Considerations for development of pregnancy and postpartum physical activity and exercise guidelines in New Zealand

Abstract

Background: The SMNZ information pamphlet “Women in Sport Exercise and Pregnancy” was produced in 1994. In recent years several countries have produced comprehensive guidelines for physical activity during pregnancy, based on systematic literature reviews and expert consensus. There are however no guidelines for physical activity and exercise (PAE) during pregnancy for Aotearoa/New Zealand (NZ). In order to reflect the range of cultures in NZ, including those of Māori and Pacific peoples, it is important to develop NZ-specific guidelines. Objective: To determine factors for consideration in developing NZ guidelines for physical activity and exercise during pregnancy and postpartum (childbirth continuum). Methods: A review of international published guidelines on exercise during pregnancy was conducted. Findings from in-progress Te Kukunetanga (Developing Cycle of Life) studies were considered for the NZ context. Results: Initial findings from Te Kukunetanga pregnancy research indicated that physically active women experienced inconsistent and conflicting information about exercise during their childbearing years in NZ. PAE could be better facilitated if health care providers provided accurate tailored advice and information informed by trustworthy relevant evidence. Although narrative reviews were conducted by professional bodies such as American Congress of Obstetricians and Gynaecologists (ACOG) and Royal Australian NZ College of Obstetricians and Gynaecologists (RANZCOG), no guidelines referenced any studies for the NZ population. There was an overall lack of empirical evidence as many subgroups are understudied and minimal evaluation of international guidelines affects ability to develop appropriate recommendations for the NZ population. Those involved in provision of care during pregnancy need to understand guidelines to encourage women to be active safely. There was minimal evidence from athletes/highly physically active women. Conclusions: The deficit of NZ based studies of pregnancy and exercise means the relevance of generalised, international recommendations should be more critically examined. Consideration of factors (personalisation, Māori and Pasifika health, specificity and delivery of information) should form the basis of a Delphi approach with health care providers and women in varying stages of childbirth journey to create formal guidelines for physical activity and exercise during pregnancy and postpartum for NZ women. Midwives should work with sports medicine health providers to help create NZ specific physical activity and exercise guidelines for pregnancy and postpartum.