Health Outcomes after Pregnancy in Elite Athletes: A Systematic Review and Meta-analysis

Abstract

This study aimed to evaluate postpartum maternal health and training outcomes of females who were competing or training as elite athletes before or during pregnancy. Methods: Online databases were searched up to August 26, 2020. Studies of any design and language were eligible if they contained information on the relevant population (postpartum athletes [any period after pregnancy]), exposure (engaged in the highest level of sport immediately before or during pregnancy), comparators (sedentary/active controls), and outcomes: maternal (breastfeeding initiation and duration, postpartum weight retention or loss, bone mineral density, low back or pelvic girdle pain, incontinence [prevalence or severity of stress, urge or mixed urinary incontinence, fecal incontinence], injury, anemia, diastasis recti, breast pain, depression, anxiety) and training (<6 wk time to resume activity, training volume or intensity, performance level). Results: Eleven studies (n = 482 females, including 372 elite athletes) were included. We identified "very low" certainty evidence demonstrating a higher rate of return to sport before 6 wk postpartum among elite athletes compared with nonelite athletes (n = 145, odds ratio = 6.93, 95% confidence interval = 2.73-17.63, I 2 = 11). "Very low" certainty evidence from three studies (n = 179) indicated 14 elite athletes obtained injuries postpartum (7 stress fractures, 9 "running injuries"). "Very low" certainty evidence from five studies (n = 262) reported that 101 (40.5%) elite athletes experienced improved performance postpartum. Conclusion: Compared with controls, "very low" quality evidence suggests that elite athletes return to physical activity early in the postpartum period and may have an increased risk of injury. Additional high-quality evidence is needed to safely guide return to sport of elite athletes in the postpartum period.

We’re not Superhuman, We’re Human: A Qualitative Description of Elite Athletes’ Experiences of Return to Sport After Childbirth

“…Eighteen athletes from nine Olympic sports (team and individual, winter and summer games) participated in this research. Between January and June 2021, we recruited postpartum elite athletes through social media (i.e., Twitter, Facebook, Instagram) and word of mouth via a purposeful and snowball sampling approach [ 10 ]. To be eligible, athletes could reside anywhere in the world, had to be ≥ 18 years old, and must have trained and/or competed at the highest level of their sport immediately prior to, and during, pregnancy, and returned to sport following childbirth within the last 5 years (2016–2021).…”

“…These statements strongly demonstrate of the paucity of data supporting safe return to sport. More recently, we conducted an updated systematic review of the literature that demonstrated elite athletes were more likely than sub-elite and recreational athletes to return to training in the first 6× weeks after delivery [ 10 ]. Participants also experienced increased rates of injury, likely exacerbated by a rapid return to sport, further illustrating the urgent need to have strong supports and return to training plans for elite athletes.…”

Rehabilitation of the Postpartum Runner: A 4-Phase Approach

“…The runner may begin running at any time postpartum if they have been medically cleared and screened for running readiness (Figure 1), as recent literature suggests that early return to exercise does not negatively impact pelvic health outcomes or increase injury risk in athletes. 73,74 Symptoms should be continuously monitored and addressed by the health care team. As each individual may have unique pregnancy and postpartum experiences, this framework should be used to assist each runner in achieving their running goals.…”

Exercise after pregnancy

“…Amateur athletes tend to return to exercise less quickly than those at the elite level. 27 The key is to start gentle walking a few days after hospital discharge and to gradually increase the amount and intensity of walking. She was advised that trying to 'bridge' from walking to running is safest (ie progressing from challenging walking, including hills and at a brisk pace, to very easy running), which she managed to do at week 10 after giving birth.…”