Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 35187

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : June | Volume : 16 | Issue : 6 | Page : YC12 - YC14 Full Version

Physical Activity and Pelvic Girdle Pain in Pregnancy- A Cross-sectional Study


Published: June 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/51877.16492
Hemalatha, B Sathyaprabha, N Venkatesh, R Sivakumar

1. Postgraduate Student, Faculty of Physiotherapy, SRIHER, Chennai, Tamil Nadu, India. 2. Associate Professor, Faculty of Physiotherapy, SRIHER, Chennai, Tamil Nadu, India. 3. Professor, Faculty of Physiotherapy, SRIHER, Chennai, Tamil Nadu, India. 4. Principal, Faculty of Physiotherapy, SRIHER, Chennai, Tamil Nadu, India.

Correspondence Address :
Dr. B Sathyaprabha,
Faculty of Physiotherapy, SRIHER, Porur, Chennai-116, Tamil Nadu, India.
E-mail: sathya.b@sriramachandra.edu.in

Abstract

Introduction: Physical Activity (PA) is an important component of a healthy pregnancy, for both the mother and her child. Sedentary lifestyle during pregnancy may increase development of pregnancy related musculoskeletal discomforts. Studies show that 25% of women experience severe Pelvic Girdle Pain (PGP) during pregnancy and 8% are severely disabled due to PGP.

Aim: To analyse the association between the PA and PGP during pregnancy.

Materials and Methods: This cross-sectional study was conducted at antenatal outpatient department, Sri Ramachandra Hospital, Chennai, Tamil Nadu, India from November 2019 to March 2020. Total 250 mothers were screened and finally 150 participants were selected. They were asked to fill-up the Pregnancy Physical Activity Questionnaire (PPAQ), Pregnancy Musculoskeletal Dysfunction Scale (PMDS) to assess the PA level and musculoskeletal dysfunction. Mothers who complaints of PGP were clinically diagnosed and were asked to fill the Pelvic Girdle Questionnaire (PGQ). Data was analysed using Statistical Package for the Social Sciences (SPSS) version 20.0.

Results: A total of 26 (17.33%) pregnant women in this study had PGP. The association between the total PA and PGP showed that the risk of PGP decreased as the PA increased which was statistically significant (p=0.03). PGP was also significantly associated with increased body weight (p=0.014).

Conclusion: It was found that there was an association between total PA and PGP in pregnancy. Increased PA is associated with reduction in PGP. Hence, moderate PA is recommended during pregnancy.

Keywords

Gestational period, Lifestyle, Pelvic girdle pain, Pregnancy discomforts, Pregnancy physical activity, Symphysis pubic pain

Our modern popular culture has embraced the concept of a “fit pregnancy,” which has health benefits of exercise. In fact, currently PA is an important part of different populations including pregnant women and the pregnant mothers are encouraged to include exercise as part of a healthy lifestyle. Adults (18 to 64 years) should indulge in atleast 150 minutes of moderate intensity aerobic PA all through the week or vigorous intensity aerobic PA for 75 minutes or an equivalent combination of the two-WHO guidelines on PA (1)

The PA is important for both the child and the mother and for a healthy pregnancy. Recent epidemiologic studies have shown that women who are more active during pregnancy may have reduced risk of gestational diabetes, hypertensive disorders and preterm birth in developed countries (2),(3). PA produces a thermal response and circulatory redistribution, shifting the blood concentration from the uterus and placenta to the extremities. During pregnancy the physiological responses to exercise such as changes in heart rate, cardiac output, ventilation and energy expenditure are increased than prepregnancy. As the energy requirement is altered during pregnancy due to maternal and foetal requirement, modification of exercise pattern and understanding the guidelines are important (4).

Pregnant women who are active had shown reduced length of labour, reduced fatigue and improved mental health (stress, anxiety and depression) as well as improved self-esteem. Inspite of several recommendations on pregnancy PA, the adherence of PA during gestation yet seems to be low worldwide (5). Maternal changes during gestation leads to musculoskeletal disorders such as upper back pain, lower back pain, PGP, leg cramps, and upper and lower limb pain. The most common pregnancy-related musculoskeletal problems that impact pregnant women’s well-being are Low Back Pain (LBP) and PGP. PGP is characterised as belt like pain around waistline or between the posterior iliac crest and the gluteal fold, especially over the Sacroiliac Joint (SIJ) and pubic symphysis sometimes it may radiate to the thighs, hips (6).

A study by Ramachandra P et al., reported that 25% of women experience severe pelvic pain during pregnancy and 8% are severely disabled due to PGP. A 31.7% of pregnant women with PGP reported pain in the symphysis pubis region (7). Women with PGP had complained of reduced capacity for carrying out their daily activities such as standing, walking and sitting. Specific clinical tests such as posterior pelvic pain provocation test reproduce the pain or functional disturbances. The experiences of PGP symptoms are worse than lumbar pain and most leading factor for functional disability among pregnant women. The physical disability due to PGP is the one of the reasons for increased sick leave at workplace during pregnancy and has important psychosocial implications. Severe PGP results poorer quality of life and predisposition to chronic pain syndrome (8). Thus, a specific focus on PGP and physical exercise are required to examine if the amount and type of exercise have an impact on pelvic girdle in pregnancy.

Furthermore, findings indicate that joint laxity is more in sedentary group as the pregnancy progress and the sedentary lifestyle during pregnancy may increase the development of pregnancy related discomfort than the mothers who involve in leisure time physical activities (7). As there is dearth of literature on PA level and PGP, this study aimed to assess the association between the PA and PGP in pregnancy.

Material and Methods

This cross-sectional study was conducted at antenatal outpatient department, Sri Ramachandra Hospital, Chennai, Tamil Nadu, India, during November 2019 till March 2020. Ethical clearance was obtained (CSP/19/ NOV/ 81/ 381).

Inclusion criteria: Mothers aged 21-36 years, gestational age of second and third trimester were included in the study.

Exclusion criteria: High-risk groups such as placenta previa, severe hypertension, cervical encirclage, seizure disorders, uncontrolled gestational diabetes, respiratory disease, renal disease, cardiac problems and history of previous miscarriage were excluded from the study.

Sample size estimation: With a prevalence of 15%, 95% confidence interval and the margin of error as 5% sample size was calculated as 195 (9). Total 250 mothers were screened and finally 150 participants were selected according to the inclusion and exclusion criteria. A written informed consent was obtained from all the mothers and were asked to fill up the questionnaires in their convenient language (Tamil or English). The primary outcomes were PPAQ, PMDS and PGQ. Initially mothers were asked fill up PPAQ and PMDS questionnaire.

The PPAQ developed by Chasan-Taber L et al., was used to assess the PA levels among pregnant women. It includes questions on trimester specific PA (10). PPAQ contains 32 activities (36 items) which measures five areas: Household/care giving activities, occupational, sports/exercise, transportation, and sedentary activities (11). The number of hours spent in each activity are multiplied by the activity intensity to arrive at a measure of average daily energy expenditure {Metabolic equivalents (MET)-hours per day} attributable to each activity. Activities are categorised by intensity (i.e., light, moderate, vigorous), type (i.e., household, occupation, sport), or as total activity. The PMDS developed with 16 items of pregnancy discomforts by Sathyaprabha B et al., contains demographic data, parity, musculoskeletal discomfort severity with interference with their daily routine (6).

Mothers were asked to mark on the body chart for better illustration of symptoms. Those mothers who marked over the pelvic girdle alone were examined by a trained physiotherapist who performed the active Straight Leg Raising (SLR), posterior pelvic pain provocation test to distinguish the PGP from the lumbar pain (6). The mothers who were confirmed with PGP were asked to fill up the PGQ. The self-reported PGQ developed for people with PGP consist of 25 items. The items focus on activity related questions (20 items) and details of symptoms (5 items). Each item scored on a 4-point likert scale, from 'Not at all' -0- to 'To a large extent'-3. Final Item scores are summed and transformed as 0 to 100, where 100 is the worst possible score (12). For queries and clarifications while filling up questionnaire and to distinguish the symptoms, a physiotherapist assisted the mothers in outpatient department.

Statistical Analysis

The statistical analysis was performed by using SPSS software version 20.0. The association between the occupation, obstetric history, gestational age, PA and PGP were analysed by Chi-square test.

Results

The mean age of the study participants were 26.05±3.41. The baseline characteristics of the participants are given in (Table/Fig 1). 36 (24%) of the study participants were in the second trimester and 114 (76%) were in third trimester. The prevalence of PGP in the study population was 17.33% (n=26) 6 (16.67%) in second trimester and 20 (17.54%) in third trimester. Mean PGQ score was more in pregnant women in their third trimester (Table/Fig 2). As the gestational age increases, complaints of PGP is increased which was not statistically significant (Table/Fig 3).

The association between the total PA and PGP shows that the risk of PGP decreases as the PA increases which was statistically significant (p=0.03) (Table/Fig 4). As the body weight increased the risk of developing PGP also increased and was statistically significant with p=0.014 (Table/Fig 5).

Discussion

The PA is an important component of a healthy pregnancy to reduce the risk of any medical complication. On the basis of research over the past 30 years, current guidelines published by the American College of Obstetricians and Gynecologists, as well as Society of Obstetricians and Gynecologists of Canada recommends PA for pregnant women (13). Indeed women who are pregnant and healthy are recommended to do 30 minutes or more of light to moderate exercise. The possible causes of all musculoskeletal problems in pregnancy are due to joint laxity which is considered to be more in sedentary group as pregnancy progress (2),(3). Thus the present study focused the association between the PA and PGP among the pregnant women. Most of the women were in light and sedentary category of PPAQ score based on intensity of work. PGP complaints were more among women with lower PA score (p=0.03).

Biering K et al., stated that there is an association between pregnancy-related PGP and pre-pregnancy BMI. High pre pregnancy BMI is a potential risk factor for pregnancy complication. Obesity results various musculoskeletal discomforts including PGP (14). Similarly, the present study also showed an association between increase in maternal body weight (p=0.014) and the risk of PGP. Bjelland EK et al., concluded that the risk of development of pelvic girdle syndrome was associated with increased number of previous deliveries (15). In the present study the PGP among primiparous mothers were 7.33% and multi mothers were 10%, the clinical association showed an increase in parity increases the PGP but was not statistically significant.

Though women experience musculoskeletal discomforts during pregnancy and one tenth are severely disabled due to PGP, there is a lack of psychometrically accepted measurement tool to assess the pregnancy induced musculoskeletal symptoms (6). Pregnancy musculoskeletal scale developed by Sathyaprabha B et al., was found to be a valid tool. They had observed the prevalence of pelvic pain was 22% in second trimester and 28% in third trimester. The present study shows as the gestational age increases the PGP also increases. It was observed that most of the patients with PGP had history of long standing work profile of house hold chores or vocational, habitual single leg standing, prolonged sitting, sedentary lifestyle and vigorous PA. These factors could be the aggravating or precipitating factors for PGP as shared by the patients with PGP (6). The altered posture and abnormal mechanical stress over pelvic girdle due to weight gain and improper ergonomics can impair and challenge the stability and mobility of pelvic girdle supporting structures. Not only the PA level, appropriate lifestyle habits also influenced PGP in pregnant women (7).

Davenport MH et al., concluded that compared with not exercising, prenatal exercise decreased the severity of LBP, PGP during and following pregnancy but did not decrease the odds of any of these conditions at any time point (16). Similarly pregnant women attending regular fitness classes reported complaints of musculoskeletal problems (LBP and PGP) (17). The present study showed association between physical activity and PGP in pregnancy and an increased PA was associated with a reduced risk of PGP which was statistically significant [OR= 3.025, 95% CI (1.138-8.046); RR=2.549, 95% CI (1.086-5.983); p =0.021].

Limitation(s)

Small sample size is the main limitation of the present study. More studies with larger sample size are required to validate the results.

Conclusion

The association between the total PA and PGP shows that the risk of PGP decreases as PA increases which was statistically significant. Hence moderate PA is recommended during pregnancy.

References

1.
World Health Organization. Global Recommendations on Physical Activity for Health. Geneva, Switzerland. 2010. [Accessed date: 2021, July 12th]. Available from Global recommendations on physical activity for health (who.int).
2.
Evenson KR, Bradley CB. Beliefs about exercise and physical activity among pregnant women. Patient Educ Couns. 2010;79(1):124-29. [crossref] [PubMed]
3.
Evenson KR, Barakat R, Brown WJ, Dargent-Molina P, Haruna M, Mikkelsen EM, et al. Guidelines for physical activity during pregnancy: Comparisons from around the world. Am J Lifestyle Med. 2014;8(2):102-21. [crossref] [PubMed]
4.
Davies GA, Wolfe LA, Mottola MF, MacKinnon C, Arsenault MY, Bartellas E, et al. SOGC Clinical Practice Obstetrics Committee, Canadian Society for Exercise Physiology Board of Directors. Exercise in pregnancy and the postpartum period. J Obstet Gynaecol Can. 2003;25(6):516-29. [crossref]
5.
Poyatos-León R, García-Hermoso A, Sanabria-Martínez G, Álvarez-Bueno C, Sánchez-López M, Martínez-Vizcaíno V. Effects of exercise during pregnancy on mode of delivery: A meta-analysis. Acta Obstet Gynecol Scand. 2015;94(10):1039-47. [crossref] [PubMed]
6.
Sathyaprabha B, Jayavijayaraghavan, Maiya AG, Venkatesh N. Pregnancy induced musculoskeletal dysfunction scale(PMDS) - development and validation. Indian J Public Heal Res Dev. 2017;8:347-51. [crossref]
7.
Ramachandra P, Maiya AG, Kumar P, Kamath A. Prevalence of musculoskeletal dysfunctions among Indian pregnant women. J Pregnancy. 2015;2015:437105. [crossref] [PubMed]
8.
Mogren I. Perceived health, sick leave, psychosocial situation, and sexual life in women with low-back pain and pelvic pain during pregnancy. Acta Obstet Gynecol Scand. 2006;85(6):647-56. [crossref] [PubMed]
9.
Mahishale A, Borkar SS. Determining the prevalence of patterns of pregnancyinduced pelvic girdle pain and low back pain in urban and rural populations: A cross-sectional study. J Sci Soc. 2016;43:70-74. [crossref]
10.
Chasan-Taber L, Schmidt MD, Roberts DE, Hosmer D, Markenson G, Freedson PS. Development and validation of a Pregnancy Physical Activity Questionnaire. Med Sci Sports Exerc. 2004; 36(10):1750-760. [crossref] [PubMed]
11.
Kavipriya S, Prabha B Sathya, Venkatesh N. Validation of pregnancy physical activity questionnaire (TAMIL). Indian Journal of Public Health Research & Development. 2019;10(8):559-62. [crossref]
12.
Stuge B, Garratt A, Krogstad Jenssen H, Grotle M. The pelvic girdle questionnaire: A condition-specific instrument for assessing activity limitations and symptoms in people with pelvic girdle pain. Phys Ther. 2011 Jul;91(7):1096-108. [crossref] [PubMed]
13.
Entin PL, Munhall KM. Recommendations regarding exercise during pregnancy made by private/small group practice obstetricians in the USA. J Sports Sci Med. 2006;5(3):449-58.
14.
Biering K, Nohr EA, Olsen J, Andersen AM, Hjollund NH, Juhl M. Pregnancyrelated pelvic pain is more frequent in women with increased body mass index. Acta Obstet Gynecol Scand. 2011;90:1132-139. [crossref] [PubMed]
15.
Bjelland EK, Eskild A, Johansen R, Eberhard-Gran M. Pelvic girdle pain in pregnancy: The impact of parity. Am J Obstet Gynecol. 2010;203(2):146.e1-6. [crossref] [PubMed]
16.
Davenport MH, Marchand AA, Mottola MF, Poitras VJ, Gray CE, Jaramillo Garcia A, et al. Exercise for the prevention and treatment of low back, pelvic girdle and lumbopelvic pain during pregnancy: A systematic review and meta-analysis. Br J Sports Med. 2019;53(2):90-98. [crossref] [PubMed]
17.
Haakstad LA, Bø K. Effect of a regular exercise programme on pelvic girdle and low back pain in previously inactive pregnant women: A randomized controlled trial. J Rehabil Med. 2015; 47(3):229-34. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2022/51877.16492

Date of Submission: Aug 12, 2021
Date of Peer Review: Nov 30, 2021
Date of Acceptance: Mar 23, 2022
Date of Publishing: Jun 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Aug 16, 2021
• Manual Googling: Mar 23, 2022
• iThenticate Software: May 28, 2022 (12%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com