Nutrional and Exercise Guideline

Exercise Guideline
During Pregnancy
ACOG : Physical activity & Exercise during
pregnancy
 Regular physical activity in all phases of life, including pregnancy,
promotes health benefits.
 Pregnancy is an ideal time for maintaining or adopting a healthy lifestyle.
 In pregnancy, physical inactivity and excessive weight gain have been

recognized as independent risk factors for:
 maternal obesity and

 related pregnancy complications, including gestational diabetes
mellitus
Women who begin their pregnancy with a healthy lifestyle (eg, exercise,
good nutrition, non-smoking) should be encouraged to maintain those
healthy habits.
Obstetrics & Gynaecology. April 2020; Vol 135. NO. 4

pregnancy
 Ideally, pregnant women should get at least 150 minutes of
moderate-intensity aerobic activity every week.
 Moderate intensity means moving enough to raise your heart

rate and start sweating. You still can talk normally, but you
cannot sing.
 Examples of moderate-intensity aerobic activity include brisk

walking and general gardening (raking, weeding, or digging).
 Divide the 150 minutes into 30-minute workouts on 5 days of

the week or into smaller 10-minute workouts throughout each day.
 If new to exercise, start out slowly and gradually increase

activity.
 Begin with as little as 5 minutes a day. Add 5 minutes each week

until you can stay active for 30 minutes a day.
RCOG: Physical activity and pregnancy
https://www.rcog.org.uk/en/patients/patient-leaflets/physical-activity-pregnancy/
pregnancy
Most pregnant patients can exercise.
There are few maternal medical conditions in which aerobic

exercise is absolutely contraindicated.
In women who have obstetric or medical comorbidities,

exercise regimens should be individualized.
 Pregnant women who were sedentary before pregnancy should

follow a more gradual progression of exercise.
 women who were regular exercisers before pregnancy and

who have uncomplicated, healthy pregnancies should be able to
engage in high-intensity exercise programs.
High-intensity exercise programs such as jogging and aerobics,

with no adverse effects

pregnancy
 High-intensity or prolonged exercise in excess of 45 minutes can
lead to hypoglycemia
 Adequate caloric intake before exercise, or limiting the

intensity or length of the exercise session, is essential to minimize
this risk
 Prolonged exercise should be performed in a thermoneutral

environment or in controlled environmental conditions
 Pregnant women should avoid prolonged exposure to heat
 Pay close attention to proper hydration and caloric intake
In those instances in which women experience low-back pain,

exercise in water is an alternative.
There may be additional benefits of aquatic exercise as well

ACOG : Examples of Exercise during pregnancy
In the absence of obstetric or medical complications or contraindications,
physical activity in pregnancy is safe and desirable.

ACOG : Characteristics of Safe & Effective
Exercise Regimen in Pregnancy

ACOG : Some exercises should avoid during
pregnancy
While pregnant, avoid activities that increased risk of injury, such
as the following:
o Skydiving
o Activities that may result in a fall, such as downhill snow

skiing, water skiing, surfing, off-road cycling, gymnastics, and
horseback riding
o "Hot yoga” or “hot Pilates,” which may cause you to become

overheated
o Scuba diving
o Activities performed above 6,000 feet (if you do not already live
at a high altitude)
https://www.acog.org/womens-health/faqs/exercise-during-pregnancy
ACOG : Warning Signs to Discontinue Exercise
While Pregnant

ACOG: Certain conditions that make exercise
during pregnancy unsafe
Women with the following conditions or pregnancy complications should
not exercise during pregnancy:
 Certain types of heart and lung diseases

 Cerclage
 Being pregnant with twins or triplets (or more) with risk factors
for preterm labor
 Placenta previa after 26 weeks of pregnancy
 Preterm labor or ruptured membranes during this pregnancy regular
physical activity
 Preeclampsia
 Severe anaemia
https://www.acog.org/womens-health/faqs/exercise-during-pregnancy
ACOG : Benefits of Exercise in pregnancy
The benefits of exercise during pregnancy are numerous

Nutrition in Pregnancy
Nutrition during pregnancy
 Pregnancy is a period of intense fetal growth and development,
as well as maternal physiological change.
 Adequate intake of macronutrients and micronutrients during

pregnancy promotes these processes.
 undernutrition and overnutrition can be associated with adverse

pregnancy outcomes.
 Both fetal undernutrition and overnutrition, can lead to

permanent changes of fetal metabolic pathways.
 These increase the risk of childhood and adult diseases related

to these pathways.
https://www.uptodate.com/contents/nutrition-in-pregnancy
Pregnancy Recommendations
The key components of healthy eating during pregnancy include :
●Appropriate gestational weight gain
●Consumption of a variety of primarily whole, unprocessed foods in

appropriate amounts to allow adequate, but not excessive, gestational
weight gain
●Appropriate vitamin and mineral supplementation
●Avoidance of alcohol, tobacco and other harmful substances
●Safe food handling
oThe amount of additional calories required for a typical pregnancy is small,
oBut some nutrient requirements are relatively large,
owomen should focus on increasing intake of high-quality, nutrient-dense foods
oAttempt to limit intake of processed empty-calorie foods and beverages.
www.uptodate.com/contents/nutrition-in-pregnancy
Gestational
weight
gain
https://wcd.nic.in/sites/default/files/Diet%20Chart%20For%20Pregnant%20Women%20East%20India.pdf
Dietary Recommendation
 The daily diet of a woman should contain an additional 350 calories,
0.5 g of protein during first trimester and 6.9 g during second trimester
and 22.7 g during third trimester of pregnancy.
Folic acid, taken throughout the pregnancy, reduces the risk of

congenital malformations and increases the birth weight
The mother as well as the growing fetus needs iron to meet the high
demands of erythropoiesis
Calcium is essential, both during pregnancy and lactation, for proper

formation of bones and teeth of the offspring, for secretion of breast-milk
rich in calcium and to prevent osteoporosis in the mother
 Iodine intake ensures proper mental health of the growing fetus and
infant
https://www.nin.res.in/downloads/DietaryGuidelinesforNINwebsite.pdf
Dietary Recommendation
 Adequate intake of a nutritious diet is reflected in optimal weight gain
during pregnancy (10 kg) by the expectant woman.
 She should choose foods rich in fibre (around 25 g/1000 kcal) like
whole grain cereals, pulses and vegetables, to avoid constipation.
She should take plenty of fluids including 8-12 glasses of water per
day.
 Salt intake should not be restricted even to prevent pregnancy-induced

hypertension and pre-eclampsia.
 Excess intake of beverages containing caffeine like coffee and tea

adversely affect fetal growth and hence, should be avoided.
https://www.nin.res.in/downloads/DietaryGuidelinesforNINwebsite.pd f
WHO Recommended qualities of Minerals &
Vitamins during Pregnancy
https://www.euro.who.int/__data/assets/pdf_file/0003/337566/Maternal-nutrition-Eng.pdf
ICMR-NIN Recommended RDA for Pregnant
women
ACCEPTABLE MACRONUTRIENT DISTRIBUTION

RANGE (AMDR) AS PERCENT OF ENERGY (%E)
*Depends on protein quality and total energy intake

# n-6 to n-3 ratio should be between 5-10:1
Balanced nutrition during pregnancy
Points to Ponder....
https://www.nin.res.in/downloads/DietaryGuidelinesforNINwebsite.pdf

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Exercise Guideline

 Pregnancy is an ideal time for maintaining or adopting a healthy lifestyle.

 In pregnancy, physical inactivity and excessive weight gain have been

 maternal obesity and

Obstetrics & Gynaecology. April 2020; Vol 135. NO. 4

 Moderate intensity means moving enough to raise your heart

 Examples of moderate-intensity aerobic activity include brisk

 Divide the 150 minutes into 30-minute workouts on 5 days of

 If new to exercise, start out slowly and gradually increase

 Begin with as little as 5 minutes a day. Add 5 minutes each week

There are few maternal medical conditions in which aerobic

In women who have obstetric or medical comorbidities,

 Pregnant women who were sedentary before pregnancy should

 women who were regular exercisers before pregnancy and

High-intensity exercise programs such as jogging and aerobics,

Obstetrics & Gynaecology. April 2020; Vol 135. NO. 4

 Adequate caloric intake before exercise, or limiting the

 Prolonged exercise should be performed in a thermoneutral

 Pregnant women should avoid prolonged exposure to heat

 Pay close attention to proper hydration and caloric intake

In those instances in which women experience low-back pain,

There may be additional benefits of aquatic exercise as well

Obstetrics & Gynaecology. April 2020; Vol 135. NO. 4

Obstetrics & Gynaecology. April 2020; Vol 135. NO. 4

o Activities that may result in a fall, such as downhill snow

o "Hot yoga” or “hot Pilates,” which may cause you to become

Obstetrics & Gynaecology. April 2020; Vol 135. NO. 4

 Certain types of heart and lung diseases

Obstetrics & Gynaecology. April 2020; Vol 135. NO. 4

 Adequate intake of macronutrients and micronutrients during

 undernutrition and overnutrition can be associated with adverse

 Both fetal undernutrition and overnutrition, can lead to

 These increase the risk of childhood and adult diseases related

●Appropriate gestational weight gain

●Consumption of a variety of primarily whole, unprocessed foods in

●Appropriate vitamin and mineral supplementation

●Avoidance of alcohol, tobacco and other harmful substances

●Safe food handling

oThe amount of additional calories required for a typical pregnancy is small,

oBut some nutrient requirements are relatively large,

owomen should focus on increasing intake of high-quality, nutrient-dense foods

oAttempt to limit intake of processed empty-calorie foods and beverages.

Folic acid, taken throughout the pregnancy, reduces the risk of

Calcium is essential, both during pregnancy and lactation, for proper

 Salt intake should not be restricted even to prevent pregnancy-induced

 Excess intake of beverages containing caffeine like coffee and tea

ACCEPTABLE MACRONUTRIENT DISTRIBUTION

*Depends on protein quality and total energy intake

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