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Fit & balanced pregnancy
Courtesy: Physionique Physiotherapy and Rehabilitation Centre, Circular Road – Dimapur.)  :  Aug/06/2017 06:22:PM
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Despite the many advantages of exercise and proper nutrition during pregnancy, many women are hesitant to engage in any sort of physical activity and to follow a balanced diet while they are pregnant probably because of the many myths and misconceptions that hold women back. A Woman’s nutrition and fitness prior to and throughout pregnancy and lactation affects not only her own health but also the growth, development and health of her child. Women who enter pregnancy with healthy body weight have done much to ensure an optimal pregnancy outcome. 
Appropriate weight prior to pregnancy benefits pregnancy outcome. Being either underweight or overweight presents medical risks of pregnancy and childbirth. Low weight gain is associated with increased risk of intra-uterine growth retardation and perinatal mortality. High weight gain is associated high birth weight and have higher risk of hypertension, gestational diabetes and postpartum infections. Between the moment of conception and birth, innumerable events determine the course and outcome of fetal development.
The American Congress of Obstetricians and Gynecologists (ACOG) recognized that sedentary lifestyle is a major health risk for pregnancy women. Another question is whether it is safe for previously sedentary women to begin exercise during pregnancy. Contrary to previous opinions, pregnancy is now considered an ideal time not only for continuing but also for initiating an active lifestyle. Exercise has been believed to increase risks associated with pregnancy but many of these beliefs have not been proven with scientific evidence. It has only been in the last ten years that this area has been thoroughly researched and today, we know differently that not only is it ok to participate in fitness activities during pregnancy, but doing so can have a positive impact on both the baby and the mother.
This is not to say that there are no risks at all. All women who exercise while pregnant should seek advice from their Gynaecologist/Obstetrician and Physiotherapist to ensure that they are not over doing it or engaging in specific activities that should be avoided. 
Benefits of Exercise and pregnancy-related risk (AMERICAN PREGNANCY ASSOCIATION)
1. Obesity and pregnancy
Maternal obesity and overweight is an increasingly prevalent issue. Most experts agree that gaining more than the recommended 25 to 35 pounds (for a woman of normal weight) or putting on 10% or more than the original body weight (before pregnancy) during pregnancy makes it harder to lose the weight after the baby is born.
Excessive weight gain during pregnancy increases the risk of pregnancy-induced hypertension (preeclampsia) and Gestational Diabetes Mellitus (GDM). Maternal overweight and obesity is a large indicator of obesity later in life for the infant and for the mother. Furthermore, foetal distress is twice as likely for the infants of obese women than those of normal weight.
Exercise can be used to combat excessive weight gain, aerobic exercises  utilises a large number of muscle groups, and it does not pose any risks during low risk pregnancies. It also maintains your muscle tone and strength.
2. Gestational diabetes mellitus (GDM)
Exercise is protective against the most common complication of pregnancy, gestational diabetes mellitus (GDM). Training large muscle groups have shown to help normalise blood sugar levels by improving glucose utilisation and insulin sensitivity. Women who exercise during pregnancy are significantly lesslikely to develop GDM than those who are physically inactive.  
3. Pre-eclampsia/ Pregnancy induced Hypertension
The risk of pre-eclampsia is significantly reduced in women who exercise during pregnancy compared to inactive women. 
4. Exercise outcomes on birth weight and foetal growth
The birth weight of the child is affected more by exercising during pregnancy than the mother’s body mass index (BMI). Overweight and obese women are more likely to have babies with a large infant birth weight. Women who exercise are less likely to have larger babies. Therefore exercise in pregnancy may elicit a “protective” effect against offspring that are identified as Large for gestational age (LGA).  LGA means that for the time spent in gestation the infant is in the largest 90% for all infants born at that age and sex.
5. Psychological benefits of exercise during pregnancy
Studies have identified that women who stay fit during pregnancy are more relaxed and therefore cope better with the emotional and physiological strains of pregnancy, including the demands of labour. Women who exercise have a better sense of wellbeing due to a number of positive effects from exercise such as greater weight control, better body image and self-esteem, improved sleep and increased energy levels. It is believed that this positive effect on mental health continues after pregnancy and may decrease the incidence of postnatal depression. It also improve sleep disturbances.
6. Physiological benefits of exercise during pregnancy
Evidence has shown that women who exercise have:
• Increased cardiovascular and muscular fitness and strength;
• Improved posture due to increased abdominal and upper body strength;
• Lower incidence of back pain;
• Improved circulation which reduces the incidence of varicose veins and deep vein thrombosis;
• Reduced constipation, bloating and swelling;
• A greater chance of experiencing easier deliveries with less medical interventions; and
• Healthier babies.
• The benefits are also maintained after birth with some women reporting improved sporting performance in the months immediately following birth. This is thought to be related to the increased respiratory volume, cardiac output and blood volume that occur during pregnancy which is accompanied by improved oxygen capacity.
Contraindications for exercise during pregnancy
Medical conditions may heighten the potential dangers of exercising for some women, and in these cases exercise should be avoided. These include women with:
• Heart disease;
• Restrictive lung disease 
• Incompetent cervix – a medical condition in which the cervix begins to dilate before the full term of the pregnancy;
• Premature labour;
• Premature ruptured membranes – after the water breaks;
• Preeclampsia/pregnancy-induced hypertension;
• Persistent second or third trimester bleeding; and
• Placenta praevia – a complication during pregnancy when the umbilical cord is attached to the uterine wall and it is close to or even covering the cervix.
With respect to nutrition each organ needs nutrition during its own intense growth period. A nutrient deficiency during one stage of development might affect the heart and during another stage, the developing limbs.
Caloric requirement during pregnancy is increased for maintaining the growth of fetus, placenta and tissues and for the increased basal metabolic rate. Indian council of Medical Research (ICMR) has suggested additional 300kcal per day during 2nd and 3rd trimesters. A women can easily obtain 300calfrom just an extra serving from each of the five food groups – a slice of bread, a serving of vegetables, an ounce of lean meat, a piece of fruit, and a cup of non-fat milk.
During pregnancy, the IMCR recommends additional 15gm/day. The additional protein is essential to meet growing tissue demands                                                                                                                                                  A good intake of all vitamins and minerals is essential but the need for folate, vitB12, iron, calcium& zinc are especially great due to their key roles.
Vitamin B12 & Folate: 
These vitamins are required for rapid cell proliferation. Folate plays an important role in preventing neural tube defects. The (ICMR) recommended allowance of folate is increased to 150-300 mg(micro grams). Although this amount can obtained by consuming 5 servings of fruit and veggies daily, supplements offer a convenient way to ingest enough folate regularly.
Iron is required for fetus and also for mother due to increased production of hemoglobin and for the loss during parturition. 
It is required for DNA & RNA synthesis. Low blood zinc predicts low birth weight. Zinc is most abundant in foods of high protein content such as meat, nuts, shell fish.
Vitamin D & Calcium:
Vitamin D plays a vital role in calcium absorption and utilization. Calcium is essential for calcification of fetal bones and teeth. Vitamin D & calcium reduce muscular cramps of pregnancy.
Essential Fatty Acids (EFA’s)
EFA’s (linoleic acid and alpha-linolenic acid) and their long chain derivatives EPA & DHA are vital for development of fetus and neural development and growth.
Sources: Vegetable oils, walnuts, oil-rich fish, peanut oil, mackerel, tuna, sardines, grass-fed meats, foods enriched or fortified with EPA/DHA.
Common Nutrition related concerns of pregnancy.
Nausea, constipation, heart burn & food sensitivities are some common nutrition related concerns
A few strategies to alleviate maternal discomforts.
1. To alleviate Nausea.
-on waking, arise slowly 
-Eat crackers, dry toast before getting out of bed in the morning 
-Chew gum or suck hard candies
 -Eat small frequent meals
-Try to take adequate fluids even if solid foods are not tolerated 
-When nauseated avoid coffee, tea, citrus juices, milk or water.
-Avoid or limit intake of fatty & spicy foods.
2. To prevent or alleviate constipation. 
-Eat high fiber foods, including cereals, whole grains, legumes and fresh fruits & vegetables
-Drink 2-3 litres of fluid daily.
-Be physically active
-Try to avoid taking laxatives
3. To relieve heart burn.
- Relax & eat small low fat meals slowly
-Chew food thoroughly
-Drink fluids mainly between meals
-Sit up while eating and elevate the head while sleeping
-Avoid spices
-Avoid lying down for 1 to 2hrs after eating
A maternal diet must provide sufficient energy and nutrients to meet the Mother’s usual requirements, as well as the needs of the growing fetus, and enable the mother to lay down stores of nutrients required for the fetal development as well as for lactation. 
The dietary recommendations for pregnant women are actually very similar to those for other adults, but with a few notable exceptions. The main recommendation is to follow a healthy balance diet for which you can consult your Nutritionist/Dietitian
Body image is a concern for all pregnant women. During pregnancy, exercise goals need to change to assure a healthy pregnancy. The enlarged belly and increased fat deposits on the hips and thighs are necessary adaptations for fetal development and protection.A positive attitude toward these physical changes allows the pregnant woman to modify exercise appropriately and enjoy this very special time in her life. 
American College of Sports Medicine (ACSM) studies show that Women should exercise 3-4 times per week for atleast 30 minutes such Aerobic exercises, dynamic and rhythmic activities. 
Strength training program that incorporates all major muscle groups in multiple repetitions under the supervision of your Physiotherapist. Exercises regimes will differ from trimester to trimester.
Generally, Postpartum exercise can be resumed as early as 2-4 weeks after delivery, assuming that they experienced a normal vaginal delivery with no complications. 
Exercising postpartum women have shown to have a more rapid recovery both physically and emotionally than women who do not exercise postpartum. The incidence of postpartum depression is also low. 
Pregnancy is no longer considered a state of confinement. In addition to exercising, eating nutritiously is an important part of the equation in assuring a healthy pregnancy. 

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