The lasting impacts of relative energy deficiency in sport imposed on pregnancy health outcomes: A survey-based investigation

BACKGROUND: Relative energy deficiency in sport (REDs) results from exposure to problematic low energy availability. It is a serious condition affecting the health and athletic performance of up to 80% of elite female athletes. REDs is established to have negative short-term effects on reproductive function, but the long-term impact of this condition is unknown. Therefore, we examined the impact of secondary amenorrhea with or without a concurrent diagnosis of REDs on perinatal health outcomes. METHODS: Postpartum individuals (≥18 years of age) completed an online questionnaire that covered demographics, reproductive history (including a diagnosis of REDs or secondary amenorrhea), and maternal/fetal health outcomes. Logistic regression was used to determine the relationship between previously diagnosed REDs or secondary amenorrhea with perinatal health outcomes. RESULTS: A total of 1025 previously pregnant participants completed the survey (33.1 ± 3.4 years, mean ± SD). Prior to pregnancy, 6.1% had been previously diagnosed with REDs and 20.5% had a history with secondary amenorrhea. Individuals diagnosed with REDs had 3.5-times higher odds of having premature labor (odds ratio, (OR) = 3.52, 95% confidence interval (95%CI): 1.26-9.81) and 2.6-times higher odds of preterm delivery (OR = 2.62, 95%CI: 1.05-6.58) compared to those who had not experienced REDs or secondary amenorrhea. However, in individuals who did not have a history of REDs, secondary amenorrhea did not increase the odds of adverse pregnancy or delivery outcomes. CONCLUSION: A history of REDs, but not secondary amenorrhea, may increase the odds of premature labor and preterm delivery.