Barriers and enablers encountered by elite athletes during preconception and pregnancy: a mixed-methods systematic review

OBJECTIVE: To synthesise the existing literature relating to barriers and enablers encountered by elite athletes during preconception and pregnancy for the purpose of identifying key recommendations and actionable steps to inform the development of pregnancy guidelines to support preconception and pregnancy in national sporting organisations. DESIGN: Mixed-methods systematic review with thematic analysis. DATA SOURCES: Four databases (Medline, SPORTDiscus, PsycINFO and CINAHL) were systematically searched to identify relevant studies, along with reference lists of included studies until 3 April 2023. ELIGIBILITY CRITERIA: Peer-reviewed primary studies from any date, language and location which identify at least one barrier and/or enabler encountered by elite female athletes during preconception and/or pregnancy were included. Grey literature, books, conference papers and other reviews were excluded. RESULTS: A total of 29 studies met the eligibility criteria for inclusion. The most common barriers identified were attitudes, perceptions and beliefs of the athlete and society, lack of support provided by sports organisations and lack of evidence-based information available. The most common enablers were specific strategies used by athletes (eg, modified training) to manage the demands of preconception and pregnancy, attitudes, perceptions and beliefs of the athlete, and support of family. CONCLUSION: Key recommendations developed from the results are for sporting organisations to (1) develop clear, transparent and multifaceted policies to support preconception and pregnancy; (2) foster supportive environments which offer flexible training, social support and positive promotion of pregnant athletes and (3) provide clear, evidence-based education and information about preconception and pregnancy to athletes, coaches, support staff and organisational staff.