Post-Pregnancy Eating For Running
What does the research say about post-pregnancy running?
It has to be said that the data is limited and it would appear that the data collated has come from research on elite athletes rather than amateur athletes and physically active individuals. BUT there is some interesting information come from the current research including:
- Athletes tend to return to training between 0-6 weeks post-pregnancy albeit the training is reduced
- Athletes find their performance is the same or better than pre-pregnancy
- There is an increased risk of stress fracture post-pregnancy
- Pre-pregnancy weight is achieved after approx. 6months post pregnancy
It is well known that pregnancy impacts the musculoskeletal system so, like the data says, it is important to return to training SLOWLY and build up to help prevent injury.
How could this be done?
Current recommendations suggest following a programme described as a continuum comprising of three elements:
Return to participation – this is more like rehabilitation training and carried out at a much lower level than before pregnancy
Return to Sport – the athlete can return to their defined sport but at a performance level below that of pre-pregnancy
Return to Performance – the athlete GRADUALLY returns to her defined sport at a level equal to or above her pre-pregnancy level
Thinking about endurance sport, there are a couple of additional points to consider when returning to training. These are:
- Reintroducing training gradually
- Including low impact endurance sports initially for example fast walking, cross country skiing, low impact aerobics
- This type of exercise is thought to place very little pressure on the pelvic floor therefore can be introduced fairly soon following birth
What impact does Pregnancy have on the musculoskeletal system?
There are many different complaints and potential disorders that a mother could experience post-partum (post-pregnancy) linked to the musculoskeletal system, but also linked to other body systems too. The most common ones include:
- Pelvic floor dysfunction/pain
- Lower back pain
- Weight gain
Pelvic floor dysfunction and/or pain – clearly if there is pain and it is long lasting this would need to be evaluated and addressed before commencing exercise. BUT for any form of exercise a strong pelvic floor is required so, as long as there is no ongoing pain, strength training of the pelvic floor could begin straight after birth.
Lower back pain – according to one small study the incidence of lower back pain following birth is similar in athletes and non-athletes, however the lumbopelvic region of the back in athletes undergoes significant loading and stress (in most sports) if competing at a high level, so these individuals may be at increased risk of lower back pain following birth.
Weight Gain – post-pregnancy weight loss can be a real struggle for some women…even active women. Clearly there is going to be some weight gain during pregnancy, which is medically known as Gestational Weight Gain (GWG). There is a recommended gestational weight gain, however that will be very individual as it will depend on pre-pregnancy weight, height, foetus size, carrying twins/triplets etc.
BUT…it is thought that:
- If a woman gains over her recommended GWG she is more likely to retain approx. 3kg-4Kg extra weight up to 21yrs post pregnancy…..which is significant
- Excess GWG occurs for up to 75% of women who enter pregnancy overweight and for 40% of those of normal pre-pregnancy weight
- Approx. 25% of women retain more than 4Kg of extra weight 1 year post pregnancy
- Approx 20% of women move into a higher BMI 18 months post-pregnancy regardless of their pre-pregnancy BMI
This post-pregnancy weight gain could potentially put the mother at increased risk of developing chronic health conditions including diabetes and cardiovascular disease, so ideally she would want to try and lose the weight, however in a gradual and healthy way.
BUT, it is important to remember that many new mothers face some unique challenges that might get in the way of them managing their weight during this post-pregnancy period including:
- Lack of time
- Lack of motivation
- Lack of social support
- Lack of child-care – no family around, husband may be working
- Low energy – due to sleepless nights
- Breast-feeding – feeling uncomfortable when running
Another potential musculoskeletal injury that athletes may be susceptible to as they return to training post-pregnancy is Stress Fracture. One study reported 12% of participants (four elite female athletes) experienced 5 stress fractures within the first 6 weeks post-pregnancy. These stress fractures occurred in the sacral area, the toe and the tibia. This same study observed that none of the non-elite athletes experienced any overuse injuries over the first 9 months post-pregnancy.
Some other facts worth pointing out about the athletes who developed the stress fractures includes:
- Two of the athletes competed in endurance sports, the other 2 were team ball players
- They had all returned to high volume sport specific training within 6 weeks post-pregnancy
- They were all breast feeding
- Two had a history of disordered eating
So, this study suggests that the likelihood of stress fracture occurring for most amateur/casual runners is slim, however it would be important to be cautious regarding how quickly you return to running and the amount of training performed whilst breastfeeding to minimise the risk of a stress or other injury/illness.
Key Nutrients to Consider Post-Pregnancy:
There are many that a new mother would need to consider, however the two being discussed here are Iron and Calcium
As we know iron is important for a runner in:
- The production of haemoglobin and myglobin. Myoglobin being the iron and oxygen-binding protein found in skeletal muscle tissue (and the heart) whereas hemoglobin is the oxygen-binding protein found in red blood cells
- The PRODUCTION of red blood cells as well as the production of haemoglobin WITHIN red blood cells
- Immune, cognitive and hormonal health
- The cell energy cycle (Krebs Cycle or Citric Acid cycle) within our cell energy power houses known as mitochondria
What about Iron status post-pregnancy?
During pregnancy the recommended daily intake of iron increases from 14.8mg per day (for non-pregnant women) to 27mg per day but interestingly some study papers have noted that the average daily intake is as low as 7.7mg per day. Health and nutrition status pre and during pregnancy will determine how a mother recovers post-pregnancy, so in order to return to running as swiftly as possible it is important to ensure that iron levels are optimal during pregnancy.
A FOOD FIRST approach to iron intake throughout pregnancy and postpartum and beyond would be recommended, however for some individuals a supplement may be necessary. It is highly recommended that you work with a professional when considering supplementation as high dose iron intake, if upper limits are exceeded, could be detrimental to both mother and foetus/child for example child neurodevelopment
Equally iron deficiency could potentially be detrimental to the foetus and/or mother-to-be. For example, if the mother-to-be is anaemic it could increase the risk of:
- Preterm birth
- Low birth weight
- Impaired psychomotor development
- Impaired cognitive function
Thinking about the detrimental effects of iron deficiency for the mother-to- be, symptoms experienced may include:
- Reduced resistance to infection
- Low BP
- Reduced cognition and mood
…and of course all this leading to poor running performance
The recommended daily intake for pregnant and breastfeeding women is the same as that for non-pregnant women, which is 700mg.
The body maintains a constant blood level of calcium via a homeostatic control mechanism. This Calcium homeostatic response during pregnancy includes:
- An increase in intestinal calcium absorption, which will be directly related to the female’s calcium intake but also her vitamin D availability as Vit D is required for calcium absorption
- An increase in urinary excretion or reabsorption of calcium (where necessary)
- An increase in bone turnover – If an inadequate amount of calcium is consumed during pregnancy it could be a major risk factor for the development of stress fracture post-pregnancy due to an increase in bone turnover
The bulk of foetal skeletal growth takes place from mid pregnancy onward, with maximum calcium needs occurring during the third trimester. As a result optimising calcium intake to prevent any detrimental effects to mother or baby would be crucial during this stage of pregnancy.
Additionally low calcium status is linked to an increased risk of pre-eclampsia and overall child health outcomes following birth.
The overarching message here is; it is very important to consider nutrient status PRE-pregnancy and DURING pregnancy to help limit or prevent any detrimental health concerns POST pregnancy for mother and baby.
Putting the nutritional advice into practice
Key actions to consider whether you are thinking about becoming pregnant, are pregnant, or have recently given birth:
1) Engage with a professional to ensure you are receiving appropriate advice for YOUR personal circumstances and running goals
2) Remember food comes first
3) Iron Rich Foods to include:
Haem iron – most readily absorbed:
But red meat is principle source
Non-haem iron – Not easily absorbed as firstly requires converting to its soluble form
- Meat, fish, poultry
- Pant foods eg. Cereals, grains, legumes, fruit and vegetables, eggs, blackstrap molasses
- Fruit and vegetables include: dried apricots, broccoli, dates, raisins, dark green leafy vegetables/herbs, peas
- Found in fortified foods
So, unless you are vegetarian or vegan it may be appropriate to introduce a portion of red meat 1-2 x weekly into your meal plan as it is the best source of iron BUT avoid liver as it contains high levels of vitamin A, which may be harmful to an unborn baby. Also, choose natural meats opposed to processed meats and consume organic wherever possible and ensure it is well cooked.
4) Calcium Rich Foods to include:
- Small fish such as sardines – calcium in bones
- Dark Green Leafy Vegetables
- Nuts & seeds such as poppy, sesame chia
- Dairy: for example milk and cheese
- Grains: for example Amaranth
- Fruits: for example Apricots, blueberries, blackberries
- Legumes: for example chickpeas, kidney beans
- Tofu, which has been fortified
- Other fortified products for example milk and milk alternatives, bread
Just a word of caution when consuming dairy products in pregnancy and during breast feeding; ensure the choices you make are pasteurised because unpasteurised dairy products may contain listeria, known to cause an infection called listeriosis which, has been linked to a potential increased risk of miscarriage and stillbirth – although the risk is thought to be low.
TOP TIPS for post-pregnancy weight loss:
- Try to achieve a healthy lifestyle and appropriate weight status pre-pregnancy to help limit the amount of weight gain during pregnancy
- A healthy approach to nutrition AND physical activity provides the best outcome linked to weight loss post-pregnancy – one or the other has limited effect
- Adequate and appropriate food intake is important so that both mother and baby are receiving SUFFICIENT nutrients
- Know your Energy Requirements including your running requirements AND for breast feeding
- Adjust your daily food intake depending on whether you are exercising or not
- Choose low GL foods
- Combine protein and CHO at each meal and snack
- Remember you could be suffering from a “biochemical imbalance” for example hormonal, digestive, immune imbalance. Seek professional advice to address this