Pro Triathlete Sarah Piampiano: Pregnancy as an Elite Athlete Part III

This is part three in a four part series. You can read about her first and second trimesters, the changes that have happened so far, and what she has observed on her Ember device here and here.

I can say, without a doubt, that pregnancy has been one wild ride.  I’ll also say it hasn’t been my favorite.  I know some women love being pregnant, and I do actually believe that the process of pregnancy has been a great exercise for me in patience, in learning to give myself grace, and also in learning to embrace the idea of not being in control at all times.  But it has been hard.  While I would say that I generally feel OK, I also generally feel not OK too, and sometimes it gets mentally exhausting to just feel average-at-best all the time.

But here I am, days before my due date and feeling a mix of excitement at meeting our new little nugget, complete fear, and also relief as I feel like I am nearing the end of what has felt like a long 10 months!

Each trimester has felt and looked so different for me - it has been fascinating to take a front row seat at watching my body change, feeling the baby grow and kick and understanding the changing limits of what I am able to do physically.

Every woman’s pregnancy is different.  But I do believe that sharing our experiences can help empower us all to understand the process of pregnancy better, to feel empowered by what our bodies are capable of, and feel supported.

Earlier I wrote a two-part blog about my experience with the first trimester and the bulk of the second trimester.  Below details my experience with the 3rd trimester, from weeks 28 through 37.

Trimester 3 - Week 28 through Birth

Training:

Goal - Stay active and healthy, but do not do anything to the point of exhaustion or to compromise my health or the health of our baby

Hours per week:

Planned: 7-12 hours (I typically train 28-35 hours per week)

Actual: 14-15 hours

Of all three trimesters, the 3rd trimester is when I have felt best in training.  I am not sure if this is because I am finally more used to feeling “average-at-best” all the time, or to the various pregnancy pains that come and go over the course of a workout/day/week/month, or to the unpredictability that comes day-to-day on how I might feel, or to the pee stops every 10 minutes on a run.  I’m not sure, but from a working out standpoint, I have both enjoyed training the most and felt the best during the 3rd trimester.

From an output perspective, my output has continued to decline and/or my capacity to do work has changed.  For example, on the bike, I have a hard time riding over 200 watts these days (an output that is lower than what I would average for an Ironman race), and anything over a 2.5 hour ride I have found to be very exhausting.  Both my capacity to hit high intensity and my body’s ability to absorb volume have declined. I have done a few 3 hour rides in the last few months, but these knocked me out for days.  And while I want to continue to push myself, I’ve also felt strongly that now is not the time for me to push my body into an exhaustive state. If I do a ride or run that leaves me tired for days, I know that it is time to take a step back.

That all said, I’ve found my body seems to be responding better to low intensity endurance.  My average watts on rides have been improving and my run pace has stabilized.   I find I have fewer days where I have to ride the bike at 80 watts, or run a 9:30 mile.  Over the last month my ride averages have gone up from 110-115 watts to 125-140 watts and even up to 150-160 watts on some rides.  Similarly, I seem to be holding pretty steady at 8:20-8:40/mile pace.  It has been so fascinating to experience this and witness how my body’s capacity has shifted and changed. Conclusion: my top end and capacity for volume has continued to decline, but my consistency at endurance pacing has improved.  Another bonus:  I’ve had no issues with my legs going numb in the 3rd trimester or having insane spikes in heart rate like I did during the 2nd trimester.

Overall I have been holding pretty steady at about 15 hours per week, and really feeling like that has been the magic number for me.  I’ve had a few weeks of 17 or 18 hours when I have felt great, and a few weeks of 10-12 hours when I have been more tired, but 15 hours is what has felt best.   This is roughly 50% of my typical weekly volume in hours.

I’ve also continued to work with my coach, Matt Dixon from Purple Patch Fitness, over this time.  While I have only very loosely followed the programming, I’ve enjoyed having some structure nonetheless.  My approach has been to do what I want and what feels good, but on the days when I’m less motivated, I’ve enjoyed having something on my schedule to encourage me to get out the door.

On average I have been swimming 3-4x per week, biking 4-5x per week, running 2-5x per week (this has been the most inconsistent), strength 1-2x per week, and then some form of walking or hiking 2-3x per week

On that end too, I will say that my motivation has definitely gone down quite a bit.  It has been really important for me to make workout dates with my friends and training partners to help get me out the door.  Without fail I am ALWAYS happy I moved and got a workout in, but when you start to feel heavier and less nimble it definitely negatively impacts the motivation!

Note to all active and pregnant women:  Make run/walk/hike/bike/swim/Zwift dates with friends - it makes a HUGE difference!

Diet:

My 3rd trimester diet has been a mixed bag.  I generally eat really well, but in the 2nd trimester I was diligent about counting my protein macros to make sure I was getting exactly the right amount of protein on a daily basis, as well as fats and carbohydrates.  I made a conscious effort to avoid processed or added sugars and I was extremely conscientious overall about my diet.  But toward the end of the 2nd trimester, I went through a 3-week period, around week 25 through week 28, of INTENSE sugar cravings. I mean, I don’t think I have ever wanted sugar as much as I did during those three weeks.  I fought it, but I also succumbed!  I ate an entire 3-layer cake that I had baked for Thanksgiving over 3 days, a full quart of ice cream in a 48 hour period, and who knows what else. I was an endless pit for cakes, ice cream, candies, chocolate - that is all I wanted to eat.  There were countless days when I didn’t even eat dinner because I had eaten so much ice cream BEFORE dinner that I was too full when the meal was ready!

That intense craving subsided (thankfully), but the carb cravings from there on out and throughout my 3rd trimester have been much stronger.  Normally I eat a snack first thing in the morning, have breakfast, lunch and dinner, along with an afternoon snack and an evening snack or dessert.  But this routine has largely gone out the door.  I still, of course, eat breakfast, lunch, and dinner, but I graze a lot throughout the day.  I’ve found I get very hungry mid-to-late afternoon and that also tends to be the time when I crave carbs the most.

It has been a challenge for me in the sense that I’m committed to providing my baby with the best nutrients possible, and yet I also feel that it is important to eat what my body is craving.

I’ve wavered back and forth between trying to count my protein macros, to ensure I am getting enough protein, and not.  The one thing I have found is that when I am attentive to my food intake, my eating is balanced.  When I don’t pay attention, my protein consumption is well below what it is supposed to be.  So, I’m just trying to be attentive 80% of the time and the rest of the time just going with the flow.

Other funny things I have noticed:

●   During the 1st and 2nd trimesters I couldn’t get enough of cream cheese or cottage cheese, but now, neither sound that good to me anymore!

●   I have been having HUGE milk cravings.  Whole, grass fed, delicious milk.

●   I’ve also been having crazy cravings for Kombucha!

●   Pasta with cheese on top is all the rage right now in my world!

Weight:

When I am Kona-fit I weigh around 118 lbs.  During the rest of my season, though, I typically weigh between 120-122 lbs.  During COVID (pre-pregnancy) I consistently weighed 123-124 lbs.

I’ve mentioned this before, but my goals for pregnancy were to gain a healthy and reasonable amount of weight (the recommended 25-35 lbs), avoiding gaining an unnecessary amount, and doing what felt good for me and my body.   That all said, I’ve found weight gain to be a challenge.  First, it is not linear.  I’ve gone through periods of 2-3 weeks where I don’t gain a pound and even sometimes the scale will say I have lost a little weight.  And then, suddenly, I gain 3 pounds practically overnight.  Initially the fits and starts of weight gain/no weight gain were stressful for me  because I wanted to ensure I was gaining the right amount.  But once I learned that it is not a linear progression I was able to take it more in stride.

In addition, I have continued to work out about 15 hours per week, all at a very low or modest intensity.  But exercise adds a caloric requirement that needs to be accounted for.  So, I’m not joking when I say that there have been periods where I will eat ice cream 3x per day.  Or eat a scone, followed by a cookie, followed by a bowl of cereal.  I’ve been eating a lot.  My weight gain has been steady and solid, but I am definitely on the lower end of the spectrum, which isn’t my goal. I’ve been committed to gaining a healthy amount of weight and making sure I am providing all the nourishment needed for my baby to grow.

However, I feel confident knowing just how much I have been eating and am comfortable with my approach.  I also strongly believe that anyone who is extremely active or competes at a high level is bound to lose muscle mass over the course of a pregnancy, which is not something I think I, or many doctors for that matter, had taken into consideration.  I’m not training at the same level either in hours or intensity, and my strength sessions are a far cry from what I typically do.  As pregnancy progresses, you lose muscle mass but are also gaining fat mass, which balance each other to some extent.

At 37 weeks I currently weigh 142 lbs, nearly 24 lbs heavier than my Kona race weight, 20-22 lbs heavier than my usual race weight, and 19 lbs or so heavier than where I was just pre-pregnancy during COVID.  My expectation is that I will gain another 2-3 lbs over the coming weeks, which is within the normal and recommended range.

I will admit that I was afraid to put on more weight than is advised for my frame, but not afraid to put on the recommended weight amount.  I also wondered how the extra weight would feel carrying around.  It has been surprising to me how good I generally feel. I certainly feel heavier, but not nearly as bad as I thought I might.

Energy:

In general I would say that my energy has been great throughout my pregnancy - aside from the first trimester.  There are certainly days when I have felt run down or more tired, but on the whole my energy has been good.  However within the last few weeks starting around week 35, I have really felt my energy levels declining.  I’ve been more tired, more emotional, and my workouts, which have typically been pretty low stress, have been wiping me out.   I’ve also grown a lot in the last few weeks and so sleeping has become much more uncomfortable and restless, which hasn’t helped with improving my energy levels.

I continue to have days where I feel great, which I try to take advantage of, but I also am ok to just rest when it feels right.

Main Pregnancy Symptoms:

Low energy

Carb cravings

A little bit of nausea in the mornings

Restless sleep

LOTS of pee stops

Pelvic pain

Mid-back pain

Physiological Changes:

In my normal training and racing, I use a device called Ember which is made by Cercacor and provides me with daily metrics like resting pulse rate, oxygen saturation, hemoglobin, pulse rate variability and more.  It has been a valuable tool for me over the past several years, and now during my pregnancy, this has been no different.  While I am not using the device in the same capacity to help manage and track performance, using the Ember throughout my pregnancy has been extremely enlightening.

If you read my earlier blogs from the 1st and 2nd trimesters, the physiological changes that were captured while taking my Ember data were so fascinating.  In the 1st trimester, there was an immediate bump up in my respiration rate, resting pulse rate, and pulse race variability.  This was due to hormonal changes, my body’s increasing blood volume, and an increased need for respiration to help manage the various processes that were taking place to start creating a baby.

As I moved into the second trimester, my PRV went up as I began to feel less tired and nauseous, although my resting pulse rate and respiration rate remained elevated.  However, as I got later into my 2nd trimester, my PRV started to fall.

As I entered the 3rd trimester, I have seen both my PRV dropping and my resting pulse rate continuing to rise.

The graphs above show an interesting picture of my pregnancy, both over the course of my entire pregnancy and over the 3rd trimester itself.  For example, over the course of my pregnancy, the overall trend is a gradually increasing resting pulse rate coupled with a gradually declining pulse rate variability.  This makes sense to me - as the baby grows it is commanding more resources to support its growth and development, forcing my body to work harder on an ongoing basis.  This equates to a higher overall pulse rate and decreased recovery and readiness (lower PRV).

Interestingly, over the course of the 3rd trimester, these trends have reversed a bit.  For the majority of the 3rd trimester, my resting PR rose, oftentimes recording at over 60 bpm, which is 18-22 bpm higher than my resting PR at peak fitness.  Similarly, my PRV was regularly recording in the high 20s to low 30s, bringing my average PRV down and indicating an under-recovered state.  This matched up well with how I was feeling - generally more tired.

However in the past two weeks or so, I’ve noticed a reversing trend.  My resting PR has dropped, recording below 50 many mornings, and my PRV has started to increase again.  I don’t have a specific explanation for this.   I’ve wondered if it indicates that my body is relaxing in preparation for labor. I’m not sure.

The graphs above show the trends in my hemoglobin levels and respiratory rate both over the course of my entire pregnancy and during the 3rd trimester.  On the whole, my hemoglobin levels have remained relatively steady and strong throughout my pregnancy.  Many women suffer from decreased hemoglobin and hematocrit during pregnancy because of the increased needs of the baby, but I did not find that to be the case for me.  When I am training full on, I regularly suffer from low hemoglobin, but always find my HgB values go up in the off season when I take a break.  Over the course of the last year, my training volume, focus, and intensity has been lower (even before pregnancy) and I have noticed an overall upward trend in my HgB values.  I believe that during my pregnancy, the decrease in training hours and intensity has contributed to the overall and sustained higher level of HgB.  Interestingly, I work with a gut health company called Ixcela Wellness, and they have been closely monitoring my gut health over the course of my pregnancy.  The results have been fascinating, but one of the metabolites that they look at is something called Xanthine.  Xanthine is a marker for stress, and mine has always been elevated and never within the normal range.  This past fall and for the first time in the three years that I have been working with Ixcela, my Xanthine numbers have fallen into the normal range.  I have found this and the HgB improvements to be interesting, and am confident that this is a side effect of my decreased training volume and intensity.

When you look at my respiratory rate, you can see that there was a consistent increase through the first half of my pregnancy that eventually plateaued.   Now, while my respiratory rate is elevated from normal, it does not seem to be increasing any more.  In my day to day life, I have found that I am more winded overall than normal, but the change in respiration doesn’t seem any different than from the prior two trimesters.  I don’t actually know the physiology behind this, but I think the findings are interesting nonetheless.   I would have expected my RR to continue to increase, particularly as the baby grew and started to crowd my lungs, but it really hasn’t.

Well, I think that is about it for the 3rd trimester.  Now it is time to kick back, relax, and wait for Baby Piampiano-Lord to arrive!  I’ll be closely tracking and following my Ember data, as well as subjective feeling postpartum, and will be writing another blog soon.

Until then, thanks for reading, and fingers crossed this whole parenting thing is all it is cracked up to be!

-Sarah