Stay in Play: a FIFA decision aid for football participation during pregnancy

OBJECTIVE: Given the uncertain risk of football participation during pregnancy, this study sought to develop and validate a clinical decision aid to support informed participation. METHODS: Development of the decision aid was founded on the knowledge-to-action cycle through the application of the intervention mapping and knowledge transfer scheme. Five steps were followed: (1) scientific literature review; (2) identifying participation barriers and facilitators; (3) developing the objective and approach; (4) identifying the key health screening components and (5) external review by experts working in football (physicians, physiotherapists and coaches), followed by a preliminary usability, content and criterion-validity assessment. RESULTS: We recommend discontinuing full-contact football beyond 12 weeks of pregnancy. Players may continue modified training, including low-intensity contact, in the absence of medical contraindications. Consultation and testing of the decision aid took place with 34 end users, including players, coaches and medical staff. These perspectives spanned 12 countries, confirming the high utility for players and their multidisciplinary teams (MDTs) at all levels. Strong support was determined across all aspects of the aid; overall (94% approval), a five-stage approach (97% approval) and the Pregnancy Medical and Performance Debrief Form (100% approval). The case study affirmed 94% respondent proficiency in using the decision aid. Qualitative feedback from the respondents was also used to enhance clarity of the decision aid. CONCLUSION: The Fédération Internationale de Football Association Stay in Play During Pregnancy decision aid is designed for amateur to professional-level football players and their MDTs to support informed and quality decision-making about football participation during pregnancy.