SPORT AND PREGNANCY (2)
WHICH CONTRAINDICATIONS ? WHICH SPORTS?
AND AFTER CHILDBIRTH?
Dr. Claude Allouche, gynecologist 
Ahuza Clinic, Ra'anana
058 726 02 64
WHICH CONTRAINDICATIONS ?
1/ ABSOLUTE CONTRAINDICATIONS:
* Premature rupture of membranes
* Premature labor in current pregnancy, or history of at least 2 preterm births
* Unexplained persistent vaginal bleeding or placenta previa after 24 weeks of gestation
* Pre-eclampsia
* Cervical open bite/cerclage
* Indices of intrauterine growth retardation
* High order pregnancy (triplets)
* Uncontrolled epilepsy
* Other serious acute or chronic cardiovascular or pulmonary diseases, haemoglobinopathies, systemic disorders
Pregnant women with an absolute contraindication to the practice of physical activity can continue the usual physical activities of daily life, but should not practice intense physical activity.
2/ RELATED CONTRAINDICATIONS:
* History of recurrent miscarriages
* Gestational high blood pressure
* Twin pregnancy from 28 weeks
* Hemoglobinemia < 9 g/L or symptomatic anemia • Poorly controlled diabetes (HbA1C > 6.5%)
* Malnutrition
* Eating disorders (anorexia, bulimia)
* Extreme obesity (BMI > 40)
* Orthopedic limitations (back, knee, hips especially), but swimming possible
* Mild to moderate cardiovascular or pulmonary diseases
* Uncontrolled type 1 diabetes
* Uncontrolled hypertension
* Uncontrolled thyroid disease
* High level of smoking
* Other important health conditions
In pregnant women with contraindications relating to the practice of physical activity, the obstetrician must assess the benefits/risks of this activity during pregnancy and discuss them with the patient.
WHICH SPORTS?
WHAT SPORTS ARE AUTHORIZED? 
1/ Swimming
- Thanks to the properties of the aquatic environment, swimming is practiced in a state of quasi-weightlessness: skeleton and joints are in fact in relief thus allowing to relieve in particular the lumbar pains.
- The pregnant woman is no longer bothered by her weight and there is no risk of injury
- Sport carried, without shocks or vibrations, swimming reduces the impact on the joints while working the large muscle chains, improves cardio-respiratory capacities promotes blood circulation in the legs and muscle relaxation.
- It can be practiced until the end of pregnancy
- Advice:
* swimming continuously with a regular rhythm and possibility of using mask and snorkel.
* Prefer swimming on your back to reduce lumbar arch and low back pain that accompanies it during pregnancy...
2/ Walking
- A good alternative to running, walking while pregnant is a very accessible physical activity that can be started at any time during pregnancy, continued until childbirth and can be practiced as a family.
It improves cardio-respiratory capacities. She. Walking can be practiced with several people!
- Active walking stimulates cardio-pulmonary and articular functions, promotes blood circulation in the legs and can also be practiced with sticks and with others!
- Advice: wear good shoes.
3/ jogging
- Running is primarily reserved for women who have already practiced this discipline.
- it can be practiced for several months depending on the weight gain and the flexibility of the joints, in general until the end of the 1st trimester
- Pain in the ankles should stop this activity, because of the risk of sprain linked to ligament hyperlaxity.
- Advice: wear good shoes and encourage running on soft ground.
4/ Gentle gymnastics
- This activity allows you to work on breathing, to become aware of your pelvis and perineum, to tone yourself gently, to relax, while remaining attentive to your body.
- Advice :
*Avoid the position completely lying on your back from the 5th month of pregnancy, which can lead to a decrease in venous return and hypotension.
* Prefer gymnastics on the floor and avoid aerobics and exercises requiring abdominal thrust efforts.
5/ Aquagym
- improves cardio-respiratory capacities.
- promotes blood circulation in the legs,
- softens the joints and the perineum without increasing joint pain.
- The pregnant woman is no longer bothered by her weight and there is no risk of injury.
- can be practiced until the end of pregnancy.
6/ Yoga
- Very relaxing, yoga allows you to become aware of your breathing, to fight against the minor ailments of pregnancy, to reduce stress and to improve sleep.
-Possible until the end of pregnancy
7/ The bike
- tones the muscles of the lower limbs and perineum.
- generally possible up to 6 months of pregnancy
- advice: practice cycling on a flat surface and at a slower speed. This sport remains feasible until 5 - 6 months of pregnancy.
- the only risk is related to falls, collisions or non-existent accidents with an exercise bike...
8/ Tennis
- Authorized in the first trimester of pregnancy.
- It improves coordination of movements and reflexes.
- Beware of sprains due to ligament hyperlaxity in pregnant women.
9/ Skiing
- Authorized until the 4th - 5th month of pregnancy but in moderation, cross-country skiing and alpine skiing sometimes require significant effort.
- Avoid black tracks and collisions.
10/ Golf
- This sport is authorized and allows you to do the course at your own pace.
- Beware of back twists for unaccustomed.
11/ Horse riding
- It is not recommended to start riding at the same time as a pregnancy.
- Authorized only for regulars and during the first trimester of pregnancy.
- Watch out for falls!
WHAT ARE THE SPORTS FORBIDDEN OR TO AVOID?
As a general rule, it is better to avoid intense, long, violent sports requiring abdominal effort or with the risk of blows, jerks, sudden movements or falls.
- Combat sports (judo, karate, aikido, boxing, fencing, krav maga, wrestling, Thai boxing, French boxing) and other martial arts,
- basketball, volleyball, handball, football: risk of abdominal trauma by falling, blows or contact;
- Scuba diving, due to the lack of oxygenation which can be dangerous for the fetus;
- Mountaineering, mainly above 2000 meters due to lack of oxygen.
- Mountain biking, rollerblading (risk of falling)
- alpine skiing or snowboarding if beginner (risk of falls)
- Water skiing (risk of falls);
- Aerobics, because of its intensity.
AND AFTER CHILDBIRTH?
1/ What are the effects of physical activity after childbirth (postpartum)? 
Practiced after childbirth, physical activity has many benefits:
* It helps to reclaim this body, modified by nine months of pregnancy
* It strengthens the abdominal muscle belt
* It reduces the risk of urinary incontinence in an initially continent woman
* It contributes (a little) to weight loss
* It improves the quality of sleep (and that is priceless!)
* It limits lower back pain
* It reduces anxiety and postpartum depressive symptoms
* It improves the quality of the mother-child relationship
2/ Can I play sports while breastfeeding?
Yes, you can play sports and breastfeed, because moderate physical activity of the mother:
* Does not alter the quantity of breast milk or its nutritional quality
* Is without influence on the suckling of the newborn
* Has no negative impact on newborn growth
* Prevents loss of bone mineral density in women
3/ When can I resume a physical activity or sport?
- After delivery by natural means, recovery generally takes place after 6 weeks.
- It can be prepared from the 4th week by brisk walking, climbing stairs, etc.
- Certain exercises, to be determined with the professional following you, promote a faster recovery.
- After delivery by caesarean section: the recovery takes place approximately 8 weeks later but varies according to the degree of discomfort and according to any surgical complications.
- You can return to your pre-pregnancy level of performance about 6 months after giving birth.
Source:
https://sports.gouv.fr/IMG/pdf/guide-apsetmaternite.pdf