A healthy 28-year-old primigravida comes to the office for her first prenatal visit. Her last menstrual period was 7 weeks ago. The patient is a former competitive gymnast and still trains recreationally 5 times a week. Her training includes 30 minutes of jogging on a treadmill as a warm up. The patient does not use tobacco, alcohol, or illicit drugs. She is taking prenatal vitamins and no other medications. BMI is 20 kg/m². Vital signs and physical examination are normal. Urine β-hCG is positive. Transvaginal ultrasound confirms an intrauterine pregnancy. Which of the following is the most appropriate advice for this patient?

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11ec25c8_d2a1_5d7f_bc81_3b38dd6d6708_MD0003_00 Exercise is encouraged in normal, uncomplicated pregnancies to prevent excessive weight gain and improve or maintain overall fitness and well-being. Exercise is also associated with a decreased risk of gestational diabetes mellitus and faster recovery from vaginal and cesarean delivery. This patient does not need to decrease the frequency or duration of her exercise (Choices C and E) as 20-30 minutes of moderate-intensity exercise on most or all days of the week is recommended. Patients who are exercising at moderate intensity should be able to engage in normal conversation during the activity. Although exercise generally is not associated with fetal abnormalities, it is contraindicated in women at risk for preterm delivery and those with preeclampsia or severe cardiopulmonary disease. Other precautions include avoidance of dehydration, which can cause contractions, and avoidance of prolonged periods of lying supine, which are associated with decreased venous return and placental perfusion. Patients should stop exercising if symptoms such as vaginal bleeding, leakage of fluid, contractions, or chest pain develop. In addition, exercise that places pregnant patients at risk of blunt trauma or falling should be avoided. Examples of high risk activities include contact sports, gymnastics (Choice A), and skiing. Swimming and walking (Choice D) are excellent, low-impact activities for pregnant women, but this patient can continue her current regimen of jogging as the risk of falling is low. Educational objective: All healthy women with uncomplicated pregnancies are encouraged to perform moderate-intensity exercise for 20-30 minutes on most or all days of the week. Contact sports and activities with high fall risk should be avoided. References: ACOG Committee opinion no. 650: physical activity and exercise during pregnancy and the postpartum period. (http://www.ncbi.nlm.nih.gov/pubmed/26595585)

A Healthy 28-Year-Old Primigravida Comes to the Office for Her