Exercise in Pregnancy and After Childbirth

Women should aim for at least 150 minutes of moderate activity a week across pregnancy, including muscle strengthening, and should choose activities that reflect their pre-pregnancy level. A woman who was very active can usually continue, building the picture around how she feels, while vigorous activity is not recommended for women who were previously inactive, who should build up gradually from light and moderate activity. Pelvic floor muscle training should be encouraged throughout. Sensible adaptations include avoiding activities with a high risk of falling or of abdominal contact, avoiding lying flat on the back for long periods after the first trimester, taking care in the heat and staying well hydrated, and using the principle of listening to your body.

Activity should stop and advice be sought with warning signs, some of which need urgent or emergency assessment. Calf pain or swelling may indicate a deep vein thrombosis and needs urgent assessment, and chest pain or breathlessness needs emergency assessment for a possible pulmonary embolism. Other warning signs include vaginal bleeding, regular painful contractions, leaking of amniotic fluid, dizziness, headache, or reduced fetal movements.

The benefits of activity in pregnancy identified by the evidence review are a reduced risk of the hypertensive disorders of pregnancy, a lower risk of gestational diabetes, less gestational weight gain and improved cardiorespiratory fitness. Activity is safe and does not increase the risk of miscarriage, low birth weight or early labour when done appropriately, and it has no negative effect on breastfeeding. Women should be reassured that staying active is beneficial, and the myth that pregnancy means rest should be challenged, while adapting intensity and type as the pregnancy progresses. The World Health Organization (WHO) guidance aligns closely, also recommending at least 150 minutes of moderate activity a week through pregnancy and the postpartum period, with muscle strengthening and pelvic floor training, so the UK and international advice give the same message.

The postpartum period, defined here as up to one year after birth, is a good time to rebuild activity, and the benefits include a reduced risk of postnatal depression, improved emotional wellbeing, better physical conditioning and a faster return towards pre-pregnancy weight.

A gradual return is sensible. Gentle activity such as walking and pelvic floor exercises can begin early, guided by how the woman feels and the type of birth. The 6 to 8 week postnatal check is not an automatic clearance to return to full activity; progression remains led by symptoms, recovery and function. After the check, and depending on how she feels, more intense activity can gradually resume, building the intensity up from moderate to vigorous over a minimum of at least 3 months. Pelvic floor rehabilitation remains important, and abdominal separation, or diastasis recti, and any continence or pelvic symptoms should guide progression and prompt referral to a pelvic health physiotherapist where needed.

Some situations need individual assessment before or during an activity programme, including significant medical or obstetric conditions, a multiple pregnancy, or symptoms such as those listed above. After birth, a caesarean or complicated delivery, persistent pelvic girdle pain, continence problems or a significant diastasis warrant a more cautious, physiotherapy-led approach. The SEM doctor's role is to encourage activity, tailor it to the stage and the individual, recognise the warning signs that need obstetric review, and signpost to pelvic health services when symptoms suggest they are needed.

It is worth separating absolute from relative contraindications explicitly rather than merging them into general caution, because the two lead to different decisions. Recognised absolute contraindications to aerobic exercise in pregnancy include haemodynamically significant heart disease, restrictive lung disease, an incompetent cervix or cervical cerclage, multiple gestation at risk of premature labour, persistent second or third trimester bleeding, placenta praevia after 26 weeks, premature labour during the current pregnancy, ruptured membranes, pre-eclampsia or pregnancy-induced hypertension, and severe anaemia. Relative contraindications, where activity may continue with modification and closer review, include less severe anaemia, unevaluated maternal arrhythmia, chronic bronchitis, poorly controlled type 1 diabetes, being significantly underweight or living with obesity, an extremely sedentary baseline, intrauterine growth restriction, poorly controlled hypertension, orthopaedic limitations, poorly controlled seizure disorder or hyperthyroidism, and heavy smoking.

Separately from those lists sit the reasons to stop exercising immediately and seek review: vaginal bleeding, regular painful contractions, leakage of amniotic fluid, breathlessness before exertion, dizziness, headache, chest pain, muscle weakness affecting balance, and calf pain or swelling. Two practical points complete the picture. From around 16 weeks, prolonged exercise in the supine position is generally avoided because the gravid uterus can compress the inferior vena cava and aorta, reducing venous return, and positions can simply be modified to side-lying or upright. And a previously inactive woman should start modestly, commonly around 15 minutes of continuous activity three times a week, building gradually toward 30 minutes on most days.

• •Aim for at least 150 minutes of moderate activity a week in pregnancy, including strengthening and pelvic floor training.
• •Reflect pre-pregnancy activity; vigorous activity is not recommended for previously inactive women.
• •Avoid lying flat on the back for long after the first trimester, and activities with fall or abdominal-contact risk.
• •Benefits include lower risk of hypertensive disorders, gestational diabetes and excess weight gain; activity does not harm breastfeeding.
• •Postpartum is up to one year; after the 6 to 8 week check build intensity from moderate to vigorous over at least 3 months.
• •Warning signs such as bleeding, chest pain, calf swelling or reduced fetal movements mean stop and seek review.