New Department of Health advice for activity during pregnancy

Rosanne Barrett

14/05/2021 1:34:47 PM

The guidelines have been welcomed by GPs as a helpful addition to existing resources, but critiqued for lacking specific detail.

Pregnant women exercising
Women without contraindications should participate in regular aerobic and strength conditioning exercise during pregnancy.

Women who exercise regularly before pregnancy can keep up their activity, while those who are inactive are encouraged to start slowly, according to new guidelines recently released by the Department of Health (DoH).
Developed by the University of Queensland (UQ) and Central Queensland University, the guidelines recommend women should continue their pre-pregnancy exercise levels while heeding some additional precautions.
Associate Professor Magdalena Simonis, a member of the RACGP’s Expert Committee on Quality Care, told newsGP the guidelines are consistent with existing advice, but could have included more pregnancy specifics.
‘The exercise should really be consistent with what [pregnant women] have been used to, and I don’t think that advice has changed,’ she said.
‘Normally what we would do as doctors would be to go to RANZCOG for the evidence-based data and guidelines.’
The new recommendations indicate that if the woman and developing baby are healthy then, they should aim to meet the standard amount of physical and sedentary behaviour guidelines for adults.
But Associate Professor Simonis said there are also specific pregnancy-related experiences that could have been addressed in more detail, such as the impact of different hormones on the body.
‘Many changes that occur in pregnancy have not been addressed in this announcement,’ she said. ‘It’s a time when the body is changing. There are ligamentous changes as well.’
A DoH spokesperson told newsGP experts from a range of clinical areas, including exercise physiology, exercise and pregnancy, epidemiology, general practice, obstetrics and gynaecology, and midwifery were consulted in the development of the guidelines.
They also said the main purpose of the guidelines is to provide ‘evidence-based best practice recommendations on physical activity/exercise during pregnancy for Australian women and those who provide healthcare during pregnancy’, after research identified that only 30% of pregnant women met guidelines for physical activity.
The new advice recommends that pregnant women to build up to activity on most days, preferably daily, with weekly totals of 2.5–5 hours of moderate-intensity physical activity, or 1.25–2.5 hours of vigorous-intensity activity.
Muscle strengthening twice weekly is also recommended. The guidelines also say pelvic floor exercises should be done daily, and long periods of standing or sitting should be broken up.
This is in line with the RANZCOG guidelines, which advocate women without contraindications should participate in regular aerobic and strength conditioning exercise during pregnancy.
However, pregnant women are advised to avoid activities with significant pressure changes, such as sky diving or scuba diving, as well as those with a risk of collision and contact or falling, and heavy lifting.
They also advise an assessment of medical and obstetric risks for the pregnant woman prior to commencing an exercise program.
Dr Wendy Burton, Chair of RACGP Antenatal and Postnatal Care Specific Interests, says the guidelines are welcome but more detail would be helpful for some women.
‘Anything that promotes physical activity in pregnancy that is clear … I think it’s a good thing,’ she said.
‘If it helps us to engage people in the community and with consumers and be specific about the activities we want them to engage in, and the caveats around it, that is wise.
‘But there are conversations we’re not having that we should be having about more specifics. [That expertise] isn’t always available depending on where women live.’
Co-author of the new guidelines, Dr Melanie Hayman, said the guidelines are applicable to all women who are pregnant or planning pregnancy, as well as health professionals.
‘The guidelines provide health professionals with evidence-based guidance on optimal physical activity during pregnancy and in the postpartum period,’ she said.
‘They may be used to encourage pregnant people to achieve levels of physical activity recommended for optimal health for them and their baby.’ 
Associate Professor Simonis says it’s important to have specific activity guidelines for women in pregnancy, both for physical health, but also to encourage overall health and wellbeing.
‘Specific guidelines for pregnancy are required,’ she says. ‘In some cultures, there is a relative taboo around pregnancy and exercise.
‘There are many benefits of being active; it helps prevent excess weight gain, maintains and builds fitness levels, [and] it helps pelvic and back pain, weight control, stress relief and anxiety and sleep.’
Other clinical benefits relate to a reduction in the risk of a high BMI, which is known to increase the risk of potentially serious complications such as diabetes, hypertension, preeclampsia, and fetal morbidity.
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Dr Lucas Anthony McLindon   18/05/2021 10:44:31 AM

Congratulations to the hard work of the commissioning team. The link to the scientific report (below) for GPs who would like to see more about the evidence underpinning the guidelines . . and more information on some of the trickier issues beyond the headline guidelines.

The report is in on the DOH website:

Dr Lisa Helen Amir   18/05/2021 4:46:24 PM

I would like to have seen more advice about the postpartum period. Research about exercise postpartum is lacking, but there could have been expert opinion about what activities GPs could recommend, and timing, taking into account method of birth and so on.