exercise. Those without
exercise had more rapid drops and rises in glucose in the blood. Excer also reduced insulin levels.
3. Foetal Physiology During Exercise
Foetal heart rate increases due to excer during and directly after. Light-moderate excer is well taken
by foetus.

Recommended exercise types

Walking, Swimming, stationary cycling and low impact aerobics.
Yoga and pilates are considered if hypotension is avoided when taking different positions. Running,
jogging and strength training are considered safe if discussed with obstetric care givers.

Exercise to avoid
Contact sports – Trauma,
Activity w/risk of falls eg: Skiing, water skiing, off-road cycling, horseback riding, gymnastics.
Nutritional Requirements
Infant induces some insulin resistance and therefore there is increased glucose availability to the
foetus. Increased exercise will decrease the resistance of insulin and can leave the infant and mother
fighting for glucose.

MSK Adaptations
Weight gain can cause increased force on hip and knee joints when doing weight bearing excer. This
can damage unstable joints and being discomfort to the pt. The uterus can also shift centre of gravity
causing lumbar lordosis and LBP. This can lead to balance problems and can cause falls.

BENEFITS OF EXERCISE IN PREGNANCY

Pre-eclampsia
Pre-eclampsia has an increased risk of preterm birth, neonatal ICU and death. Exercise can be used as
a preventative to pre-eclampsia.

Gestational Weight Gain

It reduces the risk for weight gain that can lead to high BP and DM. Exercise can reduce this risk and
lead to a healthier body following birth.
Gestational Diabetes Mellitus
There are higher rates of C-section associated with DM and pre-eclampsia. Women have 7-8x more
chance of getting DM2 later in life. This risl reduced by exercise, by reducing insulin resistance.