摘要: 孕期體育鍛煉不僅有助于改善孕婦的健康狀況，也有助于促進其胎兒的健康成長。世界各國紛紛頒布了一系列孕婦身體活動指南，而我國缺乏對孕期體育鍛煉的系統(tǒng)研究，也無專門針對孕婦身體活動的指南。為此，系統(tǒng)梳理近年來發(fā)達國家及組織頒布的孕期身體活動指南，發(fā)現(xiàn)美國婦產(chǎn)科醫(yī)師學(xué)會、美國衛(wèi)生與公眾服務(wù)部、加拿大、英國、國際奧林匹克委員會等國家和組織均對孕婦體育鍛煉提出詳細建議，明確孕期體育鍛煉的禁忌證及風(fēng)險，闡釋孕期體育鍛煉的頻率、持續(xù)時間、強度及類型，強調(diào)體育鍛煉的預(yù)防與保護措施?；趪饨?jīng)驗，得出以下啟示：良好的鍛煉意識是孕婦體育鍛煉的前提，系統(tǒng)的醫(yī)學(xué)檢查是孕婦體育鍛煉的基礎(chǔ)，科學(xué)的鍛煉方法是孕婦體育鍛煉的關(guān)鍵，安全的預(yù)防和保護措施是孕婦體育鍛煉的保障。

Abstract: Physical activity during pregnancy helps not only improve women's health, but also promote the growth of their fetuses. While all the other countries issued a series of physical activity guidelines during pregnancy, China lacks the relevant research, without physical activity guidelines for pregnant women as well. The guidelines for physical activity during pregnancy issued by developed countries and social organizations in recent years hence are sorted out, trying to provide scientific guidance for pregnant women in China.It is found that the American College of Obstetrics and Gynecology(ACOG), the United States Department of Health (USDHHS), Canada, the United Kingdom, and the International Olympic Committee(IOC) have all put forward detailed recommendations on physical activity for pregnant women, which included the contraindications and risks of physical exercise, its frequency, duration, exercise intensity and types, and the emphasis on the prevention and protection measures of physical exercise.The conclusions are therefore drawn as follows: good exercise awareness is the prerequisite for pregnant women to exercise during pregnancy, systematic medical examination the basis, scientific exercise method the key and safe prevention and protection measures the guarantee.

圖  1   孕婦體育鍛煉與母嬰健康之間的劑量效應(yīng)關(guān)系[26]

Figure  1.   Dose-response relationship between the quantity and quality of maternal exercise on maternal and fetal well-being

圖  2   美國醫(yī)護人員對孕婦體育鍛煉的5A動機咨詢程序

Figure  2.   5A's counseling strategy used by U.S. health care providers on physical activity during pregnancy

表  1   近年來發(fā)達國家及組織孕期身體活動指南概況

Table  1   Overview of the guidelines for physical activity during pregnancy in developed countries and organizations in recent years

國家/組織 發(fā)布時間 指南名稱 頒發(fā)組織 適用人群 加拿大 2019年 《2019年加拿大孕期身體活動指南》 SOGC、CSEP 產(chǎn)科醫(yī)生、婦科醫(yī)生、運動生理專家、孕婦 美國 2018年 《美國國民身體活動指南（第二版）》 USDHHS 健康專業(yè)人員和政策制定者、普通大眾 2017年 《孕期和產(chǎn)后的身體活動和鍛煉》 ACOG 產(chǎn)科醫(yī)生、婦科醫(yī)生、孕婦 英國 2019年 《孕婦身體活動指南》 ROCG 產(chǎn)科醫(yī)生、婦科醫(yī)生、孕婦 IOC 2018年 《一般和優(yōu)秀運動員孕期體育鍛煉：2016—2017年國際奧委會專家組會議的證據(jù)總結(jié)》 IOC 健康專業(yè)人員、運動員孕婦 注：SOGC為加拿大婦產(chǎn)醫(yī)學(xué)會，CSEP為加拿大運動生理學(xué)會，USDHHS為美國衛(wèi)生與公眾服務(wù)部，ACOG為美國婦產(chǎn)科醫(yī)師學(xué)會，ROCG為英國皇家婦產(chǎn)科醫(yī)師學(xué)會，IOC為國際奧林匹克委員會。

表  2   孕期體育鍛煉的禁忌證

Table  2   Contraindications of physical exercise during pregnancy

禁忌證 加拿大 英國 IOC ACOG 絕對禁忌證   先兆子癇或妊娠高血壓 + + + +   早產(chǎn) + + + +   嚴重的呼吸道疾病 + + + +   多次妊娠 + + + +   持續(xù)的妊娠中期或晚期出血 + + +   前置胎盤 + + + +   心血管疾病 + + + +   子宮頸內(nèi)口松弛癥 + + + +   胎兒生長受限 + + + +   胎膜破裂 + + + +   嚴重高血壓 + + +   甲狀腺疾病 + +   1型糖尿病或其他嚴重系統(tǒng)性疾病 + + + +   不明原因的持續(xù)性陰道出血 + + 相對禁忌證   貧血 + + +   宮頸擴張 +   癲癇 + +   復(fù)發(fā)性流產(chǎn) +   心律失常 + + +   慢性支氣管炎 + + + +   進食障礙 +   病態(tài)的肥胖 + +   煙癮大 + +   久坐行為的生活方式 + +   自然流產(chǎn) + +   營養(yǎng)不良 + + +   輕/中度心血管疾病 +   整形的限制 + +   其他重要健康問題 + 注：ACOG為美國婦產(chǎn)科醫(yī)師學(xué)會，IOC為國際奧林匹克委員會；+表示指南有該指標建議。

表  3   孕期身體活動建議

Table  3   Suggestions for physical activity during pregnancy

身體活動 加拿大 英國 USDHHS ACOG 體育鍛煉持續(xù)時間 每周≥150 min、每次≥15 min 每周≥150 min、每次≥15 min 每周≥150 min 每天不少于20~30 min 體育鍛煉頻率 每周至少3天或每天 每周大多數(shù)天 每周大多數(shù)天 每周大多數(shù)天或每天 體育鍛煉強度   低強度 +   中等強度 + + + +   較高強度 + +   心率 + +   RPE + +   談話測試 + + + 體育鍛煉類型   有氧運動 + + + +   越野滑雪 +   盆底鍛煉 +   蹬自行車 + +   力量訓(xùn)練 + + +   拉伸運動 + + +   跳舞 +   步行 + + +   游泳 + + +   壁球 +   瑜伽/普拉提 + + + 注：USDHHS為美國衛(wèi)生與公眾服務(wù)部，ACOG為美國婦產(chǎn)科醫(yī)師學(xué)會，RPE為主觀疲勞感知評估；+表示指南有該指標建議。

表  4   孕期停止體育鍛煉的癥狀

Table  4   Symptoms of stopping physical activity during pregnancy

癥狀 加拿大 英國 IOC ACOG 腹部疼痛 + + 羊水泄漏 + + + + 小腿疼痛或腫脹 + + + + 胸部疼痛 + + + + 胎兒活動減少 + 頭暈或暈厥先兆 + + + + 呼吸困難 + + + + 陰道積液過多或胎膜破裂 + + 頭疼 + + + 肌肉無力 + + + 早產(chǎn) + 子宮收縮 + + + 陰道出血 + + + + 注：IOC為國際奧林匹克委員會，ACOG為美國婦產(chǎn)科醫(yī)師學(xué)會；+表示指南有該指標建議。 [1]

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