Physiological Changes During Pregnancy: Main Adaptations, Discomforts, and Implications for Physical Activity and Exercise

  • María Perales
  • Taniya Singh Nagpal
  • Ruben Barakat


Almost the entire female body naturally modifies and changes during pregnancy, and in many cases these modifications occur normally; however there may be imbalances that occur that can cause complications or pathologies.

In fact, pregnancy is known as the most changing period in a human life as there is no other time that produces the same quantity and quality of bodily modifications. Due to the varied changes the body experiences, pregnancy and childbirth can determine the future well-being of the mother and her child.

The pregnant body must work for 40 weeks to achieve adequate fetal growth and development, and this causes a constant effort to maintain balance in all organs and systems. In summary, due to the many modifications that occur during pregnancy, exercise during pregnancy should be given unique and special considerations when compared to nonpregnant populations. However from a scientific point of view, none of these modifications contradicts exercise in healthy pregnant women without obstetric contraindications.


Pregnancy Physiology Cardiovascular Hematologic Metabolic Physical activity Exercise 


  1. 1.
    Ezcurdia GM. Ejercicio físico y deportes durante el embarazo [Spanish]. En: Grupo de trabajo sobre asistencia al embarazo normal. Sección de Medicina Perinatal. Cap. 11. Sociedad Española de Ginecología y Obstetricia. Manual de asistencia al embarazo normal. Ed. E. Fabre Gonzalez; 2001.Google Scholar
  2. 2.
    Melchiorre K, Sharma R, Thilaganathan B. Cardiac structure and function in normal pregnancy. Curr Opin Obstet Gynecol. 2012;24(6):413–21.CrossRefGoogle Scholar
  3. 3.
    Duvekot JJ, Cheriex EC, Pieters FA, Menheere PP, Peeters LH. Early pregnancy changes in hemodynamics and volume homeostasis are consecutive adjustments triggered by a primary fall in systemic vascular tone. Am J Obstet Gynecol. 1993;169(6):1382–92.CrossRefGoogle Scholar
  4. 4.
    Clapp JF, 3rd, Capeless E. (1997). Cardiovascular function before, during, and after the first and subsequent pregnancies. Am J Cardiol 80(11):1469-1473.CrossRefGoogle Scholar
  5. 5.
    Kametas NA, McAuliffe F, Cook B, Nicolaides KH, Chambers J. Maternal left ventricular transverse and long-axis systolic function during pregnancy. Ultrasound Obstet Gynecol. 2001;18(5):467–74.CrossRefGoogle Scholar
  6. 6.
    Geva T, Mauer MB, Striker L, Kirshon B, Pivarnik JM. Effects of physiologic load of pregnancy on left ventricular contractility and remodeling. Am Heart J. 1997;133(1):53–9.CrossRefGoogle Scholar
  7. 7.
    Thornburg KL, Jacobson SL, Giraud GD, Morton MJ. Hemodynamic changes in pregnancy. Semin Perinatol. 2000;24(1):11–4.CrossRefGoogle Scholar
  8. 8.
    Hytten F. Blood volume changes in normal pregnancy. Clin Haematol. 1985;14(3):601–12.PubMedGoogle Scholar
  9. 9.
    Gilson GJ, Samaan S, Crawford MH, Qualls CR, Curet LB. Changes in hemodynamics, ventricular remodeling, and ventricular contractility during normal pregnancy: a longitudinal study. Obstet Gynecol. 1997;89(6):957–62.CrossRefGoogle Scholar
  10. 10.
    Atkins AF, Watt JM, Milan P, Davies P, Crawford JS. A longitudinal study of cardiovascular dynamic changes throughout pregnancy. Eur J Obstet Gynecol Reprod Biol. 1981;12(4):215–24.CrossRefGoogle Scholar
  11. 11.
    Mesa A, Jessurun C, Hernandez A, et al. Left ventricular diastolic function in normal human pregnancy. Circulation. 1999;99(4):511–7.CrossRefGoogle Scholar
  12. 12.
    Mabie WC, DiSessa TG, Crocker LG, Sibai BM, Arheart KL. A longitudinal study of cardiac output in normal human pregnancy. Am J Obstet Gynecol. 1994;170(3):849–56.CrossRefGoogle Scholar
  13. 13.
    Mashini IS, Albazzaz SJ, Fadel HE, et al. Serial noninvasive evaluation of cardiovascular hemodynamics during pregnancy. Am J Obstet Gynecol. 1987;156(5):1208–13.CrossRefGoogle Scholar
  14. 14.
    Robson SC, Hunter S, Boys RJ, Dunlop W. Serial study of factors influencing changes in cardiac output during human pregnancy. Am J Physiol. 1989;256(4 Pt 2):H1060–5.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Valensise H, Novelli GP, Vasapollo B, et al. Maternal cardiac systolic and diastolic function: relationship with uteroplacental resistances. A Doppler and echocardiographic longitudinal study. Ultrasound Obstet Gynecol. 2000;15(6):487–97.CrossRefGoogle Scholar
  16. 16.
    Turan OM, De Paco C, Kametas N, Khaw A, Nicolaides KH. Effect of parity on maternal cardiac function during the first trimester of pregnancy. Ultrasound Obstet Gynecol. 2008;32(7):849–54.CrossRefGoogle Scholar
  17. 17.
    Dagher FJ, Lyons JH, Finlayson DC, Shamsai J, Moore FD. Blood volume measurement: a critical study prediction of normal values: controlled measurement of sequential changes: choice of a bedside method. Adv Surg. 1965;1:69–109.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Sociedad Europea de cardiologia (ESC). Guía de práctica clínica de la ESC para el tratamiento de las enfermedades cardiovasculares durante el embarazo [Spanish]. Rev Esp Cardiol. 2012;65(2):171.e1–e44.Google Scholar
  19. 19.
    Savu O, Jurcut R, Giusca S, et al. Morphological and functional adaptation of the maternal heart during pregnancy. Circ Cardiovasc Imaging. 2012;5(3):289–97.CrossRefGoogle Scholar
  20. 20.
    Novelli GP, Valensise H, Vasapollo B, et al. Left ventricular concentric geometry as a risk factor in gestational hypertension. Hypertension. 2003;41(3):469–75.CrossRefGoogle Scholar
  21. 21.
    Hall ME, George EM, Granger JP. The heart during pregnancy. Rev Esp Cardiol. 2011;64(11):1045–50.CrossRefGoogle Scholar
  22. 22.
    Schannwell CM, Zimmermann T, Schneppenheim M, Plehn G, Marx R, Strauer BE. Left ventricular hypertrophy and diastolic dysfunction in healthy pregnant women. Cardiology. 2002;97(2):73–8.CrossRefGoogle Scholar
  23. 23.
    Roos-Hesselink JW, Duvekot JJ, Thorne SA. Pregnancy in high risk cardiac conditions. Heart. 2009;95(8):680–6.CrossRefGoogle Scholar
  24. 24.
    Wolfe LA, Weissgerber TL. Clinical physiology of exercise in pregnancy: a literature review. J Obstet Gynaecol Can. 2003;25(6):473–83.CrossRefGoogle Scholar
  25. 25.
    Sohnchen N, Melzer K, Tejada BM, et al. Maternal heart rate changes during labour. Eur J Obstet Gynecol Reprod Biol. 2011;158(2):173–8.CrossRefGoogle Scholar
  26. 26.
    Artal R, Platt LD, Sperling M, Kammula RK, Jilek J, Nakamura R. I. Maternal cardiovascular and metabolic responses in normal pregnancy. Am J Obstet Gynecol. 1981;140(2):123–7.CrossRefGoogle Scholar
  27. 27.
    Pivarnik JM. Cardiovascular responses to aerobic exercise during pregnancy and postpartum. Semin Perinatol. 1996;20(4):242–9.CrossRefGoogle Scholar
  28. 28.
    Soultanakis HN, Artal R, Wiswell RA. Prolonged exercise in pregnancy: glucose homeostasis, ventilatory and cardiovascular responses. Semin Perinatol. 1996;20(4):315–27.CrossRefGoogle Scholar
  29. 29.
    Wolfe LA, Mottola MF. Aerobic exercise in pregnancy: an update. Can J Appl Physiol. 1993;18(2):119–47.CrossRefGoogle Scholar
  30. 30.
    Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377–81.CrossRefGoogle Scholar
  31. 31.
    Lee SW, Khaw KS, Ngan Kee WD, Leung TY, Critchley LA. Haemodynamic effects from aortocaval compression at different angles of lateral tilt in non-labouring term pregnant women. Br J Anaesth. 2012;109(6):950–6.CrossRefGoogle Scholar
  32. 32.
    Wolfe LA, Preston RJ, Burggraf GW, McGrath MJ. Effects of pregnancy and chronic exercise on maternal cardiac structure and function. Can J Physiol Pharmacol. 1999;77(11):909–17.CrossRefGoogle Scholar
  33. 33.
    Perales M, Santos-Lozano A, Sanchis-Gomar F, Luaces M, Pareja-Galeano H, Garatachea N, Barakat R, Lucia A. Maternal cardiac adaptation to a physical exercise program during pregnancy. Med Sci Sports Exerc. 2016;48(5):896–906.CrossRefGoogle Scholar
  34. 34.
    Barakat R. El ejercicio físico durante el embarazo [Spanish]. Madrid: Ed. Pearson Alhambra; 2006.Google Scholar
  35. 35.
    Artal R, Wiswell R, Drinkwater B. Exercise in pregnancy. 2nd ed. Williams and Wilkins: Baltimore; 1991.Google Scholar
  36. 36.
    Villaverde Fernandez S, Rodriguez Melcon A, Villaverde Baron S. Modificaciones de la sangre en el embarazo. Cambios circulatorios y respiratorios. Alteraciones de los sistemas digestivos y urinarios. Sistema óseo y dientes. Cambios en la piel. Otras modificaciones. En: Tratado de Ginecología, Obstetricia y Medicina de la Reproducción [Spanish]. Tomo 1. Ed. Panamericana. Sociedad Española de Ginecología y Obstetricia: Madrid; 2003.Google Scholar
  37. 37.
    Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY. Hematological changes. In: Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY, editors. Williams obstetrics. 23rd ed. New York: McGraw-Hill; 2010. p. 114.Google Scholar
  38. 38.
    Alaily AB, Carrol KB. Pulmonary ventilation in pregnancy. Br J Obstet Gynecol. 1978;85:518–24.CrossRefGoogle Scholar
  39. 39.
    Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY. Respiratory tract. In: Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY, editors. Williams obstetrics. 23rd ed. New York: McGraw-Hill; 2010. p. 121.Google Scholar
  40. 40.
    De Migue LJ, Sánchez M. Cambios fisiológicos y adaptación materna durante el embarazo [Spanish]. En : Grupo de trabajo sobre asistencia al embarazo normal. Sección de Medicina Perinatal. Cap. 4. Sociedad Española de Ginecología y Obstetricia. Manual de asistencia al embarazo normal, 2ª edición. Ed. E. Fabre Gonzalez; 2001.Google Scholar
  41. 41.
    Barakat R, Perales M, Garatachea N, Ruiz JR, Lucia A. Exercise during pregnancy. A narrative review asking: what do we know? Br J Sports Med. 2015;49(21):1377–81.CrossRefGoogle Scholar
  42. 42.
    Rasmussen KM, Yaktine AL (editors). Institute of Medicine (committee to reexamine IOM pregnancy weight guidelines, Food and Nutrition Board and Board on Children, Youth, and Families) weight gain during pregnancy: reexamining the guidelines. Provides new guidelines for weight gain during pregnancy that are based on minimizing the risks of inadequate or excessive gains to mothers as well as their infants. Washington, DC: National Academy Press; 2009.Google Scholar
  43. 43.
    Cerqueira M. Metabolismo en el embarazo. Modificaciones endocrinas. Modificaciones psíquicas. En: Tratado de Ginecología, Obstetricia y Medicina de la Reproducción [Spanish]. Tomo 1. Sociedad Española de Ginecología y Obstetricia. Ed. Panamericana; 2003.Google Scholar
  44. 44.
    Barakat R, Perales M. Resistance exercise in pregnancy and outcome. Clin Obstet Gynecol. 2016;59(3):591–9.CrossRefGoogle Scholar
  45. 45.
    Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY. Other system. Musculoskeletal system. In: Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY, editors. Williams obstetrics. 23rd ed. New York: McGraw-Hill; 2010. p. 129.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • María Perales
    • 1
    • 2
  • Taniya Singh Nagpal
    • 3
  • Ruben Barakat
    • 4
  1. 1.University Camilo José CelaMadridSpain
  2. 2.Research Institute Hospital 12 de Octubre (‘i+12’)MadridSpain
  3. 3.Faculty of Health ScienceUniversity of Western OntarioLondonCanada
  4. 4.Faculty of Sciences for Physical Activity and SportTechnical University of MadridMadridSpain

Personalised recommendations