The New Rules Of Pregnancy Training

Pregnancy advice for active women is changing, and not a moment too soon. I’m Christina Prevett, a pelvic floor physical therapist and researcher in exercise and pregnancy, and I’m sharing three timely topics that keep showing up in the women’s health and birth space, along with the lived reality of training while pregnant after previous losses.

First, I break down the proposed PCOS name change to PMOS (polyendocrine metabolic ovarian syndrome). The criteria for diagnosis and the core management approach are not suddenly rewritten, but the new language spotlights what many people with PCOS feel every day: this is more than “cysts on ovaries.” We talk androgen excess, insulin resistance, and why metabolic and endocrine risk matters for long-term health, fertility, and future cardiovascular disease and diabetes prevention. I also name the downside: PCOS is already underrecognized, and a transition can create confusion if education does not keep pace.

Then I dig into the new FIFA “Stay In Play” pregnancy decision aid for soccer athletes, a major step forward for pregnant athletes in so-called contact sports. Instead of a blanket ban, it uses shared decision-making and a biopsychosocial screen, looking at mental health, fear of movement, pelvic health symptoms, recovery, support, and contraindications. I walk through the stage-based framework that lets athletes modify, pause, or progress based on pain, preference, and medical clearance, not arbitrary week-by-week rules.

We close with pregnancy after miscarriage and loss. I say this clearly: exercise does not cause miscarriage, and your loss is not your fault. But anxiety is real, and it makes sense if you choose to train differently in that vulnerable first trimester. If you found this helpful, subscribe, share it with a friend, and leave a review so more active moms can find evidence-based support.

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Transcript

Welcome And Podcast Mission

SPEAKER_00 0:07

Hello everyone and welcome to the Barbell Mamas Podcast. My name is Christina Prevett. I'm a public school physical therapist, researcher in exercise and pregnancy, and a mom of two who has competed in prostitutes, powerlifting, or weightlifting, pregnant, post-partum, or both. In this podcast, we want to talk about the realities of being a mom who loves to exercise. Whether you're a recreational exerciser 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 gonna talk about fertility, pregnancy, and postpartum topics that are relevant to the active individual. While I am a public floor physical therapist, I am not your public floor physical therapist, and know that this podcast does not substitute medical advice. Alright, come along for this journey with us while we navigate motherhood together. And I can't wait to get excited. Hello everyone, and welcome to the Barbell Mamas podcast.

Surprise Pregnancy And Community Support

SPEAKER_00 1:12

Christina Previtt here. And today I wanted to talk about a couple of things that are kind of new and more like, I guess, news or kind of hot topics that are coming up in the birth space, the women's health space. And then I wanted to talk a little bit about pregnancy after miscarriage. I want to first, though, thank all of you. I had so many people who reached out to me. We did our pregnancy announcement when we were in Greece. My husband and I were in Greece last week. And so it was a little bit of a baby moon. We kind of really pulled the trigger because all of a sudden we have this third kiddo that is on the way that we were not expecting, um, but are so thankful for. And we wanted to kind of re like come together as a couple, you know, and just have that time together before our life changes in a good way as at the end of 2026. So before I kind of go into some of the things I wanted to talk about today, just a massive thank you to all of you who are listening to the podcast who sent me a message and um just shared your warm wishes. I had a couple people who have been following me with my miscarriages and losses and said that I gave them hope. And gosh, that is just such a kind gesture because I know how complicated those feelings can be when you are navigating your own grief journey and then you see somebody who has that positive pregnancy test. And so um, I was so thankful to people who reached out in those circumstances too, because I just know that those feelings are really complicated. So just a massive thank you for you all, and I'm sure I'll share more about my pregnancy as you go through podcast episodes, et cetera.

PCOS Rename To PMOS Explained

SPEAKER_00 2:59

The first thing that I wanted to talk about that was a really hot topic in the over the last week or so, has been the change to the PCOS naming. So PCOS standed for polycystic ovarian syndrome. It is a hormonal issue with androgen access, which causes issues with different processes, including insulin resistance. And PCOS has um has considerations for or can be an issue for women who are trying to conceive, but it's also an endocrine disorder, a chronic disease that does not have a cure, but it has ways to manage that condition. And out of the Lancet, there was a global consensus around changing the name of PCOS to PMOS, polyendogrine metabolic ovarian syndrome. And there was a lot of confusion, like what does this really mean? On the diagnostic side of things, on the management side of things, it really doesn't change anything. Where it does change, or the idea behind the change was on uh the way that PCOS was framed or uh in general understood. When you say PCOS, cystic ovarian, the cysts on the ovaries were seen as the main issue with or for the lay person may be seen as the main issue in this syndrome. In reality, though, it is the issues that come along with androgen access and insulin resistance that truly leads to a lot of the consequences and the cystic ovaries that can create a lot of issues, disturbances, and symptom burdens for those who are struggling with PCOS. And so this has been taken up in the women's health space with a lot of positive um thoughts and intentions. A lot of people believe this was a really great change. The negative feedback has been around how PCOS is already underdiagnosed and underrecognized in the confusion in the PCOS PMOS transition. That is a very real um negative feedback and potential negative consequence. But to have a change that gives those who are struggling with PMOS the feeling like their condition is more understood, and having that metabolic and endocrine marker in the name for the launch pad around the focus in interventions when it comes to body structures and function, um, you know, metabolism, future risk for cardiovascular disease and diabetes, like all of these kind of downstream consequences. And then obviously the fertility space, having that appropriate naming and nomenclature can sometimes make resources in that space easier down the road. So uh really interesting to see kind of how this PMOS uptake comes in to social media landscapes, women's health landscapes, research funding, and medicine is gonna be interesting in the next couple of years. Um, but I have been following that closely because uh that is quite a big change and it is exciting to see what the downstream consequences of that are gonna be. So that was kind of um thing number one that has been coming up in the women's health space.

FIFA Stay And Play Decision Aid

SPEAKER_00 7:03

Number two, um, that is very relevant to the pregnancy and postpartum space is that the stay in play FIFA pregnancy decision aid was just launched. I had done a podcast around the postpartum decision aid. This is the same group, Chine DeFor, Ivy Cascardi. I'm oh Casa Grande. I don't know if I spelled her last name or pronounced her last name wrong. I'm so sorry, Ivy, if I did. Emma Brockwell and Margie Davenport are the masterminds behind this decision aid. And I, of course, the postpartum decision aid was so influential because it it talked about individual time points, the biopsychosocial considerations, different types of recoveries, and how everyone, every athlete is gonna have her own journey. And so it wasn't saying, okay, you have to do this at this week and this at that week, but rather kind of go through stages. And that was hugely influential. I think it's gonna be hugely influential for female athletes. This pregnancy guideline, I think, is not only gonna be influential for all of those reasons because it mimics a very similar structure, but the idea of a decision aid to allow pregnant athletes to continue participating in what is seen as a contact sport with soccer, in and of itself, is just absolutely massive to think about, right? Because so often you were told as soon as you are pregnant that you are pulled off of all contact sports. And Emma and Sinead, I believe, was on that paper, and Margie and Paris Jones published a paper that was looking at adverse outcomes for those that continued to participate in contact sports and showed a very low risk of adverse events. It was like less than one point per thousand training hours. A similar study just came out looking at climbing, and it was 0.3 uh adverse events per 1,000 training hours. That argument around the contact sport being a yes-no binary question is starting to be eroded. And it is going from a yes, this is allowed if you're not pregnant, no, this is not allowed if you are, to okay, how do each athlete, how do we approach each athlete and allow them to make decisions based on their personal circumstances in combination with our risk profile in our research. When we have these athletes who are so in tune with their bodies, number one, and have been playing a sport that has a contact component, or equestrian or rock climbing, whatever it might be that's considered high risk, there is often an issue in communication, right? Because, for example, an equestrian, we have athletes who are so confident with some of the animals that they work with that they perceive their risk of being thrown off a horse to be really low. And the provider that is giving them counsel has a different risk assessment, right? Because they see or maybe aren't in the equestrian world. And so they don't have the same nuance and context to being in that sport and what it looks like for a well-loved, uh strong relationship between horse and rider versus, you know, a horse that you're unfamiliar with, for example. And that difference in context and trying to bridge those things together, I think is hugely important. And we've seen this over and over again, right? I think a lot of times our more conservative conservative exercise recommendations often come from providers who are not in those spaces. And I mean this respectfully, but you know, heavy lifting in pregnancy, for somebody who isn't heavy lifting, the risk assessment of that is so different from somebody who is in that world or in that space because they can change the way that they're bracing, how they are breathing. Like there's so many modifiable factors that you wouldn't be aware of if you weren't somebody who engaged in that type of exercise or in that sport. So when we have these big gaps, the provider is going to go on the side of being conservative. And these decision aids in aerobic training and running and resistance training, they start to bridge these two worlds together. And I freaking love that. It's so important and it's so hard to do because one is like medical liability and risk gratification, and the other is the love of the sport and mental health and so many other of these things that are that are so intangible in some ways. And so, first, before I kind of go into the decision aid, I just want to really impress upon you all one, how much work this is, two, how shattering this is, like in a good way, like ceiling shattering this can be, and how this is gonna pave the way for so many other areas for us to test kind of these ceilings when it comes to um different modalities of exercise in pregnancy. And so when it comes to the way that this decision aid was presented, the first thing that it had was a flow chart, a flow chart for stay and play. And so the first check mark that we need when looking at anything in pregnancy is are there any contraindications to participating in exercise in general? Right? Are there any reasons why, based on your circumstance of pregnancy, that exercise would be a yellow or red light? And if yes, before we clear you for anything, you need to make sure you see your provider or get counsel from your birth provider, OBGYN, midwife, maternal fetal medicine, whomever that is, you need to get that cleared. And then it comes into more of the gray. And how do we conceptualize the gray? Within this decision aid, the gray areas of screening were in the biopsychosocial domains, including mental health, fear of movement, pelvic health, and additional considerations. On the mental health side of things, right? They were asking things like I blame myself unnecessarily when things go wrong. I am anxious or worried for no reason. I feel scared or panicky for no good reasons. Um, I look forward to enjoyment of things. So there's uh negative response questions, buffered questions, and positive response questions. When it comes to prenatal depression and screening, it's not saying if you are anxious that you cannot do these exercises, but if a complication comes up, would you blame exercise even if our evidence isn't there? Maybe a consideration, or do we need to look at um what we might be considering or having some counseling or mental health consult before you know giving unrestricted return to exercise, potentially. Fear of movement, the idea that physical activity might harm me. I should not do physical activity because it could make pain worse or develop, cause the development of pain. So this idea of kinesiophobia or fear-related concerns or considerations in exercise and pregnancy and postpartum is becoming more consistently evaluated in the literature. I'm actually going to CPA Congress to talk about some of my research that is looking at um kinesiophobia in general or fear of movement in general in pregnancy, but then also hypervigilance and fear of pelvic floor and abdominal wall considerations. More on that once hopefully I get this published, but that's another domain. The fear of movement. The third one is pelvic health. So prior to your pregnancy, especially if we're seeing you early on, are you experiencing urinary leakage, urgency, bulging, fecal incontinence with loss of stool or gas, or uh pelvic girdle pain, discomfort around the lower back, genitals, undercarriage of your around the opening of your vagina? And then additional considerations are sleep, tiredness, recovery, muscle skeletal breast pain, stress, lack of support at home, lack of access to healthcare, secure housing, food and water, fear of harming the fetus, all of these things are areas where you might require additional support or counseling before considering whether or not you're going to be going into your or continuing with your conditioning and um athlete schedule as a pregnant soccer athlete. And so none of these, if you're answering in the affirmative to any of these, is a you cannot play. It's a we may need to link you with a resource that is going to help you make the right decision for you and your circumstances in your pregnancy. And so based on that, there's a guidance of who do you need to see, which I freaking love, right? It's like who would be the best resource to match you with for you to feel supported in your pregnancy. What then that creates is uh the stay in play during pregnancy framework, with the idea being that you can progress in stages which have you doing less uh full participation, you can stay at a stage or you can regress. So you can kind of move within them. So the idea is that you don't always have to be regressing, you can have some temporary dips and go one stage to the other, which again, I love. Okay, so what they show is full team involvement is stage one when player is greater than 12 weeks pregnant. Um they and and they are okay participating in sport, so they can get full team engagement as they get into their second trimester. If they desire, they no longer wish to have full team involvement or experience pain over a three out of 10. The recommendation is to move on to stage two, which is modified team training. And what I love is if you look underneath, it says move to next stage if player wants to cease involvement at this level, or pain is greater than a three out of 10 and we need to modify some things. So the modification trigger is a signal from your body that you are not ready for this level of training just right now, which is that pain of a greater than three out of 10, right? We don't ignore pain in pregnancy, or the desire of the athlete. And so then from two to three is individual football-specific training. So they're not in team participation, they are in sport-specific skills and drills to maintain the activities that they need to return to their um their participation postpartum. Individual training if sport-specific or football-specific training is not working for them. And then stage five is how do we maintain movement for those that have contraindications? So one through four is kind of the sliding scale of moving back and forth depending on athlete preference and personal circumstance. People move to stage five if at any point they have a contraindication that comes up in their pregnancy that would make it so that they are not cleared medically to be involved in training. And so when it comes to the kind of again, going through this guideline, they then give recommendations and the they have the development of the pregnancy medical and performance debris form, which gives individuals basically a template that would be, I'm uh would be just um sorry, filled out by my words today, a relevant medical provider. And it gives the yesno of what this athlete is working on at this point in her pregnancy. And I love it. I just we have seen this huge shift in pregnancy-related exercise that I think is so important from trimester-specific recommendations to understanding that every pregnancy is different and body readiness going into pregnancy is different, and postpartum goals, aspirations, desires, jobs are different. And you have to take all of those things into account as we are approaching our exercise modifications in pregnancy. I did a post online about our guidelines, how they're never going to be week specific. And I was alluding to this on the postpartum side of things, but it is also true in pregnancy. We are never gonna get trimester-specific recommendations for this reason, or I hope that we don't, because there's just so much variability in people's experiences. And giving that wiggle room and that freedom as a clinician is Chef's kiss. And as a pregnant woman now, that belief of if I had to modify earlier than what this guideline says that I'm failing, you know, I could easily find myself potentially getting into that neurotic technique. Tendency of that comparison to an arbitrary guideline that is just meant to be guidance and not set in stone. And so I think this is just such a positive push in the right direction. And I'm hoping to see that this is going to be mirrored in many other decision aids, protocols, guidelines to come.

Exercising During Pregnancy After Loss

SPEAKER_00 22:19

Lastly, the one thing that I wanted to finish off with is talking about pregnancy and exercise after miscarriage and loss. I posted some of my personal thoughts. And if you all listened to the podcast last week where I was talking about my journey and how, you know, I didn't trust my body. I didn't believe that my pregnancy was real, or I just didn't want to get excited about anything with this pregnancy because I was protecting my heart when it came to, you know, just not believing that I would hit this second trimester. When it comes to pregnancy after loss, I think more people are starting to talk about that mental health side of things around how somebody said to me that the innocence of pregnancy is lost. And I think that's a really powerful statement because it really speaks to how you have this juxtaposition of multiple emotions battling each other at once all the time, where you're so excited about that positive pregnancy test, and immediately you're nervous about it or you don't trust it. One of the things that I said on my Instagram post that I wanted to hold your hand if this is you, is speaking to how you are exercising in pregnancy following a miscarriage. We have absolutely no evidence that exercise at any dosage leads to miscarriage. I want to be very clear about that. The way you exercised did not cause your miscarriage in any way, shape, or form. It is very easy for that salience effect to happen, though, where if you are a person who exercises four to five times a week, having that bleed happen around when you were exercising is very easy to have happen. And when you have a traumatic event like a miscarriage, wanting to try and figure out what did I do? How can I have stopped this from happening? How can I prevent it from happening again? That link is very easy to be made. And exercise is one of those modifiable factors that may be an area where you feel like you have some control in changing the way that you exercise. One of the things that I said was that I would never um think negatively or badly about a person who decides to step back from exercise in the first trimester following a loss because of anxiety, stress, or fear. I would hold their hand and make sure they knew that they were not to blame for their loss. And I would validate their experience, their want, their desire to exercise less intensely in that vulnerable 12 weeks. And these seem like very opposing viewpoints, right? Of hey, like if you run and do high intensity, like you're not gonna have an increased risk of miscarriage, right? Like that narrative is true. And I have plenty of decisions that I make that I know are being led with my emotional heart, not my logical brain, right? And it is okay sometimes in those really stressful moments or those moments of high stress and anxiety for that emotional heart to guide the way. In this pregnancy, I did not do that. I was running, I was lifting, I was not doing as much, like in terms of time. It's it's funny, actually, my Apple Watch said the last 13 weeks, you have not exercised as long. Um, part of that was just fatigue and nausea. Like if I braced too hard, I would want to throw up. Um, but part of it was just time. Like it has also been a very busy season in a good way around work. And, you know, there's just so much stuff going around. My kids are in a really fun, active stage of their lives and things like that. So um it's just sometimes too, you're just responding to life and your exercise habits change, right? So now I'm, you know, almost 17 weeks pregnant. I'll be 17 weeks on Thursday. I have all the energy in the world. Well, let's not over extrapolate that. Not all the energy in the world, especially on jet lag, but I have more energy than I did, and I am not vomiting, which is great. Um, however, one of the things is that um life is just busy. And that's what happens with subsequent pregnancies.

Wrap Up And Real Life Chaos

SPEAKER_00 27:25

So, all right, that is it for today. I am so sorry if you end up hearing some dogs barking in the background. Um, I have four, and we have new chicks in the house, and we have a fox that keeps trying to get our old chickens. My life is truly chaos in the most beautiful way. Um, so apologies for that if you hear that in the background. I hope you all have a wonderful rest of your week, and we will see you all next time.