Pregnancy

• Not all pregnancies are being treated equally in Super Netball, opens in a new tab, Brittany Carter, ABC News, (22 March 2023). An important detail missing in Super Netball's parental leave policy will be a key focus throughout the bargaining process of the next collective player agreement (CPA), which is being worked through by Netball Australia (NA) and the Australian Netball Players' Association (ANPA).
• FIFA’s landmark parental leave ruling puts women’s sport on notice, opens in a new tab, Angus Dalton, Sydney Morning Herald, (20 January 2023). The football world, and sport at large, is on notice after FIFA made a landmark discrimination ruling against one of Europe’s biggest clubs for their underpayment of a player on maternity leave.
• From one mom to another: Tips for being active after welcoming a new baby, opens in a new tab, Corliss Bean, Iris Lesser and Talia Ritondo, SIRC blog, (4 May 2022). In this blog, we outline key considerations for new moms based on the advice of the postpartum women in our research. We also offer tips for returning to movement with the aim of optimizing physical and mental health during the postpartum period.
• Elite athletes shouldn’t have to choose between their sport and pregnancy, opens in a new tab, Margie Davenport, Tara-Leigh McHugh, The Conversation, (13 March 2022). The 2022 Beijing Games celebrated a growing number of Olympian mothers. Bobsledder Elana Meyers Taylor (United States), biathlete Anaïs Chevalier-Bouchet (France) and luger Natalie Geisenberger (Germany) all medalled in their respective sports. These “super moms” seemingly can do it all. But behind these successes are the struggles, challenges and heartbreaking decisions that elite athlete mothers are forced to make.
• “Playing for team motherhood”: Returning to team sport after childbirth, opens in a new tab, Talia Ritondo, SIRC blog, (15 December 2021). My master’s thesis examined how gendered expectations of motherhood affected postnatal women as they re-engaged in community team sport. I interviewed 6 mothers, 3 times over a period of 3 months. Through these interviews, I learned about the challenges that new moms face when returning to sport, how social support and relationships help moms in their return to sport, and how moms felt empowered when they played sports. This blog aims to help sport leaders empathize with postnatal women’s experiences, inspiring the creation of more inclusive sporting spaces.
• The Players With Kids Are Alright, opens in a new tab, Emma Baccellieri, SI.com, (27 May 2021). For years we asked: Can women’s leagues support parents? Given the WNBA's robust new plan for propping up players with children—and the support seen elsewhere—now the new question is: Can they afford not to?
• How Exercise Affects Pregnant Women, opens in a new tab, Alex Hutchinson, Outside, (15 May 2021). A new study looks for adaptations in the placenta, and finds positive effects from exercise during pregnancy.
• FIFA steps up protection of female players and football coaches, opens in a new tab, FIFA, (19 November 2020). The FIFA Football Stakeholders Committee (FSC) has backed two sets of landmark reforms to strengthen the protection of female players, as well as football coaches. The proposed new rules include a number of key measures: Mandatory maternity leave of at least 14 weeks, at a minimum of two thirds of the player’s contracted salary. On their return to work, clubs must reintegrate female players and provide adequate medical and physical support. No female player should ever suffer a disadvantage as a result of becoming pregnant, thus securing greater employment protection for women in football. The FSC also approved new rules to better protect the position of football coaches.
• 'Physically and emotionally I wasn't ready': Hockeyroo Jodie Kenny on returning to sport after pregnancy, opens in a new tab, Amanda Shalala, ABC News, (2 October 2020). Hockeyroo Jodie Kenny was back playing elite sport nine months after giving birth to her son.
• Exercising too much could affect fertility in young, healthy women, expert warns, opens in a new tab, Amanda Shalala, ABC News, (30 August 2020). Why would young, healthy women who keep their body in peak physical shape struggle to conceive? Well, it's complicated.
• Maternity Leave—Not Higher Pay—Is the WNBA’s Real Win, opens in a new tab, Maggie Mertens, The Atlantic, (2 February 2020). Maternity leave and parental benefits aren’t usually the first things that come to mind when considering equality for women athletes. But the WNBA took a major step forward on that front last month, announcing a new collective-bargaining agreement with its players’ association that will increase salaries significantly and guarantee players fully paid maternity leave for the first time in its history.
• Pregnancy and Players Agreements, opens in a new tab, Katrina Nissen, Netball Scoop, (8 January 2020). When considering the fact that netball is consistently rated as the highest female-dominated team sport in the country, it is little wonder that other sports turn to Netball Australia when looking for ways to improve their player’s parenting provisions. So, what do netball’s provisions look like? And, how have they shaped the playing future for female athletes across the country?
• Fertility and Elite Female Athletes, opens in a new tab, Jenny Sinclair, Netball Scoop, (2020). A series of case study reports based on the experiences of three elite female netball players who have used assisted reproduction to try and address fertility issues, some of which are particularly relevant to elite sports women. The trailblazers hope that by sharing some of their more intimate details, that people might gain a wider understanding of the problems they faced, and why all active females should consider their health as well as their sporting careers.
  • Part One: Barriers to Fertility, opens in a new tab
  • Part Two: How can female athletes be better supported, opens in a new tab
  • Part Three: Geva Mentor – I retrieved my eggs, opens in a new tab
  • Part Four: Natalie Medhurst – pregnant after fertility treatment, opens in a new tab
  • Part Five: Sonia Mkoloma – multiple miscarriages, opens in a new tab
• Infographic: Guidance for medical, health and fitness professionals to support women in returning to running postnatally, opens in a new tab [paywall], Donnelly GM, Rankin A, Mills H, et al., British Journal of Sports Medicine, Volume 54(18), pp.1114-1115, (2020). Profound physical and physiological changes accompany pregnancy,2 and subsequent tissue healing following childbirth is understood to take 4–6 months.3 These healing timescales should be considered to support a successful return to running postnatally.
• Infographic. Prenatal physical activity: baby steps for better health, opens in a new tab [paywall], Margie H Davenport, Trevor Horbachewsky, Michael Brown, et al., British Journal of Sports Medicine, Volume 54(6), pp.360-361, (2020). Based on the 2019 Canadian guideline for physical activity throughout pregnancy this infographic aims to provide women with pertinent information on the benefits of being active throughout the pregnancy and empower medical professionals to advise patients on physical activity throughout pregnancy with confidence and clarity.
• Leagues, NCAA following suit with pregnancy protections, opens in a new tab, Mia Jackson, Global Sport Matters, (3 December 2019). For years, when an athlete became pregnant, other numbers were top of mind in addition to the all-important 10 fingers and 10 toes of the baby. What’s the new ranking when I get back? How many years are left on my contract? Am I still scholarship eligible? Then, the ultimate — How long before they expect me back and ready to play?
• Is vigorous exercise safe during the third trimester of pregnancy?, opens in a new tab Kassia Beetham, The Conversation, (16 September 2019). Expectant mothers receive an avalanche of information about potential risks to their baby. There’s a growing list of foods, toxins and environmental threats to avoid. It’s normal for this to lead to an increased level of anxiety. As a result, some women believe it’s safer to avoid any risks in pregnancy, no matter how small. Vigorous exercise may be considered one of these risks. But we’ve recently reviewed the research and found vigorous exercise is safe during pregnancy, including in the third trimester. And not only is it safe; it’s healthy, too.
• Opinion: Stop penalizing female athletes for getting pregnant, opens in a new tab, Victoria Jackson, Global Sport Matters, (23 May 2019). What happens when your body is your instrument of work and also the vessel that carries and nurtures life? While this question is faced by all women who enjoy an active lifestyle and begin a pregnancy, it’s a question of critical importance to elite female athletes. An increasing number are kicking butt and choosing to stay in professional and international competition longer, and, often, during pregnancy and after childbirth.
• Pregnant AFLW players given choice to opt out, opens in a new tab, Nat Edwards, AFL.com.au, (3 November 2017). Pregnant AFLW players will be given the right to decide whether or not they continue to participate in the competition, under the League's new pregnancy and parental management travel policy.
• Benefits of sport for the pregnant woman, opens in a new tab, Wendy Brown, Caroline Finch, Diana Robinson, et al., Sports Medicine Australia, (2017). The following information is based on research in the area of exercise and pregnancy, which is current at the time of writing. It is designed to assist those who are involved in the management of active pregnant women, and the women themselves, to consider these benefits and risks, so that they can make informed decisions about participation.
• When pregnancy spells the end of a career, opens in a new tab, Pearce L, The Age (6 July 2015). Many sportswomen's career prospects disappear when they become pregnant. This news item presents the stories of several success Australian sportswomen and how they have managed their sporting career and personal commitments.

• Megan Shutt on her IVF Journey and talking about fertility in women's sport, opens in a new tab [audio; 25mins], The Scoop Cricket Podcast, (17 March 2021). Ahead of Australia's tour of New Zealand, star bowler Megan Schutt joined hosts Laura Jolly and Emily Collin from hotel quarantine to explain the process of reciprocal IVF which she has recently embarked on with her wife Jess, and why more conversations around fertility and conception are cropping up amongst elite female athletes.
• Caring for the Pregnant Athlete with Dr. Ellen Casey. Episode #452, opens in a new tab [audio; 30:05 mins], BMJ Talk Medicine, SoundCloud, (November 2020). Serenna Williams, Alysson Felix, Kerry Walsh Jennings, Lisa Leslie. Mothers and champions. In this AMSSM Sportsmedcast sports medicine specialist Dr. Rathna Nuti hosts Dr. Ellen Casey, @EllenCaseyMD, Associate Attending Physiatrist in the Department of Physiatry and the Women's Sports Medicine Center at the Hospital for Special Surgery in New York. Dr Casey who works with US Gymnastics, is also an Associate Professor of Clinical Rehabilitation Medicine at Weill Cornell Medical College.

• The Exercising Female. Science and Its Application, opens in a new tab, 1st edition, Forsyth J., and Roberts C. Routledge, (2018). Based on the latest research, and treating women as a unique population, the book seeks to critically evaluate current debates, present the science underpinning female sport and exercise performance, and inform applied practice for the exercising female. Featuring contributions from leading scientists from around the world, and adopting a multidisciplinary approach—from exercise physiology, endocrinology, and biochemistry to psychology, biomechanics, and sociology—the book includes chapters on topics such as: Exercise and the menstrual cycle, contraception, pregnancy, motherhood, and menopause.
• Sex Hormones, Exercise and Women. Scientific and Clinical Aspects, opens in a new tab, Hackney, AC. Springer, (2016). The thematic question explored in this work is: if exercise affects reproductive hormones, conversely then could the reproductive hormones have physiological effects unrelated to reproduction that influence the capacity of women to exercise? In exploring this question, the goal is to better understand the unique physiology of women and whether female sex hormones might account for some of the variance in physiological performance between amenorrheic and eumenorrheic women, and within women across the age span as they experience menarche to menopause. The book synthesizes the research by exploring the physiology and psychology behind these occurrences.

Australian guidelines for sport and physical activity

• AIS High Performance Pregnancy Guidelines, Australian Institute of Sport, (October 2021). The AIS has developed these guidelines to assist pregnant athletes, athletes planning to become pregnant, and their sports to make safe and informed decisions in relation to HP programs. These guidelines are also designed to inform athletes and their sport of their obligations around matters such as discrimination and inclusion.
• Physical activity and exercise during pregnancy – guidelines, opens in a new tab, Australian Government - Department of Health, (May 2021). Being active during and after pregnancy is essential for the good health and wellbeing of both you and your baby. You should continue to follow the guidelines for adults, and add pelvic floor exercises. But you might need to modify the exercises you do as your body changes during pregnancy.
• Pregnancy and Exercise, opens in a new tab, Sports Medicine Australia, (2017). All women without contraindications should be encouraged to participate in aerobic and strength-conditioning exercises as part of a healthy lifestyle during their pregnancy.

Australian sporting organisation parental and pregnancy policies, guidelines, and announcements

• Athlete pregnancy guidelines, opens in a new tab, Swimming Australia, (accessed 20 March 2023).
• Everything you need to know: NRLW CBA, opens in a new tab, Alicia Newton, NRL.com, (14 February 2023).
• AFLW Pregnancy and Parental Management Travel Policy, opens in a new tab, quoted in: Pregnant AFLW players given choice to opt out, opens in a new tab, Nat Edwards, AFL.com.au, (3 November 2021).
• Pregnancy and participation in motorsport policy, opens in a new tab, Motorsport Australia, (May 2020).
• Cricket Australia introduces paid maternity leave as part of new parental policy, opens in a new tab, Brittany Carter, ABC, (10 October 2019).
• Players Association and WNBL introduce Parental and Pregnancy Care Policy, opens in a new tab, WNBL, (31 October 2018).
• Pregnancy guidelines, opens in a new tab, Softball Australia, (March 2016).
• Pregnancy Policy, opens in a new tab, Australian Flying Disc Association, (revised 16 September 2014).
• Athlete and coach (Basketball Australia National Teams) pregnancy and parental management policy, opens in a new tab, Basketball Australia, (2014)

International examples

• New Maternity, Pregnant Parent, and Adoption Leave Policy for England Women Players, opens in a new tab, England Rugby, (16 February 2023). The RFU will support the right of the player who wishes to continue to be involved in the team, while ensuring that the safety of the player and the unborn child are considered first. A full risk assessment will be undertaken when a player first advises of pregnancy which will be a significant factor in determining what duties can be safely performed during pregnancy. The policy also provides opportunities for players due to go on maternity leave (26 weeks on full pay), to move into other safe employment within the rugby network, e.g., community coach, until the player goes on maternity leave.
• Pregnancy guidelines, opens in a new tab, World Netball, (December 2021). These pregnancy guidelines have been developed by WN to provide information and guidance for all those participating in netball at international level (including, in particular, players, umpires, bench officials and team officials).
• Asia-Pacific consensus on physical activity and exercise in pregnancy and the postpartum period, opens in a new tab, Ryan Lee, Serene Thain, Lay Kok Tan, et al., BMJ Open Sport and Exercise Medicine, Volume 7(2), (May 2021). In this paper, we present seven key consensus recommendations on physical activity and exercise in pregnancy and the postpartum period by 18 key members representing 10 countries in Asia-Pacific regions during an international workshop of the Asia. Our objective for these recommendations is to provide guidance on physical activity for pregnant women during the antenatal and postpartum period and encourage healthy lifestyles to achieve better pregnancy outcomes.
• Pregnancy Guidance, opens in a new tab, UK Sport, (2021). The aim of this guidance is to advise how to best support an Athlete’s pregnancy fairly and appropriately, providing recommendations to support an Athlete during their pregnancy, and for when they return to training and competition post-childbirth. Pregnancy and post-childbirth can be physically and mentally challenging for a mother and it’s essential that resources and guidance are available to the SGB and the Athlete to best support them and their partner.
  • Pregnancy Guidance for Athletes
  • Pregnancy Guidance for Sports
• Pregnant and Parenting Student-athletes, opens in a new tab, NCAA, (2021). This web site provides resources and model best practices for student-athletes who become pregnant and/or are parents and the institutions where they study and compete.
• FIFA steps up protection of female players and football coaches, opens in a new tab, FIFA, (19 November 2020). The FIFA Football Stakeholders Committee (FSC) has backed two sets of landmark reforms to strengthen the protection of female players, as well as football coaches. The proposed new rules include a number of key measures: Mandatory maternity leave of at least 14 weeks, at a minimum of two thirds of the player’s contracted salary. On their return to work, clubs must reintegrate female players and provide adequate medical and physical support. No female player should ever suffer a disadvantage as a result of becoming pregnant, thus securing greater employment protection for women in football. The FSC also approved new rules to better protect the position of football coaches.
• 2019 WTA Rule Changes: WTA introduces special seeding, shot clock, opens in a new tab, Women's Tennis Association (WTA), (17 December 2018). The 2019 WTA Rulebook will introduce a new special seeding rule for players returning from maternity leave, a modernized attire rule, and the rollout of a 25-second shot clock. WTA Insider recaps the notable rulebook changes.
• 2019 Canadian guideline for physical activity throughout pregnancy, opens in a new tab, Canadian Society for Exercise Physiology, (October 2018). New evidence-based guideline outlines the right amount of physical activity women should get throughout pregnancy to promote maternal, fetal, and neonatal health. Physical activity is now seen as a critical part of a healthy pregnancy. Following the guideline can reduce the risk of pregnancy-related illnesses such as depression by at least 25%, and the risk of developing gestational diabetes, high blood pressure and preeclampsia by 40%. Unless contraindicated pregnant women should accumulate at least 150 minutes of moderate-intensity physical activity each week over a minimum of three days per week; however, being active in a variety of ways every day is encouraged.

• Evidence-based physical activity guidelines for pregnant women, opens in a new tab, Brown WJ, Hayman M, Haakstad LAH, Mielke GI et al., Report for the Australian Government Department of Health, (March 2020). As part of the suite of national physical activity and sedentary behaviour guidelines for Australians, the Australian Government, in 2018, commissioned a review and synthesis of the evidence to inform the development of practical and safe physical activity guidelines for pregnant Australian women (“the guidelines”). A five-stage approach, which involved critical ‘umbrella’ reviews of the scientific evidence, and adaptation of recommendations included in recently published guidelines and position statements, was used to develop the Guidelines. The proposed Guidelines and Supporting Information are presented on pages 9-14 of this report.
• Physical activity during pregnancy 2011–12, opens in a new tab, Australian Institute of Health and Welfare, (2 May 2019). Currently, little is known about how much, and what types of, physical activity pregnant women undertake in Australia. This short report investigates the types and amount of physical activity undertaken by women during pregnancy, with comparisons made between pregnant and non-pregnant women of the same age, and against Australia’s Physical Activity and Sedentary Behaviour Guidelines for adults. The report found that only one third of pregnant women met the Australian physical activity guideline of at least 150 minutes per week of moderate to vigorous activity [compared to around 50% in the general female population as reported in other AIHW reports].

• The “Mother Load” and Return to Sport: A Case Report of Returning to Professional Netball Following Cesarean Section, opens in a new tab, Diggles A, International Journal of Sports Physical Therapy, Volume 18(1), pp.228-239, (February 2023). A 27-year-old primiparous Caucasian professional netballer presented at four weeks post- caesarean section (CS) for RTS screening and assessment of pelvic floor muscle (PFM) function. Measures were collected at four weeks, eight weeks, and six months post-partum. The post-partum athlete demonstrated alterations in pelvic floor muscle function, reduced lower limb power and psychological readiness. A functionally staged dynamic and sport specific pelvic floor muscle training program was implemented and adapted to the patient for her early post-partum timeline. Rehabilitation strategies were effective in achieving the primary outcome of RTS at 16 weeks post-partum with no adverse events reported at 6 months follow-up.
• Effect of Pregnancy in 42 Elite to World-Class Runners on Training and Performance Outcomes, opens in a new tab, Darroch, Francine, Schneeberg, Amy, Brodie, Ryan, et al., Medicine and Science in Sports and Exercise, Volume 55(1), pp.93-100, (January 2023). Forty-two elite (>50% competed at the World Championships/Olympic) middle-/long-distance runners’ training before, during, and after pregnancy (quality/quantity/type) data (retrospective questionnaire) and competition data (published online) were collected. Running volume decreased significantly (P < 0.01) from the first trimester (63 ± 34 km·wk−1) to the third trimester (30 ± 30 km·wk−1). Participants returned to activity/exercise at ~6 wk postpartum and to 80% of pre-pregnancy training volumes by 3 months. Participants who intended to return to equivalent performance levels post-pregnancy, there was no statistical decrease in performance in the 1 to 3 yr post-pregnancy compared with pre-pregnancy, and ~56% improved performances post-pregnancy. Taken together, this article provides much needed insights into current training practices and performance of elite pregnant runners, which should help to inform future training guidelines as well as sport policy and sponsor expectations around return to training timelines and performance.
• Public health guidelines for physical activity during pregnancy from around the world: a scoping review, opens in a new tab, Hayman M, Brown WJ, Brinson A, et al., British Journal of Sports Medicine, (5 January 2023). Our search located 30 eligible guidelines, published in 11 different languages. There is remarkable concordance in the advice offered. For women with uncomplicated pregnancy, guidelines recommend: 150–300 min/week of moderate intensity aerobic activity; pelvic floor and muscle strengthening exercises; modification of some exercises (eg, supine position); and provide lists of warning signs to cease activity (eg, persistent dizziness, vaginal bleeding) and activities that should be avoided (eg, if high risk of falling/collision). Few guidelines offer specific advice for highly active women (eg, athletes), or trimester-specific or culturally specific considerations.
• Does maternity during sports career jeopardize future athletic success in elite marathon runners?, opens in a new tab Nicolas Forstmann, Alice Meignié, Quentin De Larochelambert, et al., European Journal of Sport Science, Volume 23(6), pp.896-903, (2023). This study aims to investigate the impact of maternity among elite marathoners on their overall performance progression. For each runner listed in the top 150 female marathoners, who had experienced a mid-career maternity, performance development was reconstituted throughout the career. Among this sample, 37 runners had at least 1 child during her career. Among them, 14 had 2 children. Eleven runners (29.72%) made their personal best performance before Mat, which occurred at an average age of 28.40 ± 4.00 years. Twenty-six runners (70.28%) establish their best performances after Mat, at an average age of 32.20 ± 4.28. The age-performance relationship model explains 92% of the performance variability during the career’s progression. When age is considered, maternity does not have significant impact on performance development. World’s most competitive marathoners can still perform at their best level after pregnancy. The ability to return and surpass previous performance level is influenced by the age at which pregnancy occurs, relative to the age of peak performance during career development.
• We’re not Superhuman, We’re Human: A Qualitative Description of Elite Athletes’ Experiences of Return to Sport After Childbirth, opens in a new tab, Margie Davenport, Lauren Ray, Autumn Nesdoly, et al., Sports Medicine, Volume 53, pp.269-279, (2023). A growing number of athletes return to elite sport following childbirth. Yet, they face significant barriers to do so safely and successfully. The experiences of elite athletes returning to sport following delivery are necessary to support evidence-informed policy. Eighteen elite athletes, primarily from North America, who had returned to sport following childbirth in the last 5 years were interviewed. The findings of this study are represented by one overarching theme: Need for More Time, and five main themes: (a) Training “New Bodies” Postpartum, (b) Injuries and Safe Return to Sport, (c) Breastfeeding While Training, (d) Critical Supports for Return to Sport, (e) Navigating Motherhood and Sport. The athletes identified the urgent need to develop best-practice policies and funding to support return to sport, as well as develop evidence-based return-to-sport protocols to support a safe and injury-free return.
• Australian guidelines for physical activity in pregnancy and postpartum, opens in a new tab, Wendy Brown, Melanie Hayman, Lene Haakstad, et al., Journal of Science and Medicine in Sport, Volume 25(6), pp.511-519, (June 2022). Our evidence review found that physical activity/exercise during pregnancy and the postpartum period is safe, has health benefits for the woman and her unborn child, and may reduce the risks of some pregnancy related complications. Four specific guidelines were developed. These encourage all women without pregnancy complications to: (1) meet the Australian Physical Activity and Sedentary Behaviour Guidelines for Adults before, during and after pregnancy; (2) modify activities to accommodate the physical changes that occur as pregnancy progresses; (3) do pelvic floor exercises during and after pregnancy; and (4) take an active role in shared decision-making about their physical activity/exercise during and after pregnancy. The review also identified warning signs and contraindications for physical activity/exercise during pregnancy.
• Pregnancy and motherhood in elite sport: The longitudinal experiences of two elite athletes, opens in a new tab, Kelly Massey, Amy Whitehead, Psychology of Sport and Exercise, Volume 60, (May 2022). This study is the first to provide longitudinal insights into the experiences of both para and non-para elite athlete mothers during the initial stages of motherhood. Findings highlight the individual nature of such an experience and illuminate some of the negotiations of the personal, athlete, and mother identity that an athlete mother may experience.
• Pushing for change: a qualitative study of the experiences of elite athletes during pregnancy, opens in a new tab, Davenport MH, Nesdoly A, Ray L, et al., British Journal of Sports Medicine, Volume 56(8), pp.452-457, (March 2022). The findings of this study are represented by one overarching message: mother versus athlete, and five main themes: (1) pregnancy planning and fertility, (2) pregnancy disclosure and discrimination, (3) training pregnant athletic bodies, (4) safety concerns, and (5) supportive network and equitable funding. In-depth stories shared by participants highlight the many significant decisions athletes must make as they navigate pregnancy alongside elite sport participation. The shared experiences of pregnant athletes highlight clear challenges that should be considered in the development of sport policy and practices that are inclusive and supportive of female athletes.
• Effects of Regular Exercise During Pregnancy on Early Childhood Neurodevelopment: The Physical Activity for Mothers Enrolled in Longitudinal Analysis Randomized Controlled Trial, opens in a new tab, Otávio Amaral de Andrade Leão; , Marlos Rodrigues Domingues; , Andréa Dâmaso Bertoldi; et al., Journal of Physical Activity and Health, Volume 19(3), 203-210, (February 2022). Findings indicate that exercise during pregnancy results in a relatively small, but positive, effect on language development at 2 years and cognitive development at 4 years. Despite the lack of effect on other domains of neurodevelopment, exercise during pregnancy did not cause any harm or have any negative effects on child neurodevelopment. Therefore, due to the benefits for maternal and child health, interventions to increase participation in physical activity and exercise during pregnancy should be recommended.
• Reframing return-to-sport postpartum: the 6 Rs framework, opens in a new tab, Donnelly GM, Moore IS, Brockwell E, et al., British Journal of Sports Medicine, Volume 56(5), pp.244-245, (February 2022). In the context of the perinatal athlete, we argue that it is crucial that specialist pelvic health physiotherapists, midwives and obstetric and gynaecological consultants are included in the multidisciplinary team supporting their return-to-sport. In this editorial we will outline considerations that are necessary for supporting athletes during and after pregnancy. In doing so we aim to provide a framework to guide multidisciplinary teams managing perinatal athletes and their return-to-sport postpartum.
• The Incompatibility of Motherhood and Professional Women's Football in England, opens in a new tab, Alex Culvin, Ali Bowes, Frontiers in Sports and Active Living, Volume 3, (September 2021). This article offers an examination of the gender-specific needs of women as professional footballers, focusing specifically on the distinctive aspect of maternity policy. Sportswomen often feel compelled to make the difficult decision between motherhood and an athletic career. Contracts have become an essential component of the work-life of professional women footballers. However, these contracts pose questions regarding organisational intentions and motivations. This study draws on 30 semi-structured interviews with professional women footballers in England. Our key considerations include contracts, employment, motherhood, and athletes' bodies. This examination will develop our understanding of the complexities associated with professional football as a career choice for women.
• Elite Athletes and Pregnancy Outcomes: A Systematic Review and Meta-analysis, opens in a new tab, Jenna Wowdzia, Tara-Leigh McHugh, Jane Thornton, et al., Medicine and Science in Sport and Exercise, Volume 53(3), pp.534-542, (2021). The purpose of this systematic review was to evaluate fetal and maternal pregnancy outcomes of elite athletes who had participated in competitive sport immediately before conception. There is “low” certainty of evidence that elite athletes have reduced odds of experiencing pregnancy-related low back pain and “very low”certainty of evidence that elite athletes have increased the odds of excessive weight gain compared with active/sedentary controls. More research is needed to provide strong evidence of how elite competitive sport before pregnancy affects maternal and fetal outcomes.
• Considerations for the Postpartum Runner,, opens in a new tab Kate Mihevc Edwards, Strength and Conditioning Journal, Volume 42(1), pp.45-52, (2020). According to Running USA, today there are over 35 million runners in the United States and greater than half are women. The psychological, physiological and biomechanical differences between male and female runners are well cited however, there is little guidance provided to healthcare providers including running and strength coaches about how to transition runners back to running postpartum. This article can serve as a reference for understanding the unique challenges female runners face postpartum and give clinicians the knowledge to manage the athlete’s expectations and training progression.
• Exercise Benefits and Recommendations for the 6-Week Postpartum Period, opens in a new tab, Loewen, Brandon, Collum, Connor, Ryan, Greg, Strength and Conditioning Journal, Volume 42(4), pp.12-21, (2020). The postpartum period is the stage after childbirth and is associated with many physical and psychological changes. Exercise has been shown to be beneficial for both the physical and psychological health of a new mother. Previous literature has examined the effect of both aerobic and resistance training in this period; however, there have been no clear guidelines and recommendations provided. Therefore, the purpose of this article is to review the benefits of exercise in the postpartum period, and to provide guidelines and a sample 6-week aerobic and resistance training program after exercise initiation after delivery and medical clearance.
• From Childbirth to the Starting Blocks: Are We Providing the Best Care to Our Postpartum Athletes?, opens in a new tab Rita Deering, Shefali Christopher, Bryan Heiderscheit, Journal of Orthopaedic and Sports Physical Therapy, Volume 50(6), pp.281-345, (2020). There is minimal evidence to guide return to exercise after pregnancy and childbirth, and even less information on safe return to competitive sport. The International Olympic Committee has suggested a 3-phase approach to postpartum recovery in athletes. This Viewpoint expands on that 3-phase model and incorporates a multidisciplinary approach to ensure comprehensive care of postpartum athletes to facilitate safe return to sport with optimal health and performance outcomes. Adopting a multidisciplinary approach may also open new research avenues to ameliorate the dearth of knowledge regarding musculoskeletal recovery and facilitate the development of guidelines to inform clinicians and postpartum women about safe return to exercise, particularly, high-intensity or high-impact activities.
• Pregnancy and Postpartum Training: Coaching Considerations, opens in a new tab, Wise, Stephanie, Binkley, Jean, Binkley, Helen, Strength and Conditioning Journal, Volume 42(4), pp.93-104, (2020). Exercise is beneficial for women to continue during pregnancy and the postpartum period. However, many women do not meet the minimum guidelines set forth by the American College of Obstetricians and Gynecologists. Strength and conditioning coaches and personal trainers working specifically with athletes and nonathletes during childbearing years should continue to encourage their clientele to exercise. Educating them on altering their current exercise program and adapting it as they progress through their pregnancy into the postpartum period is important. General recommendations for exercise and certain modifications may be needed as many physical and physiological adaptations occur within the body during this time.
• ‘Provide clarity and consistency’: the practicalities of following UK national policies and advice for exercise and sport during pregnancy and early motherhood, opens in a new tab, Eilidh Macrae, International Journal of Sport Policy and Politics, Volume 12(1), pp.147-161, (2020). This qualitative study employed a social-ecological framework to investigate the experiences of new mothers based in the UK and the practicalities of engaging in regular exercise during pregnancy and the postpartum period. Three themes were generated as recommendations to the sector. The first theme was the importance of providing ‘trusted advice’ from reputable sources. The second theme was the need for provision of ‘safe, affordable sport and exercise options’. The final theme was the need for more ‘considered postpartum support’ for exercise, through further childcare options and a range of supportive environments for women to exercise within postpartum.
• Psychological effects of exercise for pregnant women: a systematic review, opens in a new tab, Lina Anisa Nasution, Irma Darmawati, EurAsian Journal of BioSciences, Volume 14(2), pp.6983-6990, (2020). The aim of this study was to conduct a systematic mapping review of the literature that explored the psychological effect of sport in pregnant women. The search identified quantitative research studies on the psychological effect of exercise for pregnant women. Nine articles were analyzed through data extraction. The types of exercise discussed in this systematic review include supervised exercise sessions, aerobic dance, endurance training, interval stationary cycling and the intervention followed American College of Obstetricians and Gynecologists (ACOG) guidelines. Pregnant women who have exercise have improved psychological conditions such as decreased sadness, hopelessness, anxiety and the incidence of antenatal depression. Furthermore, pregnant women also showed an enjoyment to exercise. Exercise may have a positive effect on psychological state and reduce risk of psychological distress for pregnant women.
• Spotlight on the fetus: how physical activity during pregnancy influences fetal health: a narrative review, opens in a new tab, Ilena Bauer, Julia Hartkopf, Stephanie Kullmann, et al., BMJ Open Sport and Exercise Medicine, Volume 6(1), (2020). In the current review, we aimed to comprehensively assess the evidence of beneficial and harmful effects of maternal PA, including high-performance sports, on fetal development. The different mental and body-based relaxation techniques presented here are frequently performed during pregnancy. We found a considerable number of studies addressing these issues. In general, neither low key, moderate maternal PA nor relaxation techniques were observed to have a harmful effect on the developing child. However, we identified some forms of PA which could have at least a transient unfavourable effect. Notably, the literature currently available does not provide enough evidence to enable us to make a general conclusive statement on this subject. This is due to the lack of longitudinal studies on the metabolic and cognitive effects of regular PA during pregnancy and the wide diversity of methods used. In particular, the kind of PA investigated in each study differed from study to study.
• Why can’t I exercise during pregnancy? Time to revisit medical ‘absolute’ and ‘relative’ contraindications: systematic review of evidence of harm and a call to action, opens in a new tab, Meah VL, Davies GA, Davenport MH, British Journal of Sports Medicine, Volume 54(23), pp.1395-1404, (2020). We found that the majority of medical conditions listed as contraindications were based on expert opinion; there is minimal empirical evidence to demonstrate harm of exercise and benefit of activity restriction. We identified 11 complications (eg, gestational hypertension, twin pregnancy) previously classified as contraindications where women may in fact benefit from regular prenatal physical activity with or without modifications. However, the evidence suggests that severe cardiorespiratory disease, placental abruption, vasa previa, uncontrolled type 1 diabetes, intrauterine growth restriction, active preterm labour, severe pre-eclampsia and cervical insufficiency are associated with strong potential for maternal/fetal harm and warrant classification as absolute contraindications.
• Elite athletes get pregnant, have healthy babies and return to sport early postpartum, opens in a new tab, Jorunn Sundgot-Borgen, Christine Sundgot-Borgen, Grethe Myklebust, et al., BMJ Open Sport and Exercise Medicine, Volume 5(1), (November 2019). 34 Norwegian elite athletes (33.1 years) and 34 active controls (31.5 years) were asked about training and competitive history, pregnancy-related issues, injuries, body dissatisfaction (BD), drive for thinness (DT), eating disorders (ED) and practical experiences, through a questionnaire and interview. The results showed that both elite athletes and active controls got pregnant easily, delivered healthy babies and decreased training during pregnancy and the first postpartum periods compared with prepregnancy. Most athletes and every third control returned to sport or exercise at week 0–6 postpartum. Athletes reported stress fractures and increased BD and DT, but decreased ED postpartum. However, since relatively few athletes were included these findings need further investigation.
• Benefits of Physical Activity during Pregnancy and Postpartum: An Umbrella Review, opens in a new tab, Dipietro, Loretta, Evenson, Kelly, Bloodgood, Boony, et al., Medicine and Science in Sports and Exercise, Volume 51(6), pp.1292-1302, (2019). This study aimed to summarize the evidence from the 2018 Physical Activity Guidelines Advisory Committee Scientific Report, including new evidence from an updated search of the effects of physical activity on maternal health during pregnancy and postpartum. The reviewers concluded that the gestational period is an opportunity to promote positive health behaviors that can have both short- and long-term benefits for the mother. Given the low prevalence of physical activity in young women in general, and the high prevalence of obesity and cardio metabolic diseases among the U.S. population, the public health importance of increasing physical activity in women of childbearing age before, during, and after pregnancy is substantial.
• Exercise and pregnancy in recreational and elite athletes: 2016/2017 evidence summary from the IOC expert group meeting, Lausanne. Part 5. Recommendations for health professionals and active women, opens in a new tab, Bø K, Artal R, Barakat R, et al., British Journal of Sports Medicine, Volume 52(17), pp.1080-1085, (2018). Summarises the recommendations for exercise during pregnancy and after childbirth in recreational exercisers and elite athletes experiencing healthy pregnancies. Part 5 also serves as a background for healthcare personnel to advise women who wish to stay active at a high level.
• Exercise and pregnancy in recreational and elite athletes: 2016/17 evidence summary from the IOC Expert Group Meeting, Lausanne. Part 3—exercise in the postpartum period, opens in a new tab, Bø K, Artal R, Barakat R, et.al., British Journal of Sports Medicine , Volume 51(21), pp.1516-1525, (2017). The aims of this paper are to present (1) the findings from a systematic review of the scientific literature on factors related to returning to exercise after childbirth in recreational and elite athletes, and (2) the prevalence, risk factors and evidence for prevention and treatment of common postpartum conditions that may affect sport performance and overall quality of life.
• Exercise and pregnancy in recreational and elite athletes: 2016/17 evidence summary from the IOC expert group meeting, Lausanne. Part 4—Recommendations for future research, opens in a new tab, Bø K, Artal R, Barakat R, et al., British Journal of Sports Medicine , Volume 51(24), pp.1724-1726, (2017). In Part 4, we recommend future research based on Parts 1–3. The systematic reviews, on which the previous Parts were based, revealed many gaps in knowledge relating to strenuous exercise during pregnancy and in the postpartum period, in both regular recreational exercisers and elite athletes. Important research questions are listed below, in relation to the foci of Parts 1–3, under the following headings: exercise during pregnancy, exercise related to birth outcomes and exercise in the postpartum period.
• Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 1—exercise in women planning pregnancy and those who are pregnant, opens in a new tab, Bo K, Aertal R, Barakat R, et al., British Journal of Sports Medicine, Volume 50(10), pp.571-589, (2016). The IOC assembled an international expert committee to review the literature on physical activity and exercise (1) during pregnancy and (2) after childbirth, using rigorous systematic review and search criteria. Part 1 focuses on the effects of training during pregnancy and on the management of common pregnancy-related symptoms experienced by athletes.
• Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 2—the effect of exercise on the fetus, labour and birth, opens in a new tab, Bø K, Artal R, Barakat R, et al., British Journal of Sports Medicine, Volume 50(21), pp.1297-1305, (2016). This evidence statement, based on a systematic literature search, examines how strenuous exercise affects the fetus. It also addresses issues relating to birth, such as risk of preterm birth, prolonged labour and mode of delivery, including injuries to the pelvic floor muscles and the perineum.
• Postpartum exercise, opens in a new tab, Brad Roy, ACSM's Health and Fitness Journal, Volume 18(6), pp.3-4, (2014). There are numerous benefits to being physically active after pregnancy, including a reduction in fat mass, increased lean mass, improved lipid profiles, and enhanced mental outlook and acuity. All women are encouraged to begin exercising as soon as medically appropriate and to remain physically active throughout their lifetimes.

• NETBALLHer, opens in a new tab, England Netball, (accessed 16 June 2023). Working with female health experts, The Well HQ, England Netball is aiming to re-write the rules and reimagine best practice around the female body’s life stages. NETBALL Her provides information on key topics such as Pelvic Health; Menopause; the Menstrual Cycle; Bras & Kit; Nutrition; Pre & Post Natal; Injury; and Puberty. More resources, myth busting articles, relatable videos, and Her Latest Stories, all rooted in netball, at every level of the game are added regularly.
• FPHI Are You An Athlete Considering Pregnancy Fact Sheet - 2022, Australian Institute of Sport, (2021). Provide general advice on medical and dental check-ups, nutrition and weight, supplements, pelvic floor exercises, mental health, travel, menstrual cycle, your environment, exercise considerations, and avoiding alcohol, smoking, and illicit drugs.
• FPHI Are you an athlete who is currently pregnant - 2021, Australian Institute of Sport, (2021). Provides general advice on medical check-ups, exercise, nutrition and weight gain, sleep, bra support, pelvic floor, travel, and mental health.
• Breastfeeding as an athlete, Australian Institute of Sport, (accessed 20 March 2023). Your milk supply, your baby's growth and development and the composition of your breastmilk is unlikely to be affected by your training.
• Pregnancy and Participation, opens in a new tab, Play by the Rules, (accessed 20 March 2023). This interactive scenario will help you learn about: The rights and responsibilities of players, coaches and administrators in relation to pregnancy and sport; Key information relating to pregnancy and sport; General guidelines for supporting pregnant women who want to participate in sport; Steps for managing the risks associated with pregnancy.