Back in this post, I outlined the benefits I’d receive as a result of my athletic pregnancy. Written in my thirty-seventh week of pregnancy, making this list public was a bold move. Of note, an ‘athletic’ pregnancy is dissimilar to a ‘fit’ pregnancy on many fronts: during a fit pregnancy one might attempt to maintain movement throughout pregnancy by doing light yoga, taking gentle walks, or swimming recreationally - all the things a medical doctor tells most women are safe. During an athletic pregnancy, the athlete continues her progression in a given discipline, mine is alpinism. 

In case you just started following along on this journey, prior to pregnancy I’d run twenty-three ultras, climbed at high altitudes on all media (rock, ice, glacier), and skied since I was a toddler. During pregnancy, I not only ran two more ultras solo and unsupported in the wilderness, sent my hardest sport climb yet, and skied my most intimidating couloir, but I maintained my hard training during all forty weeks of pregnancy. Though I experienced some nausea, mild fatigue, and a small of a lack of motivation in my first trimester, I chose to reframe these experiences. Rather than thinking of them as inevitable ‘symptoms’ to be endured, I chose to think of the first trimester of pregnancy as a purposeful acclimatization period - afterall the first trimester 'symptoms' we all hear about are strikingly similar to those experienced by a high-altitude climber just adapting to altitude and for good reason.

On every high-altitude expedition I've undertaken, the strategy upon immediately arriving in the high mountainous zone is the same: regular, slow movement on easy terrain. It is well understood that this strategy best allows the athlete to build her blood's ability to transport oxygen in the new paradigm of thinner atmospheric pressure. Symptoms of initial altitude exposure, prior to acclimatization, are:

  • shortness of breath during exercise
  • decreased VO2Max
  • frequent urination
  • headache
  • nausea

Does this sound a bit like the first few weeks of pregnancy? Well, it should.

But unlike a pregnant woman, a high-altitude climber understands that these symptoms will resolve as the body adapts. The means by which this adaptation happens is two-fold: the body decreases total plasma volume and increases hemoglobin (learn more about that process here and here). Then, upon returning to sea level after a period of weeks at altitude, the athlete experiences an increase in performance because she has increased her body's ability to efficiently transport oxygen in her blood and has again increased her blood plasma levels - this equals an ever-sought-after increase in VO2Max.

During pregnancy, physiologic conditions mimic those of an initial ascent to altitude except the oxygen-deprived state that renders her symptom-ridden is due to an initial increase in plasma volume (source); the acclimatization during those first few weeks must be focused on increasing the hemoglobin in the new blood (source). To increase hemoglobin in pregnant women, in order to decrease their first trimester symptoms and to allow nutrient-rich blood to flow through her placenta into the growing zygote, medical doctors prescribe folate- and iron-rich prenatal supplements. Essentially: more hemoglobin equals less morning sickness and other 'pregnancy symptoms'.

These doctors somehow completely miss one very important part of increasing hemoglobin that a high-altitude alpinist would never neglect: moderate to strenuous exercise. Going beyond alleviating commonly-accepted pregnancy 'symptoms', strenuous exercise in the already-conditioned pregnant athlete will manifest a host of other superhuman adaptations, most of which I listed in my previous post (Pregnant Athlete: benefits) but will recount here:

  • Increased VO2Max
  • Increased pump volume of the heart
  • Mitochondrial adaptations for improved endurance for both mother and baby
  • Higher hemoglobin and hematocrit
  • Higher anaerobic threshhold
  • Increased muscle mass
  • Increased power-endurance
  • More resilient joints
  • Balanced TSH levels
  • Balanced qi

Now that we can see adaptation to altitude and to pregnancy are quite similar, a number of questions present themselves. Why do climbers choose to acclimatize to altitude, anticipated improved athletic performance, and pregnant women do not choose to acclimatize to pregnancy? Why would a medical doctor advise a pregnant woman to reduce her activity levels even though increasing her athletic training would alleviate her symptoms and increase her lifetime fitness? Having spent many weeks in my twenties preparing for high-altitude expeditions by sleeping in an altitude tent and Cheyne–Stokes breathing then taking costly expeditions in places that made me sick, the performance increases I experienced from those trips is quite a bit more effort than those I experienced being pregnant and training at an elite level.

In the second part in this series, I'll break down the science of another well-known performance-enhancing trick: blood doping. As it turns out, the physiologic conditions of pregnancy are quite similar to what made Lance Armstrong the king of the Tour de France. In part three, I'll reveal the hard numbers: my bloodwork results pre-pregnancy, mid-pregnancy, and postpartum. There, we'll begin to answer some of these questions about the pregnant athlete and put forth a new concept of the female body as ultimate endurance machine.