Pregnancy, birth outcomes, and postpartum injury in elite to world-class runners: a mixed methods study

The International Olympic Committee (IOC) expert group on pregnancy identified a dearth of information regarding elite athletes and pregnancy outcomes. This study aimed to examine experiences of pregnancy and maternal and fetal health outcomes. A mixed methods design collected data from 42 elite to world-class middle/long-distance runners through a retrospective self-report questionnaire and 25 semi-structured interviews. Maternal and fetal variables related to experiences pre-pregnancy, during pregnancy, delivery, and postpartum were summarized. The majority of individuals reported normal cycle regularity (66.7% of participants reported > 9 in 12 months). Mean body mass index prior to pregnancy was 19.3 ± 1.2 kg/m 2 with gestational weight gain being 13.8 ± 5.5 kg. Participants reported being 1.4 ± 3.1 kg and 0.3 ± 2.6 kg heavier than their pre-pregnancy weight at 6- and 12-months postpartum. Sleep averaged 8.2 ± 1.0 h pre-pregnancy, but dropped to 6.6 ± 1.4 h 6-months postpartum. Average gestational age was 39.0 ± 1.6 weeks (range 34.0–42.0 weeks); mean birth weight was 3.2 ± 0.4 kg (range 2.4–4.3 kg). Only 3 infants were born preterm (< 37 weeks), 2 had low birth weight (< 2.5 kg), and 16.7% ( n = 7) required a NICU stay. Descriptive patterns for the need for medical intervention appeared similar across pre-pregnancy BMI, menstrual frequency, gestational weight gain, and training during pregnancy. Participants breastfed for 9.7 ± 5.3 months, 23.8% ( n = 10) discontinued due to training/competition. 50% reported an injury postpartum delaying their return to running/competition. To contextualize the quantitative results, we qualitatively generated nine themes: (1) Periodic loss of menstrual period is not uncommon, (2) Weight gain varies; all bodies are different, (3) Sleep substantially decreases postpartum, (4) Many unknowns exist with labour and birth, (5) Breastfeeding requires careful scheduling for athletes, (6) Listening to one’s body is key for postpartum recovery, (7) Multiple factors can lead to postpartum injuries, (8) Seeking advice from other elite athletes is valuable, and (9) Support systems are critical for success. Despite high levels of training, participants gave birth to healthy babies and developed effective strategies to adapt to parenthood. There is significant variability in how elite to world-class runners experience pregnancy, supporting the IOC’s assertion that postpartum return to training must be individualized across and within specific sports.