the pregnancy training framework active women have needed forever

Getting pregnant while being an active woman comes with a question nobody prepares you for: Now what?

Every piece of training knowledge you've spent years building suddenly comes with a giant question mark attached to it. Can I still run? Should I lift? What about the gym class I've been going to for three years? And who do I even ask?

If you've been through this, you'll know that the answers you get back are often vague at best ("listen to your body!") and outright fear-inducing at worst ("you should probably just walk"). Active women during pregnancy have been badly served by the information available to them, and for years, that has meant fit, motivated women stopping training they didn't need to stop, losing fitness they didn't need to lose, and feeling more isolated than they should.

Researchers have finally built the framework women need, and it was just published in the British Journal of Sports Medicine.

In early 2026, researchers Dr. Sinead Dufour, Emma Brockwell, Ivi Casagrande, and Dr. Margie Davenport published the FIFA Stay in Play During Pregnancy Decision Aid and its accompanying 5-Stage Training Framework in the British Journal of Sports Medicine. Built with footballers in mind, its implications go far wider than the pitch. If you're a runner, a gym-goer, a CrossFitter, a dancer, or a recreational anything, this research might sit with you.

Pregnancy and sport have had an uncomfortable relationship for a long time. The dominant cultural narrative has treated pregnancy as a fragile state, something to be protected from exertion rather than something that can coexist with it.

Medical guidance reflected this for decades. Much of the advice to stop or dramatically scale back training during pregnancy wasn't based on robust evidence. It was based on long-standing expert opinion and theoretical concerns about fetal safety that, it turns out, haven't held up particularly well under scientific scrutiny.

Decades of research have shown that exercise during pregnancy cuts the odds of gestational diabetes and preeclampsia by around 40% and slashes the likelihood of depression by around 67%, numbers that should be in every pregnancy app on the market but somehow aren't. It is not associated with an increased risk of miscarriage, preterm birth, or having a smaller baby.

For elite athletes specifically, science has found similar health outcomes in pregnant athletes compared to their less active counterparts. The research on contact sport, long considered especially off-limits, has also evolved: a recent study found a low, though not absent, risk of adverse outcomes even following a hard hit during early pregnancy.

Training during pregnancy requires nuance, but the message active women have been receiving, stop, rest, be careful, protect yourself, has consistently gone further than the evidence warrants. Women who wanted to keep training didn't have a framework to do it safely. They had fear, vague reassurances, 2 am Reddit threads, and an OB or midwife who said "just listen to your body."

At its core, the decision aid is a guided conversation between you and your healthcare team. At minimum, that means you, your coach or trainer, and your doctor or midwife working through it together. In a professional setting, that team might also include a physiotherapist, pelvic health physio, physical performance coach, nutritionist, and psychologist. For most women, it's the type of framework that should be in every antenatal pack but isn’t.

There are five objectives, each building on the last.

Your due date, your training history, your position or sport. It establishes that full-contact activity isn't recommended beyond 12 weeks of pregnancy, and flags the symptoms that mean you need to stop and seek medical care immediately.

The conditions that mean training needs to be modified or paused until you've spoken to your healthcare provider. These include things like unstable Type 1 diabetes, preeclampsia, unexplained bleeding, and placenta previa. This is the only part of the decision aid that can lead to a recommendation to stop training altogether.

None of these automatically stops you from training, but all three may require additional support alongside it. Fear of movement is particularly worth understanding: the research shows that avoiding exercise because of pain or anxiety during pregnancy tends to amplify both. Avoidance makes things worse, not better. If you screen positive in any of these areas, the recommendation is to seek the appropriate care, not to stop moving.

The 5-Stage Training Framework that maps how training adapts across your pregnancy and how to move between stages based on how you're feeling.

Documenting decisions and planning, including your return to training postpartum.

The tool was reviewed by 34 end users across 12 countries, players, coaches, and medical staff from amateur to professional levels, with 94% overall approval.

The framework is not a linear progression. You don't inevitably move from Stage 1 to Stage 5 as your bump grows. Some women will stay in Stage 2 until late in pregnancy. Others will move from Stage 4 back up to Stage 3 after a symptom resolves. Movement between stages goes in both directions, guided by your health and your preferences, not the calendar.

Nothing changes yet. You train as normal, with increasing attention to fuelling, breast support, and pelvic floor function. At 12 weeks, or sooner if pain or symptoms show up, you move to Stage 2.

If you're not a footballer, this might look like continuing your usual sessions while starting to tune into recovery more deliberately — and adding pelvic floor work if it isn't already part of your routine.

Full contact is off the table from 12 weeks, but modified, controlled low-intensity contact can continue. You're still training at roughly the same volume and intensity, just with adjustments where needed. Barbells give way to dumbbells or kettlebells as the bump grows. Plyometrics get modified based on how your pelvic floor is coping. You take more rest.

If you're not a footballer — and most of us aren't — this might look like swapping your barbell work for dumbbells, pulling back slightly on plyometrics, taking an extra rest day, but still showing up and still training. You're not stepping back, you're adapting.

You've stepped away from team-based play, either for safety reasons or by choice, but you're still training independently with purpose. Tempo runs, fartlek sessions, and high-intensity intervals all remain on the table. The research found that short bouts of high-intensity exercise, specifically around 10 x 1-minute intervals at over 90% of maximum heart rate, are not associated with adverse fetal or maternal outcomes when medically supervised. This directly challenges the widespread advice to avoid all intensity during pregnancy. It doesn't mean jumping straight into HIIT, but intensity, with appropriate oversight, is not automatically off the table.

If you're not a footballer, this might look like solo runs at your own pace, gym sessions planned around how you're feeling that week, or a structured program you're working through independently rather than in a group setting.

Sport-specific work winds back. Cardio moves to lower-impact options: bike, rower, swimming, cross-trainer. Strength training uses bodyweight, bands, or lighter loads. Light ball work, like keep-ups or wall passes, still fits here. Pelvic floor and mobility work run through everything.

If you're not a footballer, this might look like swapping runs for walks, moving your strength work to the cable machine or bands, spending more time on mobility, and measuring success by how you feel rather than what you lifted. Maintaining capacity at this stage is genuinely the goal.

For women who have developed a contraindication to exercise. Complete rest isn't the answer here; the research is clear that total inactivity carries its own risks. Gentle movement, walking, daily activities, and pelvic floor work if advised. This stage is temporary, pending medical guidance.

One principle applies across all stages: pain guides progression and regression. Below 2 out of 10, you can progress. Between 2 and 3, you stay put. Above 3, you step back a stage and connect with your healthcare provider. Pain here isn't a proxy for injury; it's a signal worth listening to.

The decision aid was built for football, but the underlying framework can be applied across almost any sport or movement practice under medical guidance. How you manage load, intensity, contact, and recovery during pregnancy is relevant whether you're a runner, a lifter, a CrossFitter, or someone who goes to the same pilates class every week.

The researchers are clear on one point: pregnant athletes should be included in their training environment by default, with individualised decisions made from there, not excluded first and accommodated later. Keep showing up to your gym, your run crew, your class, and work with your team to figure out what needs adjusting.

A lot of anxiety around training during pregnancy comes from not knowing where the actual lines are. Most active women can continue throughout pregnancy with modifications. But some symptoms mean stopping immediately and calling your healthcare provider: constant shortness of breath that doesn't ease with rest, severe chest pain, painful or frequent contractions, vaginal bleeding, continuous fluid leaking from the vagina, or ongoing dizziness or faintness that doesn't resolve.

The research is unequivocal that exercise is safe and beneficial for most pregnant women. Knowing where the lines are means you can train without second-guessing every session.

After 20 weeks, when the baby starts kicking, the decision aid recommends monitoring fetal movement before, during, and after training. If movement is absent or less than usual, see your healthcare provider immediately.

Two environmental cautions the research specifically flags: avoid training in high heat or humidity where possible, and avoid altitudes above 1800 metres without appropriate acclimatisation first. Both carry pregnancy-specific risks that don't always come up in standard guidance.

Also worth tracking across your pregnancy: hydration, breast support, fuelling (energy demands increase, and screening for Relative Energy Deficiency in Sport, REDs, a condition where insufficient fuelling impairs both health and performance, is embedded in the decision aid), sleep quality, and recovery. If recovery feels consistently insufficient, pull back on training load.

Before your next appointment: The Get Active Questionnaire for Pregnancy and postpartum, the validated screening tool used in Objective 2 of the decision aid, is freely available at csep.ca. Working through it beforehand gives you a concrete starting point rather than walking in cold.

If you're working with a physio or sports medicine doctor, ask about pelvic floor screening, fuelling, and their experience with active pregnant women. It's also worth asking about the Pregnancy Medical and Performance Debrief Form, a weekly check-in tool developed alongside the decision aid that records your training status, screening scores, and decisions made at each stage. It received 100% approval from the clinicians and coaches who reviewed it.

If a provider tells you to simply stop without a clear medical reason, it's reasonable to ask why, and to point to the research that supports a different approach.

For a long time, active women during pregnancy were either left without guidance or told that walking was enough. The FIFA Stay in Play Decision Aid offers something more rigorous: a framework built on decades of research, validated across 12 countries, and designed for real athletes working with healthcare teams.

Training through pregnancy won't always be straightforward. Some weeks will look very different from what you're used to. But adapting is not the same as stopping, and the research makes clear that stopping shouldn't be the default.

The same team has also published the FIFA Stepping into Play Postpartum Decision Aid, a companion framework for return to training after birth. The support continues beyond delivery.

You were never supposed to choose between being pregnant and being an athlete. The research says keep going. The framework is a big step forward in terms of how.

the bottom line

Connie Gwynne is the founder and editorial director of athletegirl™, a women's running health PhD researcher, and social media editor of the British Journal of Sports Medicine. She holds a Master’s in Sports Medicine, Exercise & Health from UCL and dual degrees in physiotherapy and sports therapy.

the science behind this article

Dufour S, Brockwell E, Casagrande I, Davenport MH. Stay in Play: a FIFA decision aid for football participation during pregnancy. British Journal of Sports Medicine, 2026. doi:10.1136/bjsports-2025-110227. Open access.

Davenport MH et al. Impact of prenatal exercise on maternal harms, labour and delivery outcomes: a systematic review and meta-analysis. Br J Sports Med 2019.

Wowdzia JB et al. Elite Athletes and Pregnancy Outcomes: A Systematic Review and Meta-Analysis. Med Sci Sports Exerc 2021.

Jones PAT, Brockwell E, Dufour S, Davenport MH. What are the Risks of Contact Sport During Pregnancy: a Survey-Based Investigation. Sports Med 2025.