Original articlePrevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain
Introduction
Diastasis recti abdominis (DRA) has been defined as an impairment characterized by the separation of the two rectus abdominis muscles along the linea alba (Axer et al., 2001). This increased inter rectus distance (IRD) may be present congenitally, but most commonly develops during pregnancy and in the early postpartum period (Boissonnault and Blaschak, 1988, Gilleard and Brown, 1996).
Studies have found that DRA may affect between 30% and 70% of pregnant women (Boissonnault and Blaschak, 1988), and that it may remain separated in the immediate postpartum period in 35%–60% of women (Bursch, 1987). However the condition has also been found in 39% of older, parous women undergoing abdominal hysterectomy (Ranney, 1990) and in 52% of urogynecological menopausal patients (Spitznagle et al., 2007). Reported prevalence of DRA or increased IRD varies and may be inaccurate due to different cut off points for the diagnosis (Bursch, 1987, Boissonnault and Blaschak, 1988, Gilleard and Brown, 1996, Rath et al., 1996, Chiarello et al., 2005, Spitznagle et al., 2007, Beer et al., 2009) and use of different measurement methods. Most prevalence studies are based on palpation (Bursch, 1987, Boissonnault and Blaschak, 1988, Mantle et al., 2004) or calipers (Boxer and Jones, 1997, Hsia and Jones, 2000) which may be less reliable than ultrasonography (Mota et al., 2013). To date there are few studies about the normal width of the IRD in postpartum women (Coldron et al., 2008, Liaw et al., 2011), and there is scant knowledge about risk factors for DRA (Benjamin et al., 2014).
There are some theories stating that failure to treat DRA successfully can lead to long term sequelae (Candido et al., 2005), including abnormal posture (Boissonnault and Blaschak, 1988), lumbo-pelvic pain and cosmetic defects (Candido et al., 2005). However, to our knowledge there are no high quality clinical studies to support these statements.
The aims of the present study were to investigate:
- 1.
the prevalence of DRA at gestational week 35, and 6–8, 12–14, and 24–26 weeks postpartum;
- 2.
possible risk factors related to the presence of DRA at 6 months postpartum;
- 3.
whether women with DRA at 6 months postpartum have more lumbo-pelvic pain than women without DRA.
Section snippets
Methods
This was a longitudinal observational study following first time pregnant women from gestational week 35 till 6 months postpartum.
Results
Eighty-four of 123 first time pregnant women concluded the longitudinal study (Fig. 1). Twenty-two women were excluded before the first measurement: 11 because of pregnancy complications, 3 lived too far away to attend the measurements after birth, 6 were not able to meet for the first measurement and 2 for unknown reasons. Seventeen women missed at least one measurement due to personal issues, and were excluded.
The mean age of the 84 participants was 32.1 years (range 25–37) and 81% of the
Discussion
The present study found that prevalence of DRA at 2 cm below the umbilicus decreased from 100% in late pregnancy to 39% at 6 months postpartum. No significant risk factors were found for the presence of DRA at 6 months postpartum. Women with DRA were not more likely to report lumbo-pelvic pain than women without DRA.
Criteria and cut off point for the diagnosis of DRA vary in the literature (Bursch, 1987, Boissonnault and Blaschak, 1988, Ranney, 1990, Gilleard and Brown, 1996, Rath et al., 1996,
Conclusion
At 6 months postpartum, 39% of the women were diagnosed with DRA. No risk factors were identified for the presence of DRA in the present study. Women with DRA were not more likely to report lumbo-pelvic pain than women without DRA.
Conflict of interest
None of the authors had a conflict of interest.
Financial interest
We confirm that we have no financial affiliation (including research funding) or involvement with any commercial organization that has direct financial interest in any matter included in this manuscript.
Acknowledgements
The authors wish to thank the subjects studied, and Tatiana Dominguez, Miguel Basto, and all the team from Centro Pré e Pós Parto (Lisboa, Portugal), and Fatima Sancho and the team from R'Equilibrius Clinic (Oeiras, Portugal) for access facilitation to the pregnant and postpartum women. We also wish to thank Dr. José Luís García (Centro Hospitalario Policlinico San Carlos, Denia, Spain) for counseling on ultrasound imaging issues and suggestions for data collection and Gill Brook (Women's
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