Moderate Intensity Exercise in Pregnant Patients with Cardiovascular Disease: A Pilot Study

Cardiovascular disease (CVD) complicates up to 1% of pregnancies in the United States and is a leading cause of maternal morbidity and mortality, accounting for up to 20% of non-obstetric maternal deaths.1 Exercise during pregnancy has been shown to be safe and beneficial in reducing gestational diabetes and preeclampsia2 as well as contributing to a lower cardiovascular risk profile later in life.3, 4, 5, 6, 7, 8, 9, 10 The American College of Obstetricians and Gynecologists recommends that healthy pregnant individuals exercise at moderate intensity for at least 150 minutes throughout the week.11 However, the safety and potential benefits of exercise in pregnant patients with underlying cardiac conditions has not been explored.

Abnormal umbilical artery Doppler profiles are a predictor of both fetal and neonatal adverse events such as intrauterine growth restriction, low Apgar score and admission to the neonatal intensive care unit (NICU).12 Smaller studies have identified an association between maternal exercise during pregnancy and favorable fetal Doppler profiles.13 Furthermore, a randomized-controlled trial studying the effects of prescribed exercise on biochemical markers of vascular injury in patients with gestational diabetes revealed an inverse association between exercise and circulating maternal C-reactive protein (CRP) levels.14 Together, these data suggest that maternal exercise may be beneficial in pregnant individuals with pre-existing CVD.

In this single center pilot study, we sought to determine if moderate intensity exercise in pregnant patients with CVD is feasible and explored the potential benefits to maternal and neonatal outcomes.

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