Contraindications to Exercise During Pregnancy

Guidelines from Canada, Japan, Spain, and the US described contraindications to exercise in absolute and relative terms; however, guidelines from Norway and the United Kingdom did not make these distinctions.

Absolute contraindications refer to conditions where exercise is not recommended, whereas relative contraindications refer to conditions where the risks of exercise may exceed the benefits.

Generally, where two or more countries identified contraindications, they agreed on whether it was an absolute or relative contraindication.

The six countries (Canada, Japan, Norway, Spain, United Kingdom, US ACOG) agreed on several contraindications to exercise including anemia, persistent bleeding, cardiovascular disease, cerclage or incompetent cervix, multiple gestation, preeclampsia or pregnancy induced hypertension, premature contractions or labor, premature rupture of membranes, and thyroid disease. Four or five of the six guidelines identified contraindications for diabetes mellitus, eating disorder, morbid obesity, and placenta previa.

Guidelines
	Canada	Japan	Norway*	Spain	United Kingdom*	United States (ACOG)
Absolute Contraindications:
Abnormal amniotic fluid		X
Bleeding, persistent	2nd–3rd trimester	X	months 4–9	X	2nd–3rd trimester	2nd–3rd trimester
CVD	serious	X	X	active CVD, cardiac failure, rheumatic disease	X	hemodynamically significant
Cerclage, incompetent cervix	X	X	X	X	cervical weakness	X
Diabetes mellitus	uncontrolled type 1
Fetal abnormality				X
Fetal growth restriction		X		X
History of fetal growth restriction	X				X	reduce in 2nd–3rd trimester
History of miscarriage, >=3		X
History of preterm birth				X
History of preterm labor					X	reduce in 2nd–3rd trimester
Hypertonia, poorly controlled			X
Infectious disease, acute				X
Lung disease, restrictive			X	X	X	X
Multiple gestation	triplets and higher	X	X	X	X	X
Placenta previa	symptomatic bleeding	X		X	after 26 weeks	after 26 weeks
Preeclampsia, pregnancy induced hypertension	X	X	X	X	X	X
Premature contractions or labor	X	X	X	X	X	X
Premature rupture of membranes	X	X	X	X	X	X
Respiratory disease, serious	X			pulmonary embolism
Rh+/Rh− immunologic disorder				X
Systemic disorder, uncontrolled	X
Thyroid disease, uncontrolled	X
Thrombophlebitis				X
Relative Contraindications:
Anemia	hemoglobin <100 g/L	or other bleeding disorder	X	severe	hemoglobin <100 g/L	severe
Arrythmia		X	non-assessed		unevaluated	unevaluated
Bronchitis, chronic	X		X		X	X
Cardiovascular disorder, mild to moderate	X		X	X
Diabetes mellitus		X	poorly controlled		poorly controlled	poorly controlled type 1
Eating disorder	X	anorexia	X		X
History of extremely sedentary lifestyle		X			X	X
History of fetal growth restriction		X
History of preterm birth	X	X
History of preterm labor	X	X
History of spontaneous abortion	X
Hypertension	X	X			poorly controlled	poorly controlled
Intrauterine growth restriction			X		X	X
Malnutrition	X		X		X
Multiple gestation, twins	after 28 weeks
Obesity, morbid (BMI >40 kg/m2)		X	X	X	X	X
Orthopedic limitation			X		X	X
Respiratory disorder, mild to moderate	X			X
Seizures, poorly controlled			epilepsy		X	X
Smoker, current			>20 cigarettes/day		>20 cigarettes/day	heavy smoker
Thyroid disease		X	X	X	poorly controlled	poorly controlled hyperthroidism
Underweight, extreme (BMI<12 kg/m2)		extreme thinness		extreme thinness		X

BMI=body mass index; CVD=cardiovascular diseaes

^*Distinction between relative and absolute contraindications not made.

Note: The Australia, Denmark, France, and USDHHS guidelines did not include contraindications, as the guidelines were all geared towards healthy women with normal pregnancies.

References:

Guidelines for Physical Activity during Pregnancy: Comparisons From Around the World. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4206837/