Management strategies for pregnancies with absolute contraindications to physical activity

Determine safe and effective management strategies, including the potential use of low-intensity activity routines, for pregnant individuals with absolute contraindications to physical activity—such as preterm premature rupture of membranes, vaginal bleeding with or without placenta previa, multiple gestation, hypertensive disorders of pregnancy, short cervical length, and fetal growth restriction—in order to mitigate deconditioning due to activity restriction without increasing the risk of adverse perinatal outcomes.

Background

Activity restriction and bedrest are commonly prescribed for several pregnancy complications, yet growing evidence suggests that restricting activity may not prevent adverse perinatal outcomes and can worsen physical and psychosocial risks. Conversely, sedentary behavior during pregnancy is associated with increased chronic disease risk and impaired birth outcomes.

Despite the recognized benefits of physical activity in healthy pregnancies, few interventions have been tested to reduce deconditioning among those with absolute contraindications, leaving a critical gap in guidance for safely maintaining some activity and preparing for postpartum demands.

References

Knowing that a physically active pregnancy (accruing 150 min/week of moderate-intensity PA) offers health benefits to both the gesP and their offspring and that evidence indicates that excessive sedentary behaviour during pregnancy increases chronic disease risk and may impair birth outcomes101-103, how do we treat those who experience what are deemed absolute contraindications? In brief, few interventions have been tested to reduce the deconditioning impacts of activity restriction in pregnancy24 and thus we are presently unsure.

— Breaking Boundaries: A Chronology with Future Directions of Women in Exercise Physiology Research, Centred on Pregnancy  (2404.08833 - Corson et al., 2024) in Section 3.2.2 High risk pregnancies — is activity restriction and bedrest the only option?