The effects of maternal exercise on fetal heart rate and movement patterns

doi:10.1016/S0378-3782(96)01858-0

Early Human Development

Volume 48, Issue 3, 28 May 1997, Pages 237-247

https://doi.org/10.1016/S0378-3782(96)01858-0 Get rights and content

Abstract

The aim of this study was to investigate the effects of maternal exercise on fetal movement and heart rate patterns. Twelve healthy women at 29–32 weeks of pregnancy performed a (sub)maximal bicycle exercise test, reaching 53–99% (median 82%) of their maximal increase in heart rate (MIHR). Fetal heart rate (FHR) and its variation and fetal body and breathing movements were recorded for 1 h before and after the exercise and also on a control day. After exercise, FHR was higher for 30 min and FHR variation reduced for 20 min as compared with pre-exercise levels (P<0.01). Fetal body movements were reduced for the first 5 min following exercise (P<0.05). In two cases, fetal bradycardia was observed (at 89 and 99% MIHR) followed by a considerable reduction in FHR variation and absence of body and breathing movements for 20 min. In the other 10 fetuses fetal breathing activity was increased for the first 5 min after exercise (P<0.05). FHR (and to a lesser extent breathing movements) increased with increasing level of maternal exercise, but decreased when the % MIHR exceeded approximately 90%. Body movements were negatively correlated with the % MIHR (P<0.05). In conclusion, moderate to heavy maternal exercise clearly affects the human fetus with signs of transient fetal impairment after heavy exercise.

Introduction

Maternal exercise is associated with reduced blood flow in the main uterine artery, both in animals and man 1, 2, 3. Fetal heart rate (FHR) responses to maternal exercise have been found to vary from none to an increased or decreased rate. The effects on basal FHR seem to depend on the level and type of exercise with, in general, no change or a slight increase during or after light exercise 4, 5, 6, 7, 8, a progressive increase during moderate exercise 4, 9, 10, 11, 12and a slight increase or decrease during or after strenuous exercise 4, 13, 14. Data on FHR variation and fetal body and breathing movements are only known for light exercise 5, 6, 7, 8, 15. After such exercise, FHR variation and body movements were unaltered, whereas fetal breathing activity remained the same 8, 15or increased 5, 6. However, in none of these studies the fetal variables were assessed simultaneously.

The aim of the present study was to investigate the effects of maternal exercise on basal FHR, FHR variation and fetal body and breathing movements, and to relate fetal responses to the level of exercise performed.

Section snippets

Subjects and methods

Twelve healthy pregnant women between 29 and 32 weeks of gestation (median 30 week) participated in this study. Their median age was 29 years, range 20–36 years. None of the women was a conditioned athlete. All pregnancies were uncomplicated and resulted in life births at term with birth weights between the 20th and 95th centile, corrected for gestational age, parity and sex (six fetuses were female and six male).

Experimental and control sessions were carried out on 2 consecutive days in a

Results

The exercise level reached during cycling varied between 53 and 99% MIHR (median 82%). The median duration of exercise was 20 min, range 15–30 min. Recording was restarted within 1.5 to 4.2 min (median 2.2 min) after cycling was stopped.

The courses of FHR and its variation and of fetal body and breathing movements on the 2 days of the study are presented in Fig. 1 and Fig. 2, respectively. No significant trends were obtained on the control day, except for breathing movements (Fig. 2B; F_r=27.9; P

Discussion

This study suffers from the same methodological problem as many in its kind, as monitoring the fetus was impossible during maternal exercise. However, monitoring was resumed immediately after the exercise. The importance of the observations on the control day is well illustrated by the progressive decrease in fetal breathing movements which occurred during both the control and experimental sessions. This decrease can be explained by the elapsed time period following the maternal meal and by the

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The majority of the identified studies examined the association between maternal physical activity and FHR. In total, 44 such studies were conducted [25–67], including 33 pertaining to acute exposure and 11 concerning chronic exposure to physical activity (Table S8). Most of them assessed the overall baseline FHR.
We carried a thorough systematic review of the contemporary literature regarding the impact of maternal physical activity during pregnancy on the fetal and neonatal well-being parameters. We searched systematically publications indexed in PubMed and ScienceDirect, according to the PRISMA protocol. Studies examining following fetal and neonatal well-being parameters were included: fetal heart rate, active fetal movements, Doppler assessment of the placental and fetal circulations, amniotic fluid index, Apgar score, and umbilical cord blood acid-basis analysis at delivery. Altogether, 73 studies were identified (pooled sample size n = 7867). Out of these, 42 pertained to acute and 31 pertained to chronic exposure to maternal physical activity. The majority of the identified studies reported a positive or neutral effect of maternal physical activity on the fetal heart rate, Doppler-derived umbilical and cerebral blood flow parameters, and Apgar score. The literature regarding uterine arteries Doppler assessment, fetal active movements, amniotic fluid index, and umbilical cord blood acid-base analysis at delivery is sparse and does not allow us to generalize the inferences. Maternal physical activity during physiological pregnancy is safe for fetal and neonatal well-being when practiced according to recommendations. There is a need for better quality studies concerning the subject.
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Moreover, we have previously observed that regular swimming exercise reduces the severity of physical and psychological dependence and voluntary morphine consumption in morphine-dependent and withdrawn rats [7] and morphine-induced reward and behavioral sensitization in maternally-separated rat offspring [1]. Swimming might be one of the most suitable exercises during the gestational period [12] to activation of antioxidant mechanisms under thermal stress [15], with no harm to the fetus [12]. On the other hand, the effect of exercise during pregnancy in morphine dependent rat mothers has been less studied.
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The earliest one, by Winn and colleagues [41] as described earlier in this paper, showed a significant decrease in fetal movement following a moderate-intensity treadmill walk, during which maternal heart rate reached 75% of its age-predicted maximum. A similar observation was later made by Manders et al. [19] who noted a decrease in fetal movement for the first 5 min following maternal high-intensity cycling test in 12 women. Both of these studies were conducted in 3rd-trimester women and controlled for maternal conditioning.
Fetal movements, which include body and breathing movement, are important indicators of fetal well-being and nervous system development. These have been shown to be affected by intrauterine conditions. While maternal physical activity does induce a change in intrauterine conditions and physiology, its impact on fetal movements is still unclear. This paper will provide a brief review of the literature and outline the current knowledge with regards to the effects of maternal exercise on fetal body and breathing movements.
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To study women’s description of fetal movements in full-term pregnancy. Further to investigate if their descriptions could be sorted with regard to intensity and type of movements, using a matrix under development to be a tool for evaluating fetal movements in clinical praxis.
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