Transitions into Pregnancy and Postpartum – Return to Sport

More and more athletes are entering motherhood and continuing to engage in sport. Pregnancy and starting a family no longer mean the end of a sporting career. Therefore, awareness, support structures and pathways need to be developed to meet the needs of this population. 

The perinatal transition – bodily changes during pregnancy

During pregnancy, the female body progresses through a multitude of physical and physiological changes (Donnelly et al., 2022a, Donnelly et al., 2022b, Chandra and Paray, 2024). Specifically, pregnancy affects musculoskeletal, respiratory, reproductive, endocrine, cardiovascular, neurological, gastrointestinal and immunological systems, as well as causing changes to the breasts and skin, see table 1 (Chandra and Paray, 2024). It can also expose psychological challenges as an individual adapts to an ever-changing body, pregnancy-related symptoms and a new identity as a mother/parent. 

Table 1 from; Chandra M, Paray AA. Natural Physiological Changes During Pregnancy. Yale J Biol Med. 2024

Musculoskeletal changes are perhaps the most obvious changes that accompany pregnancy. The abdominal wall stretches and expands exponentially to accommodate the growing foetus. In addition, the pubic symphysis and sacroiliac joints widen and become more accommodating to strain. Some pregnant individuals may find increased range of motion throughout their body owing to the influence of the altered hormonal environment, e.g. increased shoulder flexion and increased lordosis of the lower spine (Chandra and Paray, 2024). Contrary to past beliefs, the hormone relaxin is not the sole cause for joint laxity, but rather a combination of altered hormone levels (Donnelly et al., 2022a). Negative consequences of this increased laxity are not uniform and depend on individual baseline and wider biopsychosocial factors. For example, up to 50% of women are considered to report pregnancy-related pelvic girdle pain. Our understanding of the pathophysiology of this condition has progressed from traditional biomechanical models (Vleeming and Schuenke, 2019, Vleeming et al., 2008) to biopsychosocial informed models that consider contemporary pain science (Pulsifer et al., 2022).

Cardiac output increases during pregnancy to support the developing foetus and then rapidly declines towards pre-labour levels within an hour of giving birth and has nearly returned to baseline by 2 weeks postpartum (Chandra and Paray, 2024). 

The inferior vena cava is compressed by the gravid (pregnant) uterus while the patient is supine, lowering the amount of blood returning to the heart and consequently lowering cardiac output and stroke volume (Mahendru et al., 2014). This means clinicians and sports medicine team staff should be cognizant of the supine position and monitor pregnant athletes or individuals for signs of shortness of breath or distress. Moreover, although usually beginning in the third trimester, shortness of breath can occur at any point and in any position throughout the course of pregnancy. Typically, the shortness of breath occurs at rest or when speaking, and contrary to expectation, may get better during light activity (Chandra and Paray, 2024) meaning pregnant women should be encouraged and supported to remain active where medically safe to do so.