53 ‘Have we thrown the baby out with the bath water?’ A scoping review of the 32 summer olympic sports international federations’ pregnancy and postpartum policies and guidance

Introduction The number of female athletes competing at elite and Olympic level has risen exponentially over the past century. Pregnancy is no longer seen as the end of an athletic career and indeed, many mothers are reporting improved performances postpartum. However, there is limited guidance on the management of athletes specific to their sport and sporting participation during the pregnancy and the postpartum periods.

Aims This scoping review aims to examine the policy and guidance published by the International Sport Federations (ISFs) of each of the summer Olympic sports regarding exercise during pregnancy and the postpartum period. The review will appraise the published sporting guidance, reviewing the similarities and differences in the recommendations provided by these sports.

Methods The Preferred Reporting Items for Systematic Review and Meta- Analysis (PRISMA) was followed with the PRISMA extension for scoping reviews checklist. The quality and variability of policies was assessed independently using the AGREE II tool.

Results At the Paris 2024 Olympic games there will be 32 ISFs representing sports across 329 different events. No ISF was deemed to have an official pregnancy and postpartum policy. Only 12% (n=4) of ISFs having official published guidance on exercise during pregnancy and the postpartum period. All published guidance was deemed of low quality and not recommended for use.

Discussion Historically, pregnancy has been viewed as an end to athletic careers for female athletes. This review highlights the lack of trimester specific guidance on the upper limits of sporting participation during pregnancy and the postpartum period. New mothers have proven their ability and aspiration to continue training during pregnancy and return to elite competition during the postpartum period. However, ISFs lack policy in this area, which is the first step in facilitating mothers, athletes, coaches, and medical professionals to encourage the safe continuation of sports specific training during pregnancy and the postpartum period. Improved guidance for continuation of safe sport during the pregnancy and postpartum periods is required to ensure that mothers and their off-spring continue to avail of the health benefits from continued sport participation.