FIFA has launched two new decision aids to help clinicians guide soccer players who are pregnant or postpartum to continue playing safely.

The international governing body for soccer worked with Margie Davenport, PhD, a pregnancy researcher in the Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, to develop the tools, which were validated through a pair of corresponding studies. One study examined playing during pregnancy and one examined returning to the game.

The step-by-step guides are the first to offer practical, how-to advice for players on deciding when to leave and return to the game, Davenport said.

“Historically, general obstetric guidelines confirmed…that exercise is healthy and reduces birth complications, but they never offered doctors, coaches, and players a practical guide to support decision making on how to safely adapt team training, contact, and training load for soccer,” she told Medscape News Canada.

Instead of pulling players completely from their teams once they become pregnant, “our research supports continued training throughout pregnancy to reduce the risk for complications and to prevent injury postpartum,” she said.

Global validation of the tools involved a multidisciplinary team across 12 countries, with 97%-100% agreement on their practicality, she noted. “Obstetricians and other obstetric care providers are expected to feel much more comfortable supporting both recreational and competitive players using these tools.”

Filling a Gap

Davenport and her colleagues developed the decision aids by reviewing existing literature on barriers to elite sport participation during pregnancy and postpartum, then identifying the health screening components that needed to be built into a usable tool. Physicians, athletes, and coaches tested draft versions to confirm that the tools were accurate and easy to apply in practice.

The result is a pair of flowcharts that screen pregnant or postpartum players for conditions requiring medical guidance, along with related considerations such as mental health, fear of movement, and pelvic health. The tools also include graduated training frameworks that help determine whether players should progress, stay put, or regress in their playing activity. They provide examples of what the type of training would look like at each stage.

Overall, Davenport said, the tools “take away anxiety and uncertainty and provide referral pathways for players who need support from their physicians, psychologists, or lactation consultants. This [aid] elevates the quality of support they get from their teams.”

Although the current versions are soccer-specific, the underlying screening and progression-regression structure is transferable, and Davenport’s team is already working with other international sport organizations to adapt the framework for other sports, she said. An assessment of how the tools are performing in wider use is ongoing.

“While guidance for exercise during and following pregnancy have traditionally recommended caution and a reduction in overall training load, recent evidence now strongly supports the continuation of training to reduce the risk for pregnancy complications by about 50%, reduce the risk for postpartum injury, and support the athletes’ psychological health and identity,” she said.

‘Major Step Forward’

Francine Darroch, PhD, associate professor of health sciences at Carleton University in Ottawa, and Sydney Smith, her PhD student, commented on the new tools for Medscape News Canada. Darroch and Smith, who together have spent more than a decade researching elite pregnant and parenting athletes, said that the tools address a problem they have seen repeatedly in their own work, though neither was involved in developing the tools.

“These decision aids represent a major step forward and have the potential to set a new precedent for supporting pregnant and postpartum athletes,” they said. “One of the biggest challenges we’ve identified through our own research with Olympic, professional, elite, and recreational runners is the uncertainty surrounding training and return-to-sport decisions during pregnancy and postpartum.”

“Athletes frequently describe receiving inconsistent advice from different healthcare providers, coaches, and peers, leaving them unsure of what is safe or appropriate,” they noted. “These tools help address that gap by translating research into practical, evidence-informed guidance that clinicians, coaches, and athletes can actually use.”

Darroch and Smith also appreciate the philosophy underpinning the new tools: that athletes should be empowered to continue training. “That shift away from viewing pregnancy as an automatic reason to drastically slow down or stop participating in sport is incredibly important and reflects the direction that pregnancy and sport research has been moving over the past decade.”

Many of the overarching principles such as shared decision-making, individualized care, and consideration of the biopsychosocial factors that influence return to sport “are highly relevant for both elite and recreational athletes,” they continued. All athletes can benefit similarly from evidence-informed guidance and confidence to remain active throughout pregnancy and postpartum.

The fact that major sport organizations and global governing bodies such as FIFA are beginning to invest in research, policy, and practical guidance in this area “is a very promising sign,” they noted. “It suggests the system is slowly shifting toward treating pregnancy and maternity as a normal part of an athlete’s career, rather than an interruption or an endpoint.”

Davenport declared consulting with FIFA. Darroch and Smith reported having no relevant financial relationships. 

Marilynn Larkin, MA, is an award-winning medical writer and editor based in New York City whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDedge, The Lancet (where she was a contributing editor), and Reuters Health.