Pregnancy and postnatal exercise guidelines: returning female athletes to sport

2010 Team Canada alternate Kristie Moore, left, who is five months pregnant, holds her stomach during practice at the Olympic Centre during the 2010 Vancouver Olympic Winter Games in Vancouver.  (Credit Image: © The Canadian Press/

Until recently, pregnancy in female athletes was unheard of. Serena Williams famously brought the plight of the pregnant female athlete to light during her recent comeback on the tennis circuit. However, she isn’t the first female athlete to try to stay in shape while gestating a human or schedule training around nursing a baby. In fact, five athletes who are mothers competed in the 2018 Winter Olympics, including one parathlete for team USA. Still, that’s just a fraction of the female athletes competing. Therefore, we’re including today’s feature article on the pregnant athlete in our ‘uncommon’ series.

Forty percent (1,120) of the participants in the 2014 Winter Olympic Games were female. That number grew during the 2018 Winter Olympics to 1,242. The International Olympic Committee (IOC) realized that this growing population of female athletes competes during the most fertile period of their lives. Therefore, they’ve spent the last few years evaluating exercise and pregnancy in the recreational and elite female athlete. They found that having a child no longer means female athletes must step away from their sport. In fact, baring any complications, the athlete may continue to exercise at a moderate level during the entire pregnancy. If able to keep up with their training, most will still demonstrate a VO2maxafter child birth near their pre-pregnancy level(1).

This level of fitness, while possibly helpful with some aspects of pregnancy, does not prevent them from experiencing the same musculoskeletal issues as other pregnant women. Therefore, in today’s feature article, physiotherapist, athlete, and new mom Tracy Ward reviews some of the ways to manage the common musculoskeletal issues that arise. These include back, hip, and pelvic pain.

An uncomplicated pregnancy means an athlete should be able to do most activities with minor adjustments. However, certain conditions require pregnant athletes to avoid exercise altogether (see table 1). Others, while not absolute contraindications for exercise, necessitate close monitoring of both the mother and child (see table 2). Though cleared for exercise, athletes should avoid activities that increase their risk of falling or abdominal trauma. This means they may need to stop specific sport participation and focus on cross training activities. Stop exercise immediately if the athlete experiences any of the following:

  • Vaginal bleeding;
  • Regular painful contractions;
  • Leaking amniotic fluid;
  • Shortness of breath before exercise;
  • Dizziness or lightheadedness.

Table 1: Absolute contraindications for exercise during pregnancy (1)

Heart disease
Intrauterine growth retardation
Uncontrolled high blood pressure
Lung disease
Cerclage due to insufficient cervix
Multiple fetuses or increased risk of preterm labor
Bleeding after 4 months gestation
Placenta previa
Premature labor
Membrane rupture
Significant anemia
Preeclampsia or high blood pressure due to pregnancy

Table 2: Relative contraindications to exercise during pregnancy (1).

History of prior pregnancy complicated by fetal growth restriction, miscarriage, preterm birth or labor
Enlarged cervix
Unstable arrhythmia
Chronic respiratory issues
Uncontrolled diabetes
Chest pain
Swollen or painful calf muscles
Musculoskeletal concerns

Without anything to compare childbirth to except an acute injury, the IOC borrowed the return to sport guidelines from the 2016 World Congress in Sports Physical Therapy consensus statement(1). They divide the post-partum progression into three phases:

  • Return to participation – engaging in cross training activities at a lesser intensity than prior to pregnancy;
  • Return to sport – participating in actual sport and sports specific drills but still restricting intensity and duration;
  • Return to performance – executing their specific sport at or better than their pre-pregnancy status.

While ‘uncommon’, the incidence of pregnancy in female athletes should continue to rise as the numbers of women in sport increases. For now, sports scientists base current recommendations and guidelines on the scant research and the consensus of experts.  While exercise is usually safe, pregnancy is not the time to push the envelope and make performance gains. Assure athletes that they will be able to return to sport and advocate for the best training goal of all: a healthy mother and child.


  1. Br J Sports Med. 2018;52:1080-1085
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