It is well known that moderate exercise during pregnancy benefits maternal and fetal well-being. The benefits of more vigorous exercise for pregnant women are less clear. The boundaries of safe exercise during pregnancy remain a matter for continued research, which is important to the growing number of female athletes who plan on becoming pregnant. The purpose of this article is to discuss the existing research related to the physiological concerns of the pregnant endurance athlete specifically. Because endurance training includes prolonged and repetitive exercise bouts at varying intensities, topics will include the effect of high-intensity exercise on uterine blood flow and thermoregulation, metabolic, and musculoskeletal changes in pregnancy.

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Nutrition and dietary intake are key factors for exercise and sport performance. While a substantial body of research highlights the impact of nutrition on exercise, many dietary and nutrient recommendations are based on research studies only conducted in men. However, the distinct physiological, neurological, and hormonal changes across a woman’s life cycle significantly affect nutritional needs. This narrative review explores key recommendations for calories, carbohydrates, fats, proteins, and select supplements, highlighting the absence of sex-specific guidelines in current dietary frameworks for strength and conditioning female athletes. The review synthesizes current literature to provide practical guidance for coaches, sport dietitians, and health practitioners to optimize both performance and health outcomes for female athletes.