Table 2.

Actionable steps to support elite female athletes

Themes	Example supporting quotes	Policy recommendations and actionable steps to support pregnant elite athletes
Pregnancy planning and fertility	‘We had tried to get pregnant, and we weren't successful. We had a very specific timeline’. (Jillian) ‘I wasn't having a regular menstrual cycle because of heavy training volumes, I have a leaner build. So, it was a lot harder for me to get pregnant the first time around’. (Amy)	Educate coaches, medical professionals and athletes of reproductive age about the impact of training on the menstrual cycle and fertility. Develop clear maternity leave policies and support to allow athletes to plan for pregnancy.
Pregnancy disclosure and discrimination	‘I wouldn't discuss it with them [coaches] at all until I knew until I had to… I was worried that they would question my commitment’. (Leslie) ‘I think that more than anything, it was my own insecurities of thinking that as a female, if I get pregnant, they're not going to accept me anymore’. (Emma)	Provide training sessions to athletes, coaches, medical professionals and sporting organisations on promoting a supportive environment for pregnant athletes. Increase the visibility of athletes who have successfully navigated pregnancy and elite sport. Develop antidiscrimination laws to support athletes who become pregnant.
Training pregnant athletic bodies	‘It was difficult to accept early on… I sort of saw my [training] plummet … I did have quite a hard time with reconciling in my own head that I was in a different place and that I was going to have to back off’. (Pamela) ‘There may be guidelines that exist, but I'm not convinced that they apply to athletes’. (Jillian)	Increase high-quality research into the impact of elite-level training during pregnancy (eg, fertility, safety, limits and health outcomes). Improve knowledge translation of evidence-based recommendations to athletes, coaches and healthcare providers.
Safety concerns	‘I got pregnant while I was competing and pulled out of a race because I thought I was pregnant. And just thought, ‘Oh my gosh, I don't want to be like damaging the fetus’’. (Stella) ‘I want there to be more concrete answers about what I can and can’t do … can I actually harm the fetus … if it’s going to harm the baby I’m not going to do it?’ (Mallory)	Increase high-quality research into the impact of elite-level training during pregnancy. Provide training and education to healthcare providers on evidence-based recommendations for training and competing during pregnancy.
Supportive network and equitable funding	‘A supportive partner has been huge for me, a supportive coach, someone who can understand the woman’s body and what it goes through [during pregnancy]’. (Jana) ‘I don't think it’s very convenient for anybody when an elite woman becomes pregnant. But what is a support right now is more social media attention for pregnant athletes and more shaming of sponsors that don't treat their pregnant athletes or postpartum athletes properly, and the rewriting of a lot of sponsorship agreements’. (Cassidy)	Normalise and value pregnancy and elite sport by developing best-practice policies and funding to support pregnancy. Promote and provide greater visibility of athletes who successfully navigated pregnancy and elite sport. Develop networks for athletes considering pregnancy to speak with others about shared experiences.