Is Maternal Core Temperature Elevated Beyond a Critical Threshold During Exercise in Pregnancy?
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. State potential risks associated with elevated maternal core temperature 2. Discuss the results obtained from the meta-analysis by Ravanelli et al. regarding maximal core temperatures reached during pregnancy by women participating in exercise, hot tub and sauna activities
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from April 8 2018 through 07/15/2022, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
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Animal model evidence and retrospective studies in humans have demonstrated increased risk of fetal malformations in the setting of severe hyperthermia (primarily related to fever)
Maternal core temperature exceeding 39.0°C (or an elevation of ~1.5°C to 2.0°C from baseline) has been suggested as the critical threshold to avoid additional risk of birth defects, especially neural tube defects
ACOG, RANZCOG and RCOG discourage prenatal use of hot tubs and saunas and to avoid heat and humidity during pregnancy
Exercise during pregnancy is recommended, however
Concern that more intensive exercise may result in increased maternal core temperature
Alternatively, thermoregulation may keep core temperature below a critical level
Ravanelli et al. (British Journal of Sports Medicine, 2018) examined whether exercise and passive heat stress can negatively impact pregnancy by elevating core temperature to a critical level beyond 39.0°C
Systematic review and meta-analysis
Studies were included that reported the core temperature response of pregnant women
The critical core temperature for teratogenicity risk was defined as ≥39.0°C
The core temperature was measured during any period of gestation in response to exercise or passive heat stress
Data was pooled from 12 studies, for a total of 347 subjects
There were no reports of any core temperature exceeding the recommended maternal threshold of 39.0°C
Overall, 38.9°C was the highest reported individual core temperature
The highest mean end-trial core temperature was
38.3°C (95% CI 37.7°C to 38.9°C) for land-based exercise
37.5°C (95% CI 37.3°C to 37.7°C) for water immersion exercise
36.9°C (95% CI 36.8°C to 37.0°C) for hot water bathing
37.6°C (95% CI 37.5°C to 37.7°C) for sauna exposure
This study suggests that pregnant women at any gestational stage can safely engage in
Exercise for up to 35 min at 80%–90% of their maximum heart rate in 25°C temperature and 45% relative humidity
Water immersion (≤33.4°C) exercise for up to 45 min
Sitting in hot baths (40°C) or hot/dry saunas (70°C; 15% relative humidity) for up to 20 min
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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