Travel Safety Tips During Pregnancy

Many pregnant women have jobs that require frequent air travel, and vacation and holiday plans can also make travel by plane a necessity.  Most healthcare providers advise avoiding plane trips after 35 weeks, and some complications during pregnancy may make air travel contraindicated at any point. But for the majority of pregnant women, travel poses little risk as long as certain precautions are followed.

There is some concern about the radiation risk to the fetus regarding exposure to security metal detectors or full body scanners. Airport security metal detector don’t use ionizing radiation, (the type used in x ray machines but use "nonionizing" radiation-form that does not pose a risk even with routine and/or repeated scanning. As a comparison, the level of radiation from metal detectors is very low-in fact it would take 25,000 trips through an airport scanner to equal one year of normal sun exposure.

The "full-body" x-ray scanner uses a very low-energy and low-intensity radiation, and the energy of the x-ray beam is so low that it does not penetrate the skin-it just forms a picture of the outline of your external torso. Although the risk of passing through these machines is very low, pregnant women can eliminate the risk and worry by choosing to have a “pat down” by TSA instead. Here are a few tips for avoiding x-ray machines and scanners:

-Plan for arriving at the airport with extra time for the pat-down.

-Alert the TSA employees if you’re pregnant or think you may be pregnant.

-If you are concerned about exposure to security machines, you are allowed to choose a TSA pat-down instead of having to pass through the machines.

For more information on the safety of airport x-ray machines and scanners go to:

http://hps.org/publicinformation/ate/faqs/backscatterfaq.html

A very real concern during flights, train, bus or car travel is the formation of blood clots that may occur from long periods of sitting. You can reduce your risk of developing blood clots by getting up and walking every hour, and when sitting avoid crossing your legs. It is helpful to do ankle rolls and foot flexions and squeeze and relax your leg muscles every 15 minutes.

Always pack a protein rich snack and water bottle with your carry on bag, and avoid high sodium foods as they can increase edema. Keeping well hydrated is key, even if it means you will need frequent bathroom breaks, as dehydration can increase the risk of clots as well as swelling in your lower extremities.

You can help make your travel more comfortable by planning ahead and choosing seating that offers more leg room (bulk head seating on planes) and an aisle seat so you are free to get up and move or use the bathroom when needed.  Bring a lumbar support and neck roll (a zip lock gallon bag works great for a lumbar support-zip it nearly shut and blow air in to the bag until inflated to the size your want and quickly zip it shut).  Place the bag behind your back for a great low back support. Also, bring a lightweight blanket (can be used as a back support or neck support when rolled up) and it will keep you warm.

It is always important to dress comfortable when traveling, but it is even more so when pregnant. Avoid tightfitting clothing and shoes that do not provide good support and comfort. If you have to dress up for your work, wear lightweight workout shoes that you can swap out with dress shoes once you reach your destination.

Lastly, check your bag if possible to avoid having to lift a heavy suitcase into the overhead bin.  If you have to carry on, ask for assistance with your bag to keep from injuring your back. Instead of lugging a heavy purse or attaché case, use a small rolling laptop briefcase that can hold all your purse contents, computer, paperwork and other items.

Prenatal Exercise Program Design: Exercise Type

Choosing the type of exercise that is best tolerated during pregnancy depends on the following considerations:

• Which activities the client enjoys or is skilled at performing

• Whether the activity poses any risk to the mother or fetus

• Is she is able to do the activity without being compromised by balance and center of gravity changes

• Can the activity be easily modified as pregnancy progresses

Weight-bearing exercise such as walking, dancing, and running help maintain bone mass and some studies suggest they are more effective for keeping pregnancy weight gain within normal limits. As pregnancy progresses some women may not be able to continue weight-bearing exercise because of back or round ligament pain. If modifications such as wearing a belly support don’t relieve discomfort, switching to non-weight-bearing activities such as swimming, stationary biking, or other types of stationary exercise equipment is recommended.

Absolute and relative contraindicated activities for pregnant women are listed below. Pregnant women should always consult with their healthcare provider before taking part in any exercise program and assess the risk/benefit ratio whenever there is a question about the safety of any activity during pregnancy. Keep in mind that activities such as downhill skiing must be assessed for risks that are not controllable, such as the effect of high altitude on oxygen delivery to the fetus.

 Contraindicated Activities for Pregnant Women

Relative

High-altitude sports

Water-skiing

Hockey

Gymnastics

Horseback riding

Absolute

Downhill skiing

Scuba diving

Prenatal Fitness Program Design: Exercise Frequency

In my blog last week I discussed exercise duration, the second of four components used when developing a prenatal fitness program. This week exercise frequency is the focus.The number of days each week that a pregnant woman can safely exercise depends upon several factors. They include:
• Her current level of fitness
• How well she is tolerating pregnancy (ie: any discomfort, lack of weight gain or excessive fatigue)
• The intensity and type and duration of activity she is doing
• How well her body is responding to her exercise routine
Some women find that they can comfortably exercise 5-6 days a week as long as they modify the intensity, duration, and type of activity as needed to maintain a comfortable routine. Three days a week is the minimum needed to achieve cardiovascular benefits and gain improvements in fitness, and many women find that exercising most days is the best way to remain consistent with their program.
Pregnant women should reduce their exercise frequency if they experience signs of overtraining, (see below) and allow for more rest days between exercise sessions.
Signs of Overtraining:
•Lack of weight gain
•Extreme fatigue that doesn’t resolve with rest
•Increase in illness or very slow recovery from illness
•Sustained muscle soreness or pain
•Inability to maintain exercise routine 
•Increased resting heart rate
•Depressed mood 
•Slowed fetal growth 
Want to learn more about how to develop a safe and effective maternal fitness program? The CE correspondence course "Prenatal and Postpartum Exercise Design 2016" is available at: www.ppfconsulting.com

Prenatal Exercise Program Design: Exercise Duration

Exercise duration during pregnancy should reflect a woman’s current level of fitness and the type of activity she is doing. If you’re working with someone who’s just starting a prenatal exercise program the duration will be shorter (15-20 minutes) and progress slowly over time to 30-60 minutes. A pregnant woman who is already taking part in a fitness routine can continue with her current duration level, but exercise duration should be modified as needed to enable her to achieve a moderate to somewhat hard level of intensity without discomfort or undue fatigue. 

Some exercise activities, such as swimming, may require a longer duration in order to achieve a moderate to somewhat hard intensity, so close monitoring of exercise intensity will help determine whether a longer bout is needed. As pregnancy progresses, pregnant women may find that they are able to tolerate a longer duration, lower intensity exercise bout better than a higher intensity, shorter bout, but avoid taking the intensity below the targeted zone of 12 to 14 on the 20-point scale or 3 to 4 on the 10-point scale.   

In the case where a pregnant woman is having difficulty maintaining her normal exercise duration, try dividing the workout into two shorter sessions during the day. This is a helpful tool for enabling women to continue to exercise when she’s experiencing more fatigue in later pregnancy.

Want to learn more about how to develop a safe and effective maternal fitness program? The CE correspondence course "Prenatal and Postpartum Exercise Design 2016" is available at: www.ppfconsulting.com

          Prenatal Exercise Program Design: Exercise Intensity


When designing a prenatal fitness program the key components of intensity, duration, frequency, and mode are used, but specific modifications in the level of progression, supervision, and monitoring are needed in order to keep the exercise safe for mother and fetus. The goal of a prenatal exercise routine is to maintain or improve overall fitness, strength, and flexibility. Keep in mind that each woman’s fitness level and ability will vary, and as pregnancy progresses changes in her body will affect her ability to exercise comfortably. 


Although there are general physical changes during each trimester, not every woman will experience the same limitations or have the same response to exercise as other women at that stage in pregnancy. Developing modifications to exercise routines that enable your client to comfortably continue with their exercise routines throughout pregnancy is an important goal for fitness professionals working with this population. Close monitoring and a reliance on a consistent feedback loop will ensure that you are providing a safe and effective fitness routine to your client. 


Determining and Monitoring Prenatal Exercise Training Intensity 
The use of a training heart rate to measure intensity during exercise has been determined to be a poor indicator of pregnant woman’s exertion level and here’s why:During early pregnancy, hormonally  induced blood vessel dilation and the resulting vascular underfilling will cause a woman’s heart to beat more rapidly to make up for the drop in volume. If she exercises at her usual prepregnancy level, her heart rate response will be much higher than normal because of her body’s attempt to pump blood through her system. As pregnancy progresses, blood volume increases to correct the changes in circulatory volume, causing cardiac output to rise, but the continued physiological changes of pregnancy impact the heartrate response to exercise, making it a less accurate assessment of exertion.


Because of the pregnancy-induced changes affecting exercise heart rate response, the most accurate and safe way to gauge exercise intensity is to use the Borg Rating of Perceived Exertion scale (RPE). Pregnant women should exercise at a level that feels moderate to somewhat hard (12 to 14 on the 20-point scale or 3 to 4 on the 10-point scale). Some women may not be able to accurately gauge their RPE level, especially if they are just starting an exercise program, so it's recommended to use the “talk test” a simple tool for gauging exertion. Instruct the client to avoid exercising to the point where they are unable to carry on a conversation (if they’re so out of breath that they cannot talk, it is a sign that they are working past the advised Borg rating range for pregnancy). Tell clients to reduce their intensity if they feel out of breath, and instruct them on how to use the Borg scale to help them
quantify their intensity rating. 


Next week my blog will discuss prenatal exercise duration guidelines.
For more information on prenatal and postpartum exercise and our CE correspondence course, "Prenatal and Postpartum Exercise Design" please visit:www.ppfconsulting.com

The Increasing Need For Trained Maternal Fitness Instructors
The need for trained maternal fitness professionals has greatly increased as a result of the number of fit women who desire to continue with their exercise routine once they become pregnant. The past several decades has provided a large body of evidence that supports the benefit and safety of prenatal exercise in uncomplicated pregnancies, and ACOG and other fitness and medical health organizations recognize the importance of fitness in a healthy pregnancy. Studies have shown that women who continue or even start an exercise program during pregnancy gain less fat weight, have fewer complications during labor and delivery, and return to their pre-pregnancy weight faster than women who didn't exercise while pregnant.
Knowing what the current evidence based guidelines are for pregnant and postpartum women and being able to work with this population will open up opportunities to create a specialized program that fits their unique needs. Fitness professionals who have training in this field offer skilled support and guidance to pregnant and postpartum women and help them confidently include exercise as part of their lifestyle.  Pregnant women are unsure of what exercises and activities they can continue throughout pregnancy and need guidance on how to monitor their routine for safety. As pregnancy progresses, women need strategies for modifying their exercise program as their body changes to maintain a comfortable and safe routine.

Zika virus fears have left pregnant women with serious questions about how to avoid contracting the virus, and whether the use of insect repellents will put their fetuses at risk. Zika isn’t the only disease that’s bug borne (ticks also carry diseases such as Lymes and Rocky Mountain Spotted Fever) so avoiding these types of insect borne diseases depends upon the use of chemicals that deter bites. The first line a defense is avoiding areas that are affected by Zika, but the CDC has suggested that the virus will spread within the US, so the use of repellants is recommended for all pregnant women.

The most effective mosquito (and tick) repellent contains DEET, and it's considered safe to use during pregnancy and breastfeeding by the EPA. An alternative repellent is Picaridan, but that and other newer repellent chemicals haven’t been as rigorously tested for safety during pregnancy.  In studies that compared the effectiveness of 20% DEET, picaridin, IR3535 and plant based repellents such as citronella, cedar, lemon or eucalyptus, the DEET product was the most effective against the Aedes species mosquito that carries Zika.

Here are some tips for the best protection from mosquito bites:

• Most people notice mosquitos are more prevalent during early morning and dusk, but keep in mind that the mosquito that spreads Zika is more active during they day.  Make a habit of applying insect repellent every time you are going to spend time outdoors.
• Clothing can provide a barrier from bites, so when possible wear long sleeves and pants, and socks. Permethrin coated clothing provides the highest level of protection, but be sure to avoid spraying that products directly on your skin. The EPA has not seen any adverse fetal developmental issues associated with pregnant women wearing permethrin coated clothing when used as directed.
• Make sure that your home window screens aren’t torn or open in any areas.
• Some repellents decrease the SPF (duration of protection) of sunscreens, so for best sun protection apply an SPF 30 lotion or higher before applying insect spray, and reapply your sunscreen frequently when outdoors.
•  Use products that contain at least 20% DEET, which provide up to four hours of protection.  A 20-30% DEET product provides protection from 90% of mosquito or tick bites.

During pregnancy, the benefits of using DEET to avoid the Zika virus and serious birth defects for the fetus are far out weigh the concerns.  For the best protection and safety when using these products remember to carefully read all repellent instructions and apply as directed. 
For more information on the use of DEET and other products during pregnancy go to:

Organization of Teratology Information Specialists OTIS www.mothertobaby.org

High Heat Environments and Pregnancy Are a Dangerous Combination

Summer is a great time for outdoor exercise, but pregnant women need to be especially careful to avoid overheating when the temperature soars.  Hot and humid environments may cause dehydration during pregnancy, and in severe cases can lead to premature labor.  During the first trimester, sustained bouts of high maternal core temperatures during the use of hot tubs and saunas has been associated with neural tube defects, but exercise in environments that allow for maternal heat regulation has not been shown to increase core temperatures to dangerous levels.

 To avoid these concerns, pregnant women should avoid exercising in an environment where they cannot dissipate core heat effectively, (such as high heat index days) the use of saunas or hot tubs, and heated exercise rooms such as those used for hot yoga. 

Pregnant women can avoid the risk of overheating during exercise by following these tips:

-Avoid exercising outdoors when the heat index is considered dangerous-check with your local weather report to see what the index is on hot days.

-Exercise in a climate-controlled facility during the hotter and more humid summer months.

-Drink fluids early and often when exercising.  

-Monitor hydration level by checking weight before and after exercise and drinking fluids after exercise to regain lost fluid weight.

 -Exercise early or late in the day when temperatures are lowest.

-Discontinue exercising if symptoms of overheating occur (lightheadedness, nausea, faintness, excessive sweating, and feeling uncomfortably hot) and move to a cool environment.