admin November 13, 2013

You might be thinking, “Hold up; I thought pregnancy meant the freedom to gain weight. Why measure my body fat?” Body-mass index (BMI), is calculated from a formula based on your height and weight and can be factor into fertility and healthy nutrition for supporting the growth of your fetus.

If your BMI is either too high or too low, your periods can be disrupted, affecting conception. Specifically, a BMI that is below the 10th percentile, meaning your body fat is less than 22 percent of the total, means you could experience irregular periods or amenorrhea. Eating fewer calories than you use during the day can disrupt your body’s ability to produce estrogen and progesterone, which regulate your menstrual cycle and by extension your ovulation and fertility. However, when your diet includes enough fuel to support your exercise routine and energy use, there will be no change in the hormones responsible for fertility.

If you’re having house guests, you buy more groceries. If you’re going to house a baby in your body, you need enough nutrition for both of you. Your kids won’t just raid the fridge as teenagers—they’ll do it in the womb, too.

On the whole, medical experts agree that there is no real evidence that exercise intensity threatens fertility—as long as you get balanced nutrition to maintain a healthy fat store. In fact, research shows that overweight women experience a higher rate of infertility than those who have lower BMIs, with 12 percent of cases attributable to being underweight and 25 percent to obesity.

What’s more, vigorous exercise actually lowers your risk for ovulatory infertility, as long as you maintain a healthy BMI. Every hour that you exercise each week is associated with a 5 to 7 percent lower risk of infertility related to ovulation.

If your doctor or midwife is concerned about your BMI being too low, you might be advised to decrease your workout intensity or training volume temporarily while you boost your calorie intake to meet your body’s demands (based on what you’re burning). If that’s the case, don’t fret about lost workouts. Consider replacing one calorie-sucking cardio workout per week with a yoga or dance class. You might not tap into your aerobic endorphins, but you can still achieve the delicious feel of a sweaty workout.

This is a great time to try a new fitness activity you haven’t been able to fit into your regular routine or specific training regimen. It could be your chance to try belly dancing and archery—just don’t do them together. Fitness isn’t a threat to pregnancy; it’s an asset. As long as your training or exercise program increases gradually in intensity and volume, it will be less likely to jeopardize your menstruation because the reproductive system adapts to changes in exertion and metabolism.5 Older studies that linked exercise and infertility sampled women who started very intense programs or who had other complicating factors, such as stress or nutritional deficits.6 More recent research that compares exercisers of various levels of intensity with nonexercisers finds that the rate of conception is similar between groups and that approximately 5 percent of women in both groups experienced infertility.

Check back soon for the next article: More on Exercise, BMI, and Getting Pregnant

Fit and Healthy Pregnancy by Dr. Kristina Pinto and Rachel Kramer, MDFit & Healthy Pregnancy is a friendly, comprehensive guide to exercising during pregnancy from athlete-moms Kristina Pinto and Rachel Kramer, MD.

Find Fit and Healthy Pregnancy in your local bookstore or online and learn safe ways to exercise for two!

  • Amazon – Fit & Healthy Pregnancy
  • Barnes & Noble – Fit & Healthy Pregnancy
  • Your local independent bookseller – Fit & Healthy Pregnancy
  • Chapters/Indigo – Fit & Healthy Pregnancy

Please consult your doctor before embarking on an exercise program during pregnancy.

In Fit & Healthy Pregnancy, Dr. Kristina Pinto and Rachel Kramer, MD, offer guidelines for women who would like to exercise during pregnancy. They suggest:

  • Warming up for 5 to 10 minutes is important to ease into a workout and determine how your body is feeling that day. Start slowly and build to more effortful exercise during a session.
  • Exercising regularly on most days of the week is better for your fitness than a burst of exercise that’s followed by days or weeks of no activity.
  • A moderate workout of 30 minutes on most days of the week will be beneficial for most women.
  • Generally speaking, if you’re able to hold a conversation while you exercise, your exertion is in a safe zone. Use Borg’s Rate of Perceived Exertion scale (see Chapter 2) to monitor your effort level, and don’t exceed a 16 on the scale.
  • The extra weight you carry as you progress through pregnancy will make easy exercise feel harder. Stop if you feel dizzy or exhausted.
  • Drink a glass of water before and after exercise and drink based on thirst while you work out.
  • Avoid exercise with a risk of falling or blunt force to the abdomen, such as downhill skiing or soccer.
  • Be careful with any exercise that might strain your back, such as overstretching to touch your toes or the floor in yoga.
  • Avoid sit-ups or any exercise while lying on your back after the first trimester.
  • Always inform the instructor, trainer, or coach that you’re pregnant.

Fit and Healthy Pregnancy by Dr. Kristina Pinto and Rachel Kramer, MDFit & Healthy Pregnancy is a friendly, comprehensive guide to exercising during pregnancy from athlete-moms Kristina Pinto and Rachel Kramer, MD.

Find Fit and Healthy Pregnancy in your local bookstore or online and learn safe ways to exercise for two!

  • Amazon – Fit & Healthy Pregnancy
  • Barnes & Noble – Fit & Healthy Pregnancy
  • Your local independent bookseller – Fit & Healthy Pregnancy
  • Chapters/Indigo – Fit & Healthy Pregnancy

Please consult your doctor before embarking on an exercise program during pregnancy.

Your fitness practice will be most healthy for mind and body when you can see it as your individual plan without holding it up against an ideal. Try not to compare your own activity with what your best friend did when she was pregnant.

Your body will tell you how it feels; attend to those cues. Strive for balance when it comes to the reproductive process and your exercise routine, and be willing to adapt to factors in your lifestyle such as stress, work, and family dynamics. If you can avoid being rigid with your fitness program, your pregnancy and your workouts will do you much more good in body and mind.

Exercise, even vigorous exercise, is healthy for a growing fetus, provided your body is accustomed to that level of exertion. Monitor your level of effort because overexerting yourself in a workout can be problematic. If you experience bleeding, hyperventilation, blinding headache, nausea, vomiting, or dizziness, stop immediately and contact your health care provider.

There are a few conditions that point to drastically reducing or eliminating exercise, and these are nonnegotiable. If you experience any of these symptoms, stop exercising and talk to your doctor:

  • Relentless vomiting
  • Abdominal or pelvic pain
  • Severe illness (e.g., flu)
  • Vaginal bleeding
  • Injuries

Other circumstances that could influence your workout efforts should be discussed with your provider at your initial visit. These conditions include:

  • Anemia
  • Arrhythmia
  • Bronchitis or asthma
  • Diabetes that isn’t well controlled
  • Morbid obesity
  • Severely low weight or BMI
  • Intrauterine growth restriction in this pregnancy
  • High blood pressure
  • Orthopedic problems or sports injuries
  • Epilepsy
  • Hyperthyroidism
  • Smoking
  • Any other medical condition that makes you unsure whether exercise is okay

Fit and Healthy Pregnancy by Dr. Kristina Pinto and Rachel Kramer, MDFit & Healthy Pregnancy is a friendly, comprehensive guide to exercising during pregnancy from athlete-moms Kristina Pinto and Rachel Kramer, MD.

Find Fit and Healthy Pregnancy in your local bookstore or online and learn safe ways to exercise for two!

  • Amazon – Fit & Healthy Pregnancy
  • Barnes & Noble – Fit & Healthy Pregnancy
  • Your local independent bookseller – Fit & Healthy Pregnancy
  • Chapters/Indigo – Fit & Healthy Pregnancy

Please consult your doctor before embarking on an exercise program during pregnancy.

If you’re new to fitness activities, congratulations on making the move to build fitness into your daily routine as you head into this 40-week fun house, where the mirrors sometimes seem distorted and it can be hard to find your bearings with fitness.

When it comes to advice for those new to fitness, the Department of Health and Human Services offers a great maxim: “Start Low and Go Slow.”

Anyone who is training—whether new to exercise or a competitive veteran—must balance activity with recovery periods. It’s tempting to overdo a workout when you’ve made a new commitment to fitness, but more is not always better, and it’s key to realize that your body actually strengthens from rest between workouts.

Here are some guidelines for getting started:

  • Build your program from a conservative base, such as walking on a flat treadmill before increasing the incline or walking hills.
  • Your program should be based on your BMI (see earlier in this chapter) and individual fitness history. Talk to your doctor and consider working with a trainer who will personalize your workouts and keep you motivated and accountable.
  • Read Fit & Healthy Pregnancy to educate yourself on prenatal fitness so you can perceive your body’s cues regarding when to stop and when to persist with a workout.
  • Diversify your workouts to include cardio sessions, flexibility, and strength training. The variety will keep you motivated and build whole-body fitness.
  • Trade sodas and juices for water (flavored water and coconut water are good alternatives), and carry a water bottle with you throughout the day.
  • Seek medical attention if you develop warning signs of dehydration (headache, dizziness, nausea, blurred vision, cramping).

Check back for another article on How to Start Exercising During Pregnancy

Fit and Healthy Pregnancy by Dr. Kristina Pinto and Rachel Kramer, MDFit & Healthy Pregnancy is a friendly, comprehensive guide to exercising during pregnancy from athlete-moms Kristina Pinto and Rachel Kramer, MD.

Find Fit and Healthy Pregnancy in your local bookstore or online and learn safe ways to exercise for two!

  • Amazon – Fit & Healthy Pregnancy
  • Barnes & Noble – Fit & Healthy Pregnancy
  • Your local independent bookseller – Fit & Healthy Pregnancy
  • Chapters/Indigo – Fit & Healthy Pregnancy

Please consult your doctor before embarking on an exercise program during pregnancy.

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Build your program from a conservative base, such as walking on a flat treadmill before increasing the incline or walking hills.

Your program should be based on your BMI (see earlier in this chapter) and individual fitness history. Talk to your doctor and consider working with a trainer who will personalize your workouts and keep you motivated and accountable.

Educate yourself on prenatal fitness so you can perceive your body’s cues regarding when to stop and when to persist with a workout.

Diversify your workouts to include cardio sessions, flexibility, and strength training. The variety will keep you motivated and build whole-body fitness.

Trade sodas and juices for water (flavored water and coconut water are good alternatives), and carry a water bottle with you throughout the day.

Seek medical attention if you develop warning signs of dehydration (headache, dizziness, nausea, blurred vision, cramping).

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As a general guideline for beginning a new fitness practice, you want to keep your exertion below your maximum heart rate. Strive to top out your workout exertion at 60 to 70 percent of your nonpregnant max as well as consulting Borg’s scale of Rate of Perceived Exertion.

Keep your exercise plan light to moderate at first, measured by time, not distance. Gradually build your base of cardio exercise, such as walking, spinning, swimming, and prenatal aerobics, as well as light core and weight training to build muscle strength.

A great starting point if you are totally new to regular exercise entails a few weeks of the following program before adding 5 minutes per session every three days or adding another workout day to the routine:

  • 20 minutes of cardio at a conversational level, 3 to 4 days per week
  • Low-weight strength training 1 to 2 days per week
  • Flexibility exercises 2 to 3 days per week

Power walking, an elliptical machine, and an upright stationary bike are wonderful ways to begin a fitness program, and on this site, we’ll introduce some exercises that are ideal for starting a strength and flexibility routine.

Not only should you ease into a program but you also need to consider various factors that can play a role in how your body adjusts to exercise. You’re striving for balance, not overexerting yourself in any one area of your life. Give as much attention to sleep time as to work time, and make sure you achieve balance in nutrition and hydration as well.

Take a look at this article Can I Exercise During Pregnancy Even If I’ve Never Worked Out?

Fit and Healthy Pregnancy by Dr. Kristina Pinto and Rachel Kramer, MDFit & Healthy Pregnancy is a friendly, comprehensive guide to exercising during pregnancy from athlete-moms Kristina Pinto and Rachel Kramer, MD.

Find Fit and Healthy Pregnancy in your local bookstore or online and learn safe ways to exercise for two!

  • Amazon – Fit & Healthy Pregnancy
  • Barnes & Noble – Fit & Healthy Pregnancy
  • Your local independent bookseller – Fit & Healthy Pregnancy
  • Chapters/Indigo – Fit & Healthy Pregnancy

Please consult your doctor before embarking on an exercise program during pregnancy.

Research shows that exercise, and even vigorous training, are safe for you throughout pregnancy. So go ahead, exhale.

Not only is a fitness practice safe, but also it will improve your health during and after pregnancy. Even better, research shows that your fitness routine or training is both safe and healthy for your growing baby. Here’s your next one-liner comeback for the doubters: “Fit mama, fit baby.” Let those words help guide your 40 weeks, not to mention the postpartum family life you’re going to build.

The research on the effects of exercise on fetal development has kept pace with studies of the impact of exercise on women’s bodies during pregnancy, and results show that your activity brings benefit to the baby in utero. Babies of women who were active during pregnancy tend to be leaner at birth and exhibit somewhat better neurobehavioral maturation. These babies also have lower rates of long-term weight issues at age 5 as well as slightly higher brain function during childhood.

From early pregnancy through the third trimester, a fetus can tolerate your exercise very well because a woman’s body adapts to pregnancy in a way that regulates the impact of her activity on the growing baby. For instance, your body has an improved ability to regulate your core body temperature by cooling itself through sweat and heat dispensation from your skin. Similarly, fetal heart rate can increase when you exercise, but it returns to normal after you finish working out.39 This and other fetal responses to your activity are temporary and have no permanent effects on the baby’s development. Regular and sustained workouts can increase the placenta’s volume in early and mid-pregnancy but have no adverse effects on any pregnancy outcomes.

What about intensity? Well, maintaining a fantastically sweaty and vigorous level of exercise does not carry any negative health consequences for your growing baby, either, as long as that level of exercise is familiar to you and your body. There are no significant differences in the fetal heart rate (FHR), Doppler health, birth weight, and Apgar scores among babies of vigorous versus moderate exercisers.

The upshot is that training is good for your pregnancy health, and it actually benefits your baby as well. The base you’re building for a fit pregnancy is achieved by the concept of wellness: doing what feels good to the body for the sake of mom-baby health. It’s safe and healthy to train and work out, but scale it back if you experience any of the adverse symptoms listed earlier or if you feel depleted and stressed by it to the point that it fails to enhance your general wellness. As athletes, we feel empowered by our agency over our bodies in the world, and pregnancy is no time to lose that self-possession.

Fit and Healthy Pregnancy by Dr. Kristina Pinto and Rachel Kramer, MDFit & Healthy Pregnancy is a friendly, comprehensive guide to exercising during pregnancy from athlete-moms Kristina Pinto and Rachel Kramer, MD.

Find Fit and Healthy Pregnancy in your local bookstore or online and learn safe ways to exercise for two!

  • Amazon – Fit & Healthy Pregnancy
  • Barnes & Noble – Fit & Healthy Pregnancy
  • Your local independent bookseller – Fit & Healthy Pregnancy
  • Chapters/Indigo – Fit & Healthy Pregnancy

Please consult your doctor before embarking on an exercise program during pregnancy.

The sound, current medical knowledge that grounds this website and the book Fit & Healthy Pregnancy comes from the expertise of Dr. Rachel Kramer, a triathlete, mother, and Yale-educated OB-GYN. Dr. Kramer has delivered thousands of healthy babies while helping moms achieve fit pregnancies with her commitment to fostering women’s nutrition and exercise. She helps women with her unique skill as a physician who has successfully achieved a healthy weight loss of her own and built a dedication to endurance sport while raising two sons and practicing medicine.

Dr. Kramer’s story of losing 116 pounds through better nutrition and exercise, becoming a triathlete and marathoner in the process, has been highlighted in the Boston Globe and on the Today show. A trusted doctor in Boston, she tells a familiar story to many women who strive for fitness and fulfillment in work and family. Having grown up as an overweight child who dreaded phys-ed class, Dr. Kramer gained more weight in medical school, eventually topping out at 286 pounds after her second son was born.

Her wake-up call came after lab tests revealed dangerously high cholesterol and a risk for liver disease, and she committed to achieving a more healthy body mass index (BMI). Dr. Kramer isn’t shy about sharing her story with patients, inspiring them with her focus on the markers of good health and wellness, not the size of her jeans. And she didn’t set out to become an endurance athlete, either. She started her journey into sport where many of us begin—in the gym. After establishing herself as a swimmer, she signed up for her first road race. Having now completed many races, including triathlons, half-marathons, and marathons, Dr. Kramer is a dedicated athlete who empowers women by paying forward the invigoration she gets from fitness and sport.

As she puts it, “No one cheers for you at the gym. Where else do adults get people cheering for them?”

Dr. Kramer herself walks the talk as a cheerleader for women’s fit pregnancy, and she lends her wealth of knowledge, commitment to current research, and inspiration of countless patients to inform and empower you here.

Learn more about Dr. Rachel Kramer.

Fit and Healthy Pregnancy by Dr. Kristina Pinto and Rachel Kramer, MDFit & Healthy Pregnancy is a friendly, comprehensive guide to exercising during pregnancy from athlete-moms Kristina Pinto and Rachel Kramer, MD.

Find Fit and Healthy Pregnancy in your local bookstore or online and learn safe ways to exercise for two!

  • Amazon – Fit & Healthy Pregnancy
  • Barnes & Noble – Fit & Healthy Pregnancy
  • Your local independent bookseller – Fit & Healthy Pregnancy
  • Chapters/Indigo – Fit & Healthy Pregnancy

Please consult your doctor before embarking on an exercise program during pregnancy.

As a developmental psychologist, mom, running coach, and marathoner for more than a decade, I have seen and heard countless stories of the power of sport in mothers’ lives. Through my blogs, Marathon Mama and Mother Running Rampant, I discovered the legions of mother-runners on the roads and on the trails, many of whom were forging online connections with other moms, cultivating a social movement in sneakers. And with the uptick in the popularity of triathlon, you can now find more and more moms celebrating their love of fitness and sport on wheels and in the water. What I’ve learned from these women is that while being an athlete empowers each of us differently, we are unified by our need for sport and fitness, and we’ve become more committed to keeping that power in our lives as we have babies and grow our families.

The confluence of running, motherhood, and women’s identity is an area about which I write with both respect and a good dose of irreverence. These are my passions and the source of much laughter as I coach other women in running. I teach the joy of getting out of your comfort zone to find the rewards of striving for goals many women never knew they could accomplish, whether it’s completing a 5K or qualifying for Boston. Admittedly, my coaching has even included advice on how to spit while racing and how to paint toes with no nails.

When I had my baby, I didn’t think I could manage training and motherhood and frankly couldn’t imagine how any woman did. I’d exercised throughout my pregnancy by running, walking, swimming, and using the elliptical at the gym, and when I developed preeclampsia in my 40th week of pregnancy, I was quickly induced. As childbirth goes, I had an “easy” labor and vaginal delivery, due in no small part to a fit pregnancy, according to my doctor. My smooth birth experience gave way to a mentally tough postpartum transition, even with the joys of my new baby, who was born in Boston during the same October week that the Red Sox broke the curse to win the World Series. In a city full of exuberance, a crippling mix of fatigue and insomnia besieged my baby’s first few weeks of life, and I developed clinical postpartum depression. My body and mind had been thrown for a loop, and I felt guilty that I couldn’t find the bliss new moms were supposed to have. Before he was born, life had been only about my needs and goals, and I felt shell-shocked by life as a mother.

A typically frigid New England winter put us under house arrest in a small apartment, where I edited my dissertation and took care of a tiny baby who needed me in order to survive. I didn’t want to go outside on the icy sidewalks with the stroller, and running felt crazy when I was so tired. I couldn’t see straight to run and didn’t know any women with new babies who did run. No one told me that mothers can run, and—more to the point—that sport actually helps motherhood. Far beyond that, it never occurred to me that running can feel as much a part of motherhood as the primal drive to protect our young. It was the end of 2004, and I had no clue that a mother, Catherine Ndereba, had won the world’s most prestigious marathon that year. In my mind, motherhood entailed surviving the day with an infant who subjected me to intervals of crying with 90-second recovery periods of sleep.

It took six months to motivate myself to start running at all and a year to run a slow but liberating 10K. I hadn’t realized that forcing myself out the door for short distances or locating a group of running mothers would relieve my depression and insomnia. I had no clue that even a daily mile alone might give me more strength to care for a baby who I swore was saying I was not his first choice. It was no fluke that my slow return to running coincided with greater adoration of my baby and a new love for being his mother.

On spring and summer and then fall mornings, we would run to the Charles River together, his voice undulating in the jogging stroller as we bounced across cracks in the sidewalk. Occasionally I would run alone while he played with his dad, and on those runs I felt like Winged Victory, but with my head firmly— finally—restored. I shed all of the trappings of motherhood with every step. My new-mom body was completely free, bouncing loosely like clothes in the dryer as I jogged slowly. Everything about my body was slack, as my bladder liked to remind me.

But I was running, so I didn’t much care.

Fit and Healthy Pregnancy by Dr. Kristina Pinto and Rachel Kramer, MDFit & Healthy Pregnancy is a friendly, comprehensive guide to exercising during pregnancy from athlete-moms Kristina Pinto and Rachel Kramer, MD.

Find Fit and Healthy Pregnancy in your local bookstore or online and learn safe ways to exercise for two!

  • Amazon – Fit & Healthy Pregnancy
  • Barnes & Noble – Fit & Healthy Pregnancy
  • Your local independent bookseller – Fit & Healthy Pregnancy
  • Chapters/Indigo – Fit & Healthy Pregnancy

Please consult your doctor before embarking on an exercise program during pregnancy.

Exercise during pregnancy isn’t just safe, it’s healthy for you and your baby.

Fit and Healthy Pregnancy by Dr. Kristina Pinto and Rachel Kramer, MDFit & Healthy Pregnancy dispels generations of old wives’ tales about exercise and pregnancy so active women can stay strong and in shape. This book from running coach Dr. Kristina Pinto and triathlete Rachel Kramer, MD goes beyond labor and delivery through the “fourth trimester,” helping new mothers return to fitness after they’ve had their babies.

Fit & Healthy Pregnancy reviews up-to-date research to show that exercise during pregnancy isn’t just safe, it’s ideal for health and wellness. Pinto and Kramer guide moms-to-be through each trimester, showing how their bodies, nutrition needs, and workouts will change. The authors cover the months following delivery, when women adapt to a new lifestyle that balances family, fitness, self, and perhaps a return to work. They offer smart guidance and tips on breastfeeding, sleep training, nutrition and hydration, weight loss, and how to transition back into workouts and training.

Fit & Healthy Pregnancy will help new mothers experience an easier, healthier pregnancy and a faster return to fitness after delivery.

Fit & Healthy Pregnancy includes

  • Trimester guides to body changes, nutrition, and emotional health
  • Guidance on exercise, rest, body temperature, injury prevention
  • Guidelines and suggested workouts for running, swimming, and cycling
  • Strength and flexibility exercises to reduce discomfort and chance of injury
  • Tips on exercise gear for each trimester
  • Symptoms of common pregnancy conditions and when to see a doctor
  • Three chapters of expert guidance on returning to fitness after delivery

Fit & Healthy Pregnancy
How to Stay Strong and In Shape for You and Your Baby
Paperback with b&w illustrations throughout
7″ x 9″, 340 pp., 8.95, 9781934030967

Fit and Healthy Pregnancy by Dr. Kristina Pinto and Rachel Kramer, MDFit & Healthy Pregnancy is a friendly, comprehensive guide to exercising during pregnancy from athlete-moms Kristina Pinto and Rachel Kramer, MD.

Find Fit and Healthy Pregnancy in your local bookstore or online and learn safe ways to exercise for two!

  • Amazon – Fit & Healthy Pregnancy
  • Barnes & Noble – Fit & Healthy Pregnancy
  • VeloPress – Fit & Healthy Pregnancy
  • Your local independent bookseller – Fit & Healthy Pregnancy
  • Chapters/Indigo – Fit & Healthy Pregnancy

Please consult your doctor before embarking on an exercise program during pregnancy.

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