The Main Changes in Pregnancy—Therapeutic Approach to Musculoskeletal Pain

The effect of aromatherapy applied to pregnant women on sleep quality and fatigue level: A randomized clinical trial

INTRODUCTION

Sleep disturbances and fatigue can negatively impact pregnancy. The purpose of this study is to assess changes in sleep quality and fatigue levels pre- and post-aromatherapy intervention using lavender oil inhalation in pregnant women in the third trimester.

MATERIALS AND METHODS

The research was conducted in the gynecology and obstetrics outpatient clinic of a training and research hospital between October 2022 and March 2023. The study was designed as a randomized controlled experimental trial with a pretest-posttest control group. The sample consisted of a total of 74 pregnant women (37 intervention and 37 control). Aromatherapy with lavender oil was applied to pregnant women in the intervention group for one month using the "Inhalation Application Form." "Personal Information Form", "Visual Analog Scale (VAS)", "Pittsburg Sleep Quality Index (PSQI)" and " Visual Analogue Scale for Fatigue (VASF)" were used to collect data. Percentage distributions, chi-square significance test, t-test in independent groups, and Mann-Whitney U and Wilcoxon tests were used to evaluate the data.

RESULTS

In the study, the post-test PSQI score average of the pregnant women in the intervention group who received lavender oil inhalation was 4.10±1.36, it was 5.45±2.48 in the control group. The post-test fatigue score average of the pregnant women in the intervention group was 65.91±7.02, it was 75.40±10.79 in the control group. A statistically significant difference was found between the post-test PSQI and VAS-F total score averages of the pregnant women in the intervention and control groups (p < 0.05).

CONCLUSION

The study findings indicate that aromatherapy applied via inhalation to pregnant women improved sleep quality and reduced fatigue levels. According to these findings, lavender oil aromatherapy can be recommended to improve sleep quality and reduce fatigue levels in pregnant women during the third trimester.

[Review of physical exercise as treatment for low back pain in pregnant women]

Low back pain (LBP) in pregnant women can have a negative impact on daily activities, reduce quality of life and increase absenteeism from work. Despite its high prevalence, ranging from 13.2 to 80%, it is estimated that more than 50% of pregnant women receive little or no intervention from healthcare professionals, and it is often mistakenly considered as a normal phenomenon. Given the side effects of pharmacological treatment of LBP in pregnant women, and the fact that physical exercise during pregnancy has been shown to be effective in reducing the intensity of LBP, the aim of this article is to raise awareness among primary care physicians so that they prescribe physical exercise to pregnant women with LBP and avoid physical inactivity as a consequence of LBP, as this can lead to a higher incidence of obstetric complications and caesarean section.

Scorpion serotherapy during pregnancy protects rat offspring from harmful effects of venom

Despite the numerous incidents of scorpion envenoming worldwide, little is known about the effects of maternal venom exposure and serotherapy on fetal development. The impact of antivenom on pregnant rats envenomed by Tityus serrulatus venom was examined. The venom caused alterations in the development of the offspring, yet the antivenom protected against these adverse effects and does not cause harm in itself, indicating the potential benefits of serotherapy.

Retrospective study of the factors involved in the development of adenomyosis and the in vitro link between adenomyosis and breast cancer

Background and aims

Adenomyosis is a heterogeneous disease, which differs from patient to patient. The objective of our study was to evaluate the risk factors that influence the occurrence of adenomyosis, more precisely to highlight aspects that may be used in practice. In addition, the in vitro impact of levonorgestrel (a possible predisposing factor in the occurrence of adenomyosis) on MDA-MB-231 cells was evaluated, trying to obtain a link between adenomyosis and mammary cancer.

Methods

Clinical and demographic data of patients diagnosed with adenomyosis hospitalized between January and September 2023 in the Obstetrics-Gynecology Clinic were analyzed. For the in vitro assays, the MTT and LDH method was used to investigate the effect on cell viability and the potential cytotoxic effect of LG on MDA-MB-23 cells.

Results

Out of a total of 99 hysterectomies performed, the diagnosis of adenomyosis was confirmed by ultrasound in 28 cases. Among our patients, we could observe that most of cases of adenomyosis developed in women between 40 and 45 years old. Multiple pregnancies can influence the development of this uterine pathology, along with a history of uterine surgery and abortions. It was also found that treatment with sex hormones can increase the risk of adenomyosis. Our in vitro study has showed that LG stimulates the proliferation of MDA-MB-231 cells depending on the dose and time.

Conclusions

Personal history along with progestin treatment may influence myometrial lesions, leading to diffuse or focal adenomyosis. Moreover, in vitro, LG has been shown to stimulate the proliferation of breast cancer cells.

The prevalence and linkage disequilibrium of 21 genetic variations related to thrombophilia, folate cycle, and hypertension in reproductive age women of Rostov region (Russia)

Several maternal genetic variations are known to play an important role during pregnancy since they can affect mother health and/or fetal growth. The frequency of these variants is variable among different populations. This study aimed to investigate thrombophilia, folate metabolism and hypertension genetic variants in reproductive age women of Rostov region (Russia) and then assess their linkage disequilibrium (LD) and heterogeneity among populations. A total of 3108 reproductive age women were included (33.75 ± 5.13 years). Twenty-one genetic variants were detected with RT-PCR. LD was tested according to (D') coefficient and p value. The highest frequency of mutant allele in studied population was as follows: PAI-1 rs1799768, MTRR rs1801394, AGT rs699, and AGTR2 rs1403543. We showed a high possibility of coinheritance of MTHFR rs1801133 with rs1801131 and AGT rs699 with rs4762 (D'=0.992 and 0.999, respectively). In addition, comparative analysis showed F7 rs6046, FGB rs1800790, MTR rs1805087, and AGT rs699 significantly more frequent among Rostov females by 1.3-1.5 times than European. MTHFR rs1801133, ADD1 rs4961, AGTR2 rs1403543, NOS3 rs2070744, and rs1799983 were with higher frequencies in Europeans than those in the studied group. Our data could be used as a reference for further associative studies of targeted genetic variations in different pregnancy complications specifically in this population.

The association between musculoskeletal pain during pregnancy and pregnancy outcomes: A systematic review and meta-analyses

OBJECTIVE

To systematically investigate the association between musculoskeletal pain during pregnancy and birth outcomes including caesarean section, newborn birthweight, newborn birth length, and gestational age at birth.

METHODS

Medline, Embase, Web of Science, Cinahl and Scopus were systematically searched to identify eligible studies. Odds ratios, mean differences, and confidence intervals were used to describe results. Risk of Bias was assessed using the Newcastle-Ottawa Scale for observational studies. GRADE (The Grading of Recommendation Assessment, Development, and Evaluation) was used to assess the quality of each outcome.

RESULTS

Seven studies were included with a total population of 85,991 participants. There is low- quality evidence that pregnant women with musculoskeletal pain had 1.59 greater odds to experience delivery by caesarean section compared to those without musculoskeletal pain ([OR] 1.59, 95 % confidence interval [CI] 1.09 to 2.31). Both newborn birth weight (Mean Difference [MD] 77.79 g, 95 % [CI] -23.09 to 178.67) and newborn birth length ([MD] 0.55 cm, 95 % [CI] -0.47 to 1.56) were not affected by musculoskeletal pain, with very low-quality and low-quality evidence, respectively. There was moderate evidence that pregnant women with musculoskeletal pain had shorter gestational age (weeks), although the effect was small and possibly not clinically relevant ([MD] -0.41, 95 % [CI] -0.41 to -0.07).

CONCLUSION

Pregnant women experiencing musculoskeletal pain are at greater odds of delivering their babies via caesarean than those without musculoskeletal pain, however, musculoskeletal pain during pregnancy does not appear to affect newborn birth weight, length, or gestational age at birth.

In vitro Effects of Propofol and Bupivacaine on Pregnant Women’s Plasma Cholinesterase Activity and Malondialdehyde Level

Background: Propofol and bupivacaine are commonly used anesthetics for cesarean section (CS), and they might modulate plasma cholinesterase (ChE) activity and oxidative stress during the last stage of pregnancy. This study aimed to assess the in vitro effects of propofol and bupivacaine on plasma ChE activity and malondialdehyde (MDA) levels in pregnant women before undergoing elective CS. Methods: The plasma samples of 20 women set for elective CS were pooled for the in vitro determination of the effects of propofol and bupivacaine separately on plasma ChE activity (10 minutes of incubation with different concentrations at 37ºC) and the MDA level after the in vitro exposure of plasma samples containing different anesthetic concentrations to H2O2 (100 µM, incubated for 1 hour at 37ºC). Results: Bupivacaine at 1.1 and 2.2 µM significantly inhibited plasma ChE in vitro in a concentration-dependent manner by 13% and 20%, respectively. Propofol at 25 and 50 µM did not affect plasma ChE. A unique finding in this study was that both propofol and bupivacaine revealed an antioxidant effect, as both propofol at concentrations of 25, 50, and 100 µM and bupivacaine at 1.1, 2.2, and 4.4 µM reduced the MDA level in a concentration-dependent manner in vitro after the incubation of plasma samples with H2O2 as a source of oxidant. Conclusions: The in vitro findings suggest that bupivacaine exerts anti-ChE activity that should be taken into consideration in CS anesthesia, and both propofol and bupivacaine possess antioxidant properties that need additional clinical studies.

The Influence of Physical Activity during Pregnancy on Maternal Pain and Discomfort: A Meta-Analysis

Pregnant women may experience pain and discomfort during pregnancy, especially in areas such as the lower back and pelvic girdle. Pain in pregnancy is associated with poor quality of life, and because it is a common occurrence, pregnant women may be offered several resources to prevent discomforts throughout pregnancy, such as engaging in physical activity. This study was a meta-analysis of randomised controlled trials (prospectively registered in Prospero, registration number: CRD42023451320) aimed to assess the effects of physical activity during pregnancy on maternal pain and discomfort. We analysed 16 randomised clinical trials. The results of these analyses indicate that women who performed physical activity had significantly less intensity of pain (z = <2.69, p = <0.007; SMD = -0.66, 95% CI = -1.13, -0.18, I2 = <91%, Pheterogeneity = <0.001) and a reduction observed in the disability questionnaire (z = <2.37, p = <0.02; SMD = -0.80, 95% CI = -1.47, -0.14, I2 = <91%, Pheterogeneity = <0.001), and overall reduced general pain (z = <3.87, p = <0.001; SMD = -0.56, 95% CI = -0.84, -0.27, I2 = <86%, Pheterogeneity = <0.001) than women who did not practice physical activity during pregnancy. In conclusion, physical activity during pregnancy could effectively help to diminish pain intensity, reduce disability due to pain, and generally reduce pain.

Redefining Maternal Wellness: The Role of Antenatal Exercises in Musculoskeletal Issues Among Primigravida Mothers

During pregnancy, there are notable alterations in biomechanics, hormones, and vascular functioning, which frequently result in a range of musculoskeletal ailments, including back pain, leg cramps, and pelvic girdle discomfort. The significance of pregnancy-related musculoskeletal problems on women's daily functioning and general well-being is highlighted by their widespread occurrence worldwide, necessitating heightened focus and implementation of effective therapeutic approaches. The main aims of this study were to assess the effectiveness of prenatal exercises in musculoskeletal discomfort and investigate the association between post-intervention levels of discomfort and certain demographic factors. A quantitative technique was used in this study, utilizing a pre-experimental design conducted for three months. A total of 60 primigravida mothers were selected as participants through purposive sampling. The study was conducted in a Maternity Tertiary Care Center located in Tamil Nadu. The intervention encompassed the provision of antenatal exercises, specifically focusing on abdominal tightness, pelvic tilting, and foot and ankle movements. The researcher demonstrated the exercises for 20 minutes, and afterward, mothers were asked to perform the activities themselves. The process was monitored and observed for two weeks. The findings were statistically significant, suggesting a noteworthy decrease in musculoskeletal disorders following the implementation of the intervention. The statistical analysis revealed a significant degree of significance (P = 0.001), confirming the efficacy of the exercises. Before the implementation of the intervention, a significant proportion of mothers, namely, 45 (75%) reported experiencing moderate back pain. However, following the intervention, this percentage notably fell to 33.34% (20). The incidence of moderate pelvic pain decreased from 80% (48) to 30% (18), and a comparable pattern was observed in the reduction of leg cramps. Additionally, the research identified significant associations between the improvements and a range of demographic and obstetric factors, including the level of education, occupation, family structure, age at marriage, and weight of the mother. The results highlight the significance of incorporating antenatal exercises as a regular component of prenatal care to minimize musculoskeletal discomfort, hence promoting the overall health and well-being of expectant mothers.

Hypertensive Disorders of Pregnancy: Assessing the Significance of Lp(a) and ApoB Concentrations in a Romanian Cohort

Background: This research delves into the association between altered lipid profiles and hypertensive disorders of pregnancy (HDP), shedding light on cardiovascular implications in maternal health. Methods: A cohort of 83 pregnant women was studied, with 48.19% diagnosed with HDP. This investigation primarily focused on Apolipoprotein B (ApoB) and Lipoprotein(a) (Lp(a)) as indicators of cardiovascular health. A comparative examination was conducted to determine discrepancies in the ApoB and Lp(a) levels between standard pregnancies and those presenting with HDP. Results: Significant elevations in ApoB (p value = 0.0486) and Lp(a) (p value < 0.0001) levels were observed in pregnant women with HDP compared to their counterparts with typical pregnancies. The pronounced link between heightened ApoB and Lp(a) concentrations and HDP persisted, even considering pregnancy's distinct physiological conditions. Conclusions: Our research accentuates the crucial role of early detection and specialized handling of cardiovascular risks in expectant mothers, especially those predisposed to HDP. The study indicates ApoB and Lp(a)'s potential as reliable markers for gauging cardiovascular threats during gestation. Furthermore, our findings suggest an integrative care approach and guidance for pregnant women, aspiring to enhance cardiovascular health in the postpartum phase.

Trends in chronic pain conditions among delivering women with and without mood and anxiety disorders

OBJECTIVE

The co-existence of chronic pain conditions with anxiety and/or depression is common in the general population but poorly described during pregnancy. In this study, we sought to describe trends in chronic pain among a sample of delivering people and describe the co-existence of chronic pain with anxiety and/or depression among delivering people.

METHODS

This cross-sectional study used data from Optum's de-identified Clinformatics® Data Mart Database between 2008 and 2021, for delivering persons with coverage by single employer-based health plan. We computed predicted margins from generalized estimating equations to determine the marginal predicted probability of chronic pain among all delivering and non-delivering persons who identify as women with and without diagnosed anxiety and/or depression.

RESULTS

Musculoskeletal and pelvic pain occurred most often regardless of delivering status. Delivering persons with anxiety and/or depression had higher marginal predicted probabilities of chronic pain compared to all delivering persons. Between 2008 and 2021, the predicted probabilities ranged from 0.400 to 0.527 and 0.221-0.261, respectively.

CONCLUSION

Chronic pain conditions are common in pregnancy and nearly two times higher among individuals with anxiety and/or depression. The frequency of comorbid depression and/or anxiety with pain disorders among delivering persons highlights the importance of proper detection, coordination of care, and safe treatment options for this population.

Musculoskeletal steroid injections in pregnancy: a review

Pregnant women experience a wide range of musculoskeletal pain disorders, which include general ailments occurring during pregnancy, exacerbation of pre-existing conditions, or pregnancy-specific pain/inflammatory conditions. There are significant concerns and knowledge gaps surrounding the safety, dosage, and potential long-term effects of several drugs used during pregnancy. Our article reviews the use of focal steroid injections during pregnancy. A mixture of case studies, meta-analyses, and randomised controlled trials have shown at least there is no adverse side effect to the mother or baby from maternal use of non-systemic injection during pregnancy and a significant improvement in symptoms of pain or paraesthesia can be achieved in patients that do not respond to more conservative measures. As with all patients, the use of steroid injection should be judged on a case-by-case basis to ensure that it is the most appropriate treatment choice. However, being pregnant should not be considered a contraindication to a single dose of non-systemic steroid administration, as these women can achieve significant symptomatic relief that reduces reliance on systemic medication and can significantly improve their quality of life.

Gebelik Dönemindeki Potansiyel Kas-İskelet Sistemi Sorunları

Gebelik sırasında kadınlarda çeşitli fizyolojik ve anatomik değişiklikler meydana gelmektedir. Bu biyomekanik, hormonal ve vasküler değişiklikler gebelik ilerledikçe belirginleşmektedir. Kas-iskelet sistemi bu değişimlerden en çok etkilenen sistemlerden biridir. Gebelikle ilişkili kas-iskelet sistemi problemlerinin başında bel ağrısı gelmekte ve bunu sırt ağrısı, el-el bilek ağrısı ve kalça ağrısı takip etmektedir. Gebelikle ilişkili bu problemlerin çoğu gebelikten sonraki aylarda düzelmektedir. Ancak bazı gebelerde ciddi ağrı ve dizabiliteye neden olmaktadır. Bu nedenle, gebelik döneminde görülen kas-iskelet sistemi problemlerinin erken tanınması, koruyucu önlemlerin alınması ve bireysel tedavinin planlanması önemlidir. Bu yazıda, gebelik döneminde görülen kas-iskelet sistemi değişiklikleri, sık görülen patolojiler ve bu problemlerin tedavisi ile ilgili güncel literatürün gözden geçirilmesi amaçlanmaktadır.