Elite Athletes and Pregnancy: Training, Performance, Health and Psychological Aspects Across Pre-, Peri-, and Postnatal Stages - A Scoping Review

Background: The number of elite female athletes navigating pregnancy continues to rise, yet the intersection of high-performance sport and motherhood remains understudied. This scoping review summarizes the literature on training, performance, physical health, and psychological aspects before, during, and after pregnancy in elite athletes (tiers 3–5). The aim is to identify knowledge gaps and to inform future research. Methods: This review was conducted in accordance with the PRISMA-ScR guidelines and was registered with PROSPERO (CRD420250651470). At 8 ^th of January 2025, a systematic search of 10 databases (e.g., PubMed, Scopus, and PsycINFO) was conducted. Studies were eligible for inclusion if they involved elite female athletes during the pre-pregnancy, pregnancy, or postpartum phases. Data extraction included information on study design, athlete classification, training, health, performance, and psychological outcomes. Results: Of the 5,236 records examined, 102 studies met the inclusion criteria and 47 original research articles underwent detailed data extraction. Elite athletes often plan their pregnancies very carefully. Although high-performance training combined with a healthy diet does not necessarily impair fertility, some athletes reduce their training to support their fertility. Furthermore, there is no evidence to suggest that high training loads have a negative impact on the course of pregnancy. Evidence shows that elite athletes typically continue to train throughout pregnancy, adjusting the load, and resume training early after childbirth. Although highly individualized, performance recovery is feasible. Moderate-intensity exercise appears to be safe, but thresholds above 90% of maximum heart rate may impact fetal responses. Psychological stress, identity conflicts, and a lack of tailored guidelines are common challenges. Most birth outcomes match or exceed those of the general population. Conclusions: Despite the emergence of new evidence, there are still significant gaps in the research regarding individualized training protocols, postpartum return to sport strategies, and mental health interventions for elite athletes peri- and post-pregnancy. The current literature favors endurance sports and Western populations, highlighting the need for more diverse, prospective, and interdisciplinary research. Registration: The protocol for this review was registered in the PROSPERO database (CRD420250651470).