​Singapore, 10 January 2020 – Singapore's first set of guidelines on physical activity and exercise in pregnancy has been launched by Dr Amy Khor, Senior Minister of State, Ministry of Health and Ministry of the Environment and Water Resources at KK Women's and Children's Hospital (KKH) today. The set of guidelines aims at standardising advice on exercise and physical activity for pregnant women to improve their health outcomes and that of their child. The guidelines will be distributed to all obstetricians and gynaecologists practicing in Singapore.

The set of guidelines is developed by a Committee of Exercise in Pregnancy which comprises key members from the Integrated Platform for Research in Advancing Metabolic Health Outcomes in Women and Children* (IPRAMHO), led by KKH, in partnership with the SingHealth Polyclinics and National Healthcare Group Polyclinics, as well as the Obstetrical & Gynaecological Society of Singapore (OGSS), Perinatal Society of Singapore (PSS) and Exercise is Medicine Singapore (EIMS).

According to the guidelines that covers a wide range of recommendations on physical activity and exercise in pregnancy as well as in the postpartum period, healthy women with uncomplicated pregnancies should engage in at least 150 minutes of moderate-intensity physical activity and take certain precautions while exercising. For more details on the guidelines, please click here.

A KKH-led study¹ published in August 2019 found that the prevalence of obesity in pregnancy is high in Singapore. The study involved 724 patients who were managed at KKH from 2010 to 2014. About 24 per cent of the women were overweight and about 11 per cent of women were obese during their pregnancy. Overweightedness and obesity are significant risk factors for gaining excessive weight during pregnancy. Significant evidence in studies have also shown an association of obesity in pregnancy with an increased risk of diabetes during pregnancy, high blood pressure disorders, higher rates of caesarean delivery, and delivery complications. Babies of obese mothers are also at an increased risk of being born excessively heavy at more than four kilogrammes, stillborn, or with congenital malformations. Hence, appropriate weight management for overweight and obese women prior to, during and after pregnancy is important to enhance the health outcomes for every birth in Singapore.

Professor Tan Kok Hian, Head and Senior Consultant, Perinatal Audit and Epidemiology Unit, KKH, and Lead Principal Investigator of IPRAMHO, said, "Pregnant women need to adopt lifestyle interventions including diet, physical activity and behavioural changes to manage their body mass index (BMI) and weight gain during pregnancy. Research shows that regular physical activity during pregnancy improves physical fitness and is associated with greater health benefits and enhances mental health. Importantly, it limits weight gain during pregnancy and prevents adverse maternal and fetal outcomes such as delivery complications for the mother and congenital malformations in the baby."

Although the benefits of physical activity and exercise during pregnancy are well-established and well-recognised, majority of pregnant women do not engage in any moderate or vigorous physical activity during their pregnancy. Doctors caring for pregnant women also need more support in helping them to provide more physical activity and exercise advice. This is evident in two KKH-led studies involving pregnant women managed at KKH and Singapore General Hospital (SGH), conducted in 2019.

The first study² showed the attitudes and practice of exercise among pregnant women in Singapore. Significant findings included - 99 per cent of pregnant women surveyed reported that exercise is beneficial in pregnancy. However, 70 per cent of this group of women did not engage in any moderate or vigorous physical activity. Among those who performed moderate or vigorous physical activity, about 90 per cent did not exercise at least 20 minutes per day on most days of the week, which did not meet the physical activity guidelines for pregnant women recommended by the American College of Obstetricians and Gynecologists.

The second study³ attempted to assess the knowledge, attitudes and recommendations of exercise in pregnancy among doctors. 62 doctors running the obstetric clinics in KKH and SGH were involved. It was found that majority of the doctors did not consistently recommend pregnant women with sedentary lifestyles to start exercising during pregnancy. Other significant findings included - 16 per cent of the doctors were confident in advising pregnant women regarding physical activity in pregnancy, 10 per cent discussed issues related to exercise in pregnancy more than 50 per cent of the time and 15 per cent initiated the discussion, and about 94 per cent of the doctors feel that there is a need for standardised guidelines on physical activity recommendations for pregnant women in Singapore.

Professor Tan Kok Hian who is also a Senior Author of both studies, said, "With evidence showing the benefits of physical activity for pregnant women with normal pregnancies and the need for a set of standardised guidelines to support doctors in providing advice on physical activity and exercise to pregnant women, it is timely for KKH and our partners to take the lead in the development of this set of guidelines. The guidelines will help to guide obstetricians and gynaecologists in providing appropriate advice to pregnant women on physical activity and exercise during pregnancy and in the postpartum period, and encourage them to adopt healthy lifestyles, leading to better pregnancy outcomes."

Plans to raise more awareness on the importance of physical activity and exercise during pregnancy are in place. For example, following the launch of the guidelines, KKH will be leading in the active promotion of optimal exercise in pregnancy through organising more public forums. The hospital will also be looking at ways to increase patients' access to the exercise programmes led by KKH's Physiotherapy Department.

The launch of the guidelines is part of the third Asia Pacific Diabetes in Pregnancy Conference and IPRAHMHO International Meeting that focuses on Asia-Pacific perspectives in the management of diabetes and metabolic diseases in pregnant women. The annual event that will be held on 10 and 11 January 2020, will be attended by key opinion leaders from Australia, China, India, Indonesia, Japan, Malaysia, Myanmar, Philippines, Singapore, Sri Lanka, Vietnam and Thailand. At previous conferences, Singapore's guidelines on the management of gestational diabetes, as well as perinatal nutrition were launched.

*IPRAMHO is a seamless integrated model of care that seeks to optimise implementation of effective population prevention strategies and diabetes and weight reduction programmes, led by KKH in partnership with SingHealth Polyclinics and National Healthcare Group Polyclinics.  

References

1. He S, Allen JC, Razali NS, Win NM, Zhang JJ, Ng MJ, Yeo GSH, Chern BSM, Tan KH. Are women in Singapore gaining weight appropriately during pregnancy: a prospective cohort study. BMC Pregnancy Childbirth. 2019 Aug 13;19(1):290.

2. Tan YR, Tan HK, Tan KH, Tan LK.

Exercise during Pregnancy: Attitudes and Practice of Exercise among pregnant mothers in Singapore. Asia Pacific International Diabetes in Pregnancy Conference 2020 & Integrated Platform for Research in Advancing Metabolic Health Outcomes in Women and Children (IPRAMHO) International Meeting – 10 & 11 Jan 2020 KK Women's and Children's Hospital Singapore

3. Tan YR, Tan HK, Tan KH, Tan LK.

Exercise during Pregnancy: Doctor's knowledge, attitudes and recommendations of Exercise in Pregnancy. Asia Pacific International Diabetes in Pregnancy Conference 2020 & Integrated Platform for Research in Advancing Metabolic Health Outcomes in Women and Children (IPRAMHO) International Meeting – 10 & 11 Jan 2020 KK Women's and Children's Hospital Singapore