stretching
Gestational Diabetes: A Particular Problem for Mamas on Bed Rest
January 29th, 2010
Gestational Diabetes (GD) can be particularly problematic for mamas on prescribed bed rest. Previously a common indication for bed rest, with all of the medical advances and therapies most pregnant women who develop GD are easily managed as out patients. Unfortunately, women who are prescribed bed rest for another medical condition are at increased risk for developing GD as a result of inactivity and weight gain. Women who develop GD are at increased risk of developing Type II diabetes later in life as well as Metabolic Syndrome.*
Gestational Diabetes is defined as impaired (improper) glucose metabolism during pregnancy. Some women become insulin resistant, meaning that the insulin their bodies produce does not properly carry glucose from the bloodstream into the body’s cells as it should. Sometimes GD develops because a woman has gained too much weight, a common cause of insulin resistance. Other times the increased hormones of pregnancy interfere with glucose metabolism. Finally, a woman with a genetic predisposition to diabetes may manifest her first symptoms during her pregnancy. This woman is at increased risk of developing Type II diabetes later in her life.
Testing for gestational diabetes is typically done between 20 and 28 weeks of pregnancy. The normal ranges of blood glucose are:
- 70-95 mg/dL Before breakfast (fasting)
- 70-140 mg/dL 1 hour after eating a meal
- 70-120 mg/dL 2 hours after eating a meal
Women who have blood sugars that fall above these ranges during testing will be diagnosed with GD. It is essential that women diagnosed with Gestational Diabetes are treated aggressively and that they achieve and maintain tight blood sugar control. Blood sugar control is essential to ensure the health of both mother and baby. When blood sugars are not controlled during pregnancy, Some unfortunate complications can result such as:
- High blood pressure in the mother caused by preeclampsia
- Excessive birth weight (exceeding 9 pounds, 14 ounces)or Macrosomia
- C-section delivery
- Hypoglycemia (low blood sugar) in the baby at birth
- Jaundice (yellow skin) in the baby at birth
- Respiratory distress syndrome (breathing difficulties) in the baby at birth
- Low blood calcium levels in the baby at birth
- Red blood cell disorders in the baby at birth
- In very rare cases, stillbirth of the baby at 28+ of pregnancy
- In very rare cases, death of the baby in infancy
- Increased risk for type 2 diabetes in both mother and baby later in life
Treatment of Gestational Diabetes is actually quite simple. From many women, adherence to a “diabetic diet”, a regular exercise regimen and regular blood sugar testing are all that is needed. However, for many other women, blood sugar cannot be adequately regulated and controlled with diet and exercise alone, so they are prescribed oral medications or Insulin injections.
Unfortunately most pregnant women on prescribed bed aren’t able to exercise enough reduce insulin resistance with diet and exercise alone. However it is still very important, perhaps even more so, that they follow the dietary instructions from their OB or a nutritionist and that they stretch and do some muscle strengthening and toning while in bed. If women on bed rest are diagnosed with gestational diabetes, they should request a referral to a physical therapist or exercise specialist** so that they can learn safe exercises that they can do while on bed rest.
It may seem unfair to be diagnosed with gestational diabetes while on bed rest for another condition. Try not to become too discouraged. Gestational Diabetes is easily managed and with careful adherence to your obstetrician’s directions, you and your baby can be just fine.
*Metabolic Syndrome is a group of symptoms that occur together and promote the development of coronary artery disease, stroke, and type 2 diabetes. An individual is diagnosed with Metabolic syndrome if they have:
- Extra weight around the waist (central or abdominal obesity)
- High blood pressure
- High triglycerides
- Insulin resistance
- Low HDL (“good”) cholesterol
**Bedrest Fitness is a set of simple yet effective modified prenatal exercises that a pregnant woman on prescribed bed rest can do from her bed with her obstetrician’s approval. Order Bedrest Fitness here.
Please share your comments or questions on this post below.
Pregnant Mamas, Make Your Exercise Count!
January 12th, 2010“Light Resistance Exercise During Pregnancy Does Not Affect Type of Delivery”.
This is the headline that came across my desk from Medscape about a study published in the American Journal of Obstetrics & Gynecology. I have to admit my first reaction was shock, then outrage. For years we perinatal fitness instructors and other proponents of exercise have been trying to stress the importance of prenatal fitness to pregnant women. Our arguments stem from research done by obstetricians and researchers such as James Clapp, III, MD and Ann Cowlin, Dance and Movement Specialist. In their decades of research, they have found that regular, moderate intensity exercise, tends to shorten labor, increase the effectiveness of pushing, reduce the need for pain medications and interventions. The aforementioned study was in direct opposition from what I know and believe to be true anecdotally from my own perinatal fitness clients. But rather than just rant, I went and read the study to see how the researchers generated their data and how they reached their conclusions.
Study Design
In this particular study Spanish researchers took healthy yet sedentary pregnant women of low to medium 
socioeconomic status in Madrid Spain and looked to see if having them do a limited amount of low intensity exercise impacted their deliveries. The women were all aged 25-35 years old with uncomplicated singleton pregnancies. The women in the study group began exercising at the beginning of the second trimester and continued for approximately 26 weeks. Their exercise regimen consisted of 8 minutes of warm up, approximately 20 minutes of toning and light resistance exercise and 8 minutes of cool down stretching performed 3 times a week. Exercise specialists monitored the exercise sessions to be sure that each lady’s heart rate remained at 80% of maximum output or less. The researchers found that, in this study, there was no difference between rates of natural deliveries, instrumented deliveries or Cesarean deliveries even when potential confounding variables were controlled. While the researchers concluded that prenatal exercise is good for both mother and baby and did not complicate pregnancy, cause preterm labor or reduce the incidence of natural delivery, it did not alter the type of delivery a woman had.
Where They Went Wrong
Not intense enough exercise
After reading the study I completely understood why the Spanish researchers saw no impact of exercise on delivery. According to their journal article, they did not have the women engage in moderate intensity activity. Clapp, Cowlin and others have all found that pregnant women reap the most benefit from prenatal exercise when they engage in low impact moderate activity exercise. Moderate intensity is defined as a rate of exertion in the range of 12-14 on a scale of 1-20 on Borg’s Rate of Perceived Exertion Scale. Exercising in the range of 12-14 enables a woman to be able to talk, but increases her cardiovascular effort contributing to endurance training.
Many exercise professionals, myself included, don’t use heart rate to monitor exercise intensity in pregnant women. The physiologic changes of pregnancy inherently make a woman’s baseline heart rate go up. The American College of Obstetricians and Gynecologists used to recommend that pregnant women not increase their heart rates above 140 beats per minute (bpm), but for many pregnant women they reached 140 bpm just walking across the room! That is why the Borg’s Scale has replaced heart rate monitoring in many clinical exercise settings.
Not Enough Exercise
In this study, the women only exercised approximately 36 minutes per session and increased their heart rates for about 20 minutes per session. To develop any sort of strength or endurance conditioning, the American College of Sports Medicine recommends 20-30 minutes of exercise at targeted intensity 3-5 times per week. A combination of brisk walking, swimming or prenatal aerobics classes with strength training using free weights (usually not more than about 5 lbs) or exercise bands or tubing to accrue the 30-45 minutes of intense activity works well. I typically warm my clients up for 10-15 minutes before and cool them down for 10-15 minutes following the work out.
Types of Exercises
The study did not indicate what types of exercises were performed, but given they used light resistance bands, I am thinking some sort of strength training. Hopefully they included some sort of cardiovascular exercise such as brisk walking, swimming or aerobic movement. The strength training should have focused on maintaining muscle tone, muscle strength (especially upper body) and providing strength and support to the skeleton. Pregnancy creates forward movement of the neck and shoulders (a round shouldered upper body posture with a “stork neck”) while also creating lordosis (sway back) in the low back. CORE strengthening will help strengthen and stabilize the spine and skeleton and reduce the risk of pain or injury to the neck, shoulders, hips and back. Pelvic floor strengthening (Kegels and other exercises) should also be incorporated into the program to help prevent the development of urinary stress incontinence, tearing and or the need for an episiotomy during delivery and organ prolapse after delivery.
My Take
Prenatal exercise stills remains controversial in some obstetric circles, yet all the data to date support the idea that regular prenatal exercise is good for both mother and baby. Amongst birth professionals there still remains controversy as to what type and how much exercise is best. I have found that even with previously sedentary mamas-to-be, if they start exercising early in their second trimester and continue until they are ready to deliver (or as close as is comfortable), they are able to increase their cardiovascular endurance and muscle strength and tone just as if they would in the non-pregnant state. This conditioning enables the ladies that I train to have less pain and discomfort, to utilize less pain medication during labor and delivery, to spontaneously go into labor rather than needing to be induced, to have shorter labors (I’m seeing about 6-8 hours) and to more effectively push. These ladies don’t need “instrumentation” during delivery and I see a lower rate of cesarean sections.
One my call my results “anecdotal” and this is correct because my clients are not organized in to controlled study groups. But if my small prenatal fitness training population is any indication, women who engage in low impact moderate intensity exercise (in the range of 12-14 on Borg’s Rate of Perceived Exertion) for 20-30 minutes 3-5 times a week, will be more likely to experience less pain and discomfort during pregnancy, shorter labors, fewer complications during labor and delivery and a shorter recovery.
Mamas on Bedrest, Don’t despair! You too have an exercise option. Bedrest Fitness is a set of exercises designed specifically for pregnant women on prescribed bed rest. The exercises are simple but effective and easily done while in bed. Do part or all of the DVD, depending on your provider’s instructions. Order your copy of Bedrest Fitness Here
I would love to hear the experiences of other birth professionals, perinatal fitness instructors and women who have exercised throughout their pregnancies. Please add your comments below and encourage other professionals and mamas to do the same!
The Birth of Bedrest Fitness
September 16th, 2009In this podcast, MBB founder Darline Turner-Lee shares the story of how Bedrest Fitness was “conceived” and “birthed”. Bedrest Fitness is a simple yet effective set of modified prenatal exercises that pregnant women on prescribed bed rest can do comfortably in bed. For more info on Bedrest Fitness view the video clip or visit the shop to purchase.
