The aforementioned recommendations are intended for women who do not have any additional risk factors for adverse maternal or perinatal outcome. A number of medical or obstetric conditions may lead the obstetrician to recommend modifications of these principles.

The following conditions should be considered contraindications to exercise during pregnancy:

•  Pregnancy-induced hypertension
• Preterm rupture of membranes
• Preterm labor during the prior or current pregnancy or both
• Persistent second  or third trimester bleeding
• Intrauterine growth retardation

In addition, women with certain other medical or obstetric conditions, including chronic hypertension or active thyroid, cardiac, vascular or pulmonary disease, should be evaluated carefully in order to determine whether an exercise program is appropriate.

While not necessarily contraindications there are a few conditions or discomforts that may be present during pregnancy that individuals with a disability need to be aware of.

Fatigue

While fatigue is common for most pregnant women it can play a more significant role in women with a mobility disability. For example she may struggle more with transfers or activities of daily living which she will have to take into account. She may also need to note if it is typical fatigue associated with pregnancy of it is a disability exacerbation.

Women with MS may need to consider that fatigue is a symptom of an exacerbation because it is one of the most commonly experienced symptoms. "Women must be very careful to get adequate rest, and to report their symptoms to their doctors in case they need medication adjustment or other treatment. Occasionally a corticosteroid may be given if the woman has an exacerbation" (Damek and Shuster 1997).

Urinary Tract Infection (UTI)

A UTI is another common pregnancy discomfort for many women both with and without a disability though women who are more prone to UTIs because of their disability are more likely to experience them during pregnancy. Self-catheterization may also become an issue due to the enlargement of the belly.

Autonomic Dysreflexia

Autonomic dysreflexia which is typically only present in injuries above the T6 level may become more prevalent during pregnancy. It is important for these women to be aware of the symptoms and determine the cause so that it can be treated. If left untreated it can become life threatening.

Edema

Edema or swelling is very common with pregnancy. For individuals with limited movement they most likely have limited circulation which in turn can increase swelling. Precautions may need to be taken like wearing compression stockings. (Amaragiri and Lees 2000).

Back Pain

“Back pain is common both for women with and without disabilities during pregnancy due to the following reasons:

• During pregnancy hormones cause ligaments to relax, and pelvic joints to become less stable (this is an advantage during childbirth)
• The abdominal muscles are stretched and weakened as the uterus grows, which causes the back muscles to work harder
• The weight of the uterus puts additional strain on the lower back muscles.”

Women with a disability may be more susceptible to back pain and may experience it earlier in their pregnancy. It is important to consult with your doctor or physical therapist for treatment options which many include exercises to help strengthen the muscles when possible.

Mobility

With all the other discomforts it is apparent that pregnancy can affect mobility in individuals with a mobility disability. The effect on transferring alone can play a huge role in the independence. It is important to work with your doctor and physical therapy team to have an exercise program in place to avoid any permanent loss in mobility or function.