What Actually Stops Pregnant Women from Exercising
Physical activity during pregnancy reduces the risk of preeclampsia, gestational diabetes, excessive weight gain, preterm birth, and postpartum depression. It improves infant cardiac function and decreases the likelihood of operative deliveries and birth trauma.
Despite these benefits, only 52% of pregnant women meet recommended physical activity levels during pregnancy.
The question isn't whether pregnant women should exercise. It's why half of them aren't able to, even when they know the benefits.
A study published in Women's Health analyzed data from 293 pregnant women in the National Institutes of Health All of Us Research Program and found that social determinants of health—income, education, marital status, and access to supportive relationships—significantly influence health perception, quality of life, and objective physical activity during pregnancy.
Your ability to exercise during pregnancy isn't just about motivation or knowledge. It's about what's happening in the rest of your life.
The Research: Linking Social Factors to Activity
Researchers from the University of Kentucky and East Carolina University conducted a secondary analysis of survey data and Fitbit activity tracking from the NIH All of Us database. They included pregnant women over age 18 who had completed demographic surveys, social determinants of health surveys, health perception surveys, and had at least one day of Fitbit data during pregnancy.
The final sample included 293 participants, 84% of whom identified as White. All participants identified their gender as "woman."
The researchers extracted several variables:
Demographics: race, education level, marital status, employment status, annual household income
Social determinants: access to public transit, neighborhood crime, supportive relationships
Health-related quality of life: health perception and quality-of-life perception
Physical activity: average daily Fitbit data for lightly active minutes, very active minutes, and steps
Then they analyzed the relationships between these variables using one-way ANOVA and Tukey pairwise comparisons.
Finding #1: Income, Education, and Support Influence Health Perception
Women who reported higher household incomes (>$200,000 or $50,000-$200,000 annually) had significantly better health perceptions than those earning <$10,000-$50,000 per year.
Women with college degrees or advanced degrees reported better health perceptions than those with high school diplomas, GEDs, or some college education.
Married women reported better health perceptions than unmarried women.
And women who reported they could "often" find companionship when they wanted it had significantly better health perceptions than those who reported "sometimes" or "rarely" finding companionship.
These aren't just interesting correlations. They reflect real barriers and supports that shape how women experience pregnancy.
Finding #2: The Same Factors Influence Quality of Life
The pattern held for quality-of-life perception. Women with higher incomes, more education, marriage, and frequent access to companionship reported significantly better quality of life during pregnancy than those without these resources.
Quality of life during pregnancy isn't just about physical symptoms or fetal development. It's about whether you have financial stability, health literacy, a supportive partner, and people who can help when you need them.
Finding #3: Better Health Perception = More Physical Activity
Here's where perception connects to behavior.
Women who rated their health as "excellent" participated in significantly more very active minutes per week than those who rated their health as "good" or "fair." They also had higher step counts than those rating their health as "fair."
Women who rated their quality of life as "excellent" had more very active minutes than those rating "very good" or "good."
The relationship works both ways. Physical activity improves how you feel, which improves your perception of your health and quality of life. And better health perception makes you more likely to engage in physical activity.
But if you're dealing with financial stress, limited education about exercise safety, no partner support, and few people to help with daily demands—your health perception suffers, and so does your activity level.
What This Means: Barriers Are Structural, Not Individual
When pregnant women don't meet activity recommendations, the default assumption is often lack of motivation or knowledge. Just educate them more. Just tell them it's important.
But this research shows that many barriers are structural, not individual.
Income affects access to safe places to exercise, time availability (when you're working multiple jobs), ability to afford gym memberships or childcare, and stress levels that make exercise feel impossible.
Education influences health literacy—understanding how to exercise safely during pregnancy, what intensity is appropriate, and how to modify movements as pregnancy progresses.
Marital status and social support provide companionship for physical activity (a walking partner), assistance with household tasks so you have time and energy to exercise, and emotional encouragement when pregnancy symptoms make movement difficult.
These aren't things you can fix with a motivational Instagram post or a generic "you've got this" from a healthcare provider.
What Providers Can Do Differently
If you work with pregnant women, this research has direct implications for how you screen and support them.
Screen for social determinants, not just medical contraindications. Ask about income stability, education background, living situation, and social support. These factors predict who will struggle to meet activity recommendations.
Connect women to community resources. Community-based programs for pregnant women, accessible educational materials (text reminders, apps, simple handouts), and social support networks can help address barriers that individual counseling can't fix.
Use technology-based interventions. Recent studies have shown success with text message reminders, smartphone apps with educational content, and video-based exercise demonstrations. These are low-cost, scalable interventions that meet women where they are.
Provide specific, actionable guidance. Generic advice to "exercise 30 minutes most days" doesn't help a woman who doesn't know what exercises are safe, doesn't have childcare, or works two jobs. Specific recommendations—"walk for 10 minutes three times today," "try these three exercises at home"—are more useful.
Acknowledge real constraints. Some women face barriers that can't be resolved during pregnancy. Validating those constraints while problem-solving around them is more effective than pretending everyone has equal access to time, space, and support for exercise.
What Pregnant Women Can Do
If you're pregnant and struggling to stay active, this research validates what you probably already know: it's not just about willpower.
But here's what the data also shows—women who do find ways to stay active report better health and quality of life during pregnancy. The relationship is bidirectional. Movement improves how you feel, which makes you more likely to keep moving.
Find what works for your life, not someone else's ideal. You don't need a gym membership or an hour-long workout. Walking counts. Taking the stairs counts. Playing with older children counts. Ten minutes three times a day is more sustainable than forcing yourself into a 30-minute block you don't have.
Ask for help. If you have a partner, ask them to take over a chore so you have 15 minutes to walk. If you have friends or family nearby, see if they'll walk with you. Social support isn't just nice to have—it's a predictor of activity level.
Use free resources. Pregnancy exercise apps, YouTube videos, and library books cost nothing. If education is a barrier, these tools can help you understand what's safe and effective.
Talk to your provider about barriers. If you can't afford childcare, don't have a safe place to walk, or work hours that make exercise nearly impossible, tell your provider. They may be able to connect you to resources or help you problem-solve.
The Bigger Picture
Physical activity during pregnancy isn't just a personal health behavior. It's influenced by income, education, social support, and structural factors that aren't equally distributed.
The evidence is clear: women who participate in more physical activity during pregnancy have better maternal and fetal outcomes. But the ability to participate isn't equal.
Understanding these relationships helps providers offer better support and helps pregnant women contextualize their own experiences. If you're struggling to stay active, it's not a personal failure. And if you're supporting someone through pregnancy, recognizing their full context is essential.
Movement during pregnancy improves health outcomes. But access to movement isn't just about knowledge or motivation—it's about resources, support, and structural factors that shape what's actually possible.
Source: Nowell, K., Dlugonski, D., DeFranco, E., May, L., Hawk, G.S., & Hoch, J.M. (2025). Relationship between social determinants of health, health-related quality of life, health perceptions, and physical activity during pregnancy. Women's Health, 21, 1-11. https://doi.org/10.1177/17455057251407854
