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 International Journal of Medical Sciences and Pharma Research 

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The Relationship between Exercise and Hemoglobin Levels in Pregnant Women: A Review

Emmanuel Ifeanyi Obeagu *

Department of Biomedical and Laboratory Science, Africa University, Zimbabwe

 

 

Introduction

Anemia during pregnancy is one of the most common hematological conditions affecting women globally, with significant implications for both maternal and fetal health. Defined as a decrease in hemoglobin levels, anemia is prevalent in up to 40% of pregnant women, particularly in low-resource settings. The most common form of anemia during pregnancy is iron-deficiency anemia (IDA), caused by insufficient iron to meet the increased demands of maternal and fetal blood volume. Anemia in pregnancy is associated with numerous adverse outcomes, including fatigue, reduced exercise tolerance, preterm birth, low birth weight, and even maternal mortality. Effective management of anemia is crucial to improving these outcomes and promoting overall maternal health ^1-2. Hemoglobin levels, which reflect the oxygen-carrying capacity of blood, naturally fluctuate during pregnancy. As pregnancy progresses, a woman's blood volume expands to accommodate the growing fetus, leading to hemodilution, or the dilution of red blood cells. This physiological process can cause a decrease in hemoglobin concentration, making pregnant women more susceptible to anemia. Other contributing factors include inadequate dietary intake of essential nutrients like iron, folate, and vitamin B12, along with increased iron needs during pregnancy. For women with pre-existing anemia or poor nutrition, the risk of developing anemia during pregnancy is heightened, underscoring the importance of early detection and intervention ^3-4. Traditionally, the management of anemia in pregnancy focuses on iron supplementation, dietary modifications, and in some cases, blood transfusions for severe cases. However, there is growing interest in non-pharmacological approaches, such as physical activity, to enhance maternal health and prevent or manage anemia. Exercise has long been recommended for its benefits in reducing the risk of gestational diabetes, preeclampsia, and obesity, as well as improving mood and sleep. However, its impact on hemoglobin levels and overall blood health during pregnancy remains underexplored. Emerging studies suggest that regular, moderate physical activity could play a role in improving hemoglobin levels, potentially reducing the need for pharmacological treatments and enhancing overall pregnancy outcomes ^5-6.

The physiological mechanisms by which exercise may influence hemoglobin levels are complex and multifactorial. Exercise has been shown to improve cardiovascular health, enhance circulation, and promote better oxygen delivery to tissues, including the placenta. These improvements could stimulate the production of erythropoietin, a hormone that promotes red blood cell production in the bone marrow, potentially improving hemoglobin levels. Furthermore, exercise may help improve iron metabolism by increasing the bioavailability of iron, which is essential for hemoglobin synthesis. By enhancing the efficiency of the circulatory system, regular exercise may mitigate the negative impact of anemia on both maternal and fetal health ^7-8. Despite the promising benefits, concerns exist regarding the safety and effectiveness of exercise for pregnant women, particularly those with anemia. Excessive or high-intensity physical activity may exacerbate fatigue, dehydration, and oxidative stress, potentially leading to further complications. Therefore, understanding the optimal types and intensity of exercise that can safely improve hemoglobin levels during pregnancy is crucial. It is important to balance the benefits of exercise with the potential risks, ensuring that pregnant women with anemia can safely engage in physical activity that supports their overall health and well-being ^9-10. This review aims to explore the current evidence on the relationship between exercise and hemoglobin levels in pregnant women. 

Prevalence of Anemia during Pregnancy

Anemia during pregnancy is a global health concern, with prevalence rates varying across regions, populations, and healthcare settings. The World Health Organization (WHO) estimates that approximately 15-40% of pregnant women worldwide suffer from anemia, making it one of the most common pregnancy-related conditions. In low- and middle-income countries, the prevalence is often higher, primarily due to factors such as poor nutrition, limited access to healthcare, and inadequate iron supplementation programs. In contrast, more developed regions tend to report lower rates of anemia, but the condition remains significant, especially among women from disadvantaged socioeconomic backgrounds ^11-12. Iron deficiency anemia (IDA) is the most prevalent form of anemia during pregnancy, accounting for approximately 75% of all cases. Pregnancy increases the body's demand for iron due to the expansion of maternal blood volume and the nutritional needs of the growing fetus. This increased demand can lead to insufficient iron stores if not adequately supplemented, especially if the woman’s diet lacks sufficient iron-rich foods. Other causes of anemia during pregnancy include folate deficiency, vitamin B12 deficiency, and chronic diseases such as malaria, which may also contribute to a reduction in hemoglobin levels. Despite efforts to address these underlying causes, anemia remains a persistent issue during pregnancy ^13-14. The severity of anemia during pregnancy is classified based on hemoglobin levels, with mild anemia ranging from 10 to 10.9 g/dL, moderate anemia from 7 to 9.9 g/dL, and severe anemia below 7 g/dL. Mild anemia is common and may not cause significant symptoms, but moderate to severe anemia can lead to fatigue, weakness, dizziness, shortness of breath, and impaired immune function. Additionally, anemia during pregnancy is associated with increased risks of preterm birth, low birth ¹⁵. 

Exercise and Hemoglobin Levels: Physiological Mechanisms

Exercise has several physiological effects that can influence hemoglobin levels, potentially offering benefits for pregnant women, especially those at risk for anemia. Hemoglobin is a key protein in red blood cells responsible for oxygen transport throughout the body. During pregnancy, the increased blood volume and metabolic demands place extra pressure on the body’s ability to maintain adequate hemoglobin concentrations. Regular physical activity can help optimize hemoglobin levels through multiple mechanisms that involve improved circulation, increased erythropoiesis, and enhanced iron metabolism ^16-17. One of the primary physiological responses to exercise is improved cardiovascular function. Regular aerobic exercise enhances blood circulation, which promotes better oxygen delivery to tissues, including the placenta. This increased oxygen delivery may stimulate the production of erythropoietin (EPO), a hormone released by the kidneys in response to low oxygen levels (hypoxia). EPO stimulates erythropoiesis, the production of red blood cells in the bone marrow, which can help increase hemoglobin levels. As exercise increases oxygen demand, it may create a mild hypoxic environment, which in turn enhances EPO production and red blood cell synthesis ^18-19. Exercise also has a role in improving iron metabolism. Regular physical activity has been shown to increase the bioavailability of iron by enhancing its absorption in the gastrointestinal tract. Exercise-induced muscle contractions and improved circulation may facilitate better distribution and utilization of available iron stores. Moreover, physical activity can stimulate the release of hepcidin, a key regulator of iron homeostasis, which in turn can influence iron absorption and storage. In a balanced state, exercise can enhance iron metabolism, potentially mitigating the risk of iron deficiency anemia by ensuring that available iron is effectively used for hemoglobin production ^20-21. Additionally, exercise helps to regulate inflammation and oxidative stress, both of which can negatively affect hemoglobin levels. Regular moderate exercise has been associated with reduced systemic inflammation and lower levels of oxidative stress. Chronic inflammation is often observed in individuals with anemia and can disrupt iron metabolism and hemoglobin production. By promoting an anti-inflammatory environment, exercise can help optimize the body’s ability to produce hemoglobin and maintain adequate red blood cell levels. This is particularly important in preventing or managing anemia during pregnancy, as inflammatory conditions such as gestational hypertension or preeclampsia can exacerbate the impact of anemia ²².

 

Types of Exercise and Their Impact on Hemoglobin Levels

The relationship between different types of exercise and hemoglobin levels during pregnancy is complex and depends on the intensity, duration, and frequency of the activity. While all forms of exercise can improve cardiovascular health and circulation, certain types of physical activity are more likely to have a direct impact on hemoglobin levels and overall maternal health. The most commonly studied exercises in relation to hemoglobin levels during pregnancy are aerobic exercises, resistance training, and a combination of both ²³.

Aerobic Exercise

Aerobic exercises such as walking, swimming, cycling, and low-to-moderate intensity jogging are frequently recommended during pregnancy due to their low impact and safety profile. These exercises improve cardiovascular efficiency by increasing heart rate and promoting better oxygen delivery throughout the body, which may stimulate erythropoiesis, or red blood cell production, through the release of erythropoietin (EPO). Regular moderate aerobic activity also enhances blood flow and circulation, which helps deliver oxygen to the placenta and fetal tissues. In turn, this process can create a mild hypoxic environment that encourages the production of more red blood cells to increase hemoglobin levels. Furthermore, aerobic exercise has been shown to improve iron metabolism, facilitating better iron utilization and absorption, which is essential for maintaining adequate hemoglobin levels during pregnancy ²⁴.

Resistance Training

Resistance training, including activities such as weightlifting, squats, and body-weight exercises, also plays an important role in enhancing maternal health during pregnancy, though its impact on hemoglobin levels is less studied compared to aerobic exercise. This type of exercise helps improve muscle strength, endurance, and metabolic function, which can indirectly benefit hemoglobin levels. While resistance training does not directly promote erythropoiesis like aerobic exercises, it can stimulate increased circulation and enhance muscle efficiency, potentially contributing to better oxygenation of maternal tissues. However, high-intensity or excessive resistance training should be avoided, as it may increase the risk of injury or dehydration, especially in anemic pregnant women. When done in moderation, resistance exercises are a valuable component of a balanced fitness routine that supports overall health during pregnancy ²⁵.

Combined Exercise Regimens

In some cases, a combination of both aerobic and resistance exercises may be the most effective strategy for improving hemoglobin levels and maternal well-being during pregnancy. Combining moderate aerobic exercises with resistance training can offer a comprehensive approach that addresses both cardiovascular health and muscular strength. This combination allows pregnant women to experience the benefits of improved circulation, oxygen delivery, and red blood cell production from aerobic activity, while also building strength and endurance from resistance exercises. Research suggests that such balanced exercise routines can be more beneficial than engaging in a single type of exercise, as they promote better overall fitness and address multiple aspects of maternal health ²⁶.

Intensity and Frequency Considerations

While exercise can have a positive impact on hemoglobin levels, the intensity and frequency of exercise are key factors in determining its effectiveness. Moderate-intensity exercise, defined as an activity that raises heart rate but still allows for conversation, is generally recommended for pregnant women, especially those with anemia. High-intensity exercise may not be appropriate for women with anemia, as it can increase fatigue and oxidative stress, potentially exacerbating the condition. The American College of Obstetricians and Gynecologists (ACOG) recommends at least 150 minutes of moderate-intensity aerobic activity per week during pregnancy, which can be broken into smaller sessions of at least 10 minutes each. This frequency ensures that pregnant women can safely improve cardiovascular health without overburdening their body’s ability to maintain adequate hemoglobin levels²⁷.

Exercise Safety and Hemoglobin Considerations

While exercise can be beneficial for managing hemoglobin levels during pregnancy, it is essential for pregnant women, especially those with anemia, to consult with a healthcare provider before starting or modifying an exercise regimen. Inappropriate exercises or excessive intensity can pose risks, such as dehydration, premature labor, or exacerbation of anemia symptoms. Monitoring hydration, avoiding prolonged periods of high-intensity exercise, and adjusting exercise types based on energy levels are critical for ensuring that physical activity remains safe and effective. Additionally, tracking hemoglobin levels during pregnancy allows for timely interventions, including dietary adjustments or supplementation, should exercise alone not be sufficient to maintain healthy hemoglobin levels ²⁸.

Risks and Considerations

While exercise can offer significant benefits to pregnant women, particularly those at risk for anemia, there are several important risks and considerations that must be taken into account to ensure safety. The potential risks of exercise during pregnancy depend on various factors, including the woman’s baseline health, the type and intensity of exercise, and the presence of any pregnancy complications. In women with anemia, caution is particularly necessary, as strenuous physical activity can exacerbate fatigue, dehydration, and worsen iron deficiency ²⁹.

Risk of Overexertion and Fatigue

One of the primary risks of exercise for pregnant women, especially those with anemia, is overexertion. Anemia often leads to reduced oxygen-carrying capacity in the blood, which can cause fatigue, dizziness, and shortness of breath. Intense or prolonged exercise can place additional strain on the body’s cardiovascular system and further deplete energy reserves. Overexertion can worsen the symptoms of anemia, increase the risk of fainting, and may lead to premature labor if the body becomes excessively fatigued. To mitigate these risks, it is important for pregnant women with anemia to engage in moderate-intensity activities, such as walking or swimming, and to avoid high-intensity exercises that may lead to excessive fatigue ³⁰.

Dehydration and Electrolyte Imbalance

Another key consideration during exercise, particularly in pregnant women with anemia, is the risk of dehydration. Physical activity increases fluid loss through sweat and can also lead to increased urination. Dehydration can further reduce blood volume, impair oxygen delivery to tissues, and exacerbate symptoms of anemia, such as dizziness, weakness, and fatigue. It is important for pregnant women to stay well-hydrated before, during, and after exercise. Additionally, electrolyte imbalances may arise, particularly in cases of excessive sweating without proper fluid and electrolyte replenishment. Anemia can compound these issues, and it is crucial to ensure that women are consuming adequate fluids and electrolytes to maintain balance ^31-32.

Risk of Injury

Pregnant women, particularly those with anemia, are at an increased risk of injury during exercise. As the body’s physical condition changes throughout pregnancy, factors such as joint instability, altered balance, and changes in posture can make certain exercises more difficult and potentially dangerous. Anemia may further contribute to muscle weakness and fatigue, reducing coordination and reaction times, which increases the likelihood of falls and injuries. Low-impact exercises such as walking, swimming, and stationary cycling are generally safer, while high-impact exercises like running or jumping may increase the risk of musculoskeletal injuries. Resistance training should also be approached with caution, especially when heavy weights or improper techniques are involved. It is advisable to perform resistance exercises under supervision or guidance to ensure correct form and prevent strain or injury ³³.

Complications from Pre-existing Conditions

Pregnant women with pre-existing health conditions, such as hypertension, diabetes, or cardiovascular disease, should be especially cautious when engaging in exercise during pregnancy. These conditions, when coupled with anemia, can increase the risks associated with physical activity. For instance, preeclampsia, a condition characterized by high blood pressure and protein in the urine, can be exacerbated by overexertion and excessive physical strain. Additionally, women with chronic conditions may experience decreased circulation or compromised oxygen delivery, making them more vulnerable to the negative effects of strenuous exercise. It is important to consult with a healthcare provider before initiating any exercise program to ensure that it is tailored to individual health needs and pregnancy conditions ^34-35.

 

 

Monitoring and Adjusting Exercise Intensity

Pregnant women with anemia should closely monitor their energy levels and symptoms during exercise, adjusting the intensity as necessary to avoid overexertion. Using the “talk test,” where a woman should be able to talk comfortably while exercising, can help gauge appropriate intensity. If any symptoms such as dizziness, chest pain, shortness of breath, or excessive fatigue occur, exercise should be immediately stopped, and medical consultation should be sought. Additionally, regular monitoring of hemoglobin levels through routine blood tests is crucial in assessing the effectiveness of exercise as part of anemia management and in determining whether adjustments to exercise or diet are needed ³⁶.

Conclusion

Exercise during pregnancy, particularly for women with anemia, can offer significant health benefits, including improved circulation, better oxygen delivery, and enhanced iron metabolism, all of which may help in maintaining optimal hemoglobin levels. Aerobic activities, resistance training, and a combination of both have the potential to positively impact maternal health, promote erythropoiesis, and support overall physical well-being. However, it is crucial to balance exercise with caution, as women with anemia are at higher risk for overexertion, dehydration, and injury, all of which could worsen anemia symptoms or lead to pregnancy complications. Moderate-intensity exercise, when approached carefully, can stimulate the body’s adaptive mechanisms, including improved circulation and the efficient use of iron, helping to reduce the risk of anemia-related issues. Low-impact exercises such as walking, swimming, and stationary cycling are particularly safe and beneficial, while high-intensity or heavy resistance exercises should be avoided, especially in the presence of anemia or other pregnancy-related health conditions. Monitoring exercise intensity, staying hydrated, and adjusting activity levels based on fatigue and symptoms are essential to maintaining a safe exercise routine.

Conflict of Interest: Author declares no potential conflict of interest with respect to the contents, authorship, and/or publication of this article.

Source of Support: Nil

Funding: The authors declared that this study has received no financial support.

Informed Consent Statement: Not applicable. 

Data Availability Statement: The data supporting in this paper are available in the cited references. 

Ethics approval: Not applicable.

 

 

 

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