Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 1-exercise in women planning pregnancy and those who are pregnant

British Journal of Sports Medicine

Volumn 50, Issue 10, 2016, Pages 571-589

  Bø, Kari ^a   Artal, Raul ^b   Barakat, Ruben ^c   Brown, Wendy ^d   Davies, Gregory A L ^e   Dooley, Michael ^f   Evenson, Kelly R ^g,h   Haakstad, Lene A H ^a   Henriksson Larsen, Karin ⁱ   Kayser, Bengt ^j   Kinnunen, Tarja I ^k,l   Mottola, Michelle F ^m   Nygaard, Ingrid ⁿ   Van Poppel, Mireille ^o   Stuge, Britt ^p   Khan, Karim M ^q  

^a NORWEGIAN SCHOOL OF SPORT SCIENCES   (Norway)

^b SAINT LOUIS UNIVERSITY SCHOOL OF MEDICINE   (United States)

^c UNIVERSIDAD POLITÉCNICA DE MADRID   (Spain)

^d UNIVERSITY OF QUEENSLAND   (Australia)

^e QUEEN S UNIVERSITY   (Canada)

^f KING EDWARD VII HOSPITAL   (United Kingdom)

^g UNIVERSITY OF NORTH CAROLINA   (United States)

^h IL   (United States)

ⁱ SWEDISH SCHOOL OF SPORT AND HEALTH SCIENCES   (Sweden)

^j UNIVERSITY OF LAUSANNE   (Switzerland)

^k TAMPERE UNIVERSITY OF TECHNOLOGY   (Finland)

^l NATIONAL PUBLIC HEALTH INSTITUTE   (Finland)

^m UNIVERSITY OF WESTERN ONTARIO   (Canada)

ⁿ UNIVERSITY OF UTAH SCHOOL OF MEDICINE   (United States)

^o UNIVERSITY OF GRAZ   (Austria)

^p ULLEVÅL UNIVERSITY HOSPITAL   (Norway)

^q UNIVERSITY OF BRITISH COLUMBIA   (Canada)

more..

Author keywords

[No Author keywords available]

Indexed keywords

ADAPTATION; ADULT; ALTITUDE; ANXIETY; ATHLETIC PERFORMANCE; BODY EQUILIBRIUM; CARDIOVASCULAR FUNCTION; CONSENSUS DEVELOPMENT; DEPRESSION; DIABETES, GESTATIONAL; ENDURANCE; EXERCISE; FATIGUE; FEEDING AND EATING DISORDERS; FEMALE; HUMAN; HYPEREMESIS GRAVIDARUM; HYPERTENSION, PREGNANCY-INDUCED; MATERNAL NUTRITION; MUSCULOSKELETAL DISEASES; MUSCULOSKELETAL FUNCTION; PHYSIOLOGICAL STRESS; PHYSIOLOGY; PRE-ECLAMPSIA; PREGNANCY; PREGNANCY COMPLICATIONS; PREPREGNANCY CARE; PREVENTION AND CONTROL; RECREATION; SPORT; THERMOREGULATION; URINARY INCONTINENCE; WEIGHT GAIN; YOUNG ADULT;

ADAPTATION, PHYSIOLOGICAL; ADULT; ALTITUDE; ANXIETY; ATHLETIC PERFORMANCE; BODY TEMPERATURE REGULATION; CARDIOVASCULAR PHYSIOLOGICAL PHENOMENA; DEPRESSION; DIABETES, GESTATIONAL; EXERCISE; FATIGUE; FEEDING AND EATING DISORDERS; FEMALE; HUMANS; HYPEREMESIS GRAVIDARUM; HYPERTENSION, PREGNANCY-INDUCED; MATERNAL NUTRITIONAL PHYSIOLOGICAL PHENOMENA; MUSCULOSKELETAL DISEASES; MUSCULOSKELETAL PHYSIOLOGICAL PHENOMENA; PHYSICAL ENDURANCE; POSTURAL BALANCE; PRE-ECLAMPSIA; PRECONCEPTION CARE; PREGNANCY; PREGNANCY COMPLICATIONS; RECREATION; SPORTS; STRESS, PHYSIOLOGICAL; URINARY INCONTINENCE; WEIGHT GAIN; YOUNG ADULT;

EID: 84965045964     PISSN: 03063674     EISSN: 14730480     Source Type: Journal    
DOI: 10.1136/bjsports-2016-096218     Document Type: Conference Paper

References (322)

1. [No authors listed]. Committee Opinion No. 650 Summary: physical activity and exercise during pregnancy and the postpartum period. Obstet Gynecol 2015;126:1326-7.
2. Davies GA, Wolfe LA, Mottola MF, et al. Exercise in pregnancy and the postpartum period. J Obstet Gynaecol Can 2003;25:516-29.
3. Royal College of Obstetricians and Gynaecologists. Exercise in pregnancy 2006:1-7.
4. Evenson KR, Mottola MF, Owe KM, et al. Summary of international guidelines for physical activity after pregnancy. Obstet Gynecol Surv 2014;69:407-14.
5. Evenson KR, Barakat R, Brown WJ, et al. Guidelines for physical activity during pregnancy: comparisons from around the world. Am J Lifestyle Med 2014;8:102-21.
6. Szumilewicz A, Worska A, Rajkowska N, et al. Summary of guidelines for exercise in pregnancy-are they comprehensive enough for designing the contents of a prenatal exercise program? Curr Womens Health Rev 2015;11:3-12.
7. Owe KM, Nystad W, Skjaerven R, et al. Exercise during pregnancy and the gestational age distribution: a cohort study. Med Sci Sports Exerc 2012;44:1067-74.
8. Haakstad LA, Bo K. Exercise in pregnant women and birth weight: a randomized controlled trial. BMC Pregnancy Childbirth 2011;11:66.
9. Gjestland K, Bo K, Owe KM, et al. Do pregnant women follow exercise guidelines? Prevalence data among 3482 women, and prediction of low-back pain, pelvic girdle pain and depression. Br J Sports Med 2013;47:515-20.
10. Engebretsen L, Bahr R, Cook JL, et al. The IOC Centres of Excellence bring prevention to sports medicine. Br J Sports Med 2014;48:1270-5.
11. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions. John Wiley & Sons, 2008.
12. Bouchard C, Shephard S. Physical activity, fitness, and health: the model and key concepts. In: Bouchard C, Shephard R, Stephens T, eds. Physical activity, fitness and health International proceedings and consensus statement. Champaign, IL: Human Kinetics Publishers, 1993:11-23.
13. American College of Obstetricians and Gynecologists. ACOG Committee Opinion number 313, September 2005. The importance of preconception care in the continuum of women's health care. Obstet Gynecol Surv 2005;106:665-6.
14. Lu MC, Kotelchuck M, Culhane JF, et al. Preconception care between pregnancies: the content of internatal care. Matern Child Health J 2006;10 Suppl):S107-22.
15. Dunson DB, Colombo B, Baird DD. Changes with age in the level and duration of fertility in the menstrual cycle. Hum Reprod 2002;17:1399-403.
16. Jamieson ME, Coutts JR, Connor JM. The chromosome constitution of human preimplantation embryos fertilized in vitro. Hum Reprod 1994;9:709-15.
17. Habbema JD, Eijkemans MJ, Leridon H, et al. Realizing a desired family size: when should couples start? Hum Reprod 2015;30:2215-21.
18. Mountjoy M, Sundgot-Borgen J, Burke L, et al. The IOC consensus statement: beyond the Female Athlete Triad-Relative Energy Deficiency in Sport (RED-S). Br J Sports Med 2014;48:491-7.
19. Mountjoy M, Sundgot-Borgen J, Burke L, et al. Authors' 2015 additions to the IOC consensus statement: Relative Energy Deficiency in Sport (RED-S). Br J Sports Med 2015;49:417-20.
20. Mountjoy M, Sundgot-Borgen J, Burke L, et al. The IOC relative energy deficiency in sport clinical assessment tool (RED-S CAT). Br J Sports Med 2015;49:1354.
21. Mountjoy M, Sundgot-Borgen J, Burke L, et al. RED-S CAT. Relative Energy Deficiency in Sport (RED-S) Clinical Assessment Tool (CAT). Br J Sports Med 2015;49:421-3.
22. Currie A. Sport and eating disorders-understanding and managing the risks. Asian J Sports Med 2010;1:63-8.
23. Czech-Szczapa B, Szczapa T, Merritt TA, et al. Disordered eating attitudes during pregnancy in mothers of newborns requiring Neonatal Intensive Care Unit admission: a case control study. J Matern Fetal Neonatal Med 2015;28:1711-15.
24. Sundgot-Borgen J, Torstveit MK. Prevalence of eating disorders in elite athletes is higher than in the general population. Clin J Sport Med 2004;14:25-32.
25. Sundgot-Borgen J, Torstveit MK. Aspects of disordered eating continuum in elite high-intensity sports. Scand J Med Sci Sports 2010;20(Suppl 2):112-21.
26. Nielsen S, Moller-Madsen S, Isager T, et al. Standardized mortality in eating disorders-a quantitative summary of previously published and new evidence. J Psychosom Res 1998;44:413-34.
27. Cardwell MS. Eating disorders during pregnancy. Obstet Gynecol Surv 2013;68:312-23.
28. Franko DL, Spurrell EB. Detection and management of eating disorders during pregnancy. Obstet Gynecol 2000;95(Pt 1):942-6.
29. Mazzeo SE, Slof-Op't Landt MC, Jones I, et al. Associations among postpartum depression, eating disorders, and perfectionism in a population-based sample of adult women. Int J Eat Disord 2006;39:202-11.
30. Koubaa S, Hallstrom T, Lindholm C, et al. Pregnancy and neonatal outcomes in women with eating disorders. Obstet Gynecol 2005;105:255-60.
31. Park RJ, Senior R, Stein A. The offspring of mothers with eating disorders. Eur Child Adolesc Psychiatry 2003;12(Suppl 1):I110-19.
32. Patel P, Wheatcroft R, Park RJ, et al. The children of mothers with eating disorders. Clin Child Fam Psychol Rev 2002;5:1-19.
33. James DC. Eating disorders, fertility, and pregnancy: relationships and complications. J Perinat Neonatal Nurs 2001;15:36-48; quiz 2 p following 82.
34. Franko DL, Blais MA, Becker AE, et al. Pregnancy complications and neonatal outcomes in women with eating disorders. Am J Psychiatry 2001;158:1461-6.
35. Mottola M. Performance in the pregnant woman: maternal and foetal considerations. In: Taylor N, Groeller H, eds. Physiological bases of human performance during work and exercise. Elsevier, 2008:225-37.
36. Barakat R, Perales M, Garatachea N, et al. Exercise during pregnancy. A narrative review asking: what do we know? Br J Sports Med 2015;49:1377-81.
37. Hartmann S, Bung P. Physical exercise during pregnancy-physiological considerations and recommendations. J Perinat Med 1999;27:204-15.
38. Ostgaard HC, Andersson GB, Schultz AB, et al. Influence of some biomechanical factors on low-back pain in pregnancy. Spine 1993;18:61-5.
39. Hagan L, Wong C. Gait in pregnant women: spinal and lower extremity changes from pre-to Postpartum. J Womens Health Phys Ther 2010;34:46-56.
40. Branco M, Santos-Rocha R, Aguiar L, et al. Kinematic analysis of gait in the second and third trimesters of pregnancy. J Pregnancy 2013;2013:718095.
41. Carpes F, Griebeler D, Kleinpaul J, et al. Women able-bodied gait kinematics during and post pregnancy period. Rev Bras Biomeca^ nica 2008;9:16.
42. Gilleard WL. Trunk motion and gait characteristics of pregnant women when walking: report of a longitudinal study with a control group. BMC Pregnancy Childbirth 2013;13:71.
43. Forczek W, Staszkiewicz R. Changes of kinematic gait parameters due to pregnancy. Acta Bioeng Biomech 2012;14:113-9.
44. Foti T, Davids JR, Bagley A. A biomechanical analysis of gait during pregnancy. J Bone Joint Surg Am 2000;82:625-32.
45. Lymbery JK, Gilleard W. The stance phase of walking during late pregnancy: temporospatial and ground reaction force variables. J Am Podiatr Med Assoc 2005;95:247-53.
46. Lontay B, Bodoor K, Sipos A, et al. Pregnancy and Smoothelin-like Protein 1 (SMTNL1) deletion promote the switching of skeletal muscle to a glycolytic phenotype in human and mice. J Biol Chem 2015;290:17985-98.
47. Cakmak B, Ribeiro AP, Inanir A. Postural balance and the risk of falling during pregnancy. J Matern Fetal Neonatal Med 2016;29:1623-5.
48. Vladutiu CJ, Evenson KR, Marshall SW. Physical activity and injuries during pregnancy. J Phys Act Health 2010;7:761-9.
49. Norwitz ER, Schust DJ, Fisher SJ. Implantation and the survival of early pregnancy. N Engl J Med 2001;345:1400-8.
50. Weissgerber TL, Wolfe LA. Physiological adaptation in early human pregnancy: adaptation to balance maternal-fetal demands. Appl Physiol Nutr Metab 2006;31:1-11.
51. Duvekot JJ, Cheriex EC, Pieters FA, et al. Early pregnancy changes in hemodynamics and volume homeostasis are consecutive adjustments triggered by a primary fall in systemic vascular tone. Am J Obstet Gynecol 1993;169: 1382-92.
52. Morris EA, Hale SA, Badger GJ, et al. Pregnancy induces persistent changes in vascular compliance in primiparous women. Am J Obstet Gynecol 2015;212:633. e1-6.
53. Pivarnik J. Cardiovascular responses to aerobic exercise during pregnancy and postpartum. Sem Perinatol 1996;20:242-9.
54. Cong J, Fan T, Yang X, et al. Structural and functional changes in maternal left ventricle during pregnancy: a three-dimensional speckle-tracking echocardiography study. Cardiovasc Ultrasound 2015;13:6.
55. Rubler S, Damani PM, Pinto ER. Cardiac size and performance during pregnancy estimated with echocardiography. Am J Cardiol 1977;40:534-40.
56. Hart MA. Nursing implications of self-care in pregnancy. MCN Am J Matern Child Nurs 1996;21:137-43.
57. Wolfe LA, Preston RJ, Burggraf GW, et al. Effects of pregnancy and chronic exercise on maternal cardiac structure and function. Can J Physiol Pharmacol 1999;77:909-17.
58. Wolfe LA, Ohtake PJ, Mottola MF, et al. Physiological interactions between pregnancy and aerobic exercise. Exerc Sport Sci Rev 1989;17:295-351.
59. Pivarnik JM, Lee W, Miller JF, et al. Alterations in plasma volume and protein during cycle exercise throughout pregnancy. Med Sci Sports Exerc 1990;22:751-5.
60. Pivarnik JM, Mauer MB, Ayres NA, et al. Effects of chronic exercise on blood volume expansion and hematologic indices during pregnancy. Obstet Gynecol 1994;83:265-9.
61. Gilson GJ, Samaan S, Crawford MH, et al. Changes in hemodynamics, ventricular remodeling, and ventricular contractility during normal pregnancy: a longitudinal study. Obstet Gynecol 1997;89:957-62.
62. Wolfe LA, Weissgerber TL. Clinical physiology of exercise in pregnancy: a literature review. J Obstet Gynaecol Can 2003;25:473-83.
63. Ratigan TR. Anatomic and physiologic changes of pregnancy: anesthetic considerations. AANA J 1983;51:38-42.
64. Weissgerber TL, Wolfe LA, Hopkins WG, et al. Serial respiratory adaptations and an alternate hypothesis of respiratory control in human pregnancy. Respir Physiol Neurobiol 2006;153:39-53.
65. Heenan AP, Wolfe LA. Plasma acid-base regulation above and below ventilatory threshold in late gestation. J Appl Physiol 2000;88:149-57.
66. Wolfe LA, Kemp JG, Heenan AP, et al. Acid-base regulation and control of ventilation in human pregnancy. Can J Physiol Pharmacol 1998;76:815-27.
67. Milne JA, Howie AD, Pack AI. Dyspnoea during normal pregnancy. Br J Obstet Gynaecol 1978;85:260-3.
68. Field SK, Bell SG, Cenaiko DF, et al. Relationship between inspiratory effort and breathlessness in pregnancy. J Appl Physiol 1991;71:1897-902.
69. Jensen D, Webb KA, Wolfe LA, et al. Effects of human pregnancy and advancing gestation on respiratory discomfort during exercise. Respir Physiol Neurobiol 2007;156:85-93.
70. Ibrahim S, Jarefors E, Nel DG, et al. Effect of maternal position and uterine activity on periodic maternal heart rate changes before elective cesarean section at term. Acta Obstet Gynecol Scand 2015;94:1359-66.
71. Avery ND, Stocking KD, Tranmer JE, et al. Fetal responses to maternal strength conditioning exercises in late gestation. Can J Appl Physiol 1999;24:362-76.
72. Jeffreys RM, Stepanchak W, Lopez B, et al. Uterine blood flow during supine rest and exercise after 28 weeks of gestation. Br J Obstet Gyneacol 2006;113:1239-47.
73. Bauer MK, Harding JE, Bassett NS, et al. Fetal growth and placental function. Mol Cell Endocrinol 1998;140:115-20.
74. Mottola MF, Christopher PD. Effects of maternal exercise on liver and skeletal muscle glycogen storage in pregnant rats. J Appl Physiol 1991;71:1015-19.
75. Catalano PM, Tyzbir ED, Roman NM, et al. Longitudinal changes in insulin release and insulin resistance in nonobese pregnant women. Am J Obstet Gynecol 1991;165(Pt 1):1667-72.
76. Buchanan TA, Metzger BE, Freinkel N, et al. Insulin sensitivity and B-cell responsiveness to glucose during late pregnancy in lean and moderately obese women with normal glucose tolerance or mild gestational diabetes. Am J Obstet Gynecol 1990;162:1008-14.
77. Lesser KB, Carpenter MW. Metabolic changes associated with normal pregnancy and pregnancy complicated by diabetes mellitus. Semin Perinatol 1994;18:399-406.
78. Clapp JF III. Maternal carbohydrate intake and pregnancy outcome. Proc Nutr Soc 2002;61:45-50.
79. Butte NF. Carbohydrate and lipid metabolism in pregnancy: normal compared with gestational diabetes mellitus. Am J Clin Nutr 2000;71(5 Suppl):1256S-61S.
80. Boden G. Fuel metabolism in pregnancy and in gestational diabetes mellitus. Obstet Gynecol Clin North Am 1996;23:1-10.
81. Bessinger RC, McMurray RG. Substrate utilization and hormonal responses to exercise in pregnancy. Clin Obstet Gynecol 2003;46:467-78.
82. Chambers CD. Risks of hyperthermia associated with hot tub or spa use by pregnant women. Birth Defects Res A Clin Mol Teratol 2006;76:569-73.
83. Soultanakis HN, Artal R, Wiswell RA. Prolonged exercise in pregnancy: glucose homeostasis, ventilatory and cardiovascular responses. Semin Perinatol 1996;20:315-27.
84. Clapp JF III. The changing thermal response to endurance exercise during pregnancy. Am J Obstet Gynecol 1991;165(Pt 1):1684-9.
85. Lindqvist PG, Marsal K, Merlo J, et al. Thermal response to submaximal exercise before, during and after pregnancy: a longitudinal study. J Matern Fetal Neonatal Med 2003;13:152-6.
86. Jones RL, Botti JJ, Anderson WM, et al. Thermoregulation during aerobic exercise in pregnancy. Obstet Gynecol 1985;65:340-5.
87. Hytten F. Weight gain in pregnancy. In: Hytten F, Chamberlain G, eds. Clinical physiology in obstetrics. Oxford: Blackwell Scientific Publications, 1991:173-203.
88. Butte NF, King JC. Energy requirements during pregnancy and lactation. Public Health Nutr 2005;8:1010-27.
89. IOM (Institute of Medicine) and NRC (National Research Council). Weight gain during pregnancy: reexamining the guidelines. Washington DC: The National Academies Press, 2009.
90. Clapp JF III, Capeless E. The VO2max of recreational athletes before and after pregnancy. Med Sci Sports Exerc 1991;23:1128-33.
91. Kardel KR. Effects of intense training during and after pregnancy in top-level athletes. Scand J Med Sci Sports 2005;15:79-86.
92. Wolfe LA, Brenner IK, Mottola MF. Maternal exercise, fetal well-being and pregnancy outcome. Exerc Sport Sci Rev 1994;22:145-94.
93. Kennelly MM, Geary M, McCaffrey N, et al. Exercise-related changes in umbilical and uterine artery waveforms as assessed by Doppler ultrasound scans. Am J Obstet Gynecol 2002;187:661-6.
94. Kennelly MM, McCaffrey N, McLoughlin P, et al. Fetal heart rate response to strenuous maternal exercise: not a predictor of fetal distress. Am J Obstet Gynecol 2002;187:811-16.
95. van Doorn MB, Lotgering FK, Struijk PC, et al. Maternal and fetal cardiovascular responses to strenuous bicycle exercise. Am J Obstet Gynecol 1992;166:854-9.
96. Kardel KR, Johansen B, Voldner N, et al. Association between aerobic fitness in late pregnancy and duration of labor in nulliparous women. Acta Obstet Gynecol Scand 2009;88:948-52.
97. MacPhail A, Davies GA, Victory R, et al. Maximal exercise testing in late gestation: fetal responses. Obstet Gynecol 2000;96:565-70.
98. Heenan AP, Wolfe LA, Davies GA. Maximal exercise testing in late gestation: maternal responses. Obstet Gynecol 2001;97:127-34.
99. Jaque-Fortunato SV, Wiswell RA, Khodiguian N, et al. A comparison of the ventilatory responses to exercise in pregnant, postpartum, and nonpregnant women. Semin Perinatol 1996;20:263-76.
100. Mottola MF, Davenport MH, Brun CR, et al. VO2peak prediction and exercise prescription for pregnant women. Med Sci Sports Exerc 2006;38:1389-95.
101. Salvesen KA, Hem E, Sundgot-Borgen J. Fetal wellbeing may be compromised during strenuous exercise among pregnant elite athletes. Br J Sports Med 2012;46:279-83.
102. Szymanski LM, Satin AJ. Strenuous exercise during pregnancy: is there a limit? Am J Obstet Gynecol 2012;207:179.e1-6.
103. Szymanski LM, Satin AJ. Exercise during pregnancy: fetal responses to current public health guidelines. Obstet Gynecol 2012;119:603-10.
104. Dibblee L, Graham TE. A longitudinal study of changes in aerobic fitness, body composition, and energy intake in primigravid patients. Am J Obstet Gynecol 1983;147:908-14.
105. Wong SC, McKenzie DC. Cardiorespiratory fitness during pregnancy and its effect on outcome. Int J Sports Med 1987;8:79-83.
106. Pivarnik JM, Lee W, Miller JF. Physiological and perceptual responses to cycle and treadmill exercise during pregnancy. Med Sci Sports Exerc 1991;23:470-5.
107. Carey DG, Tofte C, Pliego GJ, et al. Transferability of running and cycling training zones in triathletes: implications for steady-state exercise. J Strength Cond Res 2009;23:251-8.
108. Artal R, Wiswell R, Romem Y, et al. Pulmonary responses to exercise in pregnancy. Am J Obstet Gynecol 1986;154:378-83.
109. McMurray RG, Katz VL, Berry MJ, et al. The effect of pregnancy on metabolic responses during rest, immersion, and aerobic exercise in the water. Am J Obstet Gynecol 1988;158(Pt 1):481-6.
110. Knuttgen HG, Emerson K Jr. Physiological response to pregnancy at rest and during exercise. J Appl Physiol 1974;36:549-53.
111. O'Neill ME, Cooper KA, Mills CM, et al. Accuracy of Borg's ratings of perceived exertion in the prediction of heart rates during pregnancy. Br J Sports Med 1992;26:121-4.
112. Tenforde AS, Toth KE, Langen E, et al. Running habits of competitive runners during pregnancy and breastfeeding. Sports health 2015;7:172-6.
113. Sandbakk Ø, Hegge A, Losnegard T, et al. The physiological capacity of the world's highest ranked female cross-country skiers. Med Sci Sports 2016. Published Online First.
114. Huch R. Physical activity at altitude in pregnancy. Semin Perinatol 1996;20:303-14.
115. Artal R, Fortunato V, Welton A, et al. A comparison of cardiopulmonary adaptations to exercise in pregnancy at sea level and altitude. Am J Obstet Gynecol 1995;172(Pt 1):1170-8; discussion 78-80.
116. Entin PL, Coffin L. Physiological basis for recommendations regarding exercise during pregnancy at high altitude. High Alt Med Biol 2004;5:321-34.
117. Clapp JF III. Is exercise during pregnancy related to preterm birth? Clin J Sport Med 2009;19:241-3.
118. Clapp JF III. Exercise during pregnancy. A clinical update. Clin Sports Med 2000;19:273-86.
119. Olson D, Sikka RS, Hayman J, et al. Exercise in pregnancy. Curr Sports Med Rep 2009;8:147-53.
120. O'Connor PJ, Poudevigne MS, Cress ME, et al. Safety and efficacy of supervised strength training adopted in pregnancy. J Phys Act Health 2011;8:309-20.
121. Palatini P, Mos L, Munari L, et al. Blood pressure changes during heavy-resistance exercise. J Hypertens Suppl 1989;7:S72-3.
122. Harman EA, Frykman PN, Clagett ER, et al. Intra-abdominal and intra-thoracic pressures during lifting and jumping. Med Sci Sports Exerc 1988;20:195-201.
123. Moore K, Dumoulin C, Bradley C, et al. Adult conservative management. In: Abrams P, Cardozo L, Khoury S, eds. Abrams P, Cardozo L, Khoury S, Wein A. Incontinence. 5th edn. Committee 12 International Consultation on Incontinence, 2013:1101-227.
124. Dumas GA, Reid JG. Laxity of knee cruciate ligaments during pregnancy. J Orthop Sports Phys Ther 1997;26:2-6.
125. Aitokallio-Tallberg A, Halmesmaki E. Motor vehicle accident during the second or third trimester of pregnancy. Acta Obstet Gynecol Scand 1997;76:313-17.
126. Luley T, Fitzpatrick CB, Grotegut CA, et al. Perinatal implications of motor vehicle accident trauma during pregnancy: identifying populations at risk. Am J Obstet Gynecol 2013;208:466.e1-5.
127. Vladutiu CJ, Marshall SW, Poole C, et al. Adverse pregnancy outcomes following motor vehicle crashes. Am J Prev Med 2013;45:629-36.
128. Baud D, Damnon F, de Rham M. Should a pregnancy test be required before scuba diving? Br J Sports Med 2016:(in press) File number 095770.
129. Camporesi EM. Diving and pregnancy. Semin Perinatol 1996;20:292-302.
130. Zhou Q, O'Brien B, Soeken K. Rhodes Index of Nausea and Vomiting-Form 2 in pregnant women. A confirmatory factor analysis. Nurs Res 2001;50:251-7.
131. Lacasse A, Rey E, Ferreira E, et al. Nausea and vomiting of pregnancy: what about quality of life? Br J Obstet Gyneacol 2008;115:1484-93.
132. Jewell D. Nausea and vomiting in early pregnancy. Clin Evid 2003(9):1561-70.
133. Jewell D, Young G. Interventions for nausea and vomiting in early pregnancy. Cochrane Database Syst Rev 2003;(4):CD000145.
134. Miller F. Nausea and vomiting in pregnancy: the problem of perception-is it really a disease? Am J Obstet Gynecol 2002;186(5 Suppl Understanding):S182-3.
135. Jarvis S, Nelson-Piercy C. Management of nausea and vomiting in pregnancy. BMJ 2011;342:d3606.
136. Woodhouse M. Complementary medicine for pregnancy complications Australian Family Physician 2007:35(9):695.
137. Aus Fam Phys 2007;35:695.
138. Einarson TR, Piwko C, Koren G. Prevalence of nausea and vomiting of pregnancy in the USA: a meta analysis. J Popul Ther Clin Pharmacol 2013;20:e163-70.
139. Goodwin TM. Nausea and vomiting of pregnancy: an obstetric syndrome. Am J Obstet Gynecol 2002;186(5 Suppl Understanding):S184-9.
140. Buckwalter JG, Simpson SW. Psychological factors in the etiology and treatment of severe nausea and vomiting in pregnancy. Am J Obstet Gynecol 2002;186(5 Suppl Understanding):S210-14.
141. Chan RL, Olshan AF, Savitz DA, et al. Maternal influences on nausea and vomiting in early pregnancy. Matern Child Health J 2011;15:122-7.
142. O'Brien B, Relyea MJ. Use of indigenous explanations and remedies to further understand nausea and vomiting during pregnancy. Health Care Women Int 1999;20:49-61.
143. Tan PC, Vani S, Lim BK, et al. Anxiety and depression in hyperemesis gravidarum: prevalence, risk factors and correlation with clinical severity. Eur J Obstet Gynecol Reprod Biol 2010;149:153-8.
144. Chou FH, Avant KC, Kuo SH, et al. Relationships between nausea and vomiting, perceived stress, social support, pregnancy planning, and psychosocial adaptation in a sample of mothers: a questionnaire survey. Int J Nurs Stud 2008;45:1185-91.
145. Chou FH, Kuo SH, Wang RH. A longitudinal study of nausea and vomiting, fatigue and perceived stress in, and social support for, pregnant women through the three trimesters. Kaohsiung J Med Sci 2008;24:306-14.
146. Mansour GM, Nashaat EH. Role of Helicobacter pylori in the pathogenesis of hyperemesis gravidarum. Arch Gynecol Obstet 2011;284:843-7.
147. Sandven I, Abdelnoor M, Wethe M, et al. Helicobacter pylori infection and Hyperemesis gravidarum. An institution-based case-control study. Eur J Epidemiol 2008;23:491-8.
148. Fejzo MS, Poursharif B, Korst LM, et al. Symptoms and pregnancy outcomes associated with extreme weight loss among women with hyperemesis gravidarum. J Womens Health (Larchmt) 2009;18:1981-7.
149. van Oppenraaij RH, Jauniaux E, Christiansen OB, et al. Predicting adverse obstetric outcome after early pregnancy events and complications: a review. Hum Reprod Update 2009;15:409-21.
150. Chiossi G, Neri I, Cavazzuti M, et al. Hyperemesis gravidarum complicated by Wernicke encephalopathy: background, case report, and review of the literature. Obstet Gynecol Surv 2006;61:255-68.
151. NICE (National Institute for Health & Care Excellence). Antenatal care for uncomplicated pregnancies, 2014. www.nice.org.uk/guidelines
152. Jednak MA, Shadigian EM, Kim MS, et al. Protein meals reduce nausea and gastric slow wave dysrhythmic activity in first trimester pregnancy. Am J Physiol 1999;277(Pt 1):G855-61.
153. Pugh LC. Childbirth and the measurement of fatigue. J Nurs Meas 1993;1:57-66.
154. Bialobok KM, Monga M. Fatigue and work in pregnancy. Curr Opin Obstet Gynecol 2000;12:497-500.
155. van Lier D, Manteuffel B, Dilorio C, et al. Nausea and fatigue during early pregnancy. Birth 1993;20:193-7.
156. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Arlington, VA: American Psychiatric Pub, 2013.
157. Murphy S. Transitions in competitive sport: maximizing individual potential. In: Murphy SM, ed. Sport psychology interventions. Champaign, IL: Human Kinetics, 1995:331-46.
158. Molyneaux E, Poston L, Ashurst-Williams S, et al. Pre-pregnancy obesity and mental disorders during pregnancy and postpartum: a systematic review and meta-analysis. Pregnancy Hypertens 2014;4:236.
159. Molyneaux E, Poston L, Ashurst-Williams S, et al. Obesity and mental disorders during pregnancy and postpartum: a systematic review and meta-analysis. Obstet Gynecol 2014;123:857-67.
160. Loprinzi PD, Cardinal BJ. Interrelationships among physical activity, depression, homocysteine, and metabolic syndrome with special considerations by sex. Prev Med 2012;54:388-92.
161. Loprinzi PD, Fitzgerald EM, Cardinal BJ. Physical activity and depression symptoms among pregnant women from The National Health and Nutrition Examination Survey 2005-2006. J Obstet Gynecol Neonatal Nurs 2012;41:227-35.
162. Gulliver A, Griffiths KM, Christensen H, et al. A systematic review of help-seeking interventions for depression, anxiety and general psychological distress. BMC Psychiatry 2012;12:81.
163. Appaneal RN, Levine BR, Perna FM, et al. Measuring postinjury depression among male and female competitive athletes. J Sport Exerc Psychol 2009;31:60-76.
164. Hammond T, Gialloreto C, Kubas H, et al. The prevalence of failure-based depression among elite athletes. Clin J Sport Med 2013;23:273-7.
165. Wolanin A, Gross M, Hong E. Depression in athletes: prevalence and risk factors. Curr Sports Med Rep 2015;14:56-60.
166. Reardon CL, Factor RM. Sport psychiatry: a systematic review of diagnosis and medical treatment of mental illness in athletes. Sports Med 2010;40:961-80.
167. Gulliver A, Griffiths KM, Christensen H. Barriers and facilitators to mental health help-seeking for young elite athletes: a qualitative study. BMC Psychiatry 2012;12:157.
168. Schwenk TL. The stigmatisation and denial of mental illness in athletes. Br J Sports Med 2000;34:4-5.
169. Kim DR, Sockol LE, Sammel MD, et al. Elevated risk of adverse obstetric outcomes in pregnant women with depression. Arch Womens Ment Health 2013;16:475-82.
170. Grote V, Vik T, von Kries R, et al. Maternal postnatal depression and child growth: a European cohort study. BMC Pediatr 2010;10:14.
171. Grote NK, Bridge JA, Gavin AR, et al. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry 2010;67:1012-24.
172. Brennan PA, Hammen C, Andersen MJ, et al. Chronicity, severity, and timing of maternal depressive symptoms: relationships with child outcomes at age 5. Dev Psychol 2000;36:759-66.
173. Garber J. Depression and the family. In: Hudson J, Rapee R, eds. Psychopathology and the family. Oxford: Elsevier, 2005:27-83.
174. Seligman M, Walker E, Rosenhan D. Abnormal psychology. 4th edn. New York: W.W. Norton & Company, 2000.
175. de Graaf R, ten Have M, van Gool C, et al. Prevalence of mental disorders and trends from 1996 to 2009. Results from the Netherlands Mental Health Survey and Incidence Study-2. Soc Psychiatry Psychiatr Epidemiol 2012;47:203-13.
176. Claesson IM, Josefsson A, Sydsjo G. Prevalence of anxiety and depressive symptoms among obese pregnant and postpartum women: an intervention study. BMC Public Health 2010;10:766.
177. Gulliver A, Griffiths KM, Mackinnon A, et al. The mental health of Australian elite athletes. J Sci Med Sport 2015;18:255-61.
178. Huizink AC, Mulder EJ, Robles de Medina PG, et al. Is pregnancy anxiety a distinctive syndrome? Early Hum Dev 2004;79:81-91.
179. Poikkeus P, Saisto T, Unkila-Kallio L, et al. Fear of childbirth and pregnancy-related anxiety in women conceiving with assisted reproduction. Obstet Gynecol 2006;108:70-6.
180. Storksen HT, Garthus-Niegel S, Adams SS, et al. Fear of childbirth and elective caesarean section: a population-based study. BMC Pregnancy Childbirth 2015;15:221.
181. Kaitz M. Maternal concerns during early parenthood. Child Care Health Dev 2007;33:720-7.
182. Weisskopf E, Fischer CJ, Bickle Graz M, et al. Risk-benefit balance assessment of SSRI antidepressant use during pregnancy and lactation based on best available evidence. Expert Opin Drug Saf 2015;14:413-27.
183. Vernec AR. The Athlete Biological Passport: an integral element of innovative strategies in antidoping. Br J Sports Med 2014;48:817-19.
184. Hofmann SG, Smits JA. Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. J Clin Psychiatry 2008;69:621-32.
185. Newby JM, McKinnon A, Kuyken W, et al. Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood. Clin Psychol Rev 2015;40:91-110.
186. Sockol LE, Battle CL. Maternal attitudes, depression, and anxiety in pregnant and postpartum multiparous women. Arch Womens Ment Health 2015;18:585-93.
187. Daley AJ, Foster L, Long G, et al. The effectiveness of exercise for the prevention and treatment of antenatal depression: systematic review with meta-analysis. Br J Obstet Gyneacol 2015;122:57-62.
188. Siega-Riz AM, Viswanathan M, Moos MK, et al. A systematic review of outcomes of maternal weight gain according to the Institute of Medicine recommendations: birthweight, fetal growth, and postpartum weight retention. Am J Obstet Gynecol 2009;201:339.e1-14.
189. Viswanathan M, Siega-Riz AM, Moos MK, et al. Outcomes of maternal weight gain. Evid Rep Technol Assess (Full Rep) 2008:1-223.
190. Alavi N, Haley S, Chow K, et al. Comparison of national gestational weight gain guidelines and energy intake recommendations. Obes Rev 2013;14:68-85.
191. Artal R, Lockwood CJ, Brown HL. Weight gain recommendations in pregnancy and the obesity epidemic. Obstet Gynecol 2010;115:152-5.
192. Crane JM, White J, Murphy P, et al. The effect of gestational weight gain by body mass index on maternal and neonatal outcomes. J Obstet Gynaecol Can 2009;31:28-35.
193. Macdonald-Wallis C, Tilling K, Fraser A, et al. Gestational weight gain as a risk factor for hypertensive disorders of pregnancy. Am J Obstet Gynecol 2013;209:327 e1-17.
194. Harris DE, Aboueissa AM, Baugh N, et al. 11-year trends in pregnancy-related health indicators in Maine, 2000-2010. J Pregnancy 2014;2014:780626.
195. Johnson JL, Farr SL, Dietz PM, et al. Trends in gestational weight gain: the Pregnancy Risk Assessment Monitoring System, 2000-2009. Am J Obstet Gynecol 2015;212:806.e1-8.
196. Yan J. Maternal pre-pregnancy BMI, gestational weight gain, and infant birth weight: a within-family analysis in the United States. Econ Hum Biol 2015;18:1-12.
197. Park S, Sappenfield WM, Bish C, et al. Assessment of the Institute of Medicine recommendations for weight gain during pregnancy: Florida, 2004-2007. Matern Child Health J 2011;15:289-301.
198. Simas TA, Waring ME, Liao X, et al. Prepregnancy weight, gestational weight gain, and risk of growth affected neonates. J Womens Health (Larchmt) 2012;21:410-17.
199. Merkx A, Ausems M, Bude L, et al. Weight gain in healthy pregnant women in relation to pre-pregnancy BMI, diet and physical activity. Midwifery 2015;31:693-701.
200. Kraschnewski JL, Chuang CH, Downs DS, et al. Association of prenatal physical activity and gestational weight gain: results from the first baby study. Womens Health Issues 2013;23:e233-8.
201. Stuebe AM, Forman MR, Michels KB. Maternal-recalled gestational weight gain, pre-pregnancy body mass index, and obesity in the daughter. Int J Obes (Lond) 2009;33:743-52.
202. Stuebe AM, Oken E, Gillman MW. Associations of diet and physical activity during pregnancy with risk for excessive gestational weight gain. Am J Obstet Gynecol 2009;201:58.e1-8.
203. Clapp JF, Little KD. The interaction between regular exercise and selected aspects of women's health. Am J Obstet Gynecol 1995;173:2-9.
204. Clapp JF III, Little KD. Effect of recreational exercise on pregnancy weight gain and subcutaneous fat deposition. Med Sci Sports Exerc 1995;27:170-7.
205. Jiang H, Qian X, Li M, et al. Can physical activity reduce excessive gestational weight gain? Findings from a Chinese urban pregnant women cohort study. Int J Behav Nutr Phys Act 2012;9:12.
206. Lof M, Hilakivi-Clarke L, Sandin S, et al. Effects of pre-pregnancy physical activity and maternal BMI on gestational weight gain and birth weight. Acta Obstet Gynecol Scand 2008;87:524-30.
207. Bo K, Backe-Hansen KL. Do elite athletes experience low back, pelvic girdle and pelvic floor complaints during and after pregnancy? Scand J Med Sci Sports 2007;17:480-7.
208. Ruchat SM, Davenport MH, Giroux I, et al. Nutrition and exercise reduce excessive weight gain in normal-weight pregnant women. Med Sci Sports Exerc 2012;44:1419-26.
209. Vinter CA, Jorgensen JS, Ovesen P, et al. Metabolic effects of lifestyle intervention in obese pregnant women. Results from the randomized controlled trial 'Lifestyle in Pregnancy' (LiP). Diabet Med 2014;31:1323-30.
210. Renault KM, Norgaard K, Nilas L, et al. The Treatment of Obese Pregnant Women (TOP) study: a randomized controlled trial of the effect of physical activity intervention assessed by pedometer with or without dietary intervention in obese pregnant women. Am J Obstet Gynecol 2014;210: 134.e1-9.
211. Ruiz JR, Perales M, Pelaez M, et al. Supervised exercise-based intervention to prevent excessive gestational weight gain: a randomized controlled trial. Mayo Clin Proc 2013;88:1388-97.
212. Ronnberg AK, Ostlund I, Fadl H, et al. Intervention during pregnancy to reduce excessive gestational weight gain-a randomised controlled trial. Br J Obstet Gyneacol 2015;122:537-44.
213. Phelan S, Phipps MG, Abrams B, et al. Randomized trial of a behavioral intervention to prevent excessive gestational weight gain: the Fit for Delivery Study. Am J Clin Nutr 2011;93:772-9.
214. Huang TT, Yeh CY, Tsai YC. A diet and physical activity intervention for preventing weight retention among Taiwanese childbearing women: a randomised controlled trial. Midwifery 2011;27:257-64.
215. Hui AL, Back L, Ludwig S, et al. Effects of lifestyle intervention on dietary intake, physical activity level, and gestational weight gain in pregnant women with different pre-pregnancy body mass index in a randomized control trial. BMC Pregnancy Childbirth 2014;14:331.
216. Bogaerts A, Van den Bergh BR, Ameye L, et al. Interpregnancy weight change and risk for adverse perinatal outcome. Obstet Gynecol 2013;122:999-1009.
217. Haakstad LA, Bo K. Effect of regular exercise on prevention of excessive weight gain in pregnancy: a randomised controlled trial. Eur J Contracept Reprod Health Care 2011;16:116-25.
218. Asbee SM, Jenkins TR, Butler JR, et al. Preventing excessive weight gain during pregnancy through dietary and lifestyle counseling: a randomized controlled trial. Obstet Gynecol 2009;113(Pt 1):305-12.
219. Guelinckx I, Devlieger R, Mullie P, et al. Effect of lifestyle intervention on dietary habits, physical activity, and gestational weight gain in obese pregnant women: a randomized controlled trial. Am J Clin Nutr 2010;91:373-80.
220. Harrison CL, Lombard CB, Strauss BJ, et al. Optimizing healthy gestational weight gain in women at high risk of gestational diabetes: a randomized controlled trial. Obesity (Silver Spring) 2013;21:904-9.
221. Barakat R, Cordero Y, Coteron J, et al. Exercise during pregnancy improves maternal glucose screen at 24-28 weeks: a randomised controlled trial. Br J Sports Med 2012;46:656-61.
222. Ghodsi Z, Asltoghiri M. Effects of aerobic exercise training on maternal and neonatal outcome: a randomized controlled trial on pregnant women in Iran. J Pak Med Assoc 2014;64:1053-6.
223. Korpi-Hyovalti EA, Laaksonen DE, Schwab US, et al. Feasibility of a lifestyle intervention in early pregnancy to prevent deterioration of glucose tolerance. BMC Public Health 2011;11:179.
224. Luoto R, Laitinen K, Nermes M, et al. Impact of maternal probiotic-supplemented dietary counseling during pregnancy on colostrum adiponectin concentration: a prospective, randomized, placebo-controlled study. Early Hum Dev 2012;88:339-44.
225. Nascimento SL, Surita FG, Parpinelli MA, et al. The effect of an antenatal physical exercise programme on maternal/perinatal outcomes and quality of life in overweight and obese pregnant women: a randomised clinical trial. Br J Obstet Gyneacol 2011;118:1455-63.
226. Price BB, Amini SB, Kappeler K. Exercise in pregnancy: effect on fitness and obstetric outcomes-a randomized trial. Med Sci Sports Exerc 2012;44:2263-9.
227. Kong KL, Campbell CG, Foster RC, et al. A pilot walking program promotes moderate-intensity physical activity during pregnancy. Med Sci Sports Exerc 2014;46:462-71.
228. Jackson RA, Stotland NE, Caughey AB, et al. Improving diet and exercise in pregnancy with Video Doctor counseling: a randomized trial. Patient Educ Couns 2011;83:203-9.
229. Kinnunen TI, Raitanen J, Aittasalo M, et al. Preventing excessive gestational weight gain-a secondary analysis of a cluster-randomised controlled trial. Eur J Clin Nutr 2012;66:1344-50.
230. Santos IA, Stein R, Fuchs SC, et al. Aerobic exercise and submaximal functional capacity in overweight pregnant women: a randomized trial. Obstet Gynecol 2005;106:243-9.
231. Hui A, Back L, Ludwig S, et al. Lifestyle intervention on diet and exercise reduced excessive gestational weight gain in pregnant women under a randomised controlled trial. Br J Obstet Gyneacol 2012;119:70-7.
232. Gabbe S, Niebyl J, Simpson J, et al. Obstetrics: normal and problem pregnancies. 6th edn. Saunders, 2012.
233. Stocks G. Preeclampsia: pathophysiology, old and new strategies for management. Eur J Anaesthesiol 2014;31:183-9.
234. Wolf HT, Owe KM, Juhl M, et al. Leisure time physical activity and the risk of pre-eclampsia: a systematic review. Matern Child Health J 2014;18:899-910.
235. Aune D, Saugstad OD, Henriksen T, et al. Physical activity and the risk of preeclampsia: a systematic review and meta-analysis. Epidemiology 2014;25:331-43.
236. Nakimuli A, Chazara O, Byamugisha J, et al. Pregnancy, parturition and preeclampsia in women of African ancestry. Am J Obstet Gynecol 2014;210:510-20.e1.
237. Genest DS, Falcao S, Gutkowska J, et al. Impact of exercise training on preeclampsia: potential preventive mechanisms. Hypertension 2012;60:1104-9.
238. Magee LA, Pels A, Helewa M, et al. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy: executive summary. J Obstet Gynaecol Can 2014;36:416-41.
239. Weissgerber TL, Wolfe LA, Davies GA, et al. Exercise in the prevention and treatment of maternal-fetal disease: a review of the literature. Appl Physiol Nutr Metab 2006;31:661-74.
240. Weissgerber TL, Wolfe LA, Davies GA. The role of regular physical activity in preeclampsia prevention. Med Sci Sports Exerc 2004;36:2024-31.
241. Yeo S, Davidge S, Ronis DL, et al. A comparison of walking versus stretching exercises to reduce the incidence of preeclampsia: a randomized clinical trial. Hypertens Pregnancy 2008;27:113-30.
242. Walker RL, Hemmelgarn B, Quan H. Incidence of gestational hypertension in the Calgary Health Region from 1995 to 2004. Can J Cardiol 2009;25:e284-7.
243. Ros HS, Cnattingius S, Lipworth L. Comparison of risk factors for preeclampsia and gestational hypertension in a population-based cohort study. Am J Epidemiol 1998;147:1062-70.
244. Shiozaki A, Matsuda Y, Satoh S, et al. Comparison of risk factors for gestational hypertension and preeclampsia in Japanese singleton pregnancies. J Obstet Gynaecol Res 2013;39:492-9.
245. Fortner RT, Pekow PS, Whitcomb BW, et al. Physical activity and hypertensive disorders of pregnancy among Hispanic women. Med Sci Sports Exerc 2011;43:639-46.
246. Saftlas AF, Logsden-Sackett N, Wang W, et al. Work, leisure-time physical activity, and risk of preeclampsia and gestational hypertension. Am J Epidemiol 2004;160:758-65.
247. Barakat R, Pelaez M, Cordero Y, et al. Exercise during pregnancy protects against hypertension and macrosomia: randomized clinical trial. Am J Obstet Gynecol 2015.
248. Katz VL, Ryder RM, Cefalo RC, et al. A comparison of bed rest and immersion for treating the edema of pregnancy. Obstet Gynecol 1990;75:147-51.
249. Kent T, Gregor J, Deardorff L, et al. Edema of pregnancy: a comparison of water aerobics and static immersion. Obstet Gynecol 1999;94(Pt 1):726-9.
250. Hartmann S, Huch R. Response of pregnancy leg edema to a single immersion exercise session. Acta Obstet Gynecologica Scand 2005;84:1150-3.
251. Kaaja R, Ronnemaa T. Gestational diabetes: pathogenesis and consequences to mother and offspring. Rev Diabet Stud 2008;5:194-202.
252. Kim C. Gestational diabetes: risks, management, and treatment options. Int J Womens Health 2010;2:339-51.
253. Chasan-Taber L, Marcus BH, Stanek E III, et al. A randomized controlled trial of prenatal physical activity to prevent gestational diabetes: design and methods. J Womens Health (Larchmt) 2009;18:851-9.
254. Oken E, Ning Y, Rifas-Shiman SL, et al. Associations of physical activity and inactivity before and during pregnancy with glucose tolerance. Obstet Gynecol 2006;108:1200-7.
255. Retnakaran R, Qi Y, Sermer M, et al. Pre-gravid physical activity and reduced risk of glucose intolerance in pregnancy: the role of insulin sensitivity. Clin Endocrinol (Oxf ) 2009;70:615-22.
256. Russo LM, Nobles C, Ertel KA, et al. Physical activity interventions in pregnancy and risk of gestational diabetes mellitus: a systematic review and meta-analysis. Obstet Gynecol 2015;125:576-82.
257. Dempsey JC, Sorensen TK, Williams MA, et al. Prospective study of gestational diabetes mellitus risk in relation to maternal recreational physical activity before and during pregnancy. Am J Epidemiol 2004;159:663-70.
258. Dempsey JC, Williams MA, Leisenring WM, et al. Maternal birth weight in relation to plasma lipid concentrations in early pregnancy. Am J Obstet Gynecol 2004;190:1359-68.
259. Cheung NW. The management of gestational diabetes. Vasc Health Risk Manag 2009;5:153-64.
260. Karagiannis T, Bekiari E, Manolopoulos K, et al. Gestational diabetes mellitus: why screen and how to diagnose. Hippokratia 2010;14:151-4.
261. Poyhonen-Alho MK, Teramo KA, Kaaja RJ, et al. 50gram oral glucose challenge test combined with risk factor-based screening for gestational diabetes. Eur J Obstet Gynecol Reprod Biol 2005;121:34-7.
262. Griffin ME, Coffey M, Johnson H, et al. Universal vs. risk factor-based screening for gestational diabetes mellitus: detection rates, gestation at diagnosis and outcome. Diabet Med 2000;17:26-32.
263. Hegaard HK, Pedersen BK, Nielsen BB, et al. Leisure time physical activity during pregnancy and impact on gestational diabetes mellitus, pre-eclampsia, preterm delivery and birth weight: a review. Acta Obstet Gynecol Scand 2007;86:1290-6.
264. Iqbal R, Rafique G, Badruddin S, et al. Increased body fat percentage and physical inactivity are independent predictors of gestational diabetes mellitus in South Asian women. Eur J Clin Nutr 2007;61:736-42.
265. Hu FB, Li TY, Colditz GA, et al. Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women. JAMA 2003;289:1785-91.
266. American College of Sports Medicine. Impact of physical activity during pregnancy and postpartum on chronic disease risk. Med Sci Sports Exerc 2006;38:989-1006.
267. Tomkins CC, Mottola MF, Giroux I. Dietary intake, capillary blood glucose, and activity level of activity-restricted, hospitalized, pregnant women in the third trimester: a pilot study. Appl Physiol Nutr Metab 2007;32:1105-14.
268. US Surgeon General. Physical activity and health; a report of the surgeon general. Atlanta: US Department of Health and Human Services, CDC, National Center for Disease Control and Prevention, 1996.
269. Carpenter MW. Gestational diabetes, pregnancy hypertension, and late vascular disease. Diabetes Care 2007;30(Suppl 2):S246-50.
270. Barakat R, Pelaez M, Lopez C, et al. Exercise during pregnancy and gestational diabetes-related adverse effects: a randomised controlled trial. Br J Sports Med 2013;47:630-6.
271. Vleeming A, Albert HB, Ostgaard HC, et al. European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J 2008;17:794-819.
272. Ostgaard HC, Zetherstrom G, Roos-Hansson E, et al. Reduction of back and posterior pelvic pain in pregnancy. Spine 1994;19:894-900.
273. Robinson HS, Mengshoel AM, Veierod MB, et al. Pelvic girdle pain: potential risk factors in pregnancy in relation to disability and pain intensity three months postpartum. Man Ther 2010;15:522-8.
274. Gutke A, Ostgaard HC, Oberg B. Pelvic girdle pain and lumbar pain in pregnancy: a cohort study of the consequences in terms of health and functioning. Spine (Phila Pa 1976) 2006;31:E149-55.
275. Stuge B, Laerum E, Kirkesola G, et al. The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy: a randomized controlled trial. Spine 2004;29:351-9.
276. O'Sullivan PB, Beales DJ. Diagnosis and classification of pelvic girdle pain disorders-part 1: a mechanism based approach within a biopsychosocial framework. Man Ther 2007;12:86-97.
277. Bjorklund K, Bergstrom S. Is pelvic pain in pregnancy a welfare complaint? Acta Obstet Gynecol Scand 2000;79:24-30.
278. Charpentier K, Leboucher J, Lawani M, et al. Back pain during pregnancy and living conditions: a comparison between Beninese and Canadian women. Ann Phys Rehabil Med 2012;55:148-59.
279. Mousavi SJ, Parnianpour M, Vleeming A. Pregnancy related pelvic girdle pain and low back pain in an Iranian population. Spine (Phila Pa 1976) 2007;32:E100-4.
280. Wormslev M, Juul AM, Marques B, et al. Clinical examination of pelvic insufficiency during pregnancy. An evaluation of the interobserver variation, the relation between clinical signs and pain and the relation between clinical signs and physical disability. Scand J Rheumatol 1994;23:96-102.
281. Wu WH, Meijer OG, Uegaki K, et al. Pregnancy-related pelvic girdle pain (PPP), I: terminology, clinical presentation, and prevalence. Eur Spine J 2004;13:575-89.
282. Eichenseer PH, Sybert DR, Cotton JR. A finite element analysis of sacroiliac joint ligaments in response to different loading conditions. Spine (Phila Pa 1976) 2011;36:E1446-52.
283. Snijders CJ, Vleeming A, Stoeckart R. Transfer of lumbosacral load to iliac bones and legs-part 2: loading of the sacroiliac joints when lifting in a stooped posture. Clin Biomech (Bristol, Avon) 1993;8:295-301.
284. Snijders CJ, Vleeming A, Stoeckart R. Transfer of lumbosacral load to iliac bones and legs-part 1: biomechanics of self-bracing of the sacroiliac joints and its significance for treatment and exercise. Clin Biomech (Bristol, Avon) 1993;8:285-94.
285. Palsson TS, Beales D, Slater H, et al. Pregnancy is characterized by widespread deep-tissue hypersensitivity independent of lumbopelvic pain intensity, a facilitated response to manual orthopedic tests, and poorer self-reported health. J Pain 2015;16:270-82.
286. Palsson TS, Graven-Nielsen T. Experimental pelvic pain facilitates pain provocation tests and causes regional hyperalgesia. Pain 2012;153:2233-40.
287. Palsson TS, Hirata RP, Graven-Nielsen T. Experimental pelvic pain impairs the performance during the Active Straight Leg Raise Test and causes excessive muscle stabilization. Clin J Pain 2015;31:642-51.
288. Torstensson T, Lindgren A, Kristiansson P. Corticosteroid injection treatment to the ischiadic spine reduced pain in women with long-lasting sacral low back pain with onset during pregnancy: a randomized, double blind, controlled trial. Spine (Phila Pa 1976) 2009;34:2254-8.
289. Torstensson T, Lindgren A, Kristiansson P. Improved function in women with persistent pregnancy-related pelvic pain after a single corticosteroid injection to the ischiadic spine: a randomized double-blind controlled trial. Physiother Theory Pract 2013;29:371-8.
290. Pennick V, Liddle SD. Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database Syst Rev 2013;(8):CD001139.
291. Haakstad LA, Bo K. Effect of a regular exercise programme on pelvic girdle and low back pain in previously inactive pregnant women: a randomized controlled trial. J Rehabil Med 2015;47:229-34.
292. Eggen MH, Stuge B, Mowinckel P, et al. Can supervised group exercises including ergonomic advice reduce the prevalence and severity of low back pain and pelvic girdle pain in pregnancy? A randomized controlled trial. Phys Ther 2012;92:781-90.
293. Morkved S, Salvesen KA, Schei B, et al. Does group training during pregnancy prevent lumbopelvic pain? A randomized clinical trial. Acta Obstet Gynecol Scand 2007;86:276-82.
294. Stafne SN, Salvesen KA, Romundstad PR, et al. Does regular exercise during pregnancy influence lumbopelvic pain? A randomized controlled trial. Acta Obstet Gynecol Scand 2012;91:552-9.
295. Mogren IM. Previous physical activity decreases the risk of low back pain and pelvic pain during pregnancy. Scand J Public Health 2005;33:300-6.
296. Haakstad L, Telenius E, Bø K. Exercise and pelvic girdle pain during pregnancy. Are there any associations? Open J Obstet Gynecol 2013;3:520-7.
297. Owe KM, Bjelland EK, Stuge B, et al. Exercise level before pregnancy and engaging in high-impact sports reduce the risk of pelvic girdle pain: a population-based cohort study of 39 184 women. Br J Sports Med Published Online First: 4 October 2015 doi:10.1136/bjsports-2015-094921
298. Thorell E, Kristiansson P. Pregnancy related back pain, is it related to aerobic fitness? A longitudinal cohort study. BMC Pregnancy Childbirth 2012;12:30.
299. Bump RC, Norton PA. Epidemiology and natural history of pelvic floor dysfunction. Obstet Gynecol Clin North Am 1998;25:723-46.
300. Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn 2010;29:4-20.
301. Milsom I, Altman D, Cartwright R, et al. Epidemiology of urinary incontinence (UI) and other lower urinary tract symptoms (LUTS), pelvic organ prolapse (POP) and anal incontinence. In: Abrams P, Cardozo L, Khoury A, et al. Incontinence. 5th edn. Health Publication Ltd, Committee 1, 2013:15-107.
302. Bo K, Hilde G, Staer-Jensen J, et al. Does general exercise training before and during pregnancy influence the pelvic floor "opening" and delivery outcome? A 3D/4D ultrasound study following nulliparous pregnant women from mid-pregnancy to childbirth. Br J Sports Med 2015;49:196-9.
303. Caylet N, Fabbro-Peray P, Mares P, et al. Prevalence and occurrence of stress urinary incontinence in elite women athletes. Can J Urol 2006;13:3174-9.
304. Johannessen HH, Morkved S, Stordahl A, et al. Anal incontinence and quality of life in late pregnancy: a cross-sectional study. Br J Obstet Gyneacol 2014;121:978-87.
305. Johannessen HH, Wibe A, Stordahl A, et al. Prevalence and predictors of anal incontinence during pregnancy and 1 year after delivery: a prospective cohort study. Br J Obstet Gyneacol 2014;121:269-79.
306. Vitton V, Baumstarck-Barrau K, Brardjanian S, et al. Impact of high-level sport practice on anal incontinence in a healthy young female population. J Womens Health (Larchmt) 2011;20:757-63.
307. Larsen WI, Yavorek T. Pelvic prolapse and urinary incontinence in nulliparous college women in relation to paratrooper training. Int Urogynecol J Pelvic Floor Dysfunct 2007;18:769-71.
308. Koelbl H, Igawa T, Salvatore S, et al. Pathophysiology of urinary incontinence, faecal incontinence and pelvic organ prolapse. In: Abrams P, et al, eds. Incontinence: Committee 4. 2013:261-359.
309. Delancey JO, Kane Low L, Miller JM, et al. Graphic integration of causal factors of pelvic floor disorders: an integrated life span model. Am J Obstet Gynecol 2008;199:610.e1-5.
310. Nygaard IE, Thompson FL, Svengalis SL, et al. Urinary incontinence in elite nulliparous athletes. Obstet Gynecol 1994;84:183-7.
311. Nygaard IE, Rao SS, Dawson JD. Anal incontinence after anal sphincter disruption: a 30-year retrospective cohort study. Obstet Gynecol 1997;89:896-901.
312. Bo K, Sundgot-Borgen J. Are former female elite athletes more likely to experience urinary incontinence later in life than non-athletes? Scand J Med Sci Sports 2010;20:100-4.
313. Eliasson K, Larsson T, Mattsson E. Prevalence of stress incontinence in nulliparous elite trampolinists. Scand J Med Sci Sports 2002;12:106-10.
314. Cottenden A, Bliss D, Buckley B, et al. Management using continence products. In: Abrams P, Cardozo L, Khoury S, et al, eds. Incontinence. 5th edn. Committee 20, 2015:1651-786.
315. Glavind K. Use of a vaginal sponge during aerobic exercises in patients with stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 1997;8:351-3.
316. Boyle R, Hay-Smith EJ, Cody JD, et al. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev 2012;(10):CD007471.
317. Dinc A, Kizilkaya Beji N, Yalcin O. Effect of pelvic floor muscle exercises in the treatment of urinary incontinence during pregnancy and the postpartum period. Int Urogynecol J Pelvic Floor Dysfunct 2009;20:1223-31.
318. Venes D, Taber CW. Taber's cyclopedic medical dictionary. 22nd edn. Philadelphia: FA Davis Co, 2013.
319. Boissonnault JS, Blaschak MJ. Incidence of diastasis recti abdominis during the childbearing year. Phys Ther 1988;68:1082-6.
320. Fernandes da Mota PG, Pascoal AG, Carita AI, et al. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Man Ther 2015;20:200-5.
321. Mota P, Pascoal AG, Sancho F, et al. Reliability of inter-rectus distance measured by palpation. Comparison of palpation and ultrasound measurements. Manual Therapy 2013;18:294-8.
322. Benjamin DR, van de Water AT, Peiris CL. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy 2014;100:1-8.