Most pregnant Singaporean women do not exercise enough, despite far-reaching benefits, said the Exercise in Pregnancy Committee, which comprises key members from the Integrated Platform for Research in Advancing Metabolic Health Outcomes in Women and Children (IPRAMHO), led by KK Women’s and Children’s Hospital (KKH) and in partnership with SingHealth Polyclinics, National Healthcare Group Polyclinics, as well as various medical societies.

“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,” said Professor Tan Kok Hian, Head and Senior Consultant, Perinatal Audit and Epidemiology Unit, KKH, and Lead Principal Investigator of the IPRAMHO.

This is significant because almost one in four pregnant women were found to be overweight and about 11 per cent found to be obese in a KKH study of 724 patients. Obesity in pregnancy is associated with an increased risk of gestational diabetes, hypertensive disorders, caesarean deliveries, and delivery complications. It also increases the risk of babies being born excessively large for their gestation, stillborn, or with congenital malformations.

To promote a more active lifestyle, Dr Amy Khor, Senior Minister of State for Health, launched Singapore’s first set of guidelines on physical activity and exercise during pregnancy in January this year.

Healthy women with uncomplicated pregnancies are encouraged to engage in at least 150 minutes of moderateintensity physical activity. This includes brisk walking, swimming, stationary cycling, low-impact aerobics, jogging, modified yoga, and modified Pilates, as well as resistance training activities, such as squats and push-ups, exercises with light dumb-bells or weights, and resistance band exercises.

“Many pregnant women are worried that exercising may affect the health of the pregnancy and that they may experience bleeding after exercise or that they may not gain sufficient weight,” said Dr Serene Thain Pei Ting, Associate Consultant, Department of Maternal Fetal Medicine, KKH, and a member of the Exercise in Pregnancy Committee.

However, the Committee reassures that if proper precautions are undertaken, exercise is generally safe for women with uncomplicated pregnancies. Exercising does not increase the risk of miscarriage, stillbirth, fetal anomalies, preterm birth, or other complications.

Dos and don’ts

Good pacing is key. Pregnant women are advised to start slow, exercising three times a week for 15 minutes per session or less. They may gradually increase the intensity, frequency, or duration of each session to 20 to 30 minutes in the second trimester.

They should ensure that they are well-hydrated before and after the session, exercise in a cool environment, and wear loose-fitting clothing. When attempting highintensity or prolonged physical activities lasting for more than 45 minutes, hydration and adequate food intake before exercising is even more important to avoid dehydration, overheating, and hypoglycaemia (low blood sugar).

Pregnant women should avoid contact sports (such as basketball or football), sports with a high risk of falls (such as gymnastics and non-stationary cycling), activities that involve rapid changes of direction and bouncing, as well as excessive abdominal exercises, skydiving, scuba diving, hot yoga, and hot Pilates.

Essentially, expectant mothers should seek their gynaecologist’s opinion before embarking on or continuing their exercise regime. Those with medical conditions, such as heart disease, lung disease, anaemia, and type 1 diabetes, or obstetric complications like unexplained vaginal bleeding, may be advised to avoid or limit physical activity.

With these guidelines, the Exercise in Pregnancy Committee hopes to debunk misconceptions, and break cultural and psychological barriers that may inhibit pregnant women from engaging in a healthy fitness regime.

Red flags

Stop exercising and seek immediate medical attention if you notice these warning signs:

• Chest pain or headache

• Calf pain or swelling

• Shortness of breath before or after exertion, despite a period of rest

• Muscle weakness affecting balance

• Dizziness or temporary loss of consciousness

• Vaginal bleeding

• Regular and painful contractions

• Leaking of amniotic fluid