‘Athletes are frustrated’: Better guidance needed for pregnant, postpartum elite runners

Key takeaways:

• There is little guidance on the benefits and risks of elite training regimens for athletes during and after pregnancy.
• Research suggests pregnant athletes have fewer pregnancy complications than nonathletes.

Pregnancy and parenthood can bring added concerns for elite female athletes, who often face conflicting information about safety and risks for injury associated with intense sports training regimens during pregnancy and postpartum.

Research on injury risk during pregnancy and the postpartum period for elite athletes remains limited, according to Brooke McGregor, an academic tutor and graduate of a masters of research at the University of South Australia who specializes in the allied health and human performance unit. This is despite an increasing number of elite female athletes opting to train while pregnant and return to their sports successfully after delivery, McGregor said.

The lack of guidance can also impact the livelihoods of elite athletes, who heavily rely on corporate sponsors, sporting corporations and athletic governing bodies to fund and support their athletic endeavors, McGregor said.

McGregor and colleagues conducted a scoping review and a qualitative phenomenological research study for which they interviewed 19 mothering athletes in 14 countries to assess the challenges and experiences faced by elite athletes during pregnancy and motherhood. Their scoping review paper was recently published in the journal Sport in Society.

Healio spoke with McGregor about the barriers elite runners face during and after pregnancy, the state of current research on high-level training and safety during pregnancy, and new efforts to make change for women.

Healio: What led you and your colleagues to conduct this review?

McGregor: As a teenager, I was a national-level runner and part of an elite running team. I was fortunate to have that experience and be surrounded by elite athletes. One was a mothering athlete who had a child and then came back to sport. Chatting with her one day about her experience, I was shocked to hear that when she decided to have this pregnancy, she informed her government body and they took her funding away, because pregnancy was considered an “injury.” In any other field — if you are an accountant, if you are a teacher — there are pregnancy discrimination laws in place. You cannot be fired just for being pregnant. I wanted to use my former athlete perspective to see if I could find insights into what is going on.

Healio: What does research tell us about safety and risks for the pregnant person and the fetus when training at the elite level?

McGregor: We conducted a scoping review, so it was a summary of the current understanding of what is out there. There were concerns about training during pregnancy and many athletes highlighted those concerns. For female athletes, the data show they actually had better birthing outcomes and safer birthing experiences when training during their pregnancy when compared with non-athlete populations.

One of the challenges is there is not much literature available on, say, the risk of breastfeeding on injuries. To conduct proper research, you have to ask an elite athlete to take that time away from training to be able do, say, weekly study visits or interventions. Many of the available studies in this area are retrospective, conducted after the athlete has given birth. Evidence does suggest that training and the elite athlete lifestyle is safe. But there are no national or international guidelines on how to support elite athletes during pregnancy.

When we interviewed 19 athletes from 14 countries the biggest concern was whether training at the elite level is safe during pregnancy. The women interviewed all received conflicting information. This causes a lot of stress. Health professionals need to take a step back and ask ourselves if we feel informed on this topic. If not, then further research is necessary to support these women to feel safe while training while pregnant.

Healio: This paper delves into some social factors, such as child care, that impact an elite athlete’s decisions on whether to return to sport. In speaking with these elite athletes, what concerns did they raise?

McGregor: The biggest barrier seen in the scoping review was child care and access to child care. Because this research was specific to runners, they tend not to have a “team” atmosphere. They often do not have a manager or people to help them. Responses varied widely dependent on what country the runners were from. Someone from the United States said that childcare could cost them $45,000 for the year. On the other side, a Kenyan athlete said childcare is very affordable, adding that from a 1-week sponsorship they could pay for the entire year’s child care. That is worth thinking about. We often attribute the performance of the Kenyan athletes to training in high altitude and their VO₂ max, but a lot of it might be attributable to what she described. Social factors across countries and cultural factors matter.

Healio: Aside from issues with child care, what other barriers were described?

McGregor: Another barrier in elite sport is the lack of knowledge from health practitioners, mostly due to the lack of research out there. How to support elite training during pregnancy is not taught sufficiently enough in undergraduate or postgraduate research. Even just how to teach exercise professionals how to work with pregnant women is only now starting to develop as a specialty. If you want to work for an elite sport, there is a good chance now, because of the change in the landscape, that you will have to work with a mothering athlete or a pregnant athlete one day. Academic institutions need to make sure exercise and health professionals feel comfortable with how to best support mothering athletes and the general population who want to exercise during pregnancy.

Additionally, most of the biggest sportswear companies in the world do not make maternity wear. That is difficult for athletes who are contractually obligated to wear these items and they do not fit them anymore. Sponsors need to do better to support these women with suitable clothing to wear throughout their pregnancies.

Healio: What are the top takeaways from this paper?

McGregor: For an elite athlete, having a pregnancy and becoming a mother is safe and achievable. Women may perform better athletically after giving birth than before. That idea is only now starting to develop in the social consciousness, but still it is not widely believed.

For runners to qualify for the Olympics or world championships, they must run a certain time and earn ranking points by traveling to large competitions. Theoretically, that sounds great; you have athletes going to meets all over the world to compete for these spots. What becomes challenging is many race directors have refused entry to athletes who qualified before, but then later became pregnant. Athletes are frustrated.

In Australia, marathon champion Jessica Stenson ran an Olympic qualifier and ran a personal best in the marathon, 5 months after giving birth. It is incredible. People are realizing they can run closer to pregnancy. For Stenson, it was the last chance she had to qualify for the Olympics, and she did it and she qualified so soon after giving birth.

We are going to start seeing more evidence on safety in the coming years. But the biggest takeaway is every pregnancy is unique and we should not take a cookie-cutter approach, especially when dealing with elite athletes. As health care practitioners and researchers, we must steer away from one-size-fits-all guidance.

Thankfully, there are nonprofit groups out there, like &mother, providing support for these women, with races now including breastfeeding stands and prams to run with. We must be more inclusive and provide mechanisms to support these women to be physically active.

References:

• &mother. https://www.andmother.org/. Accessed July 12, 2024.
• McGregor B, et al. Sport Soc. 2024;doi:10.1080/17430437.2023.2270438.

For more information:

Brooke McGregor can be reached at brooke.mcgregor@unisa.edu.au.