Resistance Training Does Not Decrease Placental Blood Flow During Valsalva Maneuver: A Novel Use of 3D Doppler Power Flow Ultrasonography

Overview

Journal Sports Health

Publisher Sage Publications

Specialty Orthopedics

Date 2021 Mar 12

PMID 33709855

Citations 1

Authors

Sara Gould

Chase Cawyer

Louis DellItalia

Lorie Harper

Gerald McGwin

Marcas Bamman

Affiliations

Soon will be listed here.

Abstract

Background: The Valsalva maneuver may increase maternal blood pressure and intra-abdominal pressure, resulting in decreased blood flow to the fetus during resistance training.

Hypothesis: There is no significant reduction in placental blood flow in pregnancy during resistance training in recreational athletes, as documented by a 3-dimensional power flow Doppler ultrasonography.

Study Design: Cohort.

Level Of Evidence: Level 3.

Methods: A cohort of healthy women who participated in recreational athletics was enrolled in a prospective study to assess placental blood flow during a resistance exercise. A 1 repetition maximum (1RM, up to 50 lb) was determined through a modified chest press as a marker of heavy resistance training. Three-dimensional volume measurements and power Doppler flow were determined at the rest phase and during the 1RM lift phase. The vascular flow index (VFI) was calculated to determine placental perfusion during each phase.

Results: A total of 22 women participated. The mean age of participants was 31 years. Gestational age ranged from 13 to 28 weeks. Average 1RM weight lifted was 30 lb. Four women (18%) were able to lift 50 lb, the maximum weight that the study allowed. The remaining 18 women (82%) lifted their true 1RM. Mean VFI during lift phase was 2.185 compared with 2.071 at rest ( = 0.03). There was a slight mean increase in VFI during lift phase, 0.114 (95% CI 0.009-0.182) from 2.071 to 2.185 with lifting ( = 0.03). The 15 women who participated in structured exercise had a mean VFI at rest and during the lift phase of 2.031 and 2.203, respectively ( = 0.01).

Conclusion: Three-dimensional power flow Doppler imaging can guide resistance training during pregnancy to prevent fetal injury due to hypoperfusion. Resistance training up to an RM1 of 50 lb did not result in a significant reduction of placental blood flow from resting state in the study population.

Clinical Relevance: This technique may be used to guide training parameters among pregnant athletes.

Citing Articles

Changes of placental three-dimensional power Doppler ultrasonography in third trimester among hypertensive disorders complicating pregnancy.

Liu Y, Gao X, Shi D, Wang Y, Qi X, Wang N Biomol Biomed. 2023; 23(5):894-901.

PMID: 37194610 PMC: 10494845. DOI: 10.17305/bb.2023.9085.

References

Merce L, Barco M, Bau S, Kupesic S, Kurjak A . Assessment of placental vascularization by three-dimensional power Doppler "vascular biopsy" in normal pregnancies. Croat Med J. 2005; 46(5):765-71. View

Salvesen K, Hem E, Sundgot-Borgen J . Fetal wellbeing may be compromised during strenuous exercise among pregnant elite athletes. Br J Sports Med. 2011; 46(4):279-83. DOI: 10.1136/bjsm.2010.080259. View

Avery N, Stocking K, Tranmer J, Davies G, Wolfe L . Fetal responses to maternal strength conditioning exercises in late gestation. Can J Appl Physiol. 1999; 24(4):362-76. DOI: 10.1139/h99-028. View

Petrov Fieril K, Glantz A, Fagevik Olsen M . Hemodynamic responses to single sessions of aerobic exercise and resistance exercise in pregnancy. Acta Obstet Gynecol Scand. 2016; 95(9):1042-7. DOI: 10.1111/aogs.12899. View

Petrov Fieril K, Fagevik Olsen M, Glantz A, Larsson M . Experiences of exercise during pregnancy among women who perform regular resistance training: a qualitative study. Phys Ther. 2014; 94(8):1135-43. DOI: 10.2522/ptj.20120432. View

Morel O, Pachy F, Chavatte-Palmer P, Bonneau M, Gayat E, Laigre P . Correlation between uteroplacental three-dimensional power Doppler indices and true uterine blood flow: evaluation in a pregnant sheep model. Ultrasound Obstet Gynecol. 2010; 36(5):635-40. DOI: 10.1002/uog.7741. View

. Physical Activity and Exercise During Pregnancy and the Postpartum Period: ACOG Committee Opinion, Number 804. Obstet Gynecol. 2020; 135(4):e178-e188. DOI: 10.1097/AOG.0000000000003772. View

Tuuli M, Houser M, Odibo L, Huster K, Macones G, Odibo A . Validation of placental vascular sonobiopsy for obtaining representative placental vascular indices by three-dimensional power Doppler ultrasonography. Placenta. 2010; 31(3):192-6. DOI: 10.1016/j.placenta.2009.12.018. View

Bo K, Artal R, Barakat R, Brown W, Davies G, Dooley M . Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 1-exercise in women planning pregnancy and those who are pregnant. Br J Sports Med. 2016; 50(10):571-89. DOI: 10.1136/bjsports-2016-096218. View

10.

Sady S, Carpenter M . Aerobic exercise during pregnancy. Special considerations. Sports Med. 1989; 7(6):357-75. DOI: 10.2165/00007256-198907060-00002. View

11.

Bergmann A, Zygmunt M, Clapp 3rd J . Running throughout pregnancy: effect on placental villous vascular volume and cell proliferation. Placenta. 2004; 25(8-9):694-8. DOI: 10.1016/j.placenta.2004.02.005. View

12.

Pivarnik J, Szymanski L, Conway M . The Elite Athlete and Strenuous Exercise in Pregnancy. Clin Obstet Gynecol. 2016; 59(3):613-9. DOI: 10.1097/GRF.0000000000000222. View

13.

Alcazar J, Kudla M . Three-dimensional vascular indices calculated using conventional power Doppler and high-definition flow imaging: are there differences?. J Ultrasound Med. 2010; 29(5):761-6. DOI: 10.7863/jum.2010.29.5.761. View

14.

Berghella V, Saccone G . Exercise in pregnancy!. Am J Obstet Gynecol. 2017; 216(4):335-337. DOI: 10.1016/j.ajog.2017.01.023. View

15.

Noguchi J, Hata K, Tanaka H, Hata T . Placental vascular sonobiopsy using three-dimensional power Doppler ultrasound in normal and growth restricted fetuses. Placenta. 2009; 30(5):391-7. DOI: 10.1016/j.placenta.2009.02.010. View

16.

Merce L, Barco M, Bau S . Reproducibility of the study of placental vascularization by three-dimensional power Doppler. J Perinat Med. 2004; 32(3):228-33. DOI: 10.1515/JPM.2004.043. View

17.

de Paula C, Ruano R, Campos J, Zugaib M . Quantitative analysis of placental vasculature by three-dimensional power Doppler ultrasonography in normal pregnancies from 12 to 40 weeks of gestation. Placenta. 2008; 30(2):142-8. DOI: 10.1016/j.placenta.2008.11.010. View

18.

. Effects of pregnancy on work performance. Council on Scientific Affairs. JAMA. 1984; 251(15):1995-7. View

19.

McMillan A, May L, Gaines G, Isler C, Kuehn D . Effects of Aerobic Exercise during Pregnancy on 1-Month Infant Neuromotor Skills. Med Sci Sports Exerc. 2019; 51(8):1671-1676. DOI: 10.1249/MSS.0000000000001958. View

20.

Bain E, Crane M, Tieu J, Han S, Crowther C, Middleton P . Diet and exercise interventions for preventing gestational diabetes mellitus. Cochrane Database Syst Rev. 2015; (4):CD010443. DOI: 10.1002/14651858.CD010443.pub2. View