Evaluation of a birth preparation program on lumbopelvic pain, urinary incontinence, anxiety and exercise: a randomized controlled trial

BMC Pregnancy and Childbirth

Maria Yolanda Makuch¹  José Guilherme Cecatti²  Maria Amélia Miquelutti² 

[1] Center for Research on Reproductive Health of Campinas (Cemicamp), Campinas, SP, Brazil;Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Caixa Postal 6181 13083-970, Campinas, São Paulo, Brazil

关键词: Pregnancy;    Anxiety;    Pelvic pain;    Low back pain;    Urinary incontinence;    Birth preparation program;    Antenatal exercises;   

Others  :  1137926
DOI  :  10.1186/1471-2393-13-154

 received in 2012-12-03, accepted in 2013-07-01,  发布年份 2013

【 摘 要 】

Background

Antenatal preparation programmes are recommended worldwide to promote a healthy pregnancy and greater autonomy during labor and delivery, prevent physical discomfort and high levels of anxiety. The objective of this study was to evaluate effectiveness and safety of a birth preparation programme to minimize lumbopelvic pain, urinary incontinence, anxiety, and increase physical activity during pregnancy as well as to compare its effects on perinatal outcomes comparing two groups of nulliparous women.

Methods

A randomized controlled trial was conducted with 197 low risk nulliparous women aged 16 to 40 years, with gestational age ≥ 18 weeks. Participants were randomly allocated to participate in a birth preparation programme (BPP; n=97) or a control group (CG; n=100). The intervention was performed on the days of prenatal visits, and consisted of physical exercises, educational activities and instructions on exercises to be performed at home. The control group followed a routine of prenatal care. Primary outcomes were urinary incontinence, lumbopelvic pain, physical activity, and anxiety. Secondary outcomes were perinatal variables.

Results

The risk of urinary incontinence in BPP participants was significantly lower at 30 weeks of pregnancy (BPP 42.7%, CG 62.2%; relative risk [RR] 0.69; 95% confidence interval [CI] 0.51-0.93) and at 36 weeks of pregnancy (BPP 41.2%, CG 68.4%; RR 0.60; 95%CI 0.45-0.81). Participation in the BPP encouraged women to exercise during pregnancy (p=0.009). No difference was found between the groups regarding to anxiety level, lumbopelvic pain, type or duration of delivery and weight or vitality of the newborn infant.

Conclusions

The BPP was effective in controlling urinary incontinence and to encourage the women to exercise during pregnancy with no adverse effects to pregnant women or the fetuses.

Trial registration

Clinicaltrials.gov, (NCT01155804)

【 授权许可】

   
2013 Miquelutti et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Gagnon AJ, Sandall J: Individual or group antenatal education for childbirth or parenthood, or both. Cochrane Database Syst Rev 2007, 3:CD002869.
• [2]ACOG Committee Obstetric Practice: ACOG Committee opinion. Number 267, January 2002: exercise during pregnancy and the postpartum period. Obstet Gynecol 2002, 99:171-173.
• [3]Hegaard HK, Pedersen BK, Nielsen BB, Damm P: Leisure time physical activity during pregnancy and impact on gestational diabetes mellitus, pre-eclampsia, preterm delivery and birth weight: a review. Acta Obstet Gynecol Scand 2007, 86:1290-1296.
• [4]Schmidt MD, Pekow P, Freedson PS, Markenson G, Chasan-Taber L: Physical activity patterns during pregnancy in a diverse population of women. J Womens Health 2006, 15(8):909-918.
• [5]O'Connor PJ, Poudevigne MS, Cress ME, MotI RW, Clapp JF 3rd: Safety and efficacy of supervised strength training adopted in pregnancy. J Phys Act Health 2011, 8:309-320.
• [6]Barakat R, Lucia A, Ruiz JR: Resistance exercise training during pregnancy and newborn’s birth size: a randomised controlled trial. Int J Obes (Lond) 2009, 33:1048-1057.
• [7]Haakstad L, Bø K: Exercise in pregnant women and birth weight: a randomized controlled trial. BMC Pregnancy Childbirth 2011, 11:66. BioMed Central Full Text
• [8]Zavorsky GS, Longo LD: Adding strength training, exercise intensity, and caloric expenditure to exercise guidelines in pregnancy. Obstet Gynecol 2011, 117:1399-1402.
• [9]Pennick VE, Young G: Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database Syst Rev 2007, 2:CD001139.
• [10]Hay-Smith J, Mørkved S, Fairbrother KA, Herbison GP: Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev 2008, 4:CD007471.
• [11]Bø K, Haakstad LA: Is pelvic floor muscle training effective when taught in a general fitness class in pregnancy? A randomised controlled trial. Physiotherapy 2011, 97:190-195.
• [12]Whitford HM, Alder B, Jones M: A cross-sectional study of knowledge and practice of pelvic floor exercises during pregnancy and associated symptoms of stress urinary incontinence in North-East Scotland. Midwifery 2007, 23:204-217.
• [13]Teixeira JM, Fisk NM, Glover V: Association between maternal anxiety in pregnancy and increased uterine artery resistance index: cohort based study. BMJ 1999, 318:153-157.
• [14]Copper RL, Goldenberg RL, Das A, Elder N, Swain M, Norman G, et al.: The preterm prediction study: maternal stress is associated with spontaneous preterm birth at less than thirty-five weeks’ gestation. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Am J Obstet Gynecol 1996, 175:1286-1292.
• [15]Marc I, Toureche N, Ernst E, Hodnett ED, Blanchet C, Dodin S, et al.: Mind-body interventions during pregnancy for preventing or treating women's anxiety. Cochrane Database Syst Rev 2011, 7:CD007559.
• [16]Khianman B, Pattanittum P, Thinkhamrop J, Lumbiganon P: Relaxation therapy for preventing and treating preterm labour. Cochrane Database Syst Rev 2012, 8:CD007426.
• [17]Khunpradit S, Tavender E, Lumbiganon P, Laopaiboon M, Wasiak J, Gruen RL: Non-clinical interventions for reducing unnecessary caesarean section. Cochrane Database Syst Rev 2011, 6:CD005528.
• [18]Mehdizadeh A, Roosta F, Chaichian S, Alaghehbandan R: Evaluation of the impact of birth preparation courses on the health of the mother and the newborn. Am J Perinatol 2005, 22:7-9.
• [19]Biaggio AM, Natalicio I, Spielberger CD: Desenvolvimento da forma experimental em português do inventário de ansiedade traço-estado (IDATE), de Spielberger. Arq Bras Psicol Aplic 1997, 29:31-44.
• [20]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, 36:1750-1760.
• [21]Silva FT, Costa FS: [Physical activity level evaluation during pregnancy]. Rev Bras Ginecol Obstet 2007, 29:490.
• [22]Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, International Urogynecological Association; International Continence Society: An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn 2010, 29:4-20.
• [23]Huskisson EC: Measurement of pain. Lancet 1974, 2:1127-1131.
• [24]Boutron I, Moher D, Altman DG, Schulz KF, Ravaud P, CONSORT Group: Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med 2008, 148:295-309.
• [25]Miller JM, Ashton-Miller JA, DeLancey JOL: A pelvic muscle precontraction can reduce cough-related urine loss in selected women with mild SUI. J Am Geriatr Soc 1998, 46(7):870-874.
• [26]Duncombe D, Wertheim EH, Skouteris H, Paxton SJ, Kelly L: Factors related to exercise over the course of pregnancy including women’s beliefs about the safety of exercise during pregnancy. Midwifery 2009, 25:430-438.
• [27]Fell DB, Joseph KS, Armson BA, Dodds L: The impact of pregnancy on physical activity level. Matern Child Health J 2009, 13:597-603.
• [28]Ribeiro CP, Milanez H: Knowledge, attitude and practice of women in Campinas, São Paulo, Brazil with respect to physical exercise in pregnancy: a descriptive study. Reprod Health 2011, 8:31. BioMed Central Full Text
• [29]Haakstad LAH, Voldner N, Henriksen T, Bo K: Physical activity level and weight gain in a cohort of pregnant Norwegian women. Acta Obstet Gynecol 2007, 86:64-559.
• [30]Owe KM, Nystad W, Bo K: Correlates of regular exercise during pregnancy: the Norwegian Mother and Child Cohort Study. Scand J Med Sci Sports 2009, 19:637-645.
• [31]Kluge J, Hall D, Louw Q, Theron G, Grové D: Specific exercises to treat pregnancy-related low back pain in a South African population. Int J Gynaecol Obstet 2011, 113:187-191.
• [32]Kashanian M, Akbari Z, Alizadeh MH: The effect of exercise on back pain and lordosis in pregnant women. Int J Gynaecol Obstet 2009, 107:160-161.
• [33]Garshasbi A, Faghih Zadeh S: The effect of exercise on the intensity of low back pain in pregnant women. Int J Gynaecol Obstet 2005, 88:271-275.
• [34]Martins RF, Pinto e Silva JL: An exercise method for the treatment of lumbar and posterior pelvic pain in pregnancy. Rev Bras Ginecol Obstet 2005, 27:275-282.
• [35]Figueiredo B, Conde A: Anxiety and depression in women and men from early pregnancy to 3-months postpartum. Arch Womens Ment Health 2011, 14:247-255.