A Scientific Guide to Exercise During Pregnancy for Surrogate Mothers

Introduction: The Special Characteristics and Necessity of Exercise for Surrogate Mothers

The health management of surrogate mothers directly affects embryonic development and pregnancy outcome. Exercise during pregnancy is not only a key means to control weight and prevent complications, but also a core strategy to relieve psychological stress and optimize delivery. This article combines international guidelines and industry practice to systematically analyze the principles and programs of exercise for surrogate mothers to ensure scientific and safety.

The medical value and core principles of exercise for surrogate mothers

1. Five major benefits of exercise for surrogate mothers
   Metabolic regulation: regular exercise can reduce the risk of gestational diabetes by 30%.
   Bone protection: Yoga and core training during pregnancy can relieve lumbar lordosis and pelvic pain, with an improvement rate of 45%.
   Psychological stress reduction: Positive thinking meditation combined with low-intensity aerobic exercise (e.g. walking) can reduce anxiety levels.
   Labor optimization: Pelvic floor muscle training (Kegel exercises) improves the rate of normal delivery by 22%, especially for those with a history of cesarean section.
   Fetal health promotion: moderate exercise increases placental blood oxygen supply and reduces the risk of fetal growth restriction.
2. Three core principles of surrogate pregnancy exercise
   Priority of safety: high-risk programs (e.g. horseback riding, scuba diving) are prohibited and need to comply with the terms of the surrogacy contract.
   Individualized customization: combined with the embryo transfer method, maternal BMI and underlying diseases to develop a program.
   Dynamic monitoring: assess the fetal heart rate, cervical length and maternal blood pressure every two weeks and adjust the exercise intensity.

Recommended exercise types and intensity specifications

1. Aerobic exercise
   Walking/variable speed walking: for the whole pregnancy (except for high-risk pregnancy), 30-60 minutes for a single session, 1-2 times a day. Prefer indoor treadmill to avoid external risk, heart rate control at 50%-70% of the target heart rate (220-age), for example, 30-year-old surrogate mother’s heart rate should be maintained at 95-133 beats per minute.
   Swimming/water exercise: carried out after 16 weeks of pregnancy, 20-30 minutes in a single session, 2-3 times a week. The water temperature should be controlled at 28-32℃. Avoid diving action, the buoyancy of water can reduce the pressure on joints and enhance the cardiopulmonary function.
2. Flexibility and strength training
   Yoga for pregnant women: start after 12 weeks of pregnancy, 20-40 minutes per session, 3-5 times a week. Avoid hot yoga and inversions, and focus on the cat and cow pose, butterfly pose and other movements to relieve low back pain.
   Resistance training: 14-32 weeks of pregnancy, single 15-20 minutes, 2 times a week. Use elastic bands instead of dumbbells, load ≤1.5kg, strengthen the lower limbs and core muscles.
3. Specialized training for pelvic floor muscles
   Kegel exercise: 2-3 times a day after 16 weeks of pregnancy, 10-15 minutes each time. Combined with biofeedback equipment to quantify the strength of contraction, to prevent urinary incontinence and to strengthen the labor muscles.
4. Exercise intensity quantification standard
   Subjective fatigue scale (RPE): Maintain a score of 13-14 (subjective feeling of “slightly strenuous but conversational”).
   Hydration and monitoring: hydrate before, during and after exercise to avoid dehydration and high body temperature. If symptoms such as vaginal bleeding, regular contractions or dizziness occur, stop exercising immediately and seek medical attention.

Exercise contraindications and alternatives for high-risk groups

1. Absolute contraindication groups
   Multiple pregnancies: only bedside ankle pump training is allowed; moderate to high intensity activities are prohibited.
   Cervical insufficiency: absolute bed rest until 34 weeks of pregnancy, especially if there is a history of cerclage.
   Placenta praevia/hypertension of pregnancy: only passive joint activity is allowed if systolic blood pressure is ≥160 mmHg.
2. Alternative interventions
   Respiratory training: abdominal breathing combined with diaphragmatic activation, 3 sets x 10 repetitions per day to improve oxygen saturation.
   Upper extremity circulation training: use grip ball (pressure ≤2kg) to prevent thrombosis and promote peripheral circulation.
   Music therapy: alpha wave music intervention for 20 minutes each time to reduce cortisol levels.

Sports Safety Management and Legal Ethics

1. Risk warning and emergency plan
   Immediate stop sign: vaginal bleeding, 50% reduction in fetal movement, abnormal blood glucose (<3.3 mmol/L or >13.9 mmol/L).
   Emergency treatment: Oxygen intake in left lateral position (4L/min), transfer to a hospital qualified in preterm labor resuscitation within 20 minutes.
2. Insights from legal dispute cases
   Case 1: In 2024, a surrogate mother in Florida claimed $120,000 for fetal tachycardia caused by private hot yoga. Takeaway: Contracts need to specify type of exercise and monitoring responsibilities.
   Case 2: A Ukrainian agency’s failure to screen for cervical insufficiency resulted in a miscarriage at 18 weeks gestation, and the law found the agency 70% liable. Takeaway: Mandatory early pregnancy cervical assessment and inclusion in health records.

Postpartum Exercise Rehabilitation and Long-Term Health

Surrogates with normal delivery: initiate low-intensity training (e.g., abdominal breathing) after pelvic floor assessment at 6 weeks postpartum.
Cesarean section surrogates: 8 weeks after surgery and after wound healing, prioritize water rehabilitation to avoid abdominal pressure.
Long-term follow-up priorities: annual testing of fasting blood glucose, bone density, and quarterly assessment of PTSD risk for 1 year postpartum.

Conclusion: Building a scientific and humanized exercise ecology

Pregnancy exercise for surrogate mothers needs to integrate reproductive medicine, exercise science and legal and ethical resources to promote three major changes:

Technological innovation: develop surrogate-specific wearable devices to monitor contractions and fetal heart rate in real time;
Legal Improvement: Develop an International White Paper on Surrogacy Exercise Safety to standardize risk assessment criteria;
Ethics education: mandatory course on “Surrogacy’s Right to Know” for commissioning families.