Decoding the ACOG Guidelines for Prenatal Exercise

Hopefully, you’ve taken the time to read the ACOG (American Congress of Obstetricians and Gynecologists) Guidelines for Prenatal Exercise… but in case you haven’t, or if they weren’t clear enough, here is a summary of what they recommended and what is safe during pregnancy:


  • In the absence of either medical or obstetric complications, 30 minutes or more of moderate exercise a day on most, if not all, days of the week is recommended for pregnant women.
  • Most recreational activities are acceptable, but avoid any activities that put you at risk for falling, risk for physical trauma to the stomach, and scuba diving.
  • Avoid lying flat on your back after 20 weeks gestation, and avoid standing in one place for long periods of time
  • Recreational and competitive athletes with uncomplicated pregnancies can stay active during pregnancy and should modify their usual exercise routines as medically indicated.
  • If you were previously physically inactive or have any complications, get an evaluation before engaging in physical activity during pregnancy.
  • If you are physically active but have a history of or risk for preterm labor or fetal growth restriction, reduce your activity in the second and third trimesters.


Absolute Contraindications to Aerobic Exercise During Pregnancy
(If you have any of these, it is NOT recommended to do any aerobic exercise during your pregnancy.  Please see your doctor or midwife right away and get clearance, in writing, before participating in any exercise program.  In general, your doctor or midwife would notify you if you had any of these, and she or he would also tell you what activities you can and cannot do)

  • Hemodynamically significant heart disease
  • Restrictive lung disease
  • Incompetent cervix/cerclage
  • Multiple gestation at risk for premature labor
  • Persistent second- or third-trimester bleeding
  • Placenta previa after 26 weeks of gestation
  • Premature labor during the current pregnancy
  • Ruptured membranes
  • Preeclampsia/pregnancy-induced hypertension

Relative Contraindications to Aerobic Exercise During Pregnancy
(Exercise with caution, under the approval of your OBGYN or Midwife, and preferably under the guidance of a prenatal exercise specialist)

  • Severe anemia
  • Unevaluated maternal cardiac arrhythmia
  • Chronic bronchitis
  • Poorly controlled type 1 diabetes
  • Extreme morbid obesity
  • Extreme underweight (BMI <12)
  • History of extremely sedentary lifestyle
  • Intrauterine growth restriction in current pregnancy
  • Poorly controlled hypertension
  • Orthopedic limitations
  • Poorly controlled seizure disorder
  • Poorly controlled hyperthyroidism
  • Heavy smoker

Warning Signs to Terminate Exercise While Pregnant
(Stop exercising if you experience any of these)

  • Vaginal bleeding
  • Dyspnea prior to exertion (short of breath before you exert yourself)
  • Dizziness
  • Headache
  • Chest pain
  • Muscle weakness
  • Calf pain or swelling (need to rule out thrombophlebitis)
  • Preterm labor
  • Decreased fetal movement
  • Amniotic fluid leakage

For most pregnant women, moderate to high exercise is considered safe.  To be sure, always consult with your doctor or midwife before beginning a prenatal exercise program, and when possible, seek the guidance of a prenatal personal trainer or pre/postnatal exercise specialist to help you to best support your changing body!

Any questions about the guidelines?  Let me know with a comment!


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