Funding outcome

INTRODUCTION: Relative energy deficiency in sport (REDs) stems from an energy imbalance, or low energy availability, and is a serious and multifaceted condition which affects both health and athletic performance in up to 80% of elite female athletes. It is clear that REDs has negative short-term impacts on reproductive function including reduced levels of reproductive hormones, primary and secondary amenorrhea, and anovulatory cycles. However, the long-term reproductive impacts of the condition have yet to be elucidated. Therefore, we aim to examine the relationship between a history of REDs or the presence of secondary amenorrhea (absence of menstrual cycle for at least three months outside of pregnancy or postpartum) with pregnancy and postpartum health outcomes. METHODS: Postpartum individuals (≥18 years of age) were recruited to complete an online questionnaire that covered maternal demographics, reproductive history (pregnancy loss, use of assisted reproductive technology, diagnosis of REDs, absence of menstrual cycle aside from pregnancy or contraceptive use), and health outcomes (gestational diabetes mellitus, gestational hypertension, preeclampsia, unexplained vaginal bleeding, premature labour, and preterm delivery). Logistic regression was used to determine the relationship between previously diagnosed REDs or secondary amenorrhea and pregnancy and postpartum health outcomes. RESULTS: 1025 participants completed the survey (Age at delivery 33.1 ± 3.4 years), 6.1% (n=63) of participants had been diagnosed with REDs prior becoming pregnant, 20.5% (n=210) of participants exhibited characteristics of secondary amenorrhea, and 73.4% (n=752) of participants had no history of REDs or secondary amenorrhea. Participants with a history of REDs were more than three times more likely to experience premature labour (Odds Ratio 3.52, 95% CI 1.62 - 9.81, p=0.02) and twice as likely to experience preterm delivery (>37 weeks gestation)(OR 2.62 95% CI 1.05 - 6.58, p=0.04) compared to those who had never been diagnosed with REDs. Pregnancy and delivery outcomes were not different between individuals with a history of secondary amenorrhea compared to those who did not. CONCLUSION: A history of REDs, but not secondary amenorrhea, increases the risk of premature labour and preterm delivery compared to individuals who have never been diagnosed with REDs. Given the severe consequences that may result from preterm delivery for both the mother and infant, further investigation is critical to understand how these risks may be mitigated or prevented.