Exercise and Running in Pregnancy: Point-Counterpoint

I have had a lot of fun looking up counterpoints for the feeble arguments that have been brought up on this blog and at the runango forum.

I would like to start off by reminding you that three qualified physicians (Running Doctor, Olga and myself) all believe my exercise and weight gain is perfectly healthy.

And now for the evidence:

Point #1.
Running and 6 months pregnant is fine...not gaining any weight and still looking like you're maybe 3 months pregnant is not.

Couterpoints
-Clearly if my size were appropriate for a 3 month pregnant woman, the midwives would be concerned. However yesterday my pubic bone to fundus measurement was within normal for 29 weeks.

-Though the effective size (ES) of the pregnant mothers who exercised under 30 minutes was greater than that of those who exercised between 30 and 60 minutes, the overall ES of the baby did not differ between the two groups.

ie, even though women who exercise more gain less weight, their babies' weights did not differ.
(Winter, 2002, American Journal of Health Studies).

-A current meta-analysis of randomised trials of vigorous exercise during pregnancy did not find a clinically important effect of exercise on birth weight.

(Bell, R. Journal of Science & Medicine in Sport. 5(1):32-6, 2002 Mar.)

Point #2
I had wanted to keep it [my pregnancy weight gain] to 30 pounds total... ended up with 42 I think...

Counterpoint
-This woman gained MORE than recommended during pregnancy and no one dared give her a hard time, though what she did is KNOWN to be a huge risk for her child. Why isn't everyone jumping in and accusing her of not caring about her child? Because we're a society that condones excess weight gain despite the many health risks. Because poor her, "she couldn't help it", right? Well I think that's a bunch of BS. And here are some of the risks associated with excess weight gain during pregnancy:

- gestational diabetes (and all the related complications)
- hypertension (and all the related complications)
- increased risk of c-section
- child who becomes obese and ends of with diabetes, hypertension, arthritis, heart disease, etc., etc.

Point #3
She really really pisses me off. Seriously, it makes me want to weep for that poor child's life. Also, it makes me feel like crap. I could barely keep my kids in for 6 months and I did no running whatsoever and took it easy and this crazy b!tch runs 80 miles a week and doesn't eat and she'll probably go over her due date.


Counterpoint/Agreement
-Yes, this poster is right. Premature births are most often caused by genetic factors or cervical defects, which are not affected by exercise. Bed rest, for example has never been shown to decrease premature births from cervical incompetence. And exercise itself has never been shown to cause premature births.

Points # 4 & #5
82 miles plus the cross training you did is not moderate. 3 hours is not moderate. 3 hours is more than a healthy non-pregnant elite does in a day!

You're right that they do not talk about any effects on PR's child. But that doesn't mean you can assume it's a healthy behavior like you're doing. You don't know, and you're willing to take a chance on the baby inside of you with something that is an unknown?

Counterpoint #1
-31,000 women in their second trimester were involved in this study. Those who identified their physical activity level as vigorous were, on average, slightly older and more educated, and weighed less than women in the other two categories. However, there were no significant differences in the rates of low birth weight or fetal or neonatal death.

(Rose NC. Obstetrics & Gynecology. 78(6):1078-80, 1991 Dec.)

Counterpoint #2
-There is limited evidence which suggests that exercise is related to shorter labour and is a useful treatment for gestational diabetes. Exercise is also associated with fewer symptoms and discomforts of pregnancy. This relationship is temporal in that exercise earlier in pregnancy is associated with fewer symptoms later in pregnancy. The lack of evidence for any harmful effects of exercise on pregnancy outcome indicates that, for healthy, well-nourished women, exercise during pregnancy is safe and subject to few restrictions. This conclusion is reflected in the revised recommendations of the American College of Obstetricians and Gynecologists.

(Sternfield B. Sports Medicine. 23(1):33-47, 1997 Jan.)


Point #6
I love how she mentions back when were hunters and gatherers and women barely gained weight while pregnant. Yes there is a healthy comparisson for our modern age. How many women died in pregnancy and during childbirth in those days. And how many children died before age 5 if they survived the first few months of life.

Counterpoint
-Please review the reasons for decreased infant and maternal mortality summarized by Atul Gawande, MD below.
By the fifties, owing in part to the tighter standards, and in part to the discovery of penicillin and other antibiotics, the risk of death for a mother had fallen more than ninety per cent, to just one in two thousand.

Around the world, virtually every child born in a hospital had an Apgar score recorded at one minute after birth and at five minutes after birth. It quickly became clear that a baby with a terrible Apgar score at one minute could often be resuscitated—with measures like oxygen and warming—to an excellent score at five minutes. Spinal and then epidural anesthesia were found to produce babies with better scores than general anesthesia. Neonatal intensive-care units sprang into existence. Prenatal ultrasound came into use to detect problems for deliveries in advance. Fetal heart monitors became standard. Over the years, hundreds of adjustments in care were made, resulting in what’s sometimes called “the obstetrics package.” And that package has produced dramatic results. In the United States today, a full-term baby dies in just one out of five hundred childbirths, and a mother dies in one in ten thousand. If the statistics of 1940 had persisted, fifteen thousand mothers would have died last year (instead of fewer than five hundred)—and a hundred and twenty thousand newborns (instead of one-sixth that number).
(Gawande, The Score, Oct. 9th 2006, New Yorker)

http://www.newyorker.com/archive/2006/10/09/061009fa_fact?currentPage=1

And I will end with the following from the American Association of Family Practice: "Numerous case reports can be found of women who ran extensively throughout their pregnancies and who delivered healthy, normal birth weight infants. One example is Sue Olsen, ranked fourth nationally for 24-hour races. She ran a four-hour marathon when she was eight and one-half months pregnant. The following week she partly ran and partly walked a 24-hour race posting 62.9 miles.3 One week later she delivered a healthy infant. Although these reports lack comparison groups and are not generalizable, they lend support to the conclusion that healthy women with normal, uncomplicated pregnancies may exercise with few restrictions without adversely affecting their infants or themselves."

(Khanna, "The Effects of Exercise on Pregnancy" American Family Physician. April 1998.)

I can post a multitude of additional references for any of you who are interested.

CONCLUSION:

The weak and unresearched arguments posted on runango and on this blog recently are doing a disservice to pregnant women who deserve to know that exercise (even vigorous) along with its often-associated lower weight gain are safe and healthy in pregnancy for the mother and the baby.