Photo from the 2014 Ice Age Trail 50 Miler by Ali Engin. Permission to use header photo must be obtained through Ali Elgin.

"Don't ask yourself what the world needs. Ask yourself what makes you come alive and then go do that. Because what the world needs is people who have come alive." - Howard Thurman

Wednesday, 16 February 2011

The Perfect Pregnancy Plan

Excuse the alliteration, but for some reason this post deserves it.

In the future, much as there is discussion about an optimal training plan, women will talk about the optimal pregnancy plan: to lose weight and get into the shape of their lives.

But let's back up. Why isn't it like that now? (and why do you feel that just because I suggest it, I'm perverse??) Well, Heather said it best in her comments: our way of looking at pregnancy is "anitquated". In the 19th century, life was different in the sense that only the upper class had the "luxury" of a pregnancy of rest and lots of weight gain. I imagine that (as is true today) pregnancy outcomes were greatly influenced by socio-economic class and thus these women did at least appear to have healthier pregnancies.

During the 20th century, women gradually looked at physical activity and leanness as desirable. But the rules about pregnancy weight gain and being sedentary remained. Thus women saw their physical condition and weight as something they had to "sacrifice" for the health of the baby. Women now typically get out of shape and overweight due to pregnancy. And most never get back to their pre-pregnancy weight or physical condition. And that's why you find my suggestion "perverse" - because it should be a time of sacrifice. (But while sacrifices for a good reason are noble, sacrificies without reason are simply self-gratifying).

And women don't always make "sacrifices" if they don't find them convenient. Some women go on drinking large amounts of alcohol while pregnant and we have learned from them that babies don't do well when drowned in alcohol. The would have done well making a "sacrifice". Other women went against conventional wisdom and ran multiple marathons, crossed the English Chanel swimming or won biking or running races while pregnant. The reason these women did this is perhaps not difficult for my readers to understand: exercise is healthy when not pregnant - it hardly makes sense that it wouldn't be while pregnant. The body of evidence showing it's health and safety grows and grows: these women have healthy kids.

And not only do they have healthy kids, they have healthier kids. They don't get overweight and they score better on tests of motor and verbal development.

The new "sacrifice" will thus be - I am giving up my unhealthy sendentary lifestyle and my extra pounds during this pregnancy. Pregnancy is wonderful for many, many reasons - among which is a golden opportunity to get into the shape of your life.

Let's consider the example of Stefanie Shocke. She just had a beautiful 7lb 9oz little girl. How much weight would you wager she gained? Answer: 9-10 lbs. (Bet that wasn't your guess unless you have been reading her blog). Even more impressive is the fact that she set a very fast PR in both the marathon (3:31 at 22 weeks) and half marathon (1:35 at 18 weeks) distances midway through her pregnancy! SHE exemplifies the Perfect Pregnancy Plan.

If you are reading this and thinking "everyone already agrees with you, SLG, so just shut it already!", then you have been spending too much time reading my blog. (No, not too much time, just time :)).

Here are the recommendations from the ACOG castle (that's the American College of Obstetrics and Gynecology, of course):

pregnant women should be encouraged to engage in regular, moderate intensity physical activity

(am I the only one who reads this and wonders - if intense is dangerous, then is moderate a little dangerous?)

And here's a quote from Running Times Nov. 2010.

As the research suggests, in most cases, runners are encouraged to run through much of pregnancy, but not to set any big training goals. While more than 30 minutes may be safe, this is not the time to hog mileage. Smart training will ward off stress fractures and sprains, as well as keep the baby healthy. Like a monster hill at mile 25 of a marathon, knowing what to expect can make all the difference.

I remember clearly reading this the first time and thinking "what the hell does that mean?" - basically the whole paragraph is a confusing mess. But "not the time to hog mileage" - why does there always have to be a guilt trip - and for no reason??? Sometimes all of this bullshit makes me throw up in my mouth. This whole "take it easy, don't do too much" comes from no scientific evidence and is simply ANTIQUATED. I applaud people who set new training goals, run farther and faster than ever. Heck, I ran way more miles a day during my very own first pregnancy than I had ever run before - why is it exactly that the working hypothesis is this is dangerous?

Because all of our working hypotheses stem from (another Heather quote I love) "you must rest during pregnancy, you poor delicate reproductive blob"


And here in Denmark, it is no different: - no high intensity exercise, - no long-distance running, - nothing more intense than you did before you became pregnant. Says the Danish Ministry of Health.

Not only is the above not supported by research, but it is confusing. Again what is "high intensity" - running up a hill? running a 100 miler?

I have imagined many possible scenarios in which a study could be done which would clear up this confusion. But these studies are really hard to do - I get tired just thinking of all of the confounders. The truth is more and more women will find they become more physically active than they were before pregnancy and more will participate in sports at an intense level. And this is how or views of exercise in pregnancy will change. You may not agree with me - but your kids will!

And since I'm prophesying - the weight gain recommendations will also continue to come down or widen. They were just lowered in 2009 after the recommendation of the Institutes of Medicine and now women who are normal weight should gain between 25-35 lbs. Some women can "get away" with gaining this much - and it certainly must be genetic. But many, many women who eat healthy, listen to their bodies and exercise find they gain significantly less than is currently recommended. And they are more likely to return quickly to their pre-pregnancy weight.

As I have discussed before, the current recommendations are based on one study, where women who gained less in the second trimester had babies that did worse. But the study is flawed from the outset because babies who have an illness or condition to begin with often don't grow correctly and thus these mothers ALSO gain less - making it appear as though the mother's weight gain was the problem when the baby had the problem from the beginning. Anyway, I am certain the weight gain guidelines will also widen to include much lower weight gains as being healthy. One day.

Now I am tired of writing.

I will simply mention that I had a beautiful 3 hour run in the hilly woods around Næstved - and have to admit this was the running song of the day (since I may have listened to it 8 times): Go Do by Jónsi. (Thanks for the rec again Steve Q. I have decided you are allowed to make a running music library for me to save me some time :).)

Edit: Okay, I rarely add something to my posts as an afterthought, but I really need to make one thing clear (thought it would just be assumed, but it's actually not that obvious) - there is no "perfect plan" for every pregnant woman, just like there is no "perfect plan" for everyone who wants to run fast. There are only perfect plans for every individual. Stefanie's pregnancy was simply one example of a plan. And if you're more for the high mileage preganncy, then I guess you'd be following more of my sort of plan. The LAST thing I wanted to do was make people scared or guilty because they feel they're not doing enough.

39 comments:

Jacqueline said...

I think the intensity depends on what is normal for you. I am a marathoner, and ran through both of my pregnancies (though not as much with my second pregnancy because of some injuries I had post-partum from my first).

My doctor was 100 percent behind running while pregnant, both times. Even though the first time I had low fluid issues and IUGR. I had the same issues the second time, along with pre-term labor. Both times, she attributed it to other things (my mom had and sister had identical pregnancies; neither one of them were runners).

It was interesting to me that I ran half as much with my second pregnancy, yet gained nearly the same amount (both well under the recommendations, despite nonstop eating).

It sounds awful, but I always wondered if my running caused my problems the first time around. When it happened again the second time, I felt better, knowing it really wasn't my fault (even though my doctor repeatedly said it wasn't -- I always wondered).

And just further proof your body does what it wants -- whether that is to gain 15 pounds or 50, you know? And I love how people go on about how unhealthy you are if you gain under the amount (even if it wasn't through restriction, etc.,) but never if you go OVER, which is also unhealthy.

I don't know. Just rambling. I find your blog to be pretty interesting.

Jacqueline said...

Also: Kind of an interesting article written by a friend's husband, also a doctor, about pregnancy and obesity:

http://missoulian.com/news/opinion/mailbag/article_01637f0c-bc18-11df-8b22-001cc4c03286.html?mode=story

xapis said...

I only have a moment and am not at home where I could access Clapp's book but I was curious as to what you thoughts are about his comments on weight gain, since I know you have quoted him often. :-) I just read the book and was surprised that while he said that regular exercise during pregnancy could limit weight gain he also mentioned something about competitive athletes gaining a little while trying to conceive and then a pound per week (I will have to go back and check on that to be sure it's accurate) after that. Personally I think that a 9 pound gain is along the lines of my friends on the other spectrum who gain 40-50 pounds (while exercising and eating well, seriously) and then lose it all. I still think that encouraging activity and a good diet while putting out moderate weight gain guidelines is better, especially mentally, overall, but that's just me! Thanks for posting this!

Steph said...

You talk about the health of the baby, but I am curious about your data on how running long distances into late pregnancy affects the well-being of the mother. The only two people I know of who have run long distances (i.e., 40+ miles a week) into late pregnancy (both with very little weight-gain)experienced extremely painful injuries in the last few weeks that made it almost impossible to walk, much less to continue running until the end. I'm thinking that this should at least be a consideration in your studies, conjectures and recommendations . . .

heather said...

Great post (not only because you quoted an excellent source :p) As a lay person I look at these recommendations for exercise during pregnancy and think, either nobody has any clue, OR they just don't want to say too much in case they get sued. Because really, what does "moderate intensity" mean? A tempo run but not a VO2 Max workout? Don't even get me started on the recommendation I read on a German website that weightlifting is ok, but please with "light weights only." Where is the evidence for that one? Why, if I can currently do (e.g.) biceps curls with 25lb free weights, should I suddenly downgrade to the pastel barbie weights? Are my arms going to snap off due to rising HCG levels? Argh.

I think you make a good point about the notion of "sacrifice," especially women's "sacrifices" as regards their own bodies. It seems like a lot of women think of physical fitness itself as a kind of sacrifice, something they "have" to do, giving up junk food or sweets or whatever and doing boring exercise in the name of looking good (mainly for a man, also to be considered socially adequate...). And then pregnancy means you have to sacrifice that for the good of your baby...it is like the body is always some sort of common property and its state of fitness/lack thereof a signifier for how you're doing what's considered the right thing so nobody can judge you.

So what you are suggesting is a form of taking back one's own body, doing the right thing for oneself and one's child and not for the sake of some airheaded cultural notion of femininity.

Man, here I go again with my meandering theoretical constructions, sorry!! But this is just such a fascinating topic.

heather said...

on a practical note (and I do not have any medical training so I can't really say much about that aspect...), given that pregnancy symptoms, weight gain etc. vary so much from woman to woman, I wonder if it is realistic for everyone to take pregnancy as a time to set half marathon PR's. Just thinking of the horror stories you hear of constant vomiting for three months...or what Steph said in her comment, that some women suffer injuries from running in late pregnancy...or even just that some people seem to gain more than others for no discernible reason, even if they train and eat well. But I completely agree that the current so-called guidelines are inadequate, unscientific and downright lame (that's right, ACOG, I called you lame.) and the attitudes that go along with it need...well...reeducation?

The Chapples said...

So how do you explain that you exercise a LOT more than I do (I just run, and currently ~45 mpw, all pretty slow miles - between 8:35 and 9:10 pace) and we've gained about the same amount in our pregnancies being just days apart (I've gained 5 pounds now)? :P I am just messing with you. I agree with Jacqueline that I think people's bodies just do what they need to do. I am exactly where I was weight-gain in my last pregnancy. I had gained 10 pounds by 20 weeks, 19 when I delivered.

I have other blogs that I read of super fast mamas who crank out all sorts of miles during pregnancy and still gain 35-40 pounds. Again, I think their bodies just do what they need to do. No explanation.

One of the previous posters mentioned higher mileage and the correlation with injuries and I've seen the same thing (including in myself). I am already feeling the same tight psoas and cranky pubic bone at just 16 weeks. I am much more worried about being a healthy runner post-partum than busting my butt now and being in pain.

Rambling...so, activity is awesome! I just hesitate to think that mega-distances do anything useful during those 9 months.

Anonymous said...

I also think that intensity depends on what is normal for you. I think a person can run high mileage during pregnancy, and do speed work, but I do think it is incredibly important not to run completely out of breath. Baby will always get blood/oxygen in the uterus, but the question is will it get ENOUGH to thrive when you are overexerting.
About weight gain...that also totally depends on the person... some are so nauseous during pregnancy they don t gain a pound (net).

~ a runner with a 20 week babybelly

Anonymous said...

i think it's imperative that, just as we don't like it when the ACOG bases recommendations for all pregnant womens' exercise on one study, we don't recommend EVERYONE exercise massive intensity and max miles and 9# weight gain to everyone. pregnancy is a time when we MUST listen to our body... perhaps even moreso than when not pregnant (tho i'm a big advocate of listening to our body then, too, of course). it's NOT the time for everyone to expect to set a marathon PR... it's about continuing on your journey, whatever that is. it's about maximizing your health. it's not about getting into a contest about how little weight one can gain relative to someone else... if you can run 10 sec faster than someone else... if you can run post-baby at 8 days vs 10 days of someone else... maximize your health, your baby's health, be internal about your motivations... competitiveness is one thing, but pregnancy is your experiment of one... so compete with yourself.

this isn't a msg directed at you, slg, i'm a physical therapist, ultrarunner, mom of one... so it's to any of my patients, or you, or me on future child #2, or whoever.
kzpt

sea legs girl said...

kzpt - good point about not being competitive with others while pregnant. I gave Stefanie as an example because she DID seem to listen to her body and had a great pregnancy and was not afraid of doing so despite guidelines. Just wanted to point out that we can take advantage of pregnancy to get into better shape - however we feel like doing it. That WAS a really important point to clear up.

The Chapples - well, I'm not sure if I should interpret your comment on weight gain as competing with me or what. But if you are truly interested - I have now been pregnant 3 times (including the miscarriage) and all times I have gained over 4 lbs in the first 6 weeks. Seems wild, I know, but I believe it is simply expanded blood volume. I seem to get short of breath to the extreme - even before my preg tests turn positive so I think my body expands blood volume really quickly. I did those 3 hour hills yesterday and am now no more short of breath than I am unpregnant - so the expanding of the expanding blood volume seems to have been complete long ago. It's all just a theory - but I'm stickin to it!

Also - could you send me the links to the blogs of women who ran "lots" of miles while pregnant and gained 35-45 lbs? - this I've gotta see (because I simply don't believe it!).

WNWLitigator said...

I'm thin and when I got pregnant I did not use it as an excuse to eat anything I wanted. In fact, I ran during my pregnancy and continued to eat healthy. I gained a total of 40 pounds. I only wanted to gain 20. There was nothing physical I could do to gain less. I felt like it was beyond my control. Even though I exercised and did not eat large portions- I kept my calorie intake on the low end, I still gained the weight. My point is, women don't all use pregnancy as an excuse to be lazy and get fat. Even the ones who gain more than the recommended amount (me). I weighed 125 before my pregnancy and I weigh that amount now (2 years later). During my last trimester, my body was completely beyond my control despite the running and watching my diet. To push women to thinking they should try to keep their weight gain between two numbers when pregnant is ridiculous. Each body is different.

Iris said...

Sealegsgirl, I think there is no way to make 5 pounds of increased blood volume in 6 weeks. My guess is based on the following: I used this calculator on calculating the blood volume of my non-pregnant self (I am 1,72 m and 56 kg)
http://www.easysurf.cc/cnver22.htm
This would give me aboout 3,8 l of blood. A highly trained endurance athlete might add 10-15%. So a person of my height and weight (and you probably do not weight as much as I do) might at the very last have 4,2 ml of blood. The estimations of the pregnancy-induced increase vary widely, but an increase of 50% seems to be the highest figure. I could find (many sources suggest it is only 35-40%). This would make an increase og 1,6 l throughout your whole pregnancy. Also, blood volume increases gradually from 6-8 weeks onwards:http://www.nda.ox.ac.uk/wfsa/html/u09/u09_003.htm
Don´t get me wrong, there is absolutely nothing wrong with your weight gain but I tink the symptoms you are experiencing might rather be caused by a widening of the blood wessels or soem hormonal thing...

sea legs girl said...

WNLitigator - I think my problem is I tend to think everyone is just like me, but of course they are not. And if I start creating guilt for women who gain more or exercise less intensely, then I've completely failed to encourage what I intended - which is simply that women not be afraid and feel themselves in the position to get into good shape without worrying.

There is of course no "perfect plan" for everyone - only maybe a perfect plan for an individual.

sea legs girl said...

Re injury - many of you brought up my big "chalenge" this pregnancy and that is attempting to avoid injury. So far that involved running hard/long every other day alternating with cross training and shoes for forefoot running which hopefully will protect my hips. But very valid point that it's not just about doing as much as one can - but doing it smartly. I also believe a big part of injury prevention is keeping weight gain low.

sea legs girl said...

Iris - Thanks for your input. Let me put it this way: when I had my miscarriage I had gained 4 lbs by 6 weeks. About 5 days after the miscarriage, I was back to my pre-pregnancy weight. I simply can't explain that with anything other that an accumulation of extra water somewhere! Any thoughts?

Iris said...

Sealegs, it might very well be additional water weight which doesn`t necessarily mean swelling bur might be evenly distributed (maybe in relation to the circumstances accompagnying the miscarriage?). As digestion slows down in many women it might have been just more volume in the digestive tract (I do not know, however, how much "that" might weight :-))

The Chapples said...

Woman, I am not competing with you! That's why I said I am just messing with you - comparing one person's pregnancy to another's is like apples and oranges. CHILL!! My point is that just bodies do what they're going to do - you exercise a lot more than I do and we've gained the same amount of weight. I could care less if I have gained 5 pounds or 15 at this point, just want a healthy baby in the end. I know that I can bounce back into shape post-partum and that's what matters to me!

I don't think these two would mind me linking their blogs because they are both supreme athletes AND gained plenty of weight in their pregancies because that's just what happened. Two I know personally - Alicia's a nationally ranked triathlete, all around crazy-talented athlete. Angela qualified for Kona post-partum and is also a super fast runner/triathlete. The third one I've linked has run VERY fast times pre and post-parturm

http://aliciaparr.com/blog/
(gained 40 pounds)


http://willtrainforcreamcheeseicing.blogspot.com/
(gained over 25 pounds)

http://rebeccadewire.blogspot.com/
(another great athlete who gained 58 lbs and 40 lbs with #1 and #2)

http://www.runlikeamother.com/
(Rachel Ross, world class triathlete, gained 50 pounds with her first baby)

http://notpeppery.blogspot.com/
(gained ~40 pounds with both kids)

I admit I get my feathers ruffled bit on the topic because I feel like it can be another time in life when a woman feels inadequate if her body just happens to need or want to gain more than 20 pounds.

The Chapples said...

Oops, my cutting and pasting messed up. The "not peppery" blog is the third one that I'm talking about - I added two more after I typed that and they ended up listed before that one.

sea legs girl said...

Iris - well, I think that makes sense about retaining fluid other places than the intravascular space. Thanks so much for taking the time for a discussion!

Allison/The Chappels - well, I am just relieved you didn't get mad at my comment. Just be aware that telling SLG to chill is like telling The Sahara to chill - just ask my poor family :).Thanks a lot for taking the time to give me those links. As much as I don't need to find extra things to read, I will enjoy them!

olga said...

OK, since I am neither pregnant nor plan to be anymore, I skipped your last few posts by just glancing over, but since I just came back from Bikram (hot) yoga where instructor is pregnant, it reminded me of you - and of your previous (?) post on sauna. I also saw plenty of students in a room at 105F and 55% humidity twisting and dripping sweat in my 10 years of practice. Bikram says it's very beneficial - I think so too (adding on Russian style saunas from times before time and women sitting there, including pregnant).
Anyhow, whatever. Frankly, I don't care about studies lately. Just do what feels right for you. I strongly believe unless you are a waco, you do no harm to a baby. And if you are a waco, people's blubber won't help.

SteveQ said...

The day after I made the song recommendation, I heard it in the background of a car commercial, making me do the Homer Simpson "D'Oh!" sound. My coolness badge got revoked.

Every pregnancy is different, even for the same parents. Shocke's pregnancy may have been perfect for her, but sounds risky for most women.

Diana said...

I love your posts about exercise and pregnancy. I think women, all women (for that matter, all people), should be encouraged to live lives that leave room for good food and enough exercise.

However, I think that pregnant women are coming up against factors that would discourage them from intensifying their exercise during pregnancy or even begin taking it up. While ACOG may officially state that an exercise regime is important to a pregnant woman’s health, in practice a woman’s OB/Gyn might advise against “too much” exercise. I don’t know how often that happens, but I’ve heard it from my own friends with children, and I was surprised how much sway their doctor’s had over their decisions to cut down on or even cut out exercise.

I absolutely hate this obsession with weight gain in pregnant women (not yours, I mean in general). As a person who has had some pretty bad relationships with scales in the past, I would be terrified to visit a doctor’s office in America. Not owning a scale helps me to focus on eating right and exercising in a much healthier and less obsessive way. I’m not sure I could handle knowing how much weight I gain during pregnancy. Do you think that women need to be monitored on their weight gain? I know that pregnant women are almost never weighed during pre-natal visits in The Netherlands. As some of the comments have stated, weight gain varies from woman to woman, and a healthy woman could be on the low or high end.

The questions you’ve raised about exercise and weight gain in pregnancy do make me think that there is a larger factor at play here. It seems to me that there are a lot of external agents trying to control a woman’s body during pregnancy. I realize that might be overstating a bit, and I am sure that there are many researchers and physicians who want to understand pregnancy and provide useful knowledge for the medical community and pregnant women. I just find the list of do’s and don’ts for pregnant women to be terribly exhausting, and the language used feels dictatorial. I like the comment Heather made about taking back one’s own body.

Okay, I’ve been rambling a lot now. Just wanted to say I liked the post.

Kate said...

I tend to feel more like WNLitigator. I exercise throughout pregnancy. I eat healthily, but do not obsess about it. And my body packs on the pounds to be sure. But this being my 3rd pregnancy, I also now feel confident knowing that my body is just doing what it thinks it needs to do, and the weight will come off after the baby is born. (While I get frustrated w/the pace of that at times, I do try to remind myself, 9 months on, 9 months off. That would probably drive you bonkers though.) Anyway, I just think it's funny b/c I consider myself fit and healthy, yet here I am in week 15 of pregnancy and I have not gotten on the scale at home and try not to look when they weigh me at the midwife's office, because I feel I'm just listening to my body and letting it do it's thing and trying not to worry about it. So your 16 lb. goal makes me chuckle not b/c it's right or wrong or high or low, just because I'm so much happier not even following along with my weight. I'm trying to get as much exercise as I can, and just stopping if something hurts. Anyway, to reitterate WNLitigator's point, don't assume all women gaining on the high end of the spectrum are unhealthy lazy slobs just because you sometimes feel overly criticized for gaining on the low end of the spectrum or exercising a lot.

green light said...

Oh, SLG, I'm sorry. It really seemed a couple months ago like you were on a healthier course of admitting you don't have the healthiest attitudes about food. Now here you are, pregnancy seems to have retriggered your worst tendencies and you're back to attaching significance to the mere number of how much weight you'll gain during pregnancy, and holding up as ideals or examples women who gained extremely low amounts of weight.

How about this for a radical idea? Eat reasonable quantities of healthy food, exercise as much as it feels good for your body (without overdoing it), and enjoy being pregnant as much as possible?

It doesn't sound like you'd be capable of doing that. I'd be more concerned about that, than whether you gain 10 or 20 or 50 pounds.

I'm sorry. It makes me sad for you.

sea legs girl said...

Ha! Green Light, you feel "sad" for me because I am suggesting that it is OK to not gain 25 lbs - and that 9 lbs also can be healthy! Go take your sadness and pity somewhere where it will do some good! I'm not saying I want to gain 9 lbs - but also not saying other women can't. Let's put it this way - don't cry too much over this :D.

sea legs girl said...

Steve Q, alright, I'm not going to let you say that Stefanie's pregnancy would be "risky" for most women and not explain in what way it would be risky! What is it in particular you are thinking of?

sea legs girl said...

Olga - your honesty is so refreshing. I am glad to hear that pregnanct women are doing Bikram Yoga without worries. I wish I could find a Bikram class here!

Iris said...

I would like to throw another apsect into the discussion. I absolutely do not find any links to the articles I am going to refer to right now, I will search for them later - maybe someone else can help? Concerning maternal weight gain and infant birth weight there seems to be as trong correlation between it with regard to gain of lean "mass" in the mother (blood volume and placenta, to be specific) with maternal fat gain not being related to birth weight. Of course, one would ask how to influence placental growth/increae in blood volume withot promoting fat gain? There are some guesses (not from the studies I mentioned)that keeping protein intake in the 75-100 g range and not restricting salt intake might help keeping fluid in the bloodstream, but this is, from my best knowledge, not based in scientific research. I will see if I find the articles..

Kirsten said...

Once they said that each pregnancy costs a tooth for the woman. I don't think anybody would want to sacrifice their teeth these days, and why sacrifice at all? You are so right, exercise is good and each and everyone should do what she is able to according to where she was before pregnancy. And if she was nowhere, this is the time to do at least some walking in order to prepare her lazy body for the birth!

Fast Bastard said...

I think most people reading SLGs blog are already on a page that tells us that a moderate amount of running (or other exercise, but most readers are runners) has benefits for both mother and baby.

Many people aren't on that page yet, including probably a lot of gun shy OB/GYNs. Considering what they deal with every day, their ethos has always been "don't rock the boat". There was one reader a while back who was told by several OBs not to run at all. But the OB community is coming around, I think.

But.

There is no epidemiology out there - at all - looking at intense running/exercise in pregnancy. Yes, there are plenty of anecdotes, on this blog and elewhere, but no epidemiology.

SLG, as a budding expert of epidemiology, you are forced to admit that there is no research supporting (or refuting) your assertions.

With many beneficial things in medicine, the effect curce is shaped like a U. No exercise is harmful, sure. 99% of your readers agree with this, as carefully selected as we may be. Then the risk decreases as you add exercise, but it's not unreasonable to imagine that at some point you start adding risk (and start climbing up the far side of the U). You could even argue that OF COURSE it's a U-shaped curve. At some point running to much, even non-pregnant, becomes dangerous. The question is where that U starts climbing, and the truth is we don't know.

Right now, SLG, you're headed towards being an expert in the very narrow field of retinal epidemiology. I'm just imagining if you had gone into exercise/pregnancy epidemiology.

Would you rather be setting guidelines for screening in diabetic eye disease or for running in pregnancy?

The Chapples said...

And Fat Bastard, there never WILL be epidemiology on this topic, just anecdotes because of pure ethics. No one is ever going to back a study that might put a baby at risk. The best we can do is gather information from individuals who happened to run higher mileage during pregnancy and who kept their weight to a minimum BY CHOICE to see what the short- and longterm affects are on the child.

I tend to think of things like Green Light - why not moderate and just ENJOY being pregnant? Take it as a time to truly listen to your body rather than trying to control and manipulate the experience? Actually, why not do that anyway, even when not pregnant?

I am going to add my favorite quote from Ellyn Satter, an expert on children's feeding (but also works with adults). I think this same theory can be used with exercise:

"Normal eating is going to the table hungry and eating until you are satisfied. It is being able to choose food you like and eat it and truly get enough of it -not just stop eating because you think you should. Normal eating is being able to give some thought to your food selection so you get nutritious food, but not being so wary and restrictive that you miss out on enjoyable food. Normal eating is giving yourself permission to eat sometimes because you are happy, sad or bored, or just because it feels good. Normal eating is mostly three meals a day, or four or five, or it can be choosing to munch along the way. It is leaving some cookies on the plate because you know you can have some again tomorrow, or it is eating more now because they taste so wonderful. Normal eating is overeating at times, feeling stuffed and uncomfortable. And it can be undereating at times and wishing you had more. Normal eating is trusting your body to make up for your mistakes in eating. Normal eating takes up some of your time and attention, but keeps its place as only one important area of your life.

In short, normal eating is flexible. It varies in response to your hunger, your schedule, your proximity to food and your feelings."

I'm not picking on you, just worry about how hyperfocused you are on the issue.

sea legs girl said...

The Chappels - let's just hold our horses for a second here. I don't think anyone here is encouraging starvation or an eating disorder. At least I'm not. I guess I could also try to only gain 9 lbs, but SR would never be able to put up with my crankiness. I just don't want anyone telling me it's healthier to gain 25.

I, by the way, somewhat disagree with your quote in the sense that I believe one should eat until one is 80% full, according to the Japanese/Okinowan way of thinking. I, of course, don't always follow this, but do believe in it.

Fast Bastard said...

The Chapples, epidemiology is made up of large population studies that are overwhelmingly observational in nature, ie. no intervention is made. You simply gather the data and wait to see what happens.

The data are out there, and some databases probably already contain numbers waiting for a researcher.

I guess you could say that epedimiology is made up of thousands of anecdotes. The problem with the anecdotes on this blog is that they are skewed towards fit, well-educated women. The selection bias is too significant. You could then argue that all observational studies are biased, and you would be right, but attempts are always made to control for these.

Interventional studies are rarely undertaken in studies of exercise and diet, simply because it's close to impossible to change people's behavior. One exception to this is a famous (and infamous) study looking at conscientious objectors during World War II. They calorie-resticted those poor kids to see what would happen to them. I believe it was done in Minnesota. The pictures of the emaciated non-warriors are impressive, and it's obvious that no one would have entered such a study voluntarily.

SteveQ said...

@FB: yes, that was Ancel Keys' study at the University of Minnesota. The volunteers were Mennonite, old order Amish and Brethren who would not fight for religious reasons and they each lost about 25% of their weight, eating mostly cabbage and root vegetables. In their place, I would probably have joined the study (and been tossed early, as many were, for mental derangement).

Jacqueline said...

Hey, just saw this and thought you might be interested. "Women who are extremely obese may not need to gain that much weight during pregnancy, and those who don’t add too many pounds may find themselves and their babies healthier.
The findings were presented recently at the Society for Maternal-Fetal Medicine’s annual meeting in San Francisco. The study looked at data on 73,977 women from New York’s Finger Lakes region who gave birth to one child between 2004 and 2008."

It says:
“The study suggests that even the recommended amounts of weight gain might be more than is needed for the most obese women,” said Dr. Eva Pressman, director of Maternal Fetal Medicine at New York’s University of Rochester Medical Center, in a news release.

More here:
http://www.urmc.rochester.edu/m/news/story.cfm?id=3116

The Chapples said...

Sigh.

I don't think I ever said you were encouraging EDs or starvation???? I was just wishing for your own peace of mind, Sealegsgirl, thta you could be a little more moderate with food and exercising. But that's me projecting onto you. You're obviously happy with things. I also think you're misunderstanding my tone - I like you, chica! I just worry (occupationa hazard, working with eating disorder patients day in and day out). Just trying to create some banter!

I'll bow out now. I could never stand up to two smart doctors. I'll take my lazy butt on out of here and go eat some jellybeans with my kiddo :P.

Anonymous said...

Pregnancy probably isn't the best time to start a new activity but i don't see why it isn't a good time to keep meeting goals in an activity you are used to.

My mom had me in the 80s and she was a swimmer. she swam every morning for her entire pregnancy like usual. at the time, with her doctors, swimming was considered good low-impact exercise for pregnant women at the time, and she was encouraged. She wasn't a runner, and i think taking it up while pregnant might have been a mistake, especially trail running, as balance and proper footing is something you need to be comfortable with when there's a baby on board. As someone who is notoriously clumsy, I know trail running is going to be an issue for me when i'm pregnant.

I will probably be ready for a pregnancy later in a year or two, and i'm a healthy weight now, but I would also be healthy if i was 10 pounds less. I don't know if I really need much weight gain at all during a pregnancy, but I think looking at it from the perspective of weight gain alone must be a mistake.

I've never seen the harm in exercise for health and wellness of the child, but if you are doing it for vanity reasons or starving yourself while pregnant to help with exercise goals or weight gain goals, i do think that's a problem. Health of yourself and baby should surpass everything else, and that involves being selfless and yeah, sacrificing.

Katie said...

I think many docs in the US want to see women gaining less than the 25 - 35 pounds now. I was normal weight and gained 22 pounds. When I checked into the hospital I overheard the nurses saying "her weight wasn't too crazy or completely out of control." Insinuating that I had gained too much weight. I was a little irritated. They really shouldn't recommend a certain weight gain if they want you to gain less. 5 months later I have lost all the weight plus a couple pounds with very little effort. I think for me my weight was probably fine.

Katie said...

Oh I thought I might add that I ran an average of 47 miles a week during my pregnancy and still gained 22 pounds. I was able to run to the end and ran 7 miles the day I went into labor. 5 months later I'm in fairly good shape. I just ran a half marathon on Sunday in 1:36:11. Not a PR, but I think it's the lack of sleep and being sick all winter that's impacting my training now. Not that I just had a baby.