Recommendations for postpartum athletes returning to sport: the past, present, and future.

Introduction: There is a growing percentage of elite female athletes who choose to start a family during their athletic careers. Current guidelines to manage postpartum elite athletes returning to sport are weakly rooted in athlete-centered evidence and/or are restricted by small sample sizes. The purpose of this review was to collect and compare existing protocols and guidelines for elite athletes returning to sport following childbirth and to highlight the current culture surrounding postpartum athletes.

Methods: Online databases including PubMed and BioMed Central were searched from September 2023 to May 2024. Studies of any design were included if they contained information on pregnancy and postpartum. Peer-reviewed research studies, systematic reviews, case reports, and data from organizational websites (American College of Obstetricians and Gynecologists, the World Health Organization, and the Official Olympics) were included.

Results: Athlete-mothers face numerous challenges in their transition back to competitive sport following childbirth, including the societal expectations of a 'good' mother, potential loss of financial sponsorships, and limited guidance on postpartum training. Additionally, the healthcare community historically managed postpartum athletes in a reactionary manner by treating symptoms from pregnancy and childbirth as they arise. Recent literature is pointing toward adopting a preventive and proactive model of care to optimize an athlete's health prior to pregnancy and therefore support their safe return to sport postpartum.

Conclusion: Increased support for female participation in sports must also be met by increased support for pregnant and postpartum athletes. There is a continued need for research regarding return-to-sport guidelines for postpartum athletes, and their proper implementation.