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Re : "Preventing" PIH through exercise?

Posted: Wed Feb 03, 2010 06:31 pm
by jmom08
Hi Erin, I did notice that the last/largest study seemed to involve longer periods of exercise, but was also interested that the study didn't find a protective effect with exercise/PE. Mainly because I'd been told by my MFM (who seems current on research) that there was nothing I could do to "prevent" PE this time, I wasn't aware of the older studies recommending exercise, and I think I'm personally sensitive (from last pregnancy) about the possibility of incorrect information contributing to mothers' worries that PE is somehow their fault. I guess it is hard to give patients info when the research keeps changing!

I will definitely post if/when I hear more from the nurse. That is interesting about the new trial, Caryn -- I wonder too if maybe the nurse's conference covered info from that last link in Heather's post (older 2007 article saying exercise reduces risk of both gestational diabetes and hypertension)?

Re : "Preventing" PIH through exercise?

Posted: Wed Feb 03, 2010 05:15 pm
by caryn
What's really interesting about the exercise study is the dose-response relationship -- the more exercise, the more severe the PE was. Bah!

Re : "Preventing" PIH through exercise?

Posted: Wed Feb 03, 2010 02:37 pm
by jules2
I was very fit on starting pregnancy and exercised regularly (albeit reducing intensity and duration) throughout my pregnancy, right up until the day before I was admitted to hospital with early & severe PE and then a few days later HELLP.

Of course, that is anecdotal, but I suspect strongly that exercise is not that helpful except in the GD example as Caryn states.

I am worried too about the increase risk of PE that one large cohort study showed among women who did a lot of running. Maybe I inadvertently increased the severity / speed of onset of PE for me, though I try not to feel too guilty about that (hard when my daughter died), as I really though this was the "right" thing to so for a healthy pregnancy.

Best wishes

Re : "Preventing" PIH through exercise?

Posted: Wed Feb 03, 2010 02:34 pm
by deerhart
Looking at the exercise links, its exercise itself that increases the risk, but rather its excessive amounts of exercise. What the last study looked to indicate was that for every minute over 30 minutes of exercise per day you got, you significantly increased your chances for PE.

Like so many things in life, its all about moderation...

Re :

Posted: Wed Feb 03, 2010 12:52 am
by caryn
I wonder if she's seen preliminary data on this trial: http://www.ncbi.nlm.nih.gov/pubmed/19123930

In cases where PE is accompanied by gestational diabetes, there *is* a known lowering of risk of PE, after treatment for the GD. Presumably this is because placentas using that strategy to grow the baby are stymied and so the mother's body doesn't try to boot the baby out early for growing too big.

This of course would leave anyone whose placentas weren't using that strategy at either the same risk or, if exercise somehow impacts placentas using different strategies badly, at higher risk. For example, I didn't have gestational diabetes, and exercised moderately throughout my pregnancy with Oscar with daily long walks (+2-4 miles) and periodic hikes. But exercise might not have lowered my risk simply because I didn't have GD, and it could have *raised* my risk if exercise were in some way bad for that particular placenta.

The study that showed an increase in hypertensive risk for exercisers was rather a shock because everyone thought exercise was a plausible deterrent. And maybe it is, but *only* if your gestational hypertension is accompanied by gestational diabetes!

Let us know what she says. I'm really curious.

Re : "Preventing" PIH through exercise?

Posted: Wed Feb 03, 2010 00:12 am
by jmom08
Thank you everyone, and thanks Heather for the research links! I wasn't aware of those studies. At least it sounds like the nurse had some (older?) basis for advice. I think I would like to give her a call and at least mention the more recent study, in case she doesn't know. Maybe she could reconsider the paragraph, at least for patients with prior PE, and without a note saying "check with your doctor first" ...? The only exercise I'm doing now is wading around in a pool (on advice of MFM) & trying to keep up with an almost 4-year-old with endless energy. That is a good idea about bringing the abstracts to my MFM, I will definitely do that if I consider anything new. I guess my main concern was worrying that the nurse might be giving other moms bad info. Maybe I'm just paranoid about PE misinformation these days!

Edit: I did call the nurse and she was extremely nice & receptive, and pointed out that my OB's nurse had written "no restrictions" under exercise on the maternity management program enrollment form, which explains why she didn't include a disclaimer about asking my doctor. (My bad -- I saw the form briefly before they submitted it, but didn't realize they'd made a note about exercise... although they did get another fact wrong I had to correct, so the nurse suggested I talk with my OB about that.)

She said she actually attended a high risk pregnancy training/conference (I forget which she said it was) in the past year where she was told that exercise during the first 20 weeks can reduce the chances of gestational diabetes and PIH by a pretty significant percent (??). I told her I'd send her the research links I had, and that I would love to see the information she got from her conference. She sounds like she tries to be on top of the research, so I feel better about that. If she sends me anything new, I will post it on this thread!

Re : "Preventing" PIH through exercise?

Posted: Tue Feb 02, 2010 09:04 pm
by jackparkersmom
I am a runner-I have run marathons, etc.. I excercised all thru my pregnancy- ran until it was uncomfortable then walked up to 5 miles a day, taught pilates, golfed (even the day before I delivered)-and I developed PE and HELLP. I had always been active so my doctor approved of my activities. Isn't it great to listen to everyone elses great ideas on how to prevent PE/HELLP.. I ate organic too and no prepared food-except for Taco Bell once a week...I think the healthier you are it can help you recover faster but I don't think it will prevent it. I wish excercise was the anti-PE cure - wouldn't that be great!!

Re : "Preventing" PIH through exercise?

Posted: Tue Feb 02, 2010 08:03 pm
by blythe
Here's a link to a study and discussion that says exercise increases the risk of PE
http://www.preeclampsia.org/forum/viewt ... =,exercise

and some older (smaller?) studies that say exercise decreased your risk
http://www.preeclampsia.org/forum/viewt ... =,exercise
http://www.preeclampsia.org/forum/viewt ... =,exercise
http://www.preeclampsia.org/forum/viewt ... =,exercise
http://www.preeclampsia.org/forum/viewt ... =,exercise
http://www.preeclampsia.org/forum/viewt ... =,exercise

If you have a really good MFM, I'd print out the abstracts that are mentioned (anything ncbi... tends to go to the actual abstract) and see what they think for your particular case.

Re : "Preventing" PIH through exercise?

Posted: Tue Feb 02, 2010 07:27 pm
by rebecca2
I talked to my doctor about starting up my exercise routine again (walking approx. 1-2 miles/day). Basically he said in general exercise is considered healthy during pregnancy and can help prevent excess weight gain, but he definitely didn't suggest it would prevent PIH or PE! He went as far as saying he was implying I had or was gaining to much and that isn't what caused my PE. He told me it was ok for me to walk as long as I didn't get winded. Unfortunately, the weather has been really cold, rainy or snowy ever since and I haven't had a chance to walk.

I think it is ok to question the nurse about the statement and tell her what your doctor said. I attended a loss support groups that was hosted by pastoral care, NICU nurses and OB Nurse practitioner (I think midwife). I was surprised to learn the OB Nurse actually thought my chances of developing PE were lower in a subsequent pregnancy. I had several discussions with her about what my doctors said and she was more than willing to learn. She definitely didn't take offense to it. She even asked that I share any info I gathered at the Patient Symposium with her.

I think if you approach it the right way, the nurse manager will likely be receptive to hear your thoughts. I would hate for anyone to think PE was caused by something they did wrong. I know it was hard enough not to blame myself even with my OB telling me it wasn't my fault.

Re : "Preventing" PIH through exercise?

Posted: Tue Feb 02, 2010 07:02 pm
by thirdtimesthecharm
I did excercise in the beginning and I still developed PIH. I guess the "hopefully" is there to just suggest that you be as healthy as possible during your pregnancy. My mom is still convinced that if I ate all organic with absolutely no processed foods then I could cure myself now. I just smile at her and listen to my doctor instead.