MATERNAL PHYSICAL ACTIVITY AND EFF

ECTS ON HYPERTENSION
BY
EZE CHIDIEBERE E
FETHA

INTRODUCTION

Available data, though sparse, consistently sho

w that women who engage in recreational physic
al activity during pregnancy have approximately
50% reduction in the risk for Pre eclampsia
Available data support the American College o
f Obstetrician and Gynecologists' recommendatio
ns that promote exercise during pregnancy

INTRODUCTION

The belief that women should remain physicall

y active during pregnancy is prevalent in many c
ultures, and can be traced back to ancient times
(Kitzinger 2000).
Traditionally, the nature of women's work both
within and outside the home has been such that
most of the activities would have to be performe
d during pregnancy

INTRODUCTION

In most countries throughout history, only social

ly privileged women have had a choice about the l
evel and type of physical activity they undertake d
uring pregnancy.
In the late twentieth century, as more women we
re comfortably off, and with the spread of labour s
aving machines to do household tasks, the concept
of antenatal exercises developed.

INTRODUCTION CONTD.

Although there is a range of possible effects of

exercise and other physical activity during pregn
ancy, this review deals primarily with those relat
ed to prevention of pre-eclampsia, and its conseq
uences.

DEFINITION OF PHYSICAL ACTIVITY

Physical activity is the bodily movement that is

produced by the contraction of skeletal muscles an
d that substantially increases energy expenditure. T
here are basically four(4) levels of physical activity
Inactive level
LowActivity level
Medium Activity level
High activity

INACTIVITY

There is no activity beyond baseline activities o

f daily living.
Health Benefits;
No health benefits
Being inactive is unhealthy.

LOW LEVEL PHYSICAL ACTIVITY

Low activity is activity beyond baseline but few

er than 150 minutes (2 hours and 30 minutes) of m
oderate-intensity physical activity a week or the eq
uivalent amount (75 minutes, or 1 hour and 15 min
utes) of vigorous-intensity activity.
Benefits;
some
Low levels of activity are clearly preferable to an
inactive lifestyle.

MEDIUM LEVEL PHYSICAL ACTIVITY

Medium activity is 150 minutes to 300 (5 hour

s) minutes of moderate-intensity activity a week
(or 75 to 150 minutes of vigorous-intensity physi
cal activity a week). In scientific terms, this rang
e is approximately equivalent to 500 to 1,000 me
tabolic equivalent (MET) minutes a week.
Benefits;
Activity at the high end of this range has additi
onal and more extensive health benefits than acti
vity at the low end.

HIGH LEVEL PHYSICAL ACTIVITY

High activity is more than the equivalent of 30

0 minutes of moderate-intensity physical activity
a week.
Benefits;
Current science does not allow researchers to i
dentify an upper limit of activity above which th
ere are no additional health benefits.

INTRODUCTION TO HYPERTENSION IN PREGNA

NCY

High blood pressure in pregnancy also known

as Pre-eclampsia is part of a spectrum of conditio
ns known as the hypertensive disorders of pregna
ncy. Hypertension (high blood pressure) is comm
on during pregnancy.
Around 10% of women have raised blood pres
sure at some point before delivery.

TYPES OF HYPERTENSIVE DISORDERS IN PREG

NANCY

Hypertensive disorders of pregnancy are usuall

y classified into four categories:
(i) GESTATIONAL HYPERTENSION : a rise in bl
ood pressure during the second half of pregnancy.
(ii) PRE-ECLEMPSIA : usually hypertension with
proteinuria (protein in urine) during the second h
alf of pregnancy

TYPES OF HYPERTENSIVE DISORDERS IN PREG

NANCY

(iii) CHRONIC HYPERTENSION: a rise in blood p

ressure before pregnancy or before 20 weeks' gestati
on
(iv) Pre-eclampsia superimposed on chronic hyper
tension
the outcome of most such pregnancies is good, com
plications of pre-eclampsia and severe hypertension
are associated with a substantive increase in morbidi
ty and mortality for both the woman and her baby

CAUSES OF HYPERTENSION IN PREGNANCY

The cause of pre-eclampsia is uncertain, but cu

rrent belief is that reduced blood supply to the pl
acenta leads to abnormal function of endothelial
cells , possibly as a result of oxidative stress.
Some researchers suspect poor nutrition and hi
gh body fat
Genetics plays a role as well.

RISK FACTORS FOR HYPERTENSION IN PREGNA

NCY

Hypertension in pregnancy is most often seen i

n first-time pregnancies, in pregnant teens, and i
n women over 40.
Other risk factors include:
A history of high blood pressure prior to pregn
ancy
A history of pre eclampsia

RISK FACTORS CONTD.

Carrying more than one baby

History of diabetes, kidney disease, lupus, or r
heumatoid arthritis
A history of obesity
Having a mother or sister who had preeclampsi
a

COMPLICATIONS OF HYPERTENSION IN PREGN

ANCY

Pre-eclampsia affects 2% to 8% of pregnancies

(WHO 2010). It is a multisystem disorder, which
may involve the brain, liver, kidneys and placent
a. There are two complications of pre-eclampsia;
Maternal Complications and
Complications on the Foetus

MATERNAL COMPLICATIONS

Maternal complications include:

Eclampsia
Stroke
liver and kidney failure
Coagulopathy (rare)

COMPLICATIONS ON THE FOETUS

For the baby, there is an increased risk of poor

growth and preterm birth.

PHYSIOLOGICAL EFFECTS OF PHYSICAL ACTIVI

TY ON HYPERTENSION DURING PREGNANCY

It has been suggested that the physiological ch

anges associated with regular exercise may prote
ct against pre-eclampsia (Weissgerber 2004).
Postulated mechanisms for such an effect inclu
de;
(I) Enhanced placental growth and vascularity

PHYSIOLOGICAL EFFECTS OF PHYSICAL ACTIVITY

ON HYPERTENSION DURING PREGNANCY

These may possibly be as an adaptive response

to intermittent reductions in placental blood flow
during exercise
(II) Reduced oxidative stress And
(III) Correction of vascular endothelial dysfuncti
on, particularly with aerobic exercise (Clapp 200
3)

PHYSIOLOGICAL EFFECTS OF PHYSICAL ACTIVITY

ON HYPERTENSION DURING PREGNANCY

Regular exercise is associated with an increase

in plasma volume and cardiac output.
Exercise has also been shown to lower plasma
triglycerides (Williams 2006)
Exercise has also been shown to lower inflam
matory cytokines (Clapp 2000)

PHYSIOLOGICAL EFFECTS OF PHYSICAL ACTIVITY

ON HYPERTENSION DURING PREGNANCY

It has also been shown that insulin resistance is

reduced in Physically active women during preg
nancy (Mayer-Davis 2008), all of which are elev
ated in pre-eclampsia
Exercise is associated with emotional well-bei
ng and reduction in stress and anxiety (Marquez
2000)

PHYSIOLOGICAL EFFECTS OF PHYSICAL ACTIVITY ON HY

PERTENSION DURING PREGNANCY

Moderate and vigorous-intensity physical activ

ity is associated with improved insulin sensitivit
y and reductions in fat mass
Aerobic dance and walking, the most popular f
orms of exercise among pregnant and non pregn
ant women have been shown to result in a reduct
ion in plasma insulin even during pregnancy.

PHYSIOLOGICAL EFFECTS OF PHYSICAL ACTIVI

TY ON HYPERTENSION DURING PREGNANCY

Preeclampsia,though characterized clinically b

y maternal high blood pressure and proteinuria
Also characterized by subclinical metabolic dis
orders such as hypertriglyceridemia,excessive lip
id peroxidation or oxidative stress,insulin resista
nce, and elevated plasma homocysteine

PHYSIOLOGICAL EFFECTS OF PHYSICAL ACTIVI

TY ON HYPERTENSION DURING PREGNANCY

Results from observational studies and from ra

ndomized trials have consistently demonstrated a
n inverse relation between recreational physical
activity and blood pressure in non pregnant and
pregnant women

PHYSIOLOGICAL EFFECTS OF PHYSICAL ACTIVI

TY ON HYPERTENSION DURING PREGNANCY

Results from randomized controlled trials indi

cate that aerobic exercise performed by non pr
egnant women aged 18yrs or older results in st
atistically significant reductions in resting syst
olic and diastolic blood pressures.
Physical activity profoundly affects many of
these physiological functions

PHYSIOLOGICAL EFFECTS OF PHYSICAL ACTIVI

TY ON HYPERTENSION DURING PREGNANCY

Exercise therapy is also associated with reducti

ons in diastolic blood pressures in pregnant wom
en with a history of mild hypertension, gestation
al hypertension,or family history of hypertensive
disorder.

PHYSIOLOGICAL EFFECTS OF PHYSICAL ACTIVI

TY ON HYPERTENSION DURING PREGNANCY

In 2004, Butler et al reported that mean triglyc

eride concentrations were lower (23.6 mgdL1)
among pregnant women who spend much time p
erforming physical activity as compared with ina
ctive women.

PHYSIOLOGICAL EFFECTS OF PHYSICAL ACTIVI

TY ON HYPERTENSION DURING PREGNANCY

The study by Butler in 2004 also suggest that h

abitual physical activity performed during pregn
ancy may mitigate the pregnancy-associated dysl
ipidemia commonly noted in hypertensive and di
abetic pregnancies.

PHYSIOLOGICAL EFFECTS OF PHYSICAL ACTIVI

TY ON HYPERTENSION DURING PREGNANCY

Lastly, recreational physical activity has been l

inked to improvements in emotional well-being a
nd reductions in stress and anxiety
Investigators have shown that pregnant women
experiencing anxiety and/or depression are at a
threefold increased riskfor preeclampsia.

PHYSIOLOGICAL EFFECTS OF PHYSICAL ACTIVITY ON HY

PERTENSION DURING PREGNANCY

It is reasonable to speculate that the risk of pre

eclampsia, particularly those cases attributable to
maternal psychosocial stress, maybe impacted by
the psychophysiological benefits of regular physi
cal activity.

WHAT ARE THE CURRENT GAPS IN KNOWLEDG

E?

Despite increased attention to physical activity

in pregnancy over the past two decades, much re
mains unknown about the long-and short-term fe
to-maternal effects of exercise during pregnancy.
We believe the time is right to motivate a para
digm shift towards identifying maternal and fetal
benefits of exercise in pregnancy.

WHAT ARE THE CURRENT GAPS IN KNOWLEDG

E?

Further invesigations should be designed to st

udy in greater detail the types,frequency,duratio
n, and dose-response patterns of recreational ph
ysical activity in relation to pregnancy-related di
sorders.
Knowledge gained from such studies will prov
ide insights toward preventing sports related inju
ries among expectant mothers.

CONCLUSION

Current studies and literatures does not suppor

t concerns that once promoted many to think abo
ut pregnancy as a period of confinement.
It is encouraging that the ACOG and other sim
ilar organizations now publish guidelines that mo
re assertively promote physical activity during pr
egnancy.

CONCLUSION

Additional research is needed to increase the p

recision;with which exercise programs maybe de
signed for all groups of pregnant women (e.g.,th
ose with pre-gestational diabetes, essential hyper
tension, or those who are obese)

REFERENCES

Butler C.L., M.A. Williams, T.K. Sorensen,

I.O. Frederick, and W.M. Leisenring. Relationsh
ip between maternal recreational physical activit
y and plasma lipids in early pregnancy.Am.J. Epi
demiol.160:350359,2004
Clapp, J.F.III. Pregnancy outcome:physical act
ivities inside versus outside the workplace. Se
min. Perinatol.20:7076,1996.

REFERENCES

Marcoux S., J.Brisson, and J. Fabia. The effect

of leisure time physical activity on the riskof preeclampsia and gestational hypertension.J. Epide
miol. Community Health. 43: 147152, 1989
Sorensen T.K, M.A. Williams, E.E. Dashow,
M.L. Thompson, and DA Luthy. Recreational ph
ysical activity during pregnancy and risk of pre-e
clampsia. Hypertension 41:12731280,2003.

REFERENCES

Yeo S, Steele N, Chang M-C, Leclaire S, Rovis

D, Hayashi R. Effect of exercise on blood pressure
in pregnant women with a high risk of gestational
hypertensive disorders. Journal of Reproductive M
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Collings CA, Curet LB, Mullin JP. Maternal and
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REFERENCES

Sackett N, Wang W, Woolson R, Bracken MB. W

ork, leisure-time physical activity, and risk of pree
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Patrick T. Exercise intervention to reduce recurre
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