- Prenatal/Postnatal Fitness -

The Athlete’s Guide to a Healthy Pregnancy

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Running Pregnant

An IRONMAN athlete, nutritionist, and mother of two walks us through what to expect when you’re a triathlete expecting.

Having spent the last few years of my athletic career sporting a baby bump while conquering several IRONMAN races worth of swim, cycle, and running miles, I’ve had my share of looks ranging from applaud to concern. This, while trying to get back into shape, has sparked my interest in researching the limits and capabilities of the human body during each phase of a healthy pregnancy. Here, I tackle this topic, with insight from science, experts, and mommy athletes themselves. Stay tuned for Part II, where I’ll discuss getting back into training, the surprise performance benefits of pregnancy, as well as the hurdles moms face.

Trying to Conceive? 

The good news for athletes dreaming of baby is that consistent training at a moderate intensity is proven to enhance insulin function and the body’s overall hormonal profile. In short, you’re more fertile. In fact, exercise is not thought to be a direct cause of infertility, as can be attested to by ultrarunner, Emily Toia, who was logging 100-plus miles per week when she became pregnant with her son, Bowen.

Energy deficits, especially over the long haul, can cause the reproductive hormones to essentially go on strike, leading to infertility problems.

Problems occur when the metabolic demands of training aren’t met with proper nutrition. Energy deficits, especially over the long haul, can cause the reproductive hormones to essentially go on strike, leading to infertility problems.

Elizabeth Waterstraat, four-time National Long Course Triathlon Champion and mother of Maxwell (4) and Mackenzie (3 months), is all too familiar with this. She struggled with eating disorders and excessive exercise patterns for years before finding out that her pituitary gland wasn’t kicking out adequate levels of sex hormones due to a condition known as hypogonadotropic hypogonadism (HypoHypo). This ultimately complicated her attempts to get pregnant with her second child.

Athletes who have struggled to maintain a normal menstrual cycle at any point during training and competition, or have been diagnosed with other hormonal issues, may need to taper back their overall training load and increase energy intake to increase their chance of conception. Weight and fat gain may also be necessary for athletes with very low body weights, as defined by a body mass index (BMI) of 18.5 or lower. Otherwise, there is no need to put a halt on training. Just make sure you’re nourishing your body properly.

I’m Pregnant!

Congratulations! The sweet journey of motherhood has begun. Like a triathlon, pregnancy involves three legs, or trimesters, each lasting approximately 13 weeks and each presenting an array of different challenges for an athlete. At the finish line, though, the most amazing reward you’ll ever receive awaits.

Trimester 1: “The Swim”

Course Preview: The hormonal changes, fatigue, and nausea that come with leg one of pregnancy can make life feel like an upstream swim. While most women discover the joy of pregnancy within a few days of missing their period, some soldier on through training sessions and races for several weeks, even months, before realizing their symptoms are the direct result of life blossoming inside them.

While an upstream swim might be symbolic of the first trimester, exercise in itself is not a proven cause of miscarriage and rather provides a wealth of benefits for both mother and baby. Benefits for the woman include enhanced cardiovascular fitness, prevention of urinary incontinence, gestational weight gain control, decreased musculoskeletal discomfort, reduced muscle cramps, mood stability, and protection against gestational diabetes and hypertension. Benefits to the fetus include decreased fat mass, improved stress tolerance, and advanced neurobehavioral maturation.

Most miscarriages are actually unpreventable as a result of a chromosomal abnormality. Case in point: Professional triathlete Beth Gerdes finished fourth overall at IRONMAN Wisconsin in 2013, posting a 3:05 marathon split, before discovering she was six-weeks pregnant with her daughter, Wynne, at the time.

Good Eating: It’s still important to take certain precautions with your nutrition and training in the first trimester to ensure the proper maturation and health of the fetus. Early in pregnancy, the additional calories for a woman with a healthy starting weight are minimal at just over 100 calories per day. For many, overall energy intake may actually decrease due to a dramatic reduction in training load (in response to the nausea and intense fatigue brought on by increases in estrogen). However, a woman’s daily requirement for calcium (1000 mg), iron (27 mg), and folic acid (600 mg) go up to accommodate increases in blood volume and red blood cell mass and to aid fetal growth and development.

If you are a fan of caffeinated gels, blocks, and drinks, make sure to keep your total intake to less than 200 mg per day. (Caffeine crosses the placenta and is difficult for your baby to metabolize.) In addition, it’s recommended to avoid unpasteurized cheeses, honey, and raw fish and meat, all of which bring heightened risks for harmful bacteria. Because high levels of mercury can be toxic to the nervous system, it’s best to forgo eating tilefish from the Gulf of Mexico, King mackerel, shark, and swordfish as well. While a glass of wine is not likely to present a problem, alcohol does pass from mother to baby and may hurt the growth of the baby’s cells, especially in the brain.

Keep Moving: As for training, for an uncomplicated pregnancy with a green light from your health practitioner, Jennifer Garrison, two-time USA Triathlon Age Group National Champion, gives great advice: “Just keep going. You’ll feel better when you break a sweat. But, if your body tells you to skip or stop, now is not the time to prove anything.”

Such signs that exercise is not a good idea include pain, dizziness, shortness of breath, faintness, vaginal bleeding, and contractions or cramping. In addition, avoid training in extreme heat and maintain hydration by carrying fluids with you during workouts. Overheating can trigger a wide range of structural and functional defects in the early fetus as well as death in severe cases.

Trimester 2: “The Bike”

Course Preview: Unlike the upstream swim of trimester one, the second trimester can feel like you are riding a sweet downhill with a tailwind toward T2. Toia referred to her second trimester as “pure bliss.” Her energy levels soared and nausea disappeared, allowing her to hit paces closer to her pre-pregnancy norm. Gerdes and Waterstraat were able to step up their training volume as well, often logging one- to two-hour sessions.

Good Mama: From a physiological standpoint, the heart works a good 40 percent harder in the second trimester, pumping more blood with each beat. And, while vigorous exercise, such as a cycling class or Masters swim workout can temporarily decrease blood flow to the uterus due to diversion to the working muscles, it has not been shown to hurt your baby. Rather, there is evidence that it helps improve blood and nutrient supply to the placenta at rest, thereby enhancing fetal growth. If you experience any warning signs noted above in trimester one, sense an unusual absence of fetal movements after exercise, or start having more than six contractions an hour, stop your session and contact your doctor.

Because the second trimester is an important time for growth — with your baby’s weight graduating from ounces to pounds and your own weight increasing (on average, one pound per week) — overall energy and protein demands increase by 340 calories and 20 grams of protein per day, respectively. Failure to meet your metabolic demands during pregnancy can have negative implications on your baby’s growth, leading to a lower birth weight, and may increase risk for chronic conditions like heart disease later in life.

Trimester 3: “The Run”

Course Preview: Just like running off the bike in a triathlon, a pronounced baby bump, profound pelvic pressure, and an altered center of gravity late in pregnancy can make things a bit awkward. To compound the issue, elevated levels of such hormones as estrogen and relaxin trigger the remodeling of soft tissues, cartilage, and ligaments, as well as increase laxity in skeletal joints, particularly around the pelvis. This can lead to biomechanical changes in your running gait, discomfort, and an increased risk for falls and injury.

Good Mama: Waterstraat recommends seeking alternate activities when normal exercise no longer feels good or enjoyable. For example, your outdoor bike mileage may be done on a bike trainer or in a cycling class. A portion or all of your run training may be replaced with more weightless activity such as aqua jogging and elliptical, or you may consider using a sacroiliac support belt for added support during runs. Swimming often feels best late in the pregnancy game.

Some athletes express concern about going into premature labor as a result of exercising too hard in the third trimester, but evidence does not support this — rather, consistent training throughout pregnancy is likely to prevent it. Case in point: Between all the awesome athletes interviewed for this piece, including myself, all of whom carried on training all the way up to “labor day,” eight beautiful babies were born full term. As with the rest of pregnancy, though, be sure to listen to your body, stopping when any warning signs arise or you are feeling off.

During the third trimester, an increased energy and protein intake of approximately 450 calories a day and 25 grams a day is needed to support continued growth of your baby. Be mindful about fluid intake as well; dehydration can trigger contractions and may initiate premature labor. Sip on fluids throughout the day so that your urine runs a straw-like yellow and always have a water bottle handy during a workout.

Labor Day: “The Finish Line”

You made it! After 40 weeks (or so) of “training,” you are ready to endure what is likely to be the most challenging, yet sweetest, “race” of your athletic career. The average labor lasts 12 to 24 hours (if it’s your first pregnancy) and eight to 10 hours for forthcoming pregnancies, making labor just as metabolically demanding as continuous moderate exercise — queue the carbo-loading!

While it’s hard to pinpoint labor day, unless you have a scheduled induction or C-section, it may be helpful to favor carbohydrate-rich foods as you get close to your due date. Having a pre-“race” meal is also of paramount importance, especially for scheduled inductions and C-sections where solid foods are generally not allowed during labor. Focus on familiar easy-to-digest (lower fiber) carbohydrates with small amounts of fat and protein.

As for fueling during labor, check with your health practitioner about bringing some of your favorite carbohydrate-rich snacks to help maintain your endurance throughout labor. While fluids may be provided intravenously during labor, I found it comforting to have my water bottle at my bedside. You may be able to sip on juice to help keep blood sugars from dropping.

Upon crossing that finish line, enjoy the moment. There is nothing more exhilarating than holding your baby for the first time. You will generally be offered some food postpartum, so take advantage of this fuel as you will be in, perhaps, the largest energy deficit of your life. The nutritional boost will jump-start your recovery from labor and prepare your body for nursing. Also, be prepared for hunger to kick in with a vengeance and linger for several days post-labor — much like after a really hard workout.

Post-Race: Getting Back at It

When it comes time to return to training — it’s generally recommended to wait six to eight weeks after labor and delivery to return to your usual exercise routine — some athletes bounce back much sooner.

Waterstraat, who had a C-section, was cleared to begin training three weeks postpartum and won her first triathlon back at nine-weeks postpartum. Toia, who had a vaginal birth, began running two weeks after having her son and won a half-marathon at eight weeks postpartum. Garrison, who had a vaginal birth, returned to training two weeks postpartum and a few months later won the USA Triathlon Age Group Nationals. Six months after delivery, Gerdes placed fourth at IRONMAN Western Australia. Ultimately, it is important to listen to your body, heed advice from your health practitioner, especially in the first six weeks postpartum, and enjoy the cute new addition to your cheering squad when returning to competition.

Originally written for IRONMAN by Kimberly Mueller, MS, RD, CSSD. Posted here with permission by IRONMAN.

Kimberly Mueller, MS, RD, CSSD is a Registered Dietitian and Board Certified Specialist in Sports Dietetics who enjoys helping others fine-tune their nutrition as means to achieve their goals through her company Fuel-Factor.com. After back-to-back pregnancies, she hopes to earn the Olympic Trials standard in the marathon this year. IRONMAN is more than a family of events, it's a lifestyle. Since the very first race, held on the Big Island of Hawaii in 1978, the series has growth into a movement spanning the globe. For inspirational stories, training articles, and race-day tips, visit IRONMAN.com.

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