Heather Richardson-Bergsma (speed skating), Lisa Brown-Miller (ice hockey), Michelle Granger (softball), Juno Stover-Irwin (diving), and Kerri Walsh Jennings (beach volleyball) are just a few of the elite athletes who have won Olympic medals while pregnant. But it’s also physically, emotionally, and psychologically taxing to both be an athlete and to be pregnant, as Serena Williams explained in her farewell essay for Vogue in August 2022. Here, we’ll explore what the science says about elite athletes and pregnancy, as well as talk about some warning signs that may show up during activity in pregnancy, even if you’re not elite.
In study published in February of 2022, kinesiologist Margie Davenport and colleagues interviewed 35 female athletes about their experiences at the elite levels of their sports during pregnancy.  The researchers identified one main theme of these conversations, mother versus athlete, and five subthemes: fertility, pregnancy disclosure, training as a pregnant athlete, safety, and funding and support. For instance, when an elite female athlete becomes pregnant, many people assume she will retire, rather than taking time off and returning after recovering from pregnancy.
Training can also impact how easily athletes can conceive, meaning that, if they want to be pregnant, they may have to take a step back before their pregnancies even start. Once pregnancy happens, athletes realized the dearth of evidence-based information about training in pregnancy. The commonalities in the challenges that pregnant athletes face, the Davenport and colleagues write, indicate the need for sports policies that consider these challenges and work toward cultivating an environment that supports pregnancy and pregnant athletes.
While there’s evidence that exercise is beneficial in an average pregnancy, the body of research into vigorous exercise in elite athletes is smaller and newer. In an examination of the existing evidence, Thea Jackson and colleagues call for more research, but also highlight a few of the guidelines that the research already points to.  First, they stress the importance of multidisciplinary teams that include coaches, nutritionists, physicians, and trainers to care for pregnant elite athletes. Second, the researchers encourage the involvement of pelvic health physical therapists to manage pelvic health before, during, and after pregnancy. Finally, the researchers point out that waiting six weeks to return to physical activity is arbitrary and not necessarily evidence based and discuss the need for more research of ways newly postpartum people could gradually return to activity.
According to the American College of Obstetricians and Gynecologists, pregnant people who participate in vigorous-intensity athletic activities before pregnancy can continue these activities during pregnancy and postpartum. Kinesiologist James Pivarnik and colleagues published a study in 2016 in which they reviewed the available literature about pregnancy and vigorous exercise, where the heart rate increases to over 85 percent of the maximal heart rate.  They again highlighted the difficulty of knowing what choices elite athletes should make about their activity during pregnancy due to the lack of existing data. While they acknowledge that it’s not possible to generalize beyond the exercise guidelines for average pregnant people, the researchers did recommend that pregnant athletes consult with their care providers early and often during pregnancy and decrease resistance load during training.
Another recommendation that Pivarnik and colleagues advanced in their 2016 study was that care providers can educate pregnant people who are undertaking high-intensity exercise about the potential troubling symptoms to watch out for.  Warning signs during exercise in pregnancy include: headache, lightheadedness, dizziness, fainting, chest pain, heart palpitations, swelling of the hands, face, feet, or calves, vaginal bleeding, calf pain, contractions, pelvic, pubic, or deep back pain, abdominal cramps, fluid leaking from your vagina, unusual shortness of breath, fatigue, and muscle weakness. If you experience any of these symptoms, stop or decrease the intensity of your exercise immediately and call your care provider.
- Davenport, Margie H et al. “Pushing for change: a qualitative study of the experiences of elite athletes during pregnancy.” British Journal of Sports Medicine. 2022. doi:10.1136/bjsports-2021-104755
- Jackson, Thea et al. “The Legacy of Pregnancy: Elite Athletes and Women in Arduous Occupations.” Exercise and Sport Sciences Reviews. 2022. doi:10.1249/JES.0000000000000274
- Pivarnik, James M et al. “The Elite Athlete and Strenuous Exercise in Pregnancy.” Clinical Obstetrics and Gynecology. 2016. doi:10.1097/GRF.0000000000000222