A 38-Year-Old Woman, Gravida 2 Para 0 Aborta 1, at 16

A 38-year-old woman, gravida 2 para 0 aborta 1, at 16 weeks gestation comes to the office for prenatal care.  The patient reports no pain, vaginal bleeding, or leakage of fluid.  This pregnancy was complicated by first-trimester vaginal bleeding, which resolved spontaneously.  A prophylactic cerclage was placed 2 weeks ago as her first pregnancy ended with a painless, 18-week spontaneous abortion.  The patient has a history of polycystic ovary syndrome and required in vitro fertilization for both pregnancies.  Medical history includes type 2 diabetes mellitus and chronic hypertension, both managed with oral medications.  The patient also takes a daily prenatal vitamin with iron supplementation.  She does not use tobacco, alcohol, or illicit drugs.  Prior to her in vitro fertilization, the patient jogged for 30-45 minutes approximately 3 days a week, which she would like to resume.  Blood pressure is 140/90 mm Hg and pulse is 88/min.  BMI is 30 kg/m².  The fetal heart rate is 150/min by Doppler sonography.  Laboratory results are as follows: Which of the following is the best recommendation for this patient regarding exercise during pregnancy?

A) Exercise can be resumed without restriction
B) Exercise frequency should be increased to improve control of type 2 diabetes mellitus
C) Exercise is contraindicated after cerclage placement
D) Exercise is contraindicated in pregnancies complicated by first-trimester bleeding
E) Exercise is contraindicated in pregnancies conceived via in vitro fertilization