Evaluation of postural equilibrium and fall risk during pregnancy
Introduction
Falls during pregnancy are a common occurrence. Pregnant women are at higher risk of falling and injuries due to falls compared to nonpregnant women. According to a large study conducted by Dunning et al. [1], the rate of fall is 26.8% during pregnancy and this rate is similar to that of women over the age of 65 years (29%) [2]. Although 27% of women fall while pregnant, 10% experience two or more falls [1]. Approximately, 24% of maternal injury hospitalizations are caused by falling during pregnancy [3]. Pregnant women are hospitalized due to a fall 2.3 times more than nonpregnant reproductive-aged women [4]. Falls during pregnancy may result in some maternal injuries including bone fractures, joint sprains, muscle strains, head injury, rupture of internal organs, internal hemorrhage, abruptio placentae, rupture of the uterus and membranes, and occasionally maternal death or intrauterine fetal demise [5], [6].
Several hormonal, anatomical and physiological changes are seen in the female body during pregnancy. These changes due to pregnancy include significant weight gain, increased ligamentous laxity and spinal lordosis [7], decreased neuromuscular control and abdominal muscle strength [8], altered biomechanics [9], [10] and an anterior shift in the location of the center of mass [11]. The increased risk of falling during pregnancy may be related to these anatomical, hormonal and physiological changes.
Some studies have examined postural stability during pregnancy [9], [12], [13]. These studies researched the sway changes during pregnancy, and compared between pregnant and nonpregnant women. Although there are many studies associating postural stability with different clinical situations such as lower extremity disorders in adults and elderly individuals and rheumatoid arthritis in the literature, but there are not sufficient studies evaluating dynamic postural stability during pregnancy [14], [15], [16]. But in literature, there is no study about evaluation of fall risk processing pregnancy. This is the first study related with calculation of fall risk scores and comparison the changes of fall risk among each trimester of pregnant and nonpregnant women. The purpose of this study is to evaluate dynamic postural stability and fall risk during pregnancy and compare dynamic postural stability between pregnant and non-pregnant control women.
Section snippets
Methods
The study population consisted of 110 women (80 pregnant, 30 nonpregnant control) between the ages of 18 and 40 years. The pregnant women were divided into three groups: the first, the second, and the third trimester women. Each trimester group included 25, 30 and 25 pregnant women, respectively. All participants gave their written informed consent to participate in the study. Exclusion criteria for potential control or pregnant participants included the following medical conditions: multiple
Results
Comparison of demographic characteristics of groups included in the study is given in Table 1. The demographic features were similar in pregnant groups and the nonpregnant control group. Weight was higher in third trimester group compared to the other groups but this difference was not statistically significant (p > 0.05). BMI was found to be higher in the third trimester group compared to the control group (p = 0.001).
The control group had the lowest scores of the postural stability and fall risk.
Discussion
In this study, all scores of postural stability were worse in the third trimester women compared to the nonpregnant control subjects. And FRT score was worse in the third trimester women compared to the other all subjects (pregnant women in the first and second trimester or nonpregnant control women). A population based retrospective cohort study conducted by Schiff [19] reported that the majority of the hospitalizations due to falling occurred in the third trimester. According to the study,
Conclusion
Poor dynamic postural equilibrium is most evident during the third trimester compared with the other pregnancy trimesters and nonpregnant women. Determination of pregnant women at high risk of falls using postural stability tests can help reduce falls during pregnancy by taking the necessary protective measures. Therefore, the complications that arise from falls can be prevented.
Contribution to authorship
AI conceived and designed the experiments. BC analyzed the data and wrote the paper. YH performed the experiments. FD contributed the analysis.
Details of ethics approval
The study protocol was reviewed and approved by the Medical Ethic Committee in University of Gaziosmanpaşa. Date of approval is 16 Aug 2011 and associated reference number is 11-BADK-098.
Funding
None.
Acknowledgement
None.
Conflict of interest statement
The authors declare that they have no conflicts of interest.
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