If you’re a competitive athlete and pregnant, should you still train like an athlete? 

Yes. Competitive female athletes, from the Weekend Warrior to elite athletes, can still exercise/train while pregnant. It’s a smart approach to maintain your fitness. 

In 2016, the International Olympic Committee (IOC) paid for top experts to begin research focusing on pregnancy, childbirth, training and competition for regular, serious exercisers and elite athletes. Recommendations regarding potential complications, training and gaps in the literature that need to be addressed in future studies are being gradually published in a five-part series in the British Journal of Medicine.  

In this blog, we discuss some things to keep in mind when continuing to train for the love of your sport.

• Monitor Your Training Closely

A recent study reported that highly trained women continue to exercise during pregnancy, but minimal information is available on how to best guide a pregnant athlete to get the most out of her training while not putting herself or the fetus at risk. At the highest level, there may a certain extent to which an elite athlete can train, which will, of course, differ from person-to-person. 

However, both women who seriously exercise and competitive athletes may exceed what is best for their body. The most important considerations for an athletic woman are: 1) communicate closely with your healthcare practitioner; and 2) listen to your body. The load and intensity of training is individualistic and should be discussed with everyone in the athlete’s sport performance circle (e.g., coach, trainer, dietitian/nutritionist, health care practitioner, etc.). This will allow the athlete to still train effectively and not put herself or the baby at risk. 

Consider the signs that suggest to stop training:

• Headache, dizziness, shortness of breath, chest pain, calf pain, feeling faint

Even though, compared to recreational athletes, elite athletes (because they can recover more easily) are more resilient to intense training (cue Serena Williams who continued to train and compete while pregnant), monitoring is still key. 

2. Adjust Nutrition Requirements

Of course, pregnancy will increase the needs for calories, certain nutrients and fluid. This is because energy is needed to support the development of the fetus, placenta, uterus and the increased volumes of blood and extracellular fluid. The last thing we want is for the developing fetus to be competing for nutrients with the mother. 

Low blood sugar (i.e., hypoglycemia), overheating and dehydration during strenuous exercise can be issues. Competitive athletes should pay attention to increased calorie and fluid needs. Energy expenditure will be high among elite athletes; therefore, the number of calories, protein and carbohydrate needs will depend on the type, frequency, intensity and duration of the sport. Therefore, consider working with a sport dietitian for a personalized plan of nutrient needs to optimize nutritional status for you and your baby. 

3. Forget Worrying about Insulin Resistance

A concern for pregnant women is a resistance to the hormone insulin, which results in an increase in blood sugar (i.e., insulin resistance). Typically, exercise lowers insulin resistance (also called increasing insulin sensitivity, which means less insulin needs to be released to store glucose). This may be problematic in pregnant athletes because insulin resistance in the mother is needed so the fetus can receive nutrients (and it doesn’t just go to the mother’s needs). So if exercise improves insulin sensitivity (lowers insulin resistance) then there may be a potential restriction of nutrition for the fetus if there’s a large improvement in insulin sensitivity. 

Yet, regular exercise for pregnant women does not result in the same reduction in insulin resistance that occurs in those who exercise when non-pregnant. This may be the case because (physiologically speaking) pregnancy takes precedence over major improvements in insulin sensitivity coming from exercise. In other words, your body is smart and adapts appropriately. Therefore, training during pregnancy may not have a major consequence on insulin resistance. 

4. Be Mindful of a Current or Former Eating Disorder

The IOC offers a great discussion on the topic of eating disorders and pregnancy. In this situation, the mother and fetus are competing for nutrients that are limited due to low food intake and, possibly, malnutrition. This is considered a higher risk of pregnancy complications (e.g., anemia, spontaneous abortion, preterm birth) and training can worsen the problem. 

It is advised that an athlete is monitored by a team consisting of a dietitian, doctor and psychiatrist. Early recognition of the symptoms can lead to better treatment of the symptoms, meal planning and training adjustments that are all in the best interest of the athlete and the fetus. 

5. Know the Changes that Occur at Mid-Pregnancy

The 20th week leads to changes that may conflict with competition. For example: uterine contractions can be triggered by dehydration; joints become flexible that could increase the risk for joint strains and injuries; and balance may be off because of the change in gravity for a pregnant woman. Be cognizant of these changes to keep yourself safe while training. 

6. Lift the Iron

Light-to-moderate weight training using free weights or machines typically does not have any health consequences on pregnancy. Healthy women who completed strength training two times per week for 12 weeks experienced considerable strength gains. 

As for strenuous weight training, especially of which may be performed by elite athletes, there is no knowledge regarding the effects. For example, the Valsalva maneuver may actually decrease blood flow to the fetus. However, the consequences of this are unknown. 

A three times per week (non-consecutive days) training protocol is suggested to be an optimal lifting frequency – as more could be unnecessary. Whole body resistance training is a better routine so that blood doesn’t just stay in one part of the body. 

7. Avoid Sport-Specific Training During Pregnancy for Certain Sports

If the athlete plays a contact sport (e.g., volleyball, soccer, basketball), then, yes, it’s not a good idea to continue playing while pregnant. Any sport that has a risk for trauma (e.g., concussion) or physiological risk (e.g., pool diving, scuba diving) should be discontinued. If the mother experiences trauma, then this impacts placenta function and the baby could experience short- or long-term oxygen deprivation or death. 

Other examples of sports that could result in a collision or deceleration include equestrian, pole vaulting, ice hockey and downhill ski racing. Alternative exercises, such as aerobic and strength training, can be done so that you don’t lose your athletic edge. Follow sport-specific exercises and you’ll be ready to return to your sport following pregnancy. 

8. Be Flexible with Your Training

A training plan during pregnancy should focus on maintenance and not building endurance or speed or setting PRs. Being pregnant adds a stressor on the body. The harder you go then the greater and longer the recovery you will need. Exercising at 90% of your maximal heart rate may be harmful on the fetus. This could change the heart rate of the baby and lower blood flow to the baby. 

Here are some suggestions: 

• Focus more on minutes rather than mileage or effort rather than pace.
• Avoid training in the heat and humidity or extreme cold (could increase risk for falling). 
• Add low impact exercises (e.g., elliptical, yoga, Pilates, stationary cycling, swimming). 

Practical Advice

There’s no need to give up your love for sport during pregnancy. Training smart and working closely with all in your sport performance circle can help ensure safety during pregnancy. There’s never anything wrong with lowering the volume or intensity (i.e., periodize) based on your needs and how you’re feeling. It’s about staying fit – not building endurance or speed. 

Keep up with your sport while you wait to deliver, and you won’t regret it.