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ORIGINAL RESEARCH

Risk Factors and Patient-Reported Outcomes in Chinese Women with Postpartum Diastasis Recti Abdominis: An Observational Study

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Pages 179-192 | Received 25 Aug 2023, Accepted 22 Jan 2024, Published online: 31 Jan 2024
 

Abstract

Purpose

Diastasis recti abdominis (DRA) is a condition in which the linea alba is stretched and widened, and the abdominal muscles are separated from each other. DRA typically occurs in pregnant and postpartum women. We aimed to determine the risk factors and patient-reported outcomes (PROs) of DRA in Chinese postpartum women.

Methods

This observational study was conducted in Hangzhou Hospital of Traditional Chinese Medicine, and involved 534 women who filled out the following risk-factor and PRO questionnaires: SF-MPQ-2, SF-ICIQ, LDQ, EPDS, MBIS, HerQles, and SF-36 (all Chinese versions). The inter-recti distance was measured by palpation. Statistical analyses were performed using SPSS v25.0 software and the Mann–Whitney U-test, chi-square test, binary logistic regression analysis (for risk factors of DRA), and the Kendall and Spearman tests (for correlation analysis).

Results

After childbirth, 78.1% (417/534) of the enrolled women had DRA. Abdominal surgery (P = 0.002), number of pregnancies (P = 0.035), parity (P = 0.012), number of births (P = 0.02), fetal birth weight (P = 0.014), and waist-to-hip ratio in the supine position (P = 0.045) significantly differed between the DRA and non-DRA groups. Caesarean delivery was an independent risk factor for DRA. The PROs were significantly worse in the DRA group than in the non-DRA group.

Conclusion

Caesarean delivery was an independent risk factor for DRA. Women with DRA are more likely to have limited physical activity or function after childbirth, lower self-confidence, and a decreased quality of life.

Abbreviations

DRA, Diastasis recti abdominis; PROs, patient-reported outcomes; SF-MPQ-2, Short-Form McGill Pain Questionnaire-2; SF-ICIQ, Short-Form International Consultation on Incontinence Questionnaire; LDQ, Leeds Dyspepsia Questionnaire; EPDS, 10-item Edinburgh Postnatal Depression Scale; MBIS, Modified Body Image Scale; HerQles, Hernia-Related Quality-of-Life Survey; SF-36, 36-Item Short-Form Health Survey; IRD, inter-recti distance; PGP, pelvic girdle pain; VAS, visual analog scale; PPI, present pain intensity; PF, physical functioning, RP, role-physical; BP, bodily pain; VT, vitality; HT, health transition; QoL, quality of life; BMI, body mass index; LBP, low back pain; PFD, pelvic floor dysfunction; UI, urinary incontinence; CPP, chronic pelvic pain; PRI, pain rating index; WHR, waist-to-hip ratio.

Adverse Events Reporting and Safety Monitoring

During the IRD measurements, no adverse events or side effects, such as falls or joint sprains, occurred.

Data Sharing Statement

All data have been uploaded as supplements materials.

Ethics Approval and Informed Consent

This study was approved by the ethics committee of Hangzhou Hospital of Traditional Chinese Medicine (approval code: 2020KY082). All study procedures were in accordance with the tenets of the Declaration of Helsinki (2008). Before formally entering the study, all subjects signed written informed consent forms.

Acknowledgments

We thank Dr. Yonggang Huang from the Department of Hernia and Abdominal Surgery, Hangzhou First People’s Hospital, Zhejiang University School of Medicine, who provided the Chinese version of the HerQles form. We thank Medjaden Inc. for its assistance in the preparation of this manuscript.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This study was funded by Zhejiang Traditional Chinese Medicine Science and Technology Plan Project (project number: 2021ZQ065), Hangzhou Medical and Health Science and Technology (project number: A20200483), and Medical Scientific Research Foundation of Zhejiang Province, China (grant number: 2024KY1383).