Pilates During Pregnancy: Is It Safe? A Trimester-by-Trimester Guide
By Katherine, Lead Instructor, Certified Pilates Instructor · Last updated: September 2026
Pilates, adapted for pregnancy, is considered safe for most people with an uncomplicated pregnancy once their prenatal care provider has cleared them. The American College of Obstetricians and Gynecologists (ACOG) and the 2019 Canadian guideline from SOGC and CSEP both support exercise throughout pregnancy for those without contraindications, but positions and intensity need adjusting as pregnancy progresses.
Key takeaways
For most uncomplicated pregnancies, ACOG and the Canadian SOGC/CSEP guideline both support prenatal exercise with medical clearance, and Pilates can be adapted to fit that guidance (ACOG, 2020; Mottola et al., 2018).
Some conditions are contraindications to exercise. These lists are not exhaustive — always confirm with your own obstetric provider.
What changes most by trimester: balance and fall risk, comfort lying on your back, and how much your centre of gravity has shifted.
Reformer Pilates can typically be adapted throughout pregnancy with instructor modifications, but it is not a substitute for individualized medical clearance.
Know the warning signs that mean stop exercising and call your care provider right away.
Is Pilates safe during pregnancy?
In the absence of obstetric or medical contraindications, ACOG describes physical activity in pregnancy as "safe and desirable," and states pregnant women should be encouraged to continue or initiate safe activity (ACOG Committee Opinion 804, 2020). Observational data cited by ACOG associate regular prenatal activity with a lower likelihood of gestational diabetes, caesarean birth and operative vaginal delivery, and a shorter postpartum recovery.
The 2019 Canadian guideline, developed jointly by SOGC and CSEP and endorsed by organizations including the Canadian Association of Midwives and ParticipACTION, goes further: it frames prenatal activity as a "foundational shift" from optional lifestyle advice toward "a specific prescription for physical activity to reduce pregnancy complications and optimize health across the lifespan of 2 generations" (Mottola et al., 2018). In plain terms, the guideline states that all pregnant women can take part in physical activity throughout pregnancy except those with contraindications.
Pilates fits well within this picture because it is low-impact, can be closely controlled for intensity, and is easy to individualize — which is exactly what changes as pregnancy progresses. That said, "safe" does not mean "no modifications needed." The rest of this guide covers what typically changes, what to avoid, and when to stop and call your provider.
We are not medical professionals, and this article is not a substitute for advice from your own obstetric care provider. See the safety note below for specifics.
Who should not do Pilates during pregnancy, or should check with a doctor first?
Both ACOG and the SOGC/CSEP guideline identify absolute contraindications — situations where structured exercise such as Pilates is not recommended, although usual daily activities can generally continue — and relative contraindications, where the decision should be made individually with your obstetric provider after weighing benefits and risks.
Examples of absolute contraindications include heart disease that significantly affects blood flow (hemodynamically significant heart disease), restrictive lung disease, an incompetent cervix or cerclage, and a multiple pregnancy at risk of premature labour (ACOG Committee Opinion 804, 2020). A broader comparative review of international guidelines also lists placenta previa later in pregnancy (the exact cut-off differs between guidelines), preeclampsia, premature rupture of membranes, and active preterm labour or contractions among commonly cited absolute contraindications (Evenson et al., 2014).
Examples of relative contraindications — where you and your provider weigh the specifics — include severe anemia, poorly controlled type 1 diabetes, poorly controlled hypertension or a seizure disorder, poorly controlled hyperthyroidism, and being extremely underweight or living with extreme obesity (ACOG Committee Opinion 804, 2020).
These lists are partial, not exhaustive. Neither summary above should be used to self-screen. Every prenatal client should be individually screened by their obstetric provider before starting or continuing a Pilates program. A useful Canadian starting point is the CSEP Get Active Questionnaire for Pregnancy, an evidence-informed self-screening form developed with SOGC, the College of Family Physicians of Canada and the Canadian Physiotherapy Association's Women's Health Division. You complete it yourself and bring it to your prenatal care provider if it flags anything. Bring any concerns, and this questionnaire if you like, to your prenatal appointment before your first class with us.
Pilates trimester by trimester: what typically changes
There is no single "pregnancy workout" — what feels good and what needs adjusting shifts as your body and the pregnancy change. Here is a general picture; your own experience, and your provider's guidance, should always take priority.
First trimester (weeks 1–13)
Many people feel able to continue much of their regular routine, though fatigue and nausea are common and are valid reasons to scale back intensity on a given day. This is a good time to confirm clearance with your provider and let your instructor know you are pregnant, even before it shows, so your program can be built around it from the start.
Second trimester (weeks 14–27)
Balance begins to shift as the uterus grows and your centre of gravity moves. This is typically when instructors start limiting time spent lying flat on your back (more on this below) and watching more closely for positions that feel unstable. Many people find this the most comfortable trimester for exercise.
Third trimester (weeks 28 and beyond)
Balance tends to become more challenging as your centre of gravity shifts further forward, and comfort lying face-down largely disappears as the abdomen grows. Sessions typically shift further toward supported positions, side-lying and standing or seated work, with lower ranges of motion and more rest breaks. When and how to return after your baby arrives is covered in our guide to starting Pilates after giving birth.
What movements or positions need to be modified during pregnancy?
A few specific modifications come up across almost every prenatal guideline and are worth understanding in plain terms.
Lying on your back (supine position). The Canadian guideline's own wording is that "pregnant women who experience light-headedness, nausea or feel unwell when they exercise flat on their back should modify their exercise position to avoid the supine position" (2019 Canadian Guideline, plain-language summary, CSEP). Some older guidelines advised avoiding lying on your back after the first trimester because the enlarged uterus can press on major blood vessels and reduce blood flow back to the heart (Evenson et al., 2014); the current Canadian guideline instead bases this on how you feel, so many instructors limit sustained time on the back from the second trimester as a precaution. If you ever feel dizzy, nauseated or unwell lying on your back, that is your own body's signal to change position — roll to your side right away.
Fall risk. Balance-challenging positions (single-leg work, unstable footing, some standing reformer exercises) are typically simplified or given extra support as pregnancy progresses, since ACOG specifically flags activities with a high risk of falling as needing caution during pregnancy (ACOG Committee Opinion 804, 2020).
Overheating. Studios should be kept comfortably cool, hydration encouraged, and intensity dialled back on hot days — excessive body heat and exercising in hot or humid conditions are cautions flagged across prenatal exercise guidelines (Evenson et al., 2014).
Breath-holding. Sustained breath-holding against effort (a Valsalva-type manoeuvre) is generally avoided in favour of continuous, steady breathing throughout each exercise (Evenson et al., 2014).
Deep twisting. Full spinal rotation, especially combined with flexion, is typically reduced in range as the pregnancy progresses and the abdominal wall changes.
Lying face-down. Prone (face-down) positions become uncomfortable and are usually phased out later in pregnancy as the abdomen grows; side-lying or supported alternatives replace them.
None of this means Pilates becomes "gentle" across the board — many people continue meaningful strength work throughout pregnancy. It means the positions and intensity are chosen deliberately, session by session.
Is reformer Pilates safe during pregnancy?
Reformer Pilates can typically be adapted throughout pregnancy using the same principles as mat work: limiting sustained time on the back, avoiding face-down positions later on, moderating balance-challenging setups, and adjusting spring tension and range of motion as needed. The reformer's carriage and straps can also make some supported positions (side-lying, seated, kneeling) easier to set up safely than they are on a mat.
There is no dedicated, high-quality clinical research specifically on reformer Pilates in pregnancy that we are aware of — the safety guidance above comes from applying the general prenatal exercise principles set out by ACOG and the SOGC/CSEP guideline, not from reformer-specific trials. If you already have a reformer practice, tell your instructor as soon as you know you are pregnant so your setups can be adjusted proactively rather than reactively.
Should you take a prenatal-specific Pilates session or stay in your regular class?
A private or small, prenatal-aware setting has a practical advantage during pregnancy: your instructor can adjust exercises, spring tension and positioning in real time as your pregnancy changes week to week, rather than you having to modify on your own inside a general class built for a broader group. This matters most in the second and third trimesters, when the changes above (balance, supine tolerance, comfort face-down) tend to move fastest.
That said, a general class is not automatically unsafe in early pregnancy — the deciding factors are your own comfort, your provider's clearance, and whether the instructor knows you are pregnant and can adapt the class format for you in the moment. If you are unsure which setting fits you right now, our Private vs Group Pilates guide walks through the tradeoffs in more general terms.
What about your core and pelvic floor during pregnancy?
Pregnancy changes how the abdominal wall and pelvic floor work, and it is reasonable to want your Pilates practice to support both. Two clarifications are worth knowing going in.
First, on the pelvic floor: a systematic review found that generic Pilates — mat or reformer work without deliberate pelvic floor cueing — does not reliably strengthen the pelvic floor on its own. Benefit appears to depend on the instructor explicitly cueing correct pelvic floor engagement, similar to dedicated pelvic floor muscle training (Lemos et al., 2019; Gonzaga et al., 2024). This evidence is low to moderate in quality, comes from small trials, and none of it was in pregnant women. We go into this in more depth, including who should see a pelvic health physiotherapist, in Pilates for Your Pelvic Floor.
Second, on the abdomen: many people notice the abdominal muscles separating along the midline (diastasis recti) as pregnancy progresses. What to do about it, and which core exercises to prioritize or avoid, is covered in our guide to diastasis recti and Pilates.
Lower back and pelvic pain are common in pregnancy. If they are part of your picture, tell your instructor so positions and loads can be adjusted — see Pilates for Sciatica if nerve-related pain down the leg is involved, and speak with your provider or a physiotherapist if pain is severe, sudden, or accompanied by any of the warning signs below.
What are the warning signs to stop exercising and call your doctor?
Stop exercising immediately and contact your obstetric care provider if you experience any of the following during or after a Pilates session:
Vaginal bleeding
Fluid leaking from the vagina
Regular, painful contractions
Abdominal or pelvic pain
Dizziness, light-headedness or feeling faint
Shortness of breath before you have even started exerting yourself
Chest pain, tightness or heart palpitations
Calf pain or swelling (this can signal a blood clot)
Headache
Muscle weakness affecting your balance
Decreased fetal movement
This list combines warning signs commonly cited across international prenatal exercise guidelines, including earlier and current ACOG guidance (Evenson et al., 2014; ACOG Committee Opinion 804, 2020). It is general information, not a diagnostic checklist — when in doubt, stop and call your provider rather than waiting to see if a symptom passes.
Safety note: This article is general information, not medical advice, and it does not replace an individual assessment. Before starting or continuing Pilates in pregnancy, get clearance from your family doctor, obstetrician, midwife or other prenatal care provider, and tell your Pilates instructor that you are pregnant and roughly how far along you are. We adapt sessions around the guidance your care provider gives you; we do not diagnose conditions, and we work alongside your health care provider rather than replacing them. Stop exercising and seek care right away if you notice any of the warning signs listed above, and always follow your own provider's individual instructions if they differ from the general guidance in this article.
Working on a prenatal Pilates practice with us in Markham
If you are pregnant and want a Pilates practice that adapts with you week to week, our Private 1:1 Pilates with Instructor (1 hr) sessions can be tailored trimester by trimester once you have clearance from your prenatal care provider. A private setting lets your instructor adjust positioning, intensity and equipment setup to exactly where you are that week, rather than fitting you into a fixed class format. If you are in Markham, Unionville, Richmond Hill, Thornhill or north Scarborough and would like private sessions adapted to your pregnancy, you can book online and let us know you are expecting when you book.
Frequently asked questions
Can I start Pilates for the first time while pregnant?
If you have clearance from your prenatal care provider and no contraindications, starting Pilates during pregnancy is generally supported by both ACOG and the Canadian SOGC/CSEP guideline, which encourage previously inactive women to begin appropriate activity in pregnancy rather than waiting until after birth (ACOG, 2020; Mottola et al., 2018). Start at a lower intensity than you would as an established exerciser, and tell your instructor you are new to Pilates and pregnant so your program is built accordingly.
How late in pregnancy can I keep doing Pilates?
The Canadian guideline states that women without contraindications should be physically active throughout pregnancy (Mottola et al., 2018), so many people continue adapted Pilates into the third trimester as long as their prenatal care provider keeps clearing them and no warning signs appear. Expect sessions to shift toward supported, side-lying and seated work as your due date approaches.
Is it safe to do abdominal exercises like the hundred or roll-ups while pregnant?
Classic deep spinal flexion and loaded abdominal work are usually modified or replaced as pregnancy progresses, especially once lying on your back becomes uncomfortable or your abdomen has grown noticeably. Your instructor will typically substitute alternatives that still work the core without that specific movement pattern; ask them directly at your first prenatal session.
Can Pilates help with pregnancy-related back pain?
Whether a particular exercise will ease back pain in pregnancy depends on its cause, and that's a question for your prenatal care provider rather than a general article. If back pain is persistent, severe, or radiates down a leg, speak with your provider or a pelvic health physiotherapist before continuing, and we'll adapt your sessions around what feels comfortable. Our guide to Pilates and sciatica covers what to avoid if nerve-type symptoms are involved.
Is it safe to lie on my back during Pilates while pregnant?
The Canadian guideline advises that if you feel light-headed, nauseated or unwell exercising flat on your back, you should change position to avoid lying on your back (CSEP). Many instructors also shorten time on the back from the second trimester as a precaution and offer side-lying, seated or inclined alternatives.
Sources
American College of Obstetricians and Gynecologists (2020). Physical Activity and Exercise During Pregnancy and the Postpartum Period: ACOG Committee Opinion, Number 804. Obstetrics & Gynecology, 135(4), e178–e188. https://pubmed.ncbi.nlm.nih.gov/32217980/
Mottola MF, Davenport MH, Ruchat SM, et al. (2018). 2019 Canadian guideline for physical activity throughout pregnancy. British Journal of Sports Medicine, 52(21), 1339–1346. https://pubmed.ncbi.nlm.nih.gov/30337460/
Canadian Society for Exercise Physiology. Pregnancy – 24-Hour Movement Guidelines (plain-language summary). https://csepguidelines.ca/guidelines/pregnancy/
Canadian Society for Exercise Physiology. Get Active Questionnaire for Pregnancy. https://csep.ca/2021/05/27/get-active-questionnaire-for-pregnancy/
Evenson KR, Barakat R, Brown WJ, et al. (2014). Guidelines for Physical Activity during Pregnancy: Comparisons From Around the World. American Journal of Lifestyle Medicine, 8(2), 102–121. https://pmc.ncbi.nlm.nih.gov/articles/PMC4206837/
Lemos AQ, Brasil CA, Valverde D, Ferreira JDS, Lordêlo P, Sá KN (2019). The pilates method in the function of pelvic floor muscles: Systematic review and meta-analysis. Journal of Bodywork and Movement Therapies, 23(2), 270–277. https://pubmed.ncbi.nlm.nih.gov/31103107/
Gonzaga S, de Oliveira RG, Dutra LL, Oliveira LS, de Oliveira LC (2024). Comparative analysis of pelvic floor muscle training and Pilates in managing urinary incontinence among postmenopausal women: a randomized controlled trial. International Urogynecology Journal. https://pubmed.ncbi.nlm.nih.gov/38206341/
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