Pregnancy and childbirth put increased demands on the body, so staying active is important. At the same time, hormone levels during pregnancy can drastically reduce energy levels, making it difficult for women to gain the benefits of regular exercise when their body needs it most. 
So, how do women overcome this pregnancy-induced tiredness, and when are low energy levels a concern?

Rachel Simpson, physiotherapist and women’s health educator, says 20 to 30 minutes of moderate-intensity exercise most days of the week help the pregnant body cope with the increased demands on muscles joints, heart and lungs. But as many as three in four pregnant women are not getting enough exercise.

The importance of exercise in pregnancy
Exercising in pregnancy boosts mental and physical health and also leads to better labour and birth outcomes, explains Ms Simpson.

“Women who exercise often have improved self-esteem and positive thoughts about their changing bodies during pregnancy.

“Their weight-gain is better controlled; they have less pain, more energy and are at a lower risk of developing complications, such as gestational diabetes and pre-eclampsia.

“Women who exercise regularly throughout pregnancy are also better prepared for the demands of labour and often experience smoother and shorter labour with reduced rates of induced labour and Caesarean delivery.”

An active mother also benefits her baby
Exercising during pregnancy is just as crucial for the unborn child to cope with labour and has health benefits that last a lifetime.

“Babies born to active mothers are less vulnerable to the stresses of late pregnancy and labour and are better able to deal with temporary reductions of blood flow and oxygen delivery.

“This provides extra protection to baby during times of unpredictable stress in labour, such as traumatic injury or medical emergencies.

“Babies whose mothers exercised during pregnancy have also shown improved growth and development, improved intelligence, physical and mental performance and have reduced risk of childhood obesity, heart disease and chronic illness later in life,” says Ms Simpson.

How to boost energy levels and manage fatigue
Exercising in early pregnancy can be challenging as women deal with morning sickness and fatigue.

An increase in blood volume and blood pressure can also make pregnant women more prone to low energy, dizziness, a rapid heart rate and shortness of breath, explains Ms Simpson.

“Women who exercise regularly may notice these changes during their workouts before actually realising they are pregnant.

“Morning sickness and fatigue can make exercising less than appealing, but many women find that even 10 to 15 minutes of exercise can temporarily relieve their symptoms and give them a much-needed energy boost.

“Exercise can relieve many of the discomforts associated with early pregnancy and can benefit the mother and baby.”

The role of diet in managing energy levels
Accredited Practising Dietitian & Nutritionist Stefanie Valakas says there are many reasons why energy levels are low during pregnancy and nutrition can help.

“Pregnant women particularly experience low energy levels during the first and third trimesters and generally report feeling better in their second trimester.

“During the first trimester, a reason for this can be the increase in the hormone, progesterone, which makes some women feel quite sluggish and fatigued.

“During the third trimester, the additional weight, fluid and energy and nutrient demands associated with pregnancy can contribute to poor energy levels.”

Foods to prioritise when experiencing reduced energy levels
• Red meat and other iron-rich foods, especially during the second and third trimester. Aim for red meat such as beef, lamb or pork at least three times per week to help meet iron needs. The form of iron found in red meat is more available for absorption in the body. Other iron-rich foods include legumes and beans such as kidney beans and lentils, iron-fortified breakfast cereals such as Weet-Bix, eggs, chicken and fish.

• If you are following a vegan or vegetarian diet and are concerned you're not meeting your vitamin B12 needs during pregnancy, prioritising well-cooked eggs if you're vegetarian or fortified sources of B12 such as soy or almond milk that contains added B12 or nutritional yeast containing B12 can help, alongside supplementation.

• Ensure pregnant women are eating adequately during pregnancy from the five core food groups, especially whole grains, as well as fruits, vegetables, meat and alternatives and dairy and alternatives and limit the intake of extra foods such as chips, chocolate and cakes (which can make it harder to meet nutritional needs). Educating pregnant women on the Australian Dietary Guidelines during pregnancy and a referral to an Accredited Practising Dietitian who focuses on prenatal nutrition is key to ensuring adequate dietary intake and optimal nutritional status.

“If struggling with fatigue during pregnancy, checking these key nutrients and referring onto a prenatal focused Accredited Practising Dietitian is key to help improve energy levels and nutritional status with diet and supplementation,” says Ms Valakas.

Safe exercise during pregnancy
Pregnancy is not the time to try a new and strenuous activity for the first time, says Ms Simpson. Instead, start gently with low impact exercises such as walking or swimming.

“Some women wait until the second trimester once morning sickness and fatigue have settled, but there is no risk in starting in the first trimester if feeling good.

“If new to an exercise, start with 10 to 15 minutes and gradually work up to 30 minutes each day.”

If women experience vaginal bleeding, contractions, pain, shortness of breath or dizziness, or feel that something’s not right, these are warning signs to stop exercising immediately and see a doctor, says Ms Simpson.

Several medical conditions require medical clearance before exercising, as well as pregnancy complications that mean the risks outweigh the benefits.

“Always speak with your doctor for individual advice before commencing a new exercise program during pregnancy.”

Tips for safe exercise during pregnancy

Warm-up and cool down
A proper warm-up and cool-down are essential in any workout and should last a little longer during pregnancy.

“Warmup needs to slowly raise the heart rate to get the blood flowing and prepare the body for physical activity.

“Warm up with dynamic stretches and a few minutes of gentle walking.

“Cool down after a workout brings the heart rate back down and allows stretching of the muscles strengthened.

“The cool-down should include dynamic stretches, static stretches and gentle walking to return the body to its relaxed state.”


Warmups should gradually energise the body even on days where exercising is a struggle, and cool-downs should rejuvenate and relax, says Ms Simpson.

Monitor exercise intensity
Pregnant women should regulate their exercise intensity with the Talk Test, which means they can talk while exercising and not feel short of breath.

“Use the “Talk Test” to monitor how hard you are working. If you are short of breath and cannot maintain a conversation, you are working too hard.

“Do not rely on monitoring your heart rate. This is highly individual and is dependent on many factors, including genetics, age and physical fitness.

“Use the Talk Test and be guided by your symptoms. For some, this means a lower heart rate, while others may be comfortable at a higher heart rate.”

Exercises to avoid during pregnancy

Lying on your back
Any exercises that involve lying on your back should be avoided after 16 weeks to prevent a drop in blood pressure.

“The uterus sits on top of a major blood vessel, called the vena cava. When pregnant women lie on their back, the combined weight of baby, uterus, placenta and amniotic fluid can compress the vena cava and reduce blood flow to the brain, uterus and the baby.

“This is called supine hypotensive syndrome, meaning blood pressure drops when lying on your back for a long period.

“This results in dizziness, nausea and shortness of breath.

“Instead of lying on your back, you can prop yourself up on your elbows or lie on your left side.

“Alternatively, choose exercises that can be done while sitting, standing or on your hands and knees.

“This same effect can occur with motionless standing or when holding positions for a long time without movement, such as in yoga.”

Jumping
High-force activities such as jumping, hopping and skipping put pressure on the pelvic floor muscles and should be avoided during pregnancy.

“Pregnancy hormones soften the muscles, and soft tissues of the body and the pelvic floor muscles are not left out. 

“A weakened pelvic floor, when combined with the excess weight of pregnancy and the babysitting directly on this area, places pregnant women at risk of incontinence and prolapse during and after their pregnancy.”

Exercise and rest are best
Exercise is important during pregnancy, but so is adequate rest.

“Always use common sense and be guided by how you feel. If fatigue or nausea is extreme that you cannot make it through a workout, you may need to take it easy for a few weeks until your symptoms settle.

“For every hour of exercise, plan one hour of quiet time. And for women who are looking after young children, keep an energy reserve for after your workout,” says Ms Simpson.