Exercise in Pregnancy for Reduction of Blood Pressure in Obese Patients
Exercise in Pregnancy for Reduction of Blood Pressure in Obese Patients
Preeclampsia and other high blood pressure disorders of pregnancy are a significant cause of
 both maternal and fetal complications of pregnancy. To date, there is no known "cure" for
 preeclampsia, but studies have shown that exercise may lower the risk of preeclampsia and
 high blood pressure disorders in pregnancy. Resistance training also lowers blood pressure,
 and may be easier to perform in a pregnant population, leading to higher compliance. The
 investigators propose to perform a novel prospective study of a resistance training regimen
 on blood pressure in pregnant patients at high risk for developing preeclampsia or high blood
 pressure.
Hypertension affects 5-10 percent of pregnancies, and complications from hypertensive
 disorders of pregnancy are the third leading cause of maternal death in the United States.
 Hypertensive disorders of pregnancy, including preeclampsia, lead to preterm delivery,
 morbidity and mortality of mother, fetus, and neonate, and are a predictor of development of
 chronic maternal hypertension, cardiovascular disease, and renal disease. Maternal obesity is
 increasing dramatically in the patient population, and is an independent risk factor for
 hypertension and preeclampsia, increasing the risk by two- to four-fold. To date, no
 effective preventative measure has been found to reduce the risk of preeclampsia or
 hypertension in high risk pregnant patients. However, observational studies have shown that
 patients who exercise or who have increased physical activity before and during pregnancy
 have lower rates of preeclampsia, hypertension, and gestational diabetes. Exercise has been
 shown in numerous studies to be safe in pregnancy, and is recommended by the American College
 of Obstetrics and Gynecology as part of routine prenatal care. However, aerobic exercise can
 be viewed by patients to be difficult to perform during pregnancy, particularly when the
 patient is obese and at later gestations. Adherence to exercise regimens is therefore low in
 this patient group. Dynamic resistance training has been shown to lower mean blood pressure
 both acutely and long term in non-pregnant hypertensive patients, and can be performed more
 easily by patients with mobility issues. This intervention has not been studied in an obese
 pregnant population for its effects on blood pressure throughout pregnancy.

 The long term goal is to develop an intervention that will reduce the barriers to exercise of
 obese pregnant women that will, in turn, reduce their risk of developing preeclampsia and
 other hypertensive disorders of pregnancy. The specific objective of this proposal is to
 study the effect of a structured resistance training exercise intervention on blood pressure
 in obese pregnant woman, who would be considered high risk for development of hypertensive
 disorders based on pre-pregnancy BMI. The central hypothesis is that obese pregnant patients
 who participate in a regular, structured resistance training exercise regimen will have a
 decrease in mean arterial blood pressure compared to obese pregnant patients who are strongly
 encouraged to do aerobic exercise (lifestyle intervention) or who participate in routine
 prenatal care. The investigators formulated this hypothesis, in part, based upon previous
 studies found in the literature performed in non-pregnant hypertensive patients. The
 investigators will extrapolate from the experience and methods of the collaborators, who have
 studied the effects of exercise on gestational diabetes.
Inclusion Criteria:

 -  Patient's BMI must be ≥ 30 and ≤ 40.

 -  Established viable singleton pregnancy <13 weeks

 Exclusion Criteria:

 -  Multiple gestations.

 -  Maternal diabetes established pre-pregnancy by standard guidelines

 -  Congenital or acquired heart disease

 -  Use of antihypertensive medication

 -  Inability to exercise

 -  Restrictive lung disease

 -  History of shortened/incompetent cervix

 -  History of preterm labor