Exercise in pregnant elite athletes: Physiological considerations, risks, and benefits

The American College of Obstetricians and Gynecologists (ACOG) recommends engagement in moderate exercise throughout pregnancy, including aerobic and strengthening activities, which has been shown to offer numerous benefits during pregnancy. However, the intersection of pregnancy and athletics presents a unique set of challenges. ACOG guidelines on exercise during pregnancy primarily target recreational exercisers. Tailored recommendations are needed for pregnant elite athletes. This study examines both how pregnancy affects physiology and the risks/benefits of high-intensity exercise. Two independent reviews were conducted, using MESH search terms including "pregnant athletes," "female elite athlete," "maternal health," "exercise pregnancy." From 56 total studies, 40 studies with clinical data on over 4163 women, including elite athletes, were included in the review. Regular exercise during pregnancy can improve cardiovascular fitness and fetal vascular function while reducing risks of gestational diabetes, hypertensive disorders, delivering a large-for-gestational-age infant, and excessive weight gain. High-intensity activities can compromise fetal blood flow. Endurance athletes may safely maintain their training regimens during pregnancy, whereas those in high-altitude or contact sports require adjustments. Routine, non-intense exercise during pregnancy offers significant maternal and fetal health benefits. Future work should establish individualized recommendations supporting pregnant elite athlete health.