High-Load Training, Miscarriage Myths, And Pelvic Floor Truths For Active Moms

Heavy lifting in early pregnancy carries a long shadow of fear—but the data tell a different story. We unpack a newly published study on first-trimester high-load resistance training, revealing that pelvic floor symptoms actually decreased compared to preconception, even as many athletes maintained intensities near 80% of one-rep max. We also dig into miscarriage rates in this cohort and how they align with population norms, pushing back on the narrative that smart, heavy training in early pregnancy is inherently risky.

From there, we confront an overlooked reality: most active women receive little to no guidance on returning to exercise after miscarriage. We share raw, personal experiences of medical management, bleeding, and the confusing early weeks of recovery, then introduce a new survey designed to map real-world timelines, barriers, and advice quality. Whether you lift, run, flow, or mix it up, your input can shape practical, compassionate recommendations for getting back to movement in a safe, sustainable way.

We round out the conversation with a deep dive into perimenopause and musculoskeletal pain, especially the spike in shoulder and low back-pelvic discomfort as women move from pre to peri. For athletes navigating postpartum in their 30s and 40s, this hormonal backdrop matters. Aerobic and resistance training may blunt vasomotor symptoms, but aches can still rise, calling for smarter load management, recovery, and clinical screening when needed. The throughline is clear: informed autonomy. With better data and honest dialogue, we can train hard, honor healing, and adapt across life’s transitions.

If you’ve experienced a miscarriage in the past year and were active before or during pregnancy, please check the show notes for our survey link and share it with someone who might benefit. If this resonated, subscribe, leave a review, and send this to a friend who trains. Your story moves the science forward.

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Transcript

Welcome And Scope Of The Show

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We want to talk about the reality of the amount to access it. Whether we are an acquaintance active fighter or an athlete, we want to talk about all of the things that we go through as females going into this motherhood journey. We're going to talk about fertility, pregnancy, and postpartisan topics that are relevant to the active individual. While I am a pelvic floor physical therapist, I am not your pelvic floor physical therapist and know that this podcast does not substitute medical advice. All right, come along for this journey with us while we navigate motherhood together. And I can't wait to get together. Hello everyone, and welcome back to the Barbell Mamas podcast. Christina Previtt here. And in today's episode, I want to talk about a paper that I just published, a study that I started recruitment on, and another big systematic review in the perimenopause space that I think is important for moms, especially postpartum moms, to be thinking about. Last week felt like such a huge career week for me. I have a couple of papers that I have been working on, research studies that I've been working on for several years now from a recruitment and analysis perspective. And 2026 is really the year that they all start coming out, which is really exciting. One just got published, one is in for publication. I have another one that's in final manuscript mode before it gets submitted. I am just hoping that this is the year that a lot of my postdoctoral work really starts being showcased, which is really exciting. And that means that there is a lot that I get to share on this podcast with you all. So the first thing that I wanted to talk about today was my new paper that just came out in MSSE. It's the scientific journal for the American College of Sports Medicine. And it is called High Load Resistance Training in the First Trimester, a retrospective survey, implications for exercise professionals and obstetrical providers. To give you a little bit of context and background on this study, I am currently doing retrospective and prospective studies that are taking individuals in the first trimester and following them to 18 months postpartum. I am taking individuals from less than a year postpartum and asking them about their pregnancy and doing this in the functional fitness space, high load resistance training, strength training space. And I'm also doing this in the running space. The idea behind my postdoctoral program is I am hoping to relinquish some of the buoys at high intensity exercise, meaning that no matter where you are in terms of what you want to do for exercise, we are not creating unnecessary barriers. We are not leveraging or focusing on fear when it comes to pregnancy and exercise. And from my lens as well, it's not only the safety piece, but it's also the pelvic floor dysfunction piece and how that layers in to what we know about exercise and pregnancy and postpartum recovery. This paper takes the group that has started my prospective study in the first trimester. So they were under 20 weeks in their pregnancy and reviews some of the initial data that we collected from these moms to be. In it, what we did was we looked at miscarriage history. We looked at exercise history, we looked at pre-conception pelvic floor history, and then we looked at how or if modifications were done to exercise programming principles or variables in the first trimester and try to evaluate what those were. Why this matters. When we are thinking about the pelvic floor, so often, most women, unless they had a pelvic floor complaint, don't really learn about the pelvic floor until pregnancy. And then we get hit with this idea of this new muscle growth that we had never talked about before, that all of a sudden is under strain, that we're worried that we're gonna be peeing our pants, that all these problems are gonna come up. And so often after pregnancy to postpartum, so many women were saying, I wish I would have known. In the athletic space, this is a little different. Pardon me, I'm getting over a cold. So if I sound a little nasally, that's why. In the athletic space, we know that 30 to 50% of female athletes, whether they've had kids or are not, are niliprous, have never given birth, have pelvic flora dysfunction in athletics at least. That can trickle into other areas, but we know that in sport rates of pelvic flora dysfunction are high. While we know that pregnancy is a risk factor for pelvic flor dysfunction, one of the things that I have been thinking about a lot and that came up as one of the narratives to discuss around this paper was so often if we have a high rate of pelvic flor dysfunction during pregnancy and nobody is asking about pre-conception pelvic health, what does that risk do to the relative risk of pelvic flora dysfunction in pregnancy? I hope you're you're kind of following me. In all of our data right now, we know that being pregnant can be a risk factor for pelvic floor issues. And then what happens during labor and delivery is an additional risk factor. However, if we have this cohort of athletic women where 30 to 50% of them, before they even get pregnant, are struggling with pelvic issues, what does that do for the relative risk in pregnancy? That was one of the things that I was trying to answer. And what we saw in the first trimester is that we saw a reduction in symptoms of pelvic florid dysfunction compared to pre-pregnancy, which was a super interesting finding. Now, many of you may think, well, is that because we started modifying or we started, you know, changing our load or not lifting as heavy? We controlled for that in our analysis and we saw that there was no difference. Both were statistically significant. If they maintained or increased their load, or they decreased the load that they were lifting in pregnancy. And so it doesn't seem to be that it because of modification away from heavier lifting that rates of pelvic flora dysfunction, specifically stress urinary incontinence and anal incontinence, decreased in the first trimester, which is a really interesting finding from this paper. What we saw was that actually when we looked at loads lifted, there was very little decrease in the amount of weight that people were moving in the first trimester. We had just over 40 people who had uploaded their training logs with how much weight they were lifting at different weeks of pregnancy. And when we looked at that relative load compared to their one rep petition maximum, we saw that most people were staying above 80%, which is typical of training loads. No one's going up to their one rep max every single day in the gym. And that was true for the squat, bench, deadlift, snatch, and clean and jerk, which is really exciting. So we saw that pelvic floor dysfunction, there was no increase in risk. There actually was a bit of a decrease in the amount of pelvic floor symptoms that people in the first trimester were experiencing. There was no decrease in the load lifted. Most individuals were able to lift at relatively high percentages. And when it we looked at miscarriage rate, there didn't seem to be an increase in rate of miscarriage. It was about 23% with some of those being abortion. So individuals who self-selected to terminate a pregnancy, where that was not different at 23% to what we see in our general population when we look at rates of fetal loss and miscarriage. Interestingly, from that study, and that's gonna kind of trickle into the study that I am recruiting for, what we saw was that very few individuals were giving were given any advice about returning to exercise after miscarriage. And maybe this will be my trigger warning in the middle of this. We are gonna be talking about fetal loss and miscarriage. But that was one of the things that I was looking at in this paper was are you, did you get any advice about return to exercise and did miscarriage change your exercise behaviors? And in this, we saw that, you know, about 11%, I believe. Don't quote me on the exact percentage. I should have it on the top, I should have it open on my screen, but I don't. That was the percentage of humans that were given advice on return to exercise after miscarriage, which can include a lot of, you know, persistent blood loss and bleeding, et cetera. And so there really wasn't a lot of advice given. And so to kind of wrap up this paper, what it was showing is that starting to really look at for active women, one, what preconception pelvic floor dysfunction does to relative risk during pregnancy, two, adds to a growing body of literature looking at high load resistance training during pregnancy, gives the first is the first study that looked at high intensity exercise in the first trimester of any study design. We don't have anything across any study group that looked at high load strength training in the first trimester. So this was really unique in that circumstance. And we looked at rates of fetal loss or miscarriage and didn't see any differences compared to general population, which is good news. Now, on the exercise and miscarriage piece, I have been very open on this podcast about my two fetal losses. I had a loss at seven and a half, eight weeks, and I had a loss at almost 13 weeks when I thought that I was out of the woods and was gonna be excited about a baby coming um soon. And that just did not happen for me. And pardon me. Um one of the things that came out of those experiences was a lot of emotions and a lot of uncertainty around the return to exercise process. Now, when I returned after my second loss, I had done medical management. With that, um, it basically pulled me into labor. Like that it did feel like um early to mid-labor pain um when the medication finally kicked in. And then there was just an insane amount of blood loss. They say heavy period. I have never had a period that was that intense. Um, I think it's a little bit underreported in terms of what the expectation is. Um, it is not a heavy period at all. It was definitely more intense than that. Um, and then about five weeks after my delivery, I also had a second episode of really intense bleeding. And to not be too TMI, but definitely TMI, because I share a lot on this podcast. I was literally standing over a toilet and I was oozing blood. And we were on the fence, like, this is a hospital call. Like my husband's like, Am I calling an ambulance? Like, this shouldn't be happening. And I was clotting, I was having all these problems. And so that amount of blood loss really influenced me returning post miscarriage to activity. I would get unwell, my heart rate would be erratic, the persistent bleeding would make me feel faint and dizzy. I just couldn't handle intensity. And it was really eye-opening that I was coming from a very informed place, and I did not feel well informed about what that return would look like. That prompted me to talk to Margie about it, Dr. Davenport about it, and say that I just have this huge desire to explore this topic around exercise, fetal loss, miscarriage, return to exercise after fetal loss. Obviously, because now this is the second time I've recovered from a miscarriage. My body does not feel the same. I have persistent weight gain, like all these things from just the stress on your body. And thankfully, she's amazing. And let me kind of run with this study. And so we just got ethics approval for a survey that is looking at return to exercise after miscarriage. We are looking at the mental health, emotional distress, general health. But then we're also looking at some of the physical symptoms to try and get an understanding of current or uh experienced barriers and issues around physical return and what that physical return looked like. We want to know about timelines for returning to exercise, barriers, length of barriers. We have open-ended questions that are asking about what you wish you would have known. If you are feeling like there is some hesitancy to return to high intensity exercise, if you want a subsequent pregnancy, et cetera. We're trying to explore a lot of things around the miscarriage process in individuals who are active. And this is not just for our runners and our functional fitness. This is if you do yoga, tai chi, barré, F45, you go to the gym, aerobic step class, you know, go to the YMCA and do the machines, like it's every type of fitness. I want to collect every type of fitness and explore this return to exercise process. And so if you are listening to this and you are a person who has had a miscarriage in the last 12 months and were active around preconception, pregnancy, and return after that loss, if you are interested, we will post the link to that study in the show notes. This is something that is really near and dear to me. I have to be honest with you all, because that's what I do. But I posted about this study and I sobbed. I sobbed. I sobbed tears of gratitude that something that was so life-shattering for me might turn into something beautiful. Because if I can help a mom that is feeling the same way that I was feeling and help them return to exercise, which for so many is such a positive stress-coping mechanism. Like, oh I just there was so much gratitude there, and there was so much beauty in that painful moment, and just obviously grief and sadness were overtaking me from my two babies that I have lost. And it was just such a uh just such a transformative moment, and it was so healing in some ways and so painful in others, and just this study means a lot to me, and all of my studies have meant a lot. Um, but the emotional rawness of this experience in particular is definitely hitting me very close to the heart and soul. And so we have over a hundred people who have already filled out the survey, and it just makes my heart so happy to see that because it's just such a needed study and needed information. And I'm just so excited to be able to be that conduit for that study. So if you are interested, getting off the heavy in the show notes. There is the link to that survey. And I would appreciate you sharing it with anyone that you know who might be in that first year post-loss that uh could be filling that out for us. And then finally, these have those first two are kind of in my research wheelhouse. The third one that I want to talk about because I think it's really interesting from how you're feeling in your body perspective. There was a um a massive new um systematic review of meta-analysis that came out about perimenopause and the they call it musculoskeletal manifestations, but essentially they were talking about joint pain and pain in the perimenopausal to postmenopausal transition. And while this is not a menopause podcast, obviously, but I what I am seeing is that more women are are later in their 30s or early 40s when they are starting or finishing their reproductive journeys. What that means is that it's very likely that your postpartum journey and your perimenopause journey will either be directly overlapping or fairly close together. I know it's just so great to be a woman sometimes. Um but what this study was was showing, and what I kind of want to finish with this scientific communication piece is that what we saw was in this study was from pre to peri to post, there's a lot of discussion about the muscle scalpal syndrome of menopause or this like clear understanding now, this further exploration of the fact that menopause is not just about vasomotor symptoms. While the night uh night sweats and the hot flashes are definitely something that my clients in period post-menopause complain of, what we see is that there's so much more to it than that. Um, where the increase in anxiety, depression, resentment towards partner, rage, that mental health piece is a very big bucket. In the muscle skeletal side, the shoulder pain and increase in joint pain without a reason or change in what a person has been doing, no sharp increase in what a person has been doing, is this other highlighted bucket. When I think about my really active women too, what we know is that those with a high amount of aerobic exercise have less vasomotor symptoms. And the same is true with high amounts of resistance training. And oh gosh, off the top of my head, it's eluding me. But one bucket of fitness, either aerobic or resistance, decreases frequency and the other one decreases intensity. I think it's aerobic training decreases the intensity of the hot flashes, like the amount the how long they last for. And then the resistance training decreases how often you have them. I think I could be switching it up. Clearly, my brain is doing really well today. But what that could mean is that for my active individuals, they may not suffer with the same vasomotor symptoms. Like they may not have the same hot flashes night flushes, but it might be these other things. And so, Marian Hubner, she is a researcher that is looking at master's Olympic weightlifters. And she published a study that showed that for our crossfitters, our Olympic weightlifters, going from pre-to perimenopause was characterized by an increase in joint pain. And it was up a little bit more post-menopause, which I always thought was really interesting. And now there's this big study that's kind of including everybody that is showing that the big jump in joint pain happens when you go from pre-menopause to perimenopause, where the jump is like 30 to 40% of individuals pre-menopause may have some joint pain or discomfort. And that jumps to 57% in perimenopause. And that goes to 59%. Like there's a, and it's not significantly different between perimenopause and postmenopause. And so the the big jump in how you are feeling and what you are feeling that is different in your body is in this perimenopausal transition. The most common areas for pain is low back, like pelvis area and the shoulder. And it's so funny because I remember being in physio school, obviously over 10 years ago now, and we talked about adhesive capsulitis or frozen shoulder. And we were like, yeah, risk factor is between like 40 and 50 and being a female. And you just like acknowledge those risk factors. And then I look back and I was like, Christina, you were so dumb that you just did not think about what big, major harmony. Hormonal shift was happening in that time. And I don't know if this is right or not, but I'm starting to call it menopausal shoulder because I see so many women in Perry, like in that peri approaching menopause time frame, that are coming to me with shoulder pain. And, you know, not everyone has it where their shoulder freezes, obviously. Um, but that discomfort in the shoulder is just so common in this transition. And so this big systematic review of meta-analysis was just demonstrating how it's really important that we think about our hormones in terms of how we are feeling within our body. And even though we aren't kind of in that menopausal transition, you maybe still regularly cycling, there might be some hormonal contribution to how you are feeling. And if you feel like nothing else has changed, but everything is starting to be achy, um, that might be the perimenopause on your shoulder that might be influencing how you're feeling. And so I think it's really wonderful that we're just starting to get so much more information in perimenopause. Perimenopause is so hard to study because hormones are really erratic. It's hard to conceptualize phase and control for a lot of variables because it really is this transitionary period. Um, the vast, vast, vast majority of our literature has been in the postmenopausal transition. Once your 12 months of no period is over, you're in postmenopause. And there's just been such a huge outcry for much needed information around that perimenopausal transition. And a lot of the ways that women postpartum feel are gonna mimic how they feel around peri-to-postmenopause. And so understanding menopause also helps us advocate for postpartum and vice versa. And so there really just is this big push for understanding about hormonal health and how hormonal health influences quality of life and how you're feeling within your body across the lifespan. So thought it was a cool study for me to introduce for you all. Um, and uh, if you want more information or anything like that, just make sure you reach out and let us know. All right, that is all I have for you for today. Um, thank you so much for listening to me uh blab on about my research. Um, I have, as I said, another paper is in for a peer review. I'm hoping, crossing my fingers, that it gets accepted. I'm actually presenting on it at the Canadian Physiotherapy Association Congress um end of May. And so I'll be able to kind of allude to some of the things that we are talking about. Um, but until then, um, if you want to read that research paper, just let me know and reach out. Um, and I hope you all have an incredible rest of your week.