Evidence-based recommendations to support elite athletes during preconception and pregnancy: A modified Delphi survey of elite Australian athletes and key stakeholders.

Objectives: Pregnancy policies have been identified as a critical support for elite athletes during preconception and pregnancy. However, many sporting organisations lack such policies and the resources to create them. This study aimed to establish consensus of evidence-based policy and practice recommendations for supporting preconception and pregnancy in Australian elite athletes.

Design: A three-round modified Delphi survey was conducted with elite athletes and key stakeholders between 2^nd October 2024 and 26^th November 2024.

Methods: A set of draft policy and practice recommendations was developed a priori using previous research. These were reviewed in Round I and those that did not achieve consensus (≥75 % agreement with no changes proposed) or were updated based on participant feedback were put through to a subsequent round and the process was repeated for a third round. The resulting recommendations were sent to the Australian Institute of Sport for their review and endorsement.

Results: Twenty-two, 15 and 13 respondents completed the surveys for rounds I to III respectively. Round I achieved consensus for nine recommendations, though edits were made to all 13 recommendations. Round II achieved consensus for 11 recommendations with edits to five recommendations and Round III achieved consensus for all five remaining recommendations. The final recommendations were reviewed by the Australian Institute of Sport and endorsed following minor revisions.

Conclusions: This modified Delphi study achieved consensus on evidence-based recommendations to support preconception and pregnancy in Australian elite athletes, offering a comprehensive framework for sporting organisations to adopt and adapt when developing future pregnancy policies.