1
|
Fukano M, Nomura Y, Tsukahara Y. Does the pregnancy-related adaptation of gait biomechanics after childbirth recover to its pre-pregnancy state?: A systematic review. Gait Posture 2024; 110:110-121. [PMID: 38569400 DOI: 10.1016/j.gaitpost.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 03/12/2024] [Accepted: 03/19/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Although changes in the gait biomechanics during pregnancy are known to occur, it is unclear whether they return to their original state after childbirth. RESEARCH QUESTION The objective of the current systematic review is to summarize existing literature reporting the biomechanical characteristics of gait in postpartum women and to identify knowledge gaps that calls for future investigations in this population. METHODS Relevant articles were selected using MEDLINE (PubMed), Scopus (Elsevier), Embase (Elsevier), and Web of Science (Clarivate Analytics). Articles were included if they met the following criteria: They must (1) include postpartum women, (2) report measures related to three-dimensional (3D) kinematics and/or kinetics, (3) have been published after 1990, and (4) have been published in English. RESULTS AND SIGNIFICANCE The current systematic review included a total of 14 articles, five of which compare the data from postpartum women with nulliparous women or pre-pregnancy data. We observed that gait biomechanics changes of postpartum women could persist for more than 5 years after the childbirth. This review provides novel viewpoints on the biomechanics of postpartum women's gait and recommendations for future studies to fully understand these changes and improve postpartum women's physical and mental wellbeing.
Collapse
Affiliation(s)
- Mako Fukano
- College of Engineering, Shibaura Institute of Technology, 307 Fukasaku, Minuma-ku, Saitama-shi, Saitama 337-8570, Japan.
| | - Yumi Nomura
- Faculty of Creative Engineering, Chiba Institute of Technology, 2-1-1 Shibazono, Narashino-shi, Chiba 275-0023, Japan
| | - Yuka Tsukahara
- Department of Sports Medicine, Tokyo Women's College of Physical Education, 4-30-1 Fujimidai, Kunitachi-shi, Tokyo 186-8668, Japan
| |
Collapse
|
2
|
Casto EM, Mancinelli C, Meszaros P, McCrory JL. Asymmetric changes in foot anthropometry with pregnancy may be related to onset of lower limb and low back pain. PLoS One 2024; 19:e0292115. [PMID: 38394292 PMCID: PMC10890715 DOI: 10.1371/journal.pone.0292115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 09/10/2023] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Fifty percent of pregnant females experience pain with 20% reporting long-term pain post-partum. Pregnant females undergo changes in foot anthropometry, lower extremity alignment, and joint laxity. It is unknown if asymmetric alterations may be related to development of pain. The purpose of this study was twofold: 1) to compare asymmetric alignment in pregnant females with and without pain during pregnancy and in nulliparous controls and 2) to assess the relationship between asymmetric alignment and pain severity in all participants. METHODS Ten pregnant females in their third trimester and nine nulliparous controls participated. Bilateral asymmetry of foot length, width, arch index, arch height index, arch rigidity index, arch drop, rearfoot angle, and pelvic obliquity were determined. Joint laxity and musculoskeletal pain were also assessed. ANOVAs were utilized to compare asymmetries between pregnant females reporting pain (n = 5), those not reporting pain (n = 5), and controls. Spearman's Rho correlations were used to relate asymmetry to pain magnitude (α = 0.05). RESULTS No statistical differences (p>0.05) were found between pregnant females with or without pain and controls for any of the metrics. Negative correlations were found between arch index asymmetry and low back pain (p = 0.005), foot length asymmetry and lower leg pain (p = 0.008), and pelvic obliquity and lower leg pain (p = 0.020). Positive correlations were found between foot width asymmetry and knee pain (p = 0.028), as well as arch drop asymmetry and upper leg (p = 0.024), knee (p = 0.005), and lower leg pain (p = 0.019). CONCLUSIONS This study was successful in identifying potential targets for prevention and treatment of pain in pregnancy. Furthermore, because pain during pregnancy may be predictive of pain post-partum, it is important to conduct future research to determine both if interventions such as footwear or exercise can prevent or treat these asymmetries and prevent post-partum pain.
Collapse
Affiliation(s)
- Erica M. Casto
- Division of Exercise Physiology, Department of Human Performance and Applied Exercise Science, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
| | - Corrie Mancinelli
- Division of Physical Therapy, Department of Human Performance and Applied Exercise Science, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
| | - Petronela Meszaros
- Department of Obstetrics and Gynecology, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
| | - Jean L. McCrory
- Division of Exercise Physiology, Department of Human Performance and Applied Exercise Science, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
| |
Collapse
|
3
|
Stewart BC, Dai S, Havens KL, Eggleston JD, Bagwell JJ, Deering RE, Little EE, Catena RD. Determining fall risk change throughout pregnancy: the accuracy of postpartum survey and relationship to fall efficacy. ERGONOMICS 2023:1-10. [PMID: 38131152 DOI: 10.1080/00140139.2023.2296827] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023]
Abstract
All epidemiological studies on pregnancy fall risk to date have relied on postpartum recall. This study investigated the accuracy of postpartum recall of falls that were reported during pregnancy, including assessment of fall efficacy as a possible reason for recall inaccuracy. Twenty participants reported fall experiences weekly during pregnancy, but one participant was excluded as an outlier. A fall efficacy questionnaire was completed every six weeks during pregnancy. A postpartum survey to mimic previous studies (Dunning, Lemasters, and Bhattacharya 2010; Dunning et al. 2003) was delivered to determine recall accuracy. Postpartum recall of fall events each gestational month matches the previous study (Dunning, Lemasters, and Bhattacharya 2010). However, recall of falls is 16% underestimated and recall of all fall events is 30% overestimated in postpartum survey. There is a slight relationship between fall efficacy and true falls, but not between fall efficacy and fall recall. Our study suggests fall risk needs to be intermittently surveyed throughout pregnancy rather than assessed via postpartum survey.Practitioner summary: This study investigated the accuracy of postpartum survey of fall risk during pregnancy and the possibility of fall efficacy as a covariate. We used three corresponding surveys. We found inaccuracies in postpartum survey, not explain by fall efficacy.
Collapse
Affiliation(s)
| | - Shenghai Dai
- Washington State University, Pullman, Washington, USA
| | | | | | | | | | | | | |
Collapse
|
4
|
Music HE, Bailey JP, Catena RD. Upper extremity kinematics during walking gait changes through pregnancy. Gait Posture 2023; 104:97-102. [PMID: 37356228 DOI: 10.1016/j.gaitpost.2023.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 05/24/2023] [Accepted: 06/21/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Thirty percent of adults in the United States use wearable fitness devices as of 2020 [1], such as fitness watches, to monitor and track health and physical activity parameters. Physical changes during pregnancy may impact wrist worn device accuracy. The arms may be needed as compensation during walking because thorax axial rotation may be inhibited by pelvic tilt during pregnancy [2]. METHODS To examine arm motion changes, twenty-three pregnant women (28 ± 4 y) were tested in four-week intervals ( ± 2 weeks) at 18-, 22-, 26-, 30- and 34-weeks' gestation. Kinematic data were measured during self-selected speed walking. Segment angles and angular velocities were analyzed over time. Linear regressions were used to analyze the correlations between arm motion and the other kinematic variables. RESULTS Arm range of motion significantly increased (p = 0.006) over gestation, but leg, thorax, and pelvis range of motions did not significantly change. Arm range of motion was correlated with pelvis (r2 =0.311, p = 0.001, β = 1.724) and leg (r2 = 0.285, p = 0.004, β = 1.520) range of motion and gait velocity (r2 =0.566, p = 0.001, β = 39.110). Arm velocities significantly increased (p < 0.012), as did leg velocities (p < 0.022) over gestation time, but thorax and pelvis rotational velocities did not significantly change over time. Arm velocity was correlated with leg velocity in both flexion (r2 =0.598, p = 0.001, β = 1.61) and extension (r2 =0.568, p = 0.001, β = 1.35). SIGNIFICANCE Arm swing increases over the course of gestation during walking, which does not follow the exact pattern of changes seen in the legs, thorax, and pelvis. These results show that a typical gait analysis of lower body motions may miss important biomechanical changes or compensations at different points over pregnancy. Future studies should examine why these changes may occur. Studies should also be conducted to see if arm changes impact outcome parameters from fitness watches and affect their validity as an exercise tracker during pregnancy.
Collapse
|
5
|
Doğan H, Demir Çaltekin M. Plantar sensation, proprioception, and balance levels in pregnant women with gestational diabetes mellitus. Clin Biomech (Bristol, Avon) 2023; 107:106016. [PMID: 37295341 DOI: 10.1016/j.clinbiomech.2023.106016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND The aim of the study was to compare plantar sensation, proprioception, and balance levels between pregnant women with Gestational Diabetes Mellitus and healthy pregnant women. Also, we aimed to investigate the relationship between parameters that were found to be different and sensory sensitivity, balance, and position sense. METHODS Seventy-two pregnant women (35 with Gestational Diabetes Mellitus and 37 controls) were included in this case-control study. Plantar sensory levels of the ankle joint (Semmes-Weinstein Monofilament-Test), position sense (digital inclinometer), and balance levels (Berg Balance Scale) were evaluated. FINDINGS The Gestational Diabetes Mellitus group could not detect small filament thickness in the heel region compared to the control group (p < 0.05). In the ankle proprioception measurements of the Gestational Diabetes Mellitus group, deviation angle values were higher (p < 0.05) and the balance level was lower compared to the control group (p < 0.001). In addition, there was a positive correlation between glucose metabolism parameters and plantar sense and proprioception and a negative correlation with balance level (p < 0.05). INTERPRETATION Plantar sense in the heel area, ankle joint position, and balance level of pregnant women with Gestational Diabetes Mellitus were lower than those of the healthy pregnant women. Disruption of glucose metabolite levels, which causes Gestational Diabetes Mellitus, is related to poorer balance, ankle position sense, and plantar sense in the heel. We recommend evaluating position sense and plantar sense for postural instability and risk of falling in pregnant women with Gestational Diabetes Mellitus.
Collapse
Affiliation(s)
- Hanife Doğan
- Necmettin Erbakan University, Nezahat Keleşoğlu Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Konya, Turkey.
| | - Melike Demir Çaltekin
- Ordu University, Medical School, Department of Obstetrics and Gynecology, Ordu, Turkey
| |
Collapse
|
6
|
Taub M, Mazar O, Yovel Y. Pregnancy-related sensory deficits might impair foraging in echolocating bats. BMC Biol 2023; 21:60. [PMID: 36973777 PMCID: PMC10044376 DOI: 10.1186/s12915-023-01557-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 03/02/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Reproduction entails substantial demands throughout its distinct stages. The mammalian gestation period imposes various energetic costs and movement deficits, but its effects on the sensory system are poorly understood. Bats rely heavily on active sensing, using echolocation to forage in complete darkness, or when lighting is uncertain. We examined the effects of pregnancy on bat echolocation. RESULTS We show that pregnant Kuhl's pipistrelles (Pipistrellus kuhlii) altered their echolocation and flight behavior. Specifically, pregnant bats emitted longer echolocation signals at an ~ 15% lower rate, while flying more slowly and at a lower altitude compared to post-lactating females. A sensorimotor foraging model suggests that these changes could lead to an ~ 15% reduction in hunting performance during pregnancy. CONCLUSIONS Sensory deficits related to pregnancy could impair foraging in echolocating bats. Our study demonstrates an additional cost of reproduction of possible relevance to other sensory modalities and organisms.
Collapse
Affiliation(s)
- Mor Taub
- School of Zoology, Faculty of Life Sciences, Tel Aviv University, 6997801, Tel Aviv, Israel.
| | - Omer Mazar
- Sagol School of Neuroscience, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Yossi Yovel
- School of Zoology, Faculty of Life Sciences, Tel Aviv University, 6997801, Tel Aviv, Israel.
- Sagol School of Neuroscience, Tel Aviv University, 6997801, Tel Aviv, Israel.
| |
Collapse
|
7
|
Assessment of postural sway with a pendant-mounted wearable sensor. Gait Posture 2022; 92:199-205. [PMID: 34864485 DOI: 10.1016/j.gaitpost.2021.11.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 11/01/2021] [Accepted: 11/23/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Body-worn inertial measurement unit (IMU) sensors have been widely used in postural stability and balance studies because of their low cost and convenience. In most of these studies, a single IMU sensor is attached to a waist belt near the body's center of mass. Some populations such as pregnant women, however, may find a waist belt challenging in terms of fit and comfort. For this reason it may be useful to identify an alternative location for placement of an IMU and a more comfortable means for attaching the sensor to the body. Research question Does placing an IMU sensor in a pendant worn around the neck permit discrimination between conditions with varying postural stability? METHODS Twenty-six healthy participants performed three standing tasks (double-leg, tandem, and single-leg standing) under eyes-open and eyes-closed vision conditions to preliminarily assess the ability of the pendant sensor to discriminate between balance conditions. Discrimination based upon data from a belt-mounted IMU was assessed in the same trials. Differences in standard deviation of acceleration components, sway area, and jerkiness due to trial condition and sensor were evaluated using analysis of variance followed by post hoc comparisons. These data were also incorporated into receiver-operator characteristic (ROC) curve analysis to assess the effectiveness of each sensor at discriminating between conditions. RESULTS Stability was found to vary across conditions, but there was no interaction between stability and sensor location (all p ≥ 0.323). ROC curve analysis showed that sensors in both locations were good discriminators between conditions. Significance Placing an IMU in a pendant may be feasible for studying and monitoring postural instability. This approach may be especially valuable when considering populations for which wearing a belt is uncomfortable.
Collapse
|
8
|
Mehraban SS, Lagodka S, Kydd J, Mehraban S, Cabbad M, Chendrasekhar A, Lakhi NA. Predictive risk factors of adverse perinatal outcomes following blunt abdominal trauma in pregnancy. J Matern Fetal Neonatal Med 2021; 35:8929-8935. [PMID: 34852716 DOI: 10.1080/14767058.2021.2007876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The primary objective was to identify predictive risk factors of preterm delivery following blunt abdominal trauma. The secondary objective was to identify risk factors of other adverse outcomes, Neonatal Intensive Care Unit (NICU) admission, placental abruption, fetal demise, and Cesarean Delivery (CD). METHODS This retrospective study included pregnant patients with gestational age (GA) ≥23 weeks who presented after blunt abdominal trauma to Richmond University Medical Center from October 2015 to January 2020. Patients were identified using the following diagnostic International diagnostic classification (ICD-10) codes: O9A.212, O9A.213, and 071.89, and excluded if trauma did not involve the abdomen, penetrating, <23 weeks, or incomplete records. Collected data points included maternal demographic factors, clinical laboratory values, maternal clinical findings at presentation, abdominal ultrasound, results of fetal monitoring, Abbreviated Injury Score (AIS) for abdomen, and Injury Severity Score (ISS). Univariate analyses were compared using the Student's t-test or Mann-Whitney U-test. Categorical data were compared using the chi-squared test or Fisher's exact test with P-value < .05 as significant. RESULTS 154 patients were included in the final analysis. The incidence of the primary outcome, preterm delivery before 37 weeks, was 11.0% (17/154). The incidence of secondary outcomes following blunt abdominal trauma were abruption 0% (0/154), fetal demise 0.6% (1/154), CD 44% (68/154), NICU admission 24% (37/154). Maternal demographic factors, presence of uterine contractions, maternal clinical conditions (abdominal pain, abdominal tenderness, vaginal bleeding), hematologic and coagulation studies, ultrasound findings, fetal heart rate tracing category, AIS score for abdomen, and ISS score were not predictive of preterm delivery or other secondary outcomes. CONCLUSION The incidence of adverse maternal and neonatal outcomes is low following blunt abdominal trauma. Extended monitoring of asymptomatic patients including laboratory tests and coagulation profiles were not predictive of preterm labor or secondary adverse perinatal outcomes. LEVEL OF EVIDENCE Therapeutic/Care management, Level III.
Collapse
Affiliation(s)
- Shadan S Mehraban
- Department of Obstetrics and Gynecology, Richmond University Medical Center, Staten Island, New York, USA
| | - Sylvie Lagodka
- Department of Obstetrics and Gynecology, Richmond University Medical Center, Staten Island, New York, USA
| | - Jessica Kydd
- Department of Obstetrics and Gynecology, Richmond University Medical Center, Staten Island, New York, USA
| | - Shadi Mehraban
- Department of Obstetrics and Gynecology, Richmond University Medical Center, Staten Island, New York, USA
| | - Michael Cabbad
- Department of Obstetrics and Gynecology, Richmond University Medical Center, Staten Island, New York, USA
| | - Akella Chendrasekhar
- Department of Trauma Surgery, Richmond University Medical Center, Staten Island, New York, USA
| | - Nisha A Lakhi
- Department of Obstetrics and Gynecology, Richmond University Medical Center, Staten Island, New York, USA.,Department of Trauma Surgery, Richmond University Medical Center, Staten Island, New York, USA.,Department of Obstetrics and Gynecology, New York Medical College, Valhalla, New York, USA
| |
Collapse
|
9
|
Self-selection of gestational lumbopelvic posture and bipedal evolution. Gait Posture 2021; 89:7-13. [PMID: 34217002 DOI: 10.1016/j.gaitpost.2021.06.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/21/2021] [Accepted: 06/25/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Not all pregnant women seem to select the more curved lumbopelvic posture that their sexual dimorphic anatomy allows even though many previous researchers have assumed lumbopelvic curvature to be standard during pregnancy. This study is vital to understanding coevolution of lumbopelvic sexual dimorphism and bipedalism, and understanding some clinical implications of intervening in gestational posture changes. RESEARCH QUESTIONS Are there anthropometric changes that correspond with selection of lumbopelvic curvature change during pregnancy? What are the biomechanical costs and benefits of gestational lumbopelvic curvature change? METHODS Twenty pregnant women were tested at five different times in the 2nd and 3rd trimesters of pregnancy. Lumbopelvic posture, standing kinetics and gait kinetics were measured longitudinally. Additionally, we modeled the effects on standing and gait without lumbopelvic postural changes, but with anthropometric changes, for each individual. RESULTS We found greater lumbopelvic angulation to correspond with a shorter body height (6 cm difference between groups, p = 0.048) and deeper 2nd trimester abdomen (2 cm difference between groups, p = 0.013). Lumbopelvic angulation lowers support requirements (in standing and walking (6% lower support impulse, p = 0.056), but at the cost of shifting the propulsive actions to a less efficient pulling action rather than pushoff (13 % reduction in pushoff time, p = 0.001). We observed minimal effects on walking kinematics and balance control. SIGNIFICANCE Our findings suggest the evolutionary advantage of the female lumbopelvic unit is the adaptability it provides to adjust for the individual needs of the pregnant woman. We discuss multiple potential contributing factors that may have shaped hominin female lumbopelvic evolution and are involved in self-selecting lumbopelvic posture.
Collapse
|
10
|
Eckland CB, Vasavada A, Catena RD. Shoulder and elbow requirements during sagittal reach as a result of changing anthropometry throughout pregnancy. APPLIED ERGONOMICS 2021; 94:103411. [PMID: 33725557 DOI: 10.1016/j.apergo.2021.103411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 06/12/2023]
Abstract
During pregnancy, anthropometric and physiological changes can result in difficulty reaching for and lifting everyday objects. The aims of this study were to determine the changes in sagittal plane anterior reach space (SPARS) and shoulder/elbow strength requirements throughout pregnancy. Seventeen participants were tested through a longitudinal observational cohort study between 16 and 36 weeks gestation in four-week intervals. A 25% decrease in SPARS was observed at the L3-4 torso height. Combined with arm mass increases, shoulder and elbow moment requirements at the minimum and maximum static reach distances significantly increased. However, inverse dynamics analysis determined that mass gains in the arm alone only minimally impact dynamic shoulder moments. Additionally, torso flexion increases throughout pregnancy demonstrates that women are attempting to compensate for decreased SPARS, possibly indicating the additional perceptual importance of reach space in accommodations for pregnant workers.
Collapse
Affiliation(s)
- Chantel B Eckland
- Washington State University, 19 Smith Gym, Pullman, WA, 99164-1410, USA.
| | - Anita Vasavada
- Washington State University, 205 Wegner Hall, Pullman, WA, 99164-1565, USA.
| | - Robert D Catena
- Washington State University, 113F Smith Gym, Pullman, WA, 99164-1410, USA.
| |
Collapse
|
11
|
Catena RD, Bailey JP, Campbell N, Stewart BC, Marion SJ. Correlations between joint kinematics and dynamic balance control during gait in pregnancy. Gait Posture 2020; 80:106-112. [PMID: 32502792 DOI: 10.1016/j.gaitpost.2020.05.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/01/2020] [Accepted: 05/18/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Dynamic balance control degrades during pregnancy, but it is not yet understood why. Mechanical aspects of the body should directly affect walking balance control, but we have recently published papers indicating that weight gains during pregnancy explain very little dynamic balance changes. Our goal was to determine if lower extremity joint kinematic changes are an indicator of walking balance control. This information is vital to understanding the route by which pregnancy increases fall risk. METHODS Twenty-three pregnant women were tested at five different times in the 2nd and 3rd trimesters of pregnancy. Participants performed walking trials at a self-selected pace. Motion capture was used to measure joint kinematics (discrete and coordination variables) and body center of mass motion. Changes over time were statistically analyzed. Correlations between kinematics and walking balance were modelled with hierarchical multiple regression models. RESULTS As pregnancy progresses, it appears that a more flexed hip posture could be driving lower extremity kinematic changes toward increased coordination between joints and increased knee and ankle motions. Walking balance changes were also detected through increased COM motion (lateral range of motion and velocity) in the lateral directions. However, there was little correlation between kinematic and balance changes (r2 < 0.4). Strong correlations were only observed when all kinematics (including those that don't ubiquitously change during pregnancy) were used in the regression model (r2 > 0.7). SIGNIFICANCE Our findings suggest that walking balance control is not altered by a common kinematic change between all pregnant women. While increased lateral center of mass motion should be expected with pregnancy, the kinematics leading to this increase may be person-specific. The cause of dynamic imbalance in each pregnant women (physiological, mechanical, and neurocognitive) may play an important role in determining the kinematic means by which lateral center of mass motion increases.
Collapse
Affiliation(s)
- Robert D Catena
- Washington State University, 101 Physical Education Building, Pullman, WA, United States.
| | - Joshua P Bailey
- University of Idaho, 875 Perimeter Drive MS 2401, Moscow, ID, United States
| | - Nigel Campbell
- Moscow/Pullman OBGYN, 1205 SE Professional Mall Blvd #102, Pullman, WA, United States
| | - Brett C Stewart
- Washington State University, 101 Physical Education Building, Pullman, WA, United States
| | - Shawn J Marion
- Washington State University, 101 Physical Education Building, Pullman, WA, United States
| |
Collapse
|
12
|
Rothwell SA, Eckland CB, Campbell N, Connolly CP, Catena RD. An analysis of postpartum walking balance and the correlations to anthropometry. Gait Posture 2020; 76:270-276. [PMID: 31883494 DOI: 10.1016/j.gaitpost.2019.12.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 12/08/2019] [Accepted: 12/13/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Falls caused by balance issues during pregnancy are quite common, and these issues can continue postpartum, potentially posing a danger to both the mother and baby. While there has been research on changes to walking gait during pregnancy, walking balance in the postpartum period has yet to be examined. Therefore, the aims of this study were to examine if balance changes persist in postpartum and the contribution of anthropometry changes. METHODS This was done through longitudinal observational cohort study at 16 and 40 weeks gestation and at four-week intervals postpartum. Balance was measured as lateral center of mass motion during treadmill walking, and recorded with motion capture cameras following anthropometric measurements. Balance variables were statistically analyzed to observe how they changed over time. Hierarchical regression analyses determined correlations between balance and anthropometry. RESULTS Balance was observed to improve significantly just following birth. Additionally, there were changes that continued to indicate improvement throughout the postpartum period. Anthropometry changes were significantly, but minimally, correlated with balance changes. SIGNIFICANCE Many women begin to return to normal activities soon after birth. With women participating in various forms of exercise, potentially rigorous work requirements, and tasks around the home, it is important that they, their medical providers, and employers understand and consider the continued risks of imbalance.
Collapse
Affiliation(s)
- Sarah A Rothwell
- Department of Kinesiology and Educational Psychology, Washington State University, 101 Physical Education Building, Pullman, WA, United States
| | - Chantel B Eckland
- Department of Kinesiology and Educational Psychology, Washington State University, 101 Physical Education Building, Pullman, WA, United States
| | - Nigel Campbell
- Moscow/Pullman OBGYN, 1205 SE Professional Mall Blvd #102, Pullman, WA, United States
| | - Christopher P Connolly
- Department of Kinesiology and Educational Psychology, Washington State University, 101 Physical Education Building, Pullman, WA, United States
| | - Robert D Catena
- Department of Kinesiology and Educational Psychology, Washington State University, 101 Physical Education Building, Pullman, WA, United States.
| |
Collapse
|
13
|
Greco PS, Day LJ, Pearlman MD. Guidance for Evaluation and Management of Blunt Abdominal Trauma in Pregnancy. Obstet Gynecol 2019; 134:1343-1357. [PMID: 31764749 DOI: 10.1097/aog.0000000000003585] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Blunt abdominal trauma is the leading type of traumatic injury in pregnancy, with motor vehicle crashes, falls, and assault being the most common etiologies. Several adverse outcomes can occur in pregnancy, including placental abruption, preterm labor and preterm delivery, uterine rupture, and pelvic fracture. Understanding and integration of key anatomic and physiologic changes in pregnancy are key when evaluating a pregnant trauma patient. Pregnant women should be managed in a medical center with the ability to provide adequate care to both trauma patients-the pregnant woman and fetus. Multiple clinical providers are usually involved in the care of pregnant trauma patients, but obstetric providers should play a central role in the evaluation and management of a pregnant trauma patient given their unique training, knowledge, and clinical skills. An algorithm for management of trauma in pregnancy should be used at all sites caring for pregnant women. An alignment of policies within each system optimizes appropriate triage, integration of care, management, and monitoring of pregnant trauma patients and their fetuses. Ensuring effective protocols for prehospital and hospital treatment, as well as thorough training of involved health care providers, is essential in ensuring that optimal care is provided.
Collapse
Affiliation(s)
- Patricia S Greco
- University of Michigan Department of Obstetrics and Gynecology, Ann Arbor, Michigan
| | | | | |
Collapse
|
14
|
Catena RD, Bailey JP, Campbell N, Music HE. Stand-to-sit kinematic changes during pregnancy correspond with reduced sagittal plane hip motion. Clin Biomech (Bristol, Avon) 2019; 67:107-114. [PMID: 31100701 DOI: 10.1016/j.clinbiomech.2019.05.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 02/16/2019] [Accepted: 05/08/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The stand-to-sit motion has been linked to falls during pregnancy. It is also used in the clinical evaluation of functional performance. The physical and physiological changes during pregnancy may necessitate a change in stand-to-sit kinematic performance. Therefore, this study was conducted to evaluate the longitudinal changes to stand-to-sit kinematics during pregnancy. METHODS Fifteen pregnant women were tested in 4-week intervals from 16 weeks to 36 weeks gestational age. They performed a 60-second trial of semi-continuous stand-to-sit motion. Sagittal plane motions at the ankle, knee, spine, and shoulders were measured. Additionally, three-dimensional hip motion was measured. Discrete variables (e.g. range of motion) and joint coordinations (through vector coding) were analyzed over time through a linear mixed model analysis. FINDINGS The results indicate a shift away from sagittal hip motion throughout pregnancy. Hip range of motion and standing angle changed in favor of spine motion. Joint coordination shifted from hip dominant to spine- and shoulder-dominate coordination just before the start of sitting motion. Hip-knee joint coordination just before seat contact shifted from hip to a knee-dominant motion during pregnancy. INTERPRETATION Discrete variable changes in the entire stand-to-sit motion seem to be driven by initial standing posture related to an increase in gestational lordosis. Likewise, standing joint coordination shift to upper body motion can be attributed to gestational lordosis limiting functional ability around the hip. The shift in motion away from the hip may provide insight into why both fall rates and low back pain rates increase during stand-to-sit during pregnancy.
Collapse
Affiliation(s)
- Robert D Catena
- Washington State University, 101 Physical Education Building, Pullman, WA 99164-1410, United States.
| | - Joshua P Bailey
- University of Idaho, 875 Perimeter Drive MS 2401, Moscow, ID 83844-2401, United States
| | - Nigel Campbell
- Moscow/Pullman OBGYN, 1205 SE Professional Mall Blvd #102, Pullman, WA 99163, United States
| | - Hallie E Music
- Washington State University, 101 Physical Education Building, Pullman, WA 99164-1410, United States
| |
Collapse
|
15
|
Anthropometric Changes During Pregnancy Provide Little Explanation of Dynamic Balance Changes. J Appl Biomech 2019; 35:232-239. [DOI: 10.1123/jab.2018-0345] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
16
|
Catena RD, Campbell N, Wolcott WC, Rothwell SA. Anthropometry, standing posture, and body center of mass changes up to 28 weeks postpartum in Caucasians in the United States. Gait Posture 2019; 70:196-202. [PMID: 30897492 DOI: 10.1016/j.gaitpost.2019.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/13/2019] [Accepted: 03/11/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Anthropometric models are used when body center of mass motion is calculated for assessment of dynamic balance. It is currently unknown how body segments and posture change in the postpartum period. Therefore, this study was conducted to evaluate the longitudinal changes in anthropometry, center of mass, and standing posture postpartum. METHODS Seventeen pregnant women were tested at nine different times: 16-20 weeks and 36-40 weeks gestation, and then in 4-week intervals from childbirth to 28 weeks postpartum. Anthropometry was measured and then participants conducted a static standing and static laying trial. Force plate data and motion capture data were used in combination with anthropometry to calculate the masses of individual segments and the body center of mass. Change over time was determined through a linear mixed model analysis. RESULTS Anthropometric changes related to the abdomen or fluid retention during pregnancy immediately regress to early pregnancy levels following childbirth. However, other changes related to breast tissue and fat deposits persist postpartum. As such, masses of different segments affect an anthropometric model for center of mass calculation, and body center of mass changes in the lateral and anterior directions postpartum. Vertical body center of mass position was unaffected. SIGNIFICANCE Increased postpartum breast mass may be the cause of persistent lordotic curvature changes in the lumbar spine. There is potential that this affects postpartum back pain. Future research should explore how body center of mass changes postpartum for individuals that do not breast feed, and thus may not have significant breast mass postpartum.
Collapse
Affiliation(s)
- Robert D Catena
- Washington State University, 101 Physical Education Building, Pullman, WA, United States.
| | - Nigel Campbell
- Moscow/Pullman OBGYN, 1205 SE Professional Mall Blvd #102, Pullman, WA, United States
| | - W Connor Wolcott
- Washington State University, 101 Physical Education Building, Pullman, WA, United States
| | - Sarah A Rothwell
- Washington State University, 101 Physical Education Building, Pullman, WA, United States
| |
Collapse
|