Activities to Avoid During Pregnancy

Falls or Trauma

All guidelines generally ruled-out sports involving risks of either falls, trauma, or collisions. A sport’s safety was determined based on the movements required to participate in it. One concern was that the ligaments become relaxed due to increasing hormone levels, making joints more prone to injury (Australia, Canada). The Norwegian guideline was the only one to warn against high loads during strengthening exercises due to the risk of pressure reflex.

Position

All but two guidelines (France, Spain) warned against activities in the supine position (lying on one’s back) due to the chance of decreased cardiac output and orthostatic hypotension caused by the enlarged uterus, which may obstruct venous return or blood flow from the abdominal aorta. As a result, these guidelines recommended avoiding the supine position during physical activity after the first trimester or 16 weeks’ gestation. Canada’s guideline suggested modifying the position of the exercise to instead be on one’s side, sitting, or standing. Denmark’s guidelines recommended a seated position during strength training.

Altitude and Depth

Four guidelines included recommendations about physical activity or exercise at altitude. Canada’s guideline accepted moderate exercise at altitudes up to 6000–8250 feet (1800–2500 meters). The US ACOG guideline stated that exercise up to 6000 feet (1800 meters) appeared safe, but exercise at higher altitudes carried risk. It also stated that women should be informed of the signs of altitude sickness and advised that if it develops, to stop exercising and descend from altitude to seek medical attention. Norway and the United Kingdom guideline suggested women at altitudes above 8250 feet (2500 meters) obtain 4 to 5 days of exposure at that altitude to avoid exertion and to regulate uterine blood flow. Seven guidelines specifically warned against scuba diving during pregnancy, because the fetus is not protected from decompression sickness and the fetal pulmonary circulation cannot filter bubble formation in the maternal bloodstream.

Heat and Cold

The Australian and Norwegian guideline warned of excessive body heat during exercise for pregnant women. Several other guidelines (Canada, Japan, Spain, United Kingdom) warned of exercising in hot or humid weather.

Sedentary Behavior and Motionless Standing

The United Kingdom guideline specifically mentioned avoiding a sedentary lifestyle, stating that “women and care providers should consider the effects of a sedentary lifestyle during pregnancy” (page 3) because it can contribute to a number of adverse maternal outcomes. The Norwegian and US ACOG guidelines were the only ones to advise against motionless standing due to its association with decreased cardiac output.

Avoidance of Vigorous Intensity Activity

Regarding vigorous activity, the Canadian and Norwegian guidelines cautioned against athletic competition, while the Australian guideline advised close monitoring by a physician. For both Japan and Norway, the recommended rating of perceived exertion categories did not include the vigorous intensity range. The USDHHS guideline stated that women not already highly active or engaged in vigorous activity should focus on moderate intensity activity. The Denmark guidelines cautioned against vigorous activity for women not engaged in it prior to pregnancy. These guidelines also advised that pregnant women accustomed to high intensity physical activity during pre-pregnancy could continue this activity as long as they felt well. The Spanish guideline recommended no more than 15 minutes of vigorous activity and to decrease intensity by 20% to 30% for pregnant athletes. The French guideline mentioned that women engaged in jobs that involved hard or strenuous aspects or long travel time should refer to her occupational or family physician and consider specific adjustments to job tasks.

Guidelines
	Australia	Canada	Denmark	France	Japan	Norway	Spain	United Kingdom	United States (ACOG)	United States (USDHHS)
General Activities to Avoid:
Abdominal trauma or pressure	blunt trauma	fetal trauma	X	X	X		X
Altitude		X				X		X	X
Contact or collision sports	X	X	X	X	X	4–6 months	X	X	X	X
Excessive body heat	X					X
Excessive joint stress		X		X			X
Falls or fall-related sports	X	X		X	X	X	X		X	X
Hot or humid weather	hot conditions	especially in first trimester			X	X	X	X
High impact		X		X	X		X
High loads during strengthening						X
Hyperthermia							X	X
Sedentary								X
Standing, motionless						X			X
Supine position (lying on back)	not after the first trimester	not after 16 weeks; modify position	use a seated position during strength training		not after 16 weeks	not after 16 weeks		not after 16 weeks	not after the first trimester	not after the first trimester
Uneven load during stretching		stretch with controlled movements				X	avoid extreme positions
Vigorous intensity activities		no training for athletic competition	if not done before pregnancy		implied based on Borg scale	implied based on Borg scale	no more than 15 minutes per session			if not already highly active or doing vigorous intensity activity
Examples of Specific Activites to Avoid:
Basketball					X				X	X
Bicycling outdoors	X	X						X
Combat sports (e.g., boxing, karate)							X
Floor or roller hockey							X
Gymnastics		X		X	X	X		X	X
Horseback riding		X	X		X	X		X	X	X
Ice hockey		X				X	X	X	X
Isometric exercises		X
Mountain biking			X
Mountain climbing					X
Race car driving							X
Racquet sports, vigorous				X					X
Rugby							X
Running, long distance			X
Scuba diving		X		X	X	X	X	X	X
Surfing							X
Skating						X
Skiing			X
Skiing, downhill	X	X				X	X	X	X	X
Skiing, water					X		X
Soccer							X		X	X
Volleyball					X

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4206837/