(657) Physician recommendations for physical activity in complicated growth restricted pregnancies

Friday, February 10, 2023

10:30 AM – 12:00 PM

Objective: Guidelines are unclear about maternal physical activity (PA) in pregnancies with fetal growth restriction (FGR), especially with FGR and complicating conditions. ACOG guidelines previously included FGR as a contraindication to PA but this recommendation was recently removed. Our study sought to evaluate current physician recommendations regarding PA in FGR pregnancies according to severity.

Study Design: An online survey was distributed to OBGYN physicians via physician specific social media groups and academic department emails. Physicians were asked to report their PA counseling in various complicated and uncomplicated FGR pregnancies. They were given the option of reporting that they recommend to ‘increase’, ‘continue’ or ‘decrease’ current PA levels or to recommend ‘modified bedrest’. Participants were also given the option to ‘defer counseling to MFM’. Data were evaluated using SPSS. Responses were stratified by general OBGYN vs MFM and total years in practice.

Results: Most physicians (N=246) reported that they recommend continuing current PA levels in uncomplicated FGR pregnancies (84.5%). Both OBGYNs and MFMs report recommending decreased PA levels or modified bedrest with increasingly complicated FGR pregnancies (Figure 1). With complex FGR pregnancies, more general OBGYNs defer PA counseling to MFM. Those in practice for more than 10 years were more likely to recommend decreasing PA in uncomplicated and severe FGR pregnancies as well as elevated umbilical dopplers. In FGR pregnancies with comorbidities or abnormal dopplers, there was no reported difference when evaluated by practice length (Table 1).

Conclusion: Many patients use exercise to maintain physical and mental health during pregnancy. Yet significant data are lacking regarding risks and benefits of exercise in FGR. Differences in PA counseling according to years in practice could reflect slower adaptations to recent changes in exercise guidelines. Even with changing guidelines that promote exercise for pregnant people, general OBGYNs and MFMs report recommending patients decrease PA as FGR pregnancies become more complicated.

Primary & Presenting Author(s)

Alissa Paudel, MD
Maternal Fetal Medicine Fellow
University of Tennessee Medical Center Knoxville
Knoxville, Tennessee, United States

Coauthor(s)

JM
Jill Maples, PhD
University of Tennessee Medical Center
Knoxville, Tennessee, United States
RT
Rachel Tinius, PhD
Western Kentucky University
Bowling Green, Kentucky, United States
NZ
Nikki B. Zite, MD, MPH
Vice Chair of Education and Advocacy
University of Tennessee Medical Center Knoxville
Knoxville, Tennessee, United States
KF
Kimberly B. Fortner, MD
Director, Division of Maternal-Fetal Medicine
University of Tennessee Medical Center
Knoxville, Tennessee, United States