Pregnancy in Spanish elite sportswomen: A qualitative study

Barriers and enablers encountered by elite athletes during preconception and pregnancy: a mixed-methods systematic review

OBJECTIVE

To synthesise the existing literature relating to barriers and enablers encountered by elite athletes during preconception and pregnancy for the purpose of identifying key recommendations and actionable steps to inform the development of pregnancy guidelines to support preconception and pregnancy in national sporting organisations.

DESIGN

Mixed-methods systematic review with thematic analysis.

DATA SOURCES

Four databases (Medline, SPORTDiscus, PsycINFO and CINAHL) were systematically searched to identify relevant studies, along with reference lists of included studies until 3 April 2023.

ELIGIBILITY CRITERIA

Peer-reviewed primary studies from any date, language and location which identify at least one barrier and/or enabler encountered by elite female athletes during preconception and/or pregnancy were included. Grey literature, books, conference papers and other reviews were excluded.

RESULTS

A total of 29 studies met the eligibility criteria for inclusion. The most common barriers identified were attitudes, perceptions and beliefs of the athlete and society, lack of support provided by sports organisations and lack of evidence-based information available. The most common enablers were specific strategies used by athletes (eg, modified training) to manage the demands of preconception and pregnancy, attitudes, perceptions and beliefs of the athlete, and support of family.

CONCLUSION

Key recommendations developed from the results are for sporting organisations to (1) develop clear, transparent and multifaceted policies to support preconception and pregnancy; (2) foster supportive environments which offer flexible training, social support and positive promotion of pregnant athletes and (3) provide clear, evidence-based education and information about preconception and pregnancy to athletes, coaches, support staff and organisational staff.

The Translation of Policy to Person: A Qualitative Analysis of Elite Athletes' Perceptions of Pregnancy in the United Kingdom

BACKGROUND

An increasing number of female athletes are navigating an athletic career alongside pregnancy. Limited qualitative research has investigated the experiences of elite athletes in the United Kingdom (UK). This study aimed to explore the experiences of elite athletes in the UK as they navigated pregnancy, employing a socio-ecological framework to inform future research and policy recommendations on sport participation during pregnancy.

METHODS

A descriptive qualitative study design, adopting a relativist ontology and constructivist epistemology, was implemented. Semi-structured online interviews were conducted with elite athletes ≥ 18 years old, who resided in the UK, and who trained and/or competed at the highest level of their sport prior to and/or during pregnancy. Interviews were recorded, transcribed and analysed using reflexive thematic analysis.

RESULTS

Eleven athletes (mean age 31 ± 3 years) from nine team and individual sports participated in the study. Four key themes were developed: (1) From the Podium to Parenthood: Institutional versus Individual Influence on Reproductive Planning; (2) Is My Career Over? Micro Level Support versus Macro Level Doubt and Worry; (3) Athlete to Mother: Internal Conflict to Community Role Model; (4) Navigating the Bump: Individual Drive to Tackle Systemic Gaps.

CONCLUSIONS

Findings highlight the complexity female athletes face when navigating pregnancy, motherhood and elite sport. There is a need for high-quality research focusing on preconception and pregnancy-specific training and nutrition modifications for elite athletes, particularly regarding nutrient intake and supplementation. Additionally, efforts to improve the translation of evidence-based research into practical applications remain essential.

Sport and exercise recommendations for pregnant athletes: a systematic scoping review

Objectives

To analyse the available evidence and identify gaps in current knowledge regarding physical activity volume and intensity and their effects on pregnancy outcomes in female athletes.

Design

Scoping review.

Data sources

A structured literature search of three electronic databases (Embase, PubMed and Web of Science) was conducted on 25 February 2022, and a rerun search was conducted on 8 September 2022.

Eligibility criteria

Studies were eligible if they contained information on the relevant population (ie, elite or competitive amateur female athletes), intervention/exposure (ie, minimum of 10 hours of sport per week) and fetal and maternal outcomes. Eligible comparators included female recreational athletes and pregnant non-exercisers.

Risk of bias

The risk of bias was evaluated with the National Institutes of Health (National Heart, Lung and Blood Institute) quality assessment tool.

Results

The results revealed a discrepancy between the number of original research papers and the number of reviews and recommendations derived from them. The identified studies focused primarily on pregnant recreational athletes. Sixteen clinical studies met the inclusion criteria. No adverse effects on maternal or fetal outcomes were reported. Only during performance tests involving acute intensive exercise with the mother exercising at more than 90% of her maximal heart rate did some fetuses experience decelerations in heart rate.

Summary/conclusion

A lack of high-quality studies and direct evidence on pregnant elite and competitive amateur female athletes is evident. Further prospective observational cohort studies are needed using new monitoring methods (eg, non-invasive, wireless monitoring systems) aiming to gain a broader understanding of the stress tolerance of pregnant athletes and fetuses during exercise. Following that, interventional studies with stress tests in laboratory settings should be conducted. Therefore, technology plays a decisive role in gaining new knowledge and providing evidence-based recommendations on this topic.

PROSPERO registration number

CRD42022309541.

Triple careers of athletes: exploring the challenges of planning a pregnancy among female elite athletes using semi-structured interviews

Background

The challenging factors that elite athletes perceive for combining their sportive career with planning a pregnancy and motherhood need to be identified in order to develop supportive measures. Therefore, this phenomenological qualitative study aimed to explore challenges associated with planning a pregnancy among female, non-pregnant elite athletes.

Methods

Semi-structured skype-interviews were performed among female elite athletes (athletes competing on national or international level) aged 28 years or older. Using Mayring’s qualitative content analysis approach, anchor examples served to identify potential challenges of planning a pregnancy which were categorized independently by two researchers.

Results

Interviews of 16 elite athletes (mean age 30.7 years) entered analysis. Eleven challenges of planning a pregnancy were identified, categorized into organizational / environmental, financial, personal, and physical factors.

Conclusions

With regard to financial challenges, we propose mandatory maternity leave and continuation of the contracts and salary. Furthermore, mentoring programs may help to provide support and advice to new generations of female elite athletes and help to reduce concerns regarding the wish of becoming pregnant during a sportive career. In order to reduce physical concerns regarding pregnancy and exercise, we see a need for scientific studies investigating the association of sport discipline specific characteristics on sportive performance and the mother´s, fetus’ and child´s health. Finally, the results of the current study may be used in future quantitative studies to test specific hypotheses.

Obstetric and Neonatal Outcomes of Pregnant Indian Pilgrims: A three-year experience at the Indian Hajj Medical Mission

Objectives

The Hajj, an annual mass gathering of Muslim pilgrims, is known for its high morbidity and mortality rates. However, pregnant women sometimes participate in this pilgrimage, despite guidelines that discourage such an undertaking due to potential fetomaternal complications. This study aimed to evaluate fetomaternal outcomes among pregnant Indian Hajj pilgrims.

Methods

This prospective cross-sectional study was conducted at two Indian Hajj Medical Mission (IHMM)-affiliated secondary care hospitals in Saudi Arabia during the Hajj periods of August-October 2015 and 2016 and July-September 2017. All female Indian pilgrims of reproductive age who underwent pregnancy screening at secondary care IHMM hospitals during this period were included in the study. Definitive obstetric care was provided at the Makkah Maternity & Child Hospital. Data regarding the pilgrims' obstetric characteristics, antenatal complications, management and fetomaternal outcomes were evaluated.

Results

A total of 114 pregnant Indian pilgrims were identified during the study period. The most common antenatal complications were respiratory tract infections (51.75%), followed by iron deficiency anaemia (17.54%), hyperemesis gravidarum (14.04%), hypothyroidism (9.65%) and gestational diabetes mellitus (5.26%). There were 20 vaginal deliveries (17.54%), two Caesarean sections (1.75%) and 32 abortions (28.07%). The cumulative three-year birth rate was 24.60 per 1,000 females.

Conclusion

During Hajj, pregnant pilgrims have a high risk of abortion, respiratory tract infections and various antenatal, perinatal and neonatal complications which may go unreported or untreated. Women should therefore be educated regarding the risk of adverse fetomaternal outcomes which may occur while undertaking a Hajj pilgrimage during pregnancy.