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Exercise and pregnancy in recreational and elite athletes: 2016/2017 evidence summary from the IOC expert group meeting, Lausanne. Part 5. Recommendations for health professionals and active women
  1. Kari Bø1,2,
  2. Raul Artal3,
  3. Ruben Barakat4,
  4. Wendy J Brown5,
  5. Gregory A L Davies6,
  6. Michael Dooley7,
  7. Kelly R Evenson8,
  8. Lene A H Haakstad9,
  9. Bengt Kayser10,
  10. Tarja I Kinnunen11,
  11. Karin Larsen12,
  12. Michelle F Mottola13,
  13. Ingrid Nygaard14,
  14. Mireille van Poppel15,
  15. Britt Stuge16,
  16. Karim M Khan17
  1. 1 Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
  2. 2 Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway
  3. 3 Department of Obstetrics/Gynecology and Women’s Health, St Louis University, St Louis, Missouri, USA
  4. 4 Facultad de Ciencias de la ActividadFísica y del Deporte—INEF, Universidad Politécnica de Madrid, Madrid, Spain
  5. 5 Centre for Research on Exercise Physical Activity and Health, School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Queensland, Australia
  6. 6 Queens University, Kingston, Ontario, Canada
  7. 7 The Poundbury Clinic Dorchester—The Poundbury Suite, King Edward VII Hospital, London, UK
  8. 8 USA Gillings School of Global Public Health, Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
  9. 9 Department of Sport Sciences, Norwegian School of Sport Sciences, Oslo, Norway
  10. 10 Faculty of Biology and Medicine, Institute of Sport Science, University of Lausanne, Lausanne, Switzerland
  11. 11 Faculty of Social Sciences/Health Sciences, University of Tampere, Tampere, Finland
  12. 12 The Swedish School of Sport and Health Sciences, Stockholm and Department of Community Medicine and Rehabilitation/Sports Medicine Unit, Umeå University, Umeå, Sweden
  13. 13 R. Samuel McLaughlin Foundation—Exercise and Pregnancy Lab, The University of Western Ontario, London, Ontario, Canada
  14. 14 Department of Obstetrics and Gynecology, University of Utah, Utah, Salt Lake City, USA
  15. 15 Institute of Sport Science, University of Graz, Graz, Austria
  16. 16 Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
  17. 17 Department of Family Practice & School of Kinesiology, Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Kari Bø, Department of Sport Medicine, Norwegian School of Sport Science, Oslo 0806, Norway; kari.bo{at}nih.no

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Background

This is part 5 in the series of reviews from the IOC expert committee on exercise and pregnancy in recreational and elite athletes. Part 1 focused on the effects of training during pregnancy and on the management of common pregnancy-related complaints that may be experienced by athletes1; part 2 addressed maternal and fetal perinatal outcomes2; part 3 reviewed the implications of pregnancy and childbirth on return to exercise and on common illnesses and complaints in the postpartum period.3 Part 4 provided recommendations for future research based on parts 1 through 3.4 In part 5, we summarise our recommendations for exercise during pregnancy and after childbirth in recreational exercisers and elite athletes experiencing healthy pregnancies. Part 5 also serves as a background for healthcare personnel to advise women who wish to stay active at a high level.

Most of the references to existing research in the respective research areas are listed in the previously published parts1–3 and are not repeated here. The recommendations are divided into exercise during conception planning, exercise during pregnancy, effect of exercise during pregnancy on birth outcomes and exercise after childbirth. The level of evidence supporting the majority of the recommendations is very low or low-to-moderate. Therefore, advice to elite athletes regarding exercise frequency, duration and intensity that is beyond current guidelines must be individualised with regular close observation of maternal and fetal well-being.

Preconception

The optimal fertile age period for women coincides with peak performance for many athletes, and some athletes may have impaired fertility related to relative energy deficiency in sport (RED-S). In addition to normal preconception advice, we advise that elite athletes who wish to become pregnant, should discuss specific issues, including their age, body weight, body mass index (BMI), body composition (% body fat), history of menstrual …

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