Is it safe to run when pregnant? Here's everything you need to know
Fear of harming their unborn child has led to many women giving up running during pregnancy. And it’s easy to see why. When a public figure is seen exercising while heavily pregnant there’s often a backlash accusing her of acting selfishly. The stats show that almost half of women stop running during pregnancy, with many citing anxiety, nervousness or fear of miscarriage as the reasons, according to a 2022 survey published in the Journal of Women's Health Physical Therapy.
‘I miscarried at seven weeks when first pregnant. I had been running three times a week. My partner, family and midwife at the time made me feel like this had something to do with the miscarriage. So, I've never ran pregnant since then,’ says one telling survey response.
Yet a wealth of evidence to the contrary is finally coming to light. Exercise during pregnancy helps to prevent gestational diabetes, pre-eclampsia and excessive weight gain, while decreasing the risk of postnatal depression by 25%. It also improves a mother’s cardiovascular fitness and sleep quality, while research in Clinical Medical Insights: Women's Health demonstrates it reduces the risk of chronic disease for the baby, too.
Another myth that has recently been dispelled is that running during pregnancy causes early delivery or low birth weight. A study of more than 1,200 pregnant women published in BMJ Sport and Exercise Medicine detected no association.
What is the current guidance for running when pregnant?
The recent shift in medical thinking has been profound. ‘If you go back five to 10 years, women were being told to avoid exercise in the first trimester and then dial it back [after the first trimester] and now we recommend pregnant individuals engage in physical activity and exercise from conception until delivery,’ says Margie Davenport, associate professor at the University of Alberta, Canada, one of the world's leading maternal-foetal health researchers.
Unfortunately, lingering misconceptions and attitudes mean only three to 15% of women currently meet the recommended guidelines for physical activity during pregnancy and there’s a lack of consistent advice and support for those who wish to stay active, especially women from poorer socio-economic backgrounds.
Pregnant women had been largely ignored in sports science research in the past and, shockingly, the UK had no national guidelines on exercise and pregnancy until 2019. The publication of these guidelines was a ‘complete game changer’ says Active Pregnancy Foundation co-founder Dr Marlize de Vivo, who explains that the Chief Medical Officer's physical activity guidelines for pregnancy and after birth led to ‘an explosion of the research’.
Though it doesn’t recommended non-runners start during pregnancy, the Active Pregnancy advice for women with uncomplicated pregnancies is to keep running if you’re already a runner. The key message is to listen to your body and adapt. ‘If it feels comfortable, keep going,’ says de Vivo. ‘If it is uncomfortable or you notice anything unusual, stop and seek advice.’
In what cases shouldn't you run when pregnant?
Women with complications such as severe pre-eclampsia or pre-existing heart disease are not recommended to undertake moderate to intense activity. And women with relative contraindications such as gestational hypertension or mild cardiovascular disease may need to reduce their running duration or volume.
But for non-complicated pregnancies the key message is simply, ‘don't bump, the bump’. In other words, any activities that put pregnant women at higher risk of falling or injury should be carefully considered, particularly as centre of gravity changes as a bump grows.
In 2020 the World Health Organisation reviewed the evidence on vigorous activity during pregnancy, concluding it was safe to continue running at this intensity, but it was not advised as a new activity. For de Vivo, it was another important development: ‘The more pregnant women move the better, but even moving a little has benefits,’ she says. But there are some caveats...
Is high-intensity or long duration running safe?
'For high intensity, long duration, we just don't know a lot so we recommend speaking to your healthcare provider,’ says Davenport. And, as mentioned, women with relative contraindications such as gestational hypertension or mild cardiovascular disease may need to reduce their running duration.
The areas pregnant women need to be most attuned to are heart rate and hydration, says Davenport. ‘There is no relationship between miscarriage and exercise,’ she clarifies, but she warns that dehydration is potentially, ‘quite harmful because the baby needs lots of amniotic fluid.'
In terms of intensity, the rule of thumb is to stay below 90% of maximal heart rate, meaning a speed session is still possible with plenty of fluid. Again, the caveat is that the woman must feel comfortable and have trained at this level prior to pregnancy.
Moving away from the didactic notion of what pregnant women should and shouldn’t do, the emphasis has shifted to trusting them to respond to their bodies accordingly. ‘The guidelines don’t say there are things you shouldn't do – women should make their own informed decision,’ explains de Vivo. This reflects the recommendation of a 2019 qualitative analysis of women runners' pregnancy experiences published in Women in Birth. Researchers concluded that healthcare providers should ‘recognise running as a key piece of women runners' identities’ and trust they knew what was healthy regarding running and foetal health. ‘Women have a strong sense of embodiment and are tuned in to the needs of their body as well as the needs of their baby,’ concluded the study.
Dealing with entrenched attitudes
There is, of course, more to this than the hard science. Pregnant runners are also dealing with entrenched attitudes and patriarchal barriers, even at the top of the performance pyramid. Prior to 2021, when UK Sport finally issued pregnancy guidance, the subject remained taboo in elite athletics says Emma Pullen, senior lecturer in sports management at Loughborough University, who conducted research with elite sprint and middle-distance runners. ‘There was a sense of nervousness amongst the female athletes I spoke to about broaching the topic of pregnancy with coaches or support staff,’ says Pullen. ‘And there was also this assumption that you just retire if you wanted to start a family.’
Thankfully this narrative is changing. It’s now recognised that peak performance often coincides with peak fertility and there are more and more examples of women returning to – and excelling in – elite competition after giving birth. The US sprinter Allyson Felix broke a world record less than a year after giving birth, for example. But Felix had to fight to renegotiate her contract during her pregnancy after Nike initially offered her just 30% of her previous pay, despite her achievements being on a par with Usain Bolt. So although attitudes are starting to change, Pullen laments that the 'paternalistic treatment of women's bodies' still persists in sport.
When is it safe to return to running after having a baby?
While runners are encouraged to continue through pregnancy, returning to running postpartum requires far more caution. This is due to the serious risk of causing pelvic floor dysfunction, such as incontinence or vaginal prolapse, by running too soon after childbirth. ‘We see women returning too soon and often and this has implications and puts them at risk of vaginal prolapse,’ says de Vivo. ‘It’s really important to take a gradual and staged approach, building up activity over around three months.’
Pregnancy causes major physical and physiological changes, and tissue healing following childbirth can take four to six months. Running’s high impact puts pressure on the abdominal muscles and considerable force through the lower limbs and pelvis, which can in turn affect the uterus. Impact is a major problem postpartum, with a review of urinary incontinence in female athletes finding that high-impact exercise brought over four times the risk of pelvic floor dysfunction of low-impact exercise.
The survey in Clinical Medical Insights: Women's Health found that runners delay returning to running postpartum due to concerns about leaking urine and vaginal heaviness. And when they do return, 84% experience musculoskeletal pain and 29% experience running related stress urinary incontinence, according to research led by Dr Isabel Moore at Cardiff Metropolitan University.
Unfortunately, it’s hard to give a definitive timeline here as returning to running can vary hugely between women. ‘There isn't a one-size-fits-all and we shouldn't necessarily be stuck on a rigid timeframe,’ says de Vivo. ‘Each person's journey will be different depending on whether they were active during pregnancy, the type of birth they had and how well they recover afterwards. So, I think it's really important to stress that everyone's journey is different and you shouldn’t compare yourself to others.’
The varied experience was clear in Dr Moore's research, which recorded a median time of 12 weeks for women's first postpartum run, but found that 26% per cent of women had not returned at all. The highly individual nature of returning to running following birth is recognised in the advice set out by physiotherapists Tom Goom, Gráinne Donnelly and Emma Brockwell in their 2019 Returning to Running Postnatal Guidance. They advocate returning between three and six months postpartum, but only providing the runner has been assessed and passed certain criteria. They stress that returning to running is not advisable for anyone who is experiencing incontinence or pelvic floor pain, feels pressure in the vagina, or has vaginal bleeding not related to the menstrual cycle during or after exercise.
‘If you're really symptomatic – you’re having urinary leakage from sneezing or laughing or just from standing up from a sitting position – that suggests your body probably isn't ready for the high-impact forces of running,’ advises Rita Deering, assistant professor of physical therapy at Carroll University, US, who also raises some other red flags: ‘If you're having significant pain, if you have gestational hypertension or you had significant blood loss during birth, those are things that take priority over returning to running.’
According to Goom, Donnelly and Brockwell, a new mum should be able to achieve a series of activities without pain, heaviness, dragging or incontinence before they consider running again. These include walking for 30 minutes, single leg-exercises, jogging on the spot and hopping. Running should then be gradually reintroduced starting with one to two minutes at an easy pace, building up distance/time first, before increasing training intensity.
It's also important to continually monitor symptoms of incontinence, pain and vaginal heaviness, which may indicate running needs to be reduced, modified or stopped altogether. Meanwhile, running with a buggy should not begin until a baby is between six and nine months old when they are able to support their own neck and spine.
The importance of a phased return to running
It’s rarely what runners want to hear, but putting in some time to work on strength is important, too. Supplementing or complementing running with strength training during and after pregnancy is important not only for staying fit and healthy but also for recovery, says Shefali Christopher, clinical specialist in sports physical therapy at Elon University, US.
Christopher’s research, co-authored with a team of sports scientists, including Deering, recommends a phased approach to running postpartum which begins with strength first. ‘It's important to have that resistance training, to build up, and be strong again for the running,’ says Christopher.
Their four-phased approach to getting back to running, published in the Journal of Women's Health Physical Therapy, recommends beginning with hip, foot, pelvic floor muscle and abdominal exercises, while integrating gentle walking. Through phases two to four, more strength exercises are introduced, plus progressively longer walk-runs.
Strength training of the pelvic floor muscles during and following pregnancy is certainly a vital component of returning to running and can prevent and treat urinary incontinence.
Following childbirth, the pelvic floor is weak and injured, meaning high-impact activity like running is associated with a sudden rise in intra-abdominal pressure, which is often felt as vaginal heaviness.
As with everything in running and pregnancy, experiences are highly individual and the details of your return-to-running plan should be tailored to you and, if possible, rely on expert advice specific to you. ‘Engage with a specialist physiotherapist in your pregnancy and then have a follow up appointment after pregnancy,’ says de Vivo. ‘That's not in any guidelines but it comes from personal experience working with women.’
‘It's all about finding what works for you because every body is different and reacts differently,’ agrees Nell McAndrew, mum-of-two, sub-three marathoner and author of Nell McAndrew's Guide to Running. And that means not having your personal approach dictated by the attitudes of others. 'I’ve always lifted weights to help prevent injuries and people would joke with me, “I bet you'll go into labour in the gym”,’ says McAndrew. ‘But as my mum pointed out when she was pregnant she was rushing around, lifting and carrying kids and bags of shopping. No-one ever told her to stop!’
Three women on their experiences of running when pregnant
‘Your pace and distance will drop, but definitely keep running’
Parkrun has been the cornerstone of Kirsty Hingston's running before, during and after pregnancy. The 37-year-old from Suffolk ran three to four times a week before becoming pregnant with her daughter, who is now six months old.
At the time she was training for her first marathon by mixing up events, social runs and a long Sunday run. ‘When I found out I was pregnant I was kind of gutted as I knew my marathon training had to stop,’ says Hingston. But instead of stopping altogether Kirsty spoke to her GP and midwife, and did her own research. ‘They said carry on but don't over do it,’ she says. ‘So I knew I could keep running as long as I wasn’t pushing too hard.’
Suffering from Crohn’s disease, arthritis and fibromyalgia meant running was important to keep her muscles strong and reduce pain. The more pregnant she became, the harder Kirsty found running but she adapted her style and frequency. ‘I was “jeffing” (run-walking) a lot and running less,’ she says. ‘It was no more than 5km once or twice a week. I wore a support belt the bigger my bump got and I didn't have any issues.’
Her final pregnant run was a parkrun at 39 weeks, the day before she was induced. ‘All the comments I got were really supportive,’ she says. ‘People couldn’t believe I was running at 39 weeks and said, "well done, you are amazing".’
As soon as she was checked out at six weeks and told she could run again, Kirsty returned to Great Cornard parkrun. ‘I began by run-walking and built up gradually and slowly to get my fitness and strength back,’ she say. ‘It's been hard because I was recovering from labour and the after-effects. The birth was a little traumatic with a forceps delivery and episiotomy.’
To build strength Hingston did regular pelvic floor exercises, with a four-mile run during the week plus parkrun on Saturdays. She is about to run her first parkrun with her daughter in the buggy and aiming to run her deferred marathon in Halstead, Essex next year. ‘To other pregnant women I would say that your pace and distance will drop, but definitely keep running because it helps in the long run,’ she says.
‘My runs were about doing something beneficial for mine and my baby’s health’
Running was the only thing that stopped St Albans club runner Lucy Waterlow, 42, from feeling nauseous during her second pregnancy. ‘When I was running, I felt great,’ she says. ‘It was the best I would feel all day. I only had a couple of bad runs when I felt uncomfortable. On all the others, I felt really strong and often forgot I was pregnant.’
Up until her third trimester Waterlow continued to run up to five miles, five times a week, but reduced intensity, dropping interval and tempo sessions. ‘I didn’t think of my runs as training – they were just about getting out in the fresh air, being active and doing something beneficial for mine and my baby’s health,’ she says. ‘I kept the pace comfortable and my heart rate low, and stuck to routes close to home so I wouldn’t have far to walk back if I felt I needed to stop running.’
Waterlow also learned that eating before morning runs and regular Pilates helped her feel strong. But by her third trimester in both pregnancies she was less comfortable and the summer months meant she had less desire to run in the heat. She switched to walking with her dog twice a day and swimming once a week.
After the ‘straightforward and super-quick’ birth of her children, now aged two and four, Waterlow was back to running in between six and nine weeks. ‘I did notice the difference from waiting those extra three weeks the second time around as I felt stronger and less achy on the first few runs,’ she says.
Waterlow used her own Bump-to-5K plan, beginning with walk-runs of up to eight minutes. Within six weeks she was running 5km several times a week and gradually began introducing interval sessions and longer runs. ‘I started running with the buggy when my children were six months,’ she says. ‘It was a revelation. It gave me back a lot more freedom to run and to meet running friends as I didn’t need childcare.’
By the time her second child was just 14 months old Waterlow was close to her pre-pregnancy PBs, clocking a sub-40 10K, a sub-19 5K and a sub-85-minute half marathon.
‘Every pregnancy is different’
For Team GB ultrarunner Sophie Power, 40, her three pregnancies were completely different, meaning her approach shifted between running, weight training and cross training.
During her first pregnancy, Power kept up her normal running routine, plus strength training twice a week. ‘I listened to my body,’ she says. ‘It told me when I was getting hot or it was getting hard and I got to know the heart rates around it. Then one day, seven and a half months in, I didn't want to run anymore, so I didn't.'
But her recovery was much harder than she anticipated. ‘I expected to be able to run straight away but for three months I couldn't run a single step without leaking,’ says Power. ‘It was really difficult mentally, not knowing why my body wasn't reacting the “right way”. I saw other women running and I couldn't, and I didn't really get any help to know what to do.'
Eventually Sophie found EVB shorts to support her pelvic floor and was able to run again the moment she put them on. Fairly soon after that she completed a 50-miler.
During her second pregnancy Power was training for the Ultra Trail du Mont Blanc and it was this event that shot her into the limelight when she was photographed breastfeeding and pumping milk for her three-month-old baby at an aid station. The picture went viral.
To prepare for UTMB and protect her pelvic floor she stopped running at five months pregnant and switched to hiking on a 15% inclined treadmill, climbing on a stair mill plus spin classes and lots of strength work. Her recovery was much quicker – running again at six weeks postpartum and finishing UTMB eight weeks later.
‘My third pregnancy was the most active and I took on some pretty big challenges,’ says Power. ‘I worked with my coach, Edwina Sutton, to find ways to challenge my body without the impact. My higher intensity sessions were on the bike and hiking on the treadmill. You can maintain your running fitness in many other ways. I climbed Everest in just over two days on the treadmill.’
However, despite running the day her waters broke, recovery from her third pregnancy was the hardest. Power was diagnosed with a prolapse which was documented in the film The Journey from Pregnancy to Performance. ‘Having a prolapse meant I had to take things much more slowly – even when my body felt fine,’ she says. ‘I did get back to running with a pessary, but having the patience to build my strength first was very difficult.’
Despite this, just over a year later Power was representing Britain at the 24-Hour European Champs in Verona. ‘Every pregnancy is different,’ she says. ‘You can have a great pregnancy and then a really difficult recovery or vice versa. The important thing is to find the right support to get you back to where you want to be.’
Running mum’s kit-list
Want to continue running through pregnancy, and beyond? This specialist kit will help keep you on your feet...
EVB shorts
A favourite of ultrarunner Sophie Power, these highly supportive shorts are ideal for runners experiencing leakage or prolapse issues and could make the difference between running and not running.
Susie Sporty Hip Hugger
Sustainable cotton knickers designed to be super-absorbent with four discreet layers for extra security against bladder leaks. The comfy elasticated fit makes them ideal for exercise.
Maternity & Postnatal Active Support Leggings
Designed to adapt to your changing body, these high-waisted leggings are made from a light compression support fabric which is also sweat-wicking.
Gabrialla Pregnancy Support Band
A belly band with moderate compression, this is a must-have for runners looking for support to cradle their bump and relieve strain on the lower back and hips.
Natal Active Nursing Sports Bra
This stretchy bra comes in cup sizes B to G and has the option of wearing the straps straight down or cross-back for extra support. There is a single hand clip to make feeding easy, so, like Sophie Power, you can stop to nurse midway through a run.
Out N About Nipper Sport
A firm favourite amongst the Run Mummy Run community, this sports buggy is ideal when baby reaches six months. There are handy optional accessories like a bottle-holder and a rain cover makes it an all-weather option.
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