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

Figures & data

Table 1 Demographic and Clinical Characteristics of the Study Subjects

Basic Information	Non-DRA Group	DRA Group	P
Participants, n (%)	117 (21.9%)	417 (78.1%)
IRD (cm), median (IQR)	1.50 (0)	3.00 (0.50)
Age (years)	31.53 (6)	31.78 (5)	0.951
≤35 years	92 (21.9%)	329 (78.1%)
>35 years	25 (22.1%)	88 (77.9%)
Days after childbirth	141.00 (166)	91 (110)	0.421
≤365 days	105 (21.5%)	384 (78.5%)
>365 days	12 (26.7%)	33 (73.3%)
Disease history	20 (28.6%)	50 (71.4%)	0.149
Medicine history	10 (29.4%)	24 (70.6%)	0.275
Allergy history	5 (18.5%)	22 (81.5%)	0.662
Education background			0.446
Higher education	86 (22.8%)	292 (77.2%)
Secondary education	28 (21.4%)	103 (78.6%)
Primary education	3 (12%)	22 (88%)
Occupation			0.761
Professional and technical staff	87 (21.5%)	318 (78.5%)
General services	13 (21%)	49 (79%)
Other/unemployed	17 (25.4%)	50 (74.6%)

Notes: The data for the IRD at the umbilical level, age, and days after childbirth were skewed quantitative data and are expressed as median (IQR). The data for age group, groups based on days after childbirth, disease history, medicine history, and allergy history are dichotomous data, and are represented as n (%); the Pearson chi-square (χ²) test and progressive significance P were used. Education background and occupation are ordinal data, and are represented as n (%); the Mann–Whitney U-test was used. P < 0.05 is considered statistically significant.

Abbreviations: DRA, diastasis recti abdominis; IRD, inter-recti distance; IQR, interquartile range.

Figure 1 Flow chart of subject selection.

Table 2 Possible Risk Factors for DRA in the Study Subjects

Basic information	Non-DRA Group	DRA Group	χ^2, Z, F	P
Height (m)	1.61 (0.075)	1.60 (0.065)	−0.943	0.346
Weight (kg)
Pre-pregnancy	52.50 (10)	53.00 (10)	−0.789	0.43
Pregnancy	67.00 (12.3)	67.00 (10.5)	−0.226	0.821
Postpartum	60.00 (11.5)	60.00 (11.2)	−0.251	0.802
Weight gain during pregnancy (kg)	14.00 (6)	14.00 (6.5)	−0.502	0.615
BMI (kg/m^2)
Pre-pregnancy	20.03 (3.02)	20.55 (3.55)	−1.503	0.133
Pregnancy	25.65 (3.78)	26.04 (4.09)	−0.882	0.378
Postpartum	23.05 (3.98)	23.11 (3.79)	−0.114	0.909
Number of pregnancies	1.00 (1)	2.00 (2)	−2.105	0.035
Number of births	1.00 (1)	1.00 (1)	−2.324	0.02*
Number of cesarean deliveries	0.00 (0)	0.00 (1)	−3.977	0**
Number of vaginal deliveries	1.00 (0)	1.00 (1)	−2.437	0.015*
Gestational weeks at delivery	39.00 (2)	39.00 (2)	−0.115	0.909
Fetal birth weight (kg)	3.23 (0.65)	3.40 (0.50)	−2.45	0.014*
Waist circumference in supine position (cm)
Supraumbilical level	78.00 (9.5)	78.00 (8.7)	−0.762	0.446
Umbilical level	80.5 (9.0)	81.5 (10.5)	−1.421	0.155
Sub-umbilical level	83.8 (9.5)	85.00 (9.7)	−1.397	0.162
Hip circumference in supine position (cm)	91.50 (8.0)	91.20 (8.5)	−0.238	0.812
Skinfold thickness at umbilical level (mm)
Left	39.00 (15.5)	37.00 (20)	−1.806	0.071
Right	40.00 (17)	38.00 (18)	−1.78	0.075
Average	38.5 (16)	37.5 (18.5)	−1.805	0.071
Waist-to-hip circumference ratio	0.89 ± 0.04 (0.88–0.89)	0.89 ± 0.05 (0.89–0.90)	7.458	0.045*
History of abdominal surgery^!			13.744	0.003**
None	83 (27.2%)	222 (72.8%)
Cesarean section	25 (13.4%)	161 (86.6%)
Gynecological or abdominal visceral surgery	8 (22.2%)	28 (77.8%)
Both	1 (14.3%)	6 (85.7%)
Parity^#			6.264	0.012**
Primiparas	86 (25.3%)	254 (74.7%)
Multiparas	31 (16%)	163 (84%)
Delivery method^#			14.519	0**
Cesarean delivery	27 (13.2%)	177 (86.8%)
Vaginal delivery	90 (27.3%)	240 (72.7%)
Twin/multiple births^!	1 (20.0%)	4 (80.0%)	0.000	1.000
Exercise frequency^#			3.59	0.058
Moderate	91 (20.4%)	355 (79.6%)
High	26 (29.5%)	62 (70.5%)
Pre-pregnancy weight-bearing frequency^!			0.236	0.627
Moderate	114 (22.2%)	400 (77.8%)
High	3 (15.0%)	17 (85%)
Weight-bearing frequency during pregnancy^!			0.000	1.000
Moderate	115 (21.8%)	412 (78.2%)
High	2 (28.6%)	5 (71.4%)
Postpartum weight-bearing frequency^#			0.087	0.768
Moderate	96 (21.7%)	347 (78.3%)
High	21 (23.1%)	70 (76.9%)

Notes: Quantitative data that conformed to normality are expressed as mean ± standard deviation (95% confidence interval), and were evaluated using the independent-samples t-test. Skewed quantitative data are expressed as median (interquartile range), and were assessed using the Mann–Whitney U-test. The remaining data are dichotomous, and were examined using the chi-square test. According to the n and T values, ^#Represents the Pearson chi-square test asymptotic significance P, and ^!Represents the chi-square test progressive P. *P < 0.05. **P < 0.01. Moderate exercise frequency was defined as <20 min of high-intensity exercise 3 times per week or <30 min of low-intensity exercise 5 times per week, whereas high exercise frequency was defined as ≥20 min of high-intensity exercise 3 times per week or ≥30 min of low-intensity exercise 5 times per week. The weight-bearing frequency was categorized as moderate in women who performed weight-bearing (≥5 kg) activities <20 times per week and as high in women who performed weight-bearing (≥5 kg) activities ≥20 times per week.

Abbreviations: DRA, diastasis recti abdominis; BMI, body mass index.

Table 3 Comparison of Pelvic Symptoms, Low Back Pain, and SF-MPQ-2 and SF-ICIQ Scores

Item	Non-DRA Group	DRA Group	χ^2/Z	P
Pelvic girdle pain
Pre-pregnancy^!			0.000	1.000
None/mild	115 (21.9%)	410 (78.1%)
Severe	2 (22.2%)	7 (77.8%)
During pregnancy^#			4.187	0.041*
None/mild	107 (23.4%)	350 (76.6%)
Severe	10 (13%)	67 (87%)
Postpartum^#			3.114	0.078
None/mild	109 (23%)	364 (77%)
Severe	8 (13.1%)	53 (86.9%)
Low back pain
Pre-pregnancy!			0.018	0.893
None/mild	114 (22.1%)	403 (77.9%)
Severe	3 (17.6%)	14 (82.4%)
During pregnancy^#			0.241	0.515
None/mild	105 (22.3%)	365 (77.7%)
Severe	12 (18.8%)	52 (81.3%)
Postpartum^#			0.794	0.373
None/mild	98 (22.7%)	334 (77.3%)
Severe	19 (18.6%)	83 (81.4%)
Urine leakage^#	60 (22.1%)	211 (77.9%)	0.017	0.896
Frequent urination^#	54 (24.1%)	170 (75.9%)	1.089	0.297
Sexual dysfunction^#	28 (25.9%)	80 (74.1%)	1.276	0.259
Chronic pelvic pain^#	8 (25%)	24 (75%)	0.190	0.663
SF-MPQ-2 (current)
PRI	2 (3)	2 (3)	−1.36	0.174
VAS	2 (3)	3 (2)	−3.313	0.001**
PPI^%			15.469	0.001**
0	70 (27.7%)	183 (72.3%)
1	40 (20.2%)	158 (79.8%)
2	7 (10.3%)	61 (89.7%)
3	0 (0%)	15 (100%)
4	0 (0%)	0 (0%)
5	0 (0%)	0 (0%)
SF-ICIQ (in the past 1 month)
Total score	0 (4)	0 (4)	−2.212	0.027*
Occurrence of urine leakage^%			5.502	0.471
Never	83 (22.6%)	284 (77.4%)
Before reaching toilet	7 (19.4%)	29 (80.6%)
While coughing or sneezing	23 (17.2%)	111 (82.8%)
While asleep	0 (0%)	1 (100%)
During activity or exercise	9 (18.4%)	40 (81.6%)
After urinating and getting dressed	3 (25.0%)	9 (75.0%)
No obvious reason	3 (50.0%)	3 (50.0%)
All the time	0 (0%)	0 (0%)

Notes: The PRI, VAS, and SF-ICIQ scores were skewed quantitative data and were assessed using the Mann–Whitney U-test; the rest of the items were dichotomous data and assessed using the chi-square test. According to the n and T values, ^#Represents the Pearson chi-square test asymptotic significance P, ^!Represents the chi-square test progressive P, and ^%represents the Fisher exact test (bilateral) P. *P < 0.05. **P < 0.01.

Abbreviations: SF-MPQ-2, Short-Form McGill Pain Questionnaire-2; SF-ICIQ, Short-Form International Consultation on Incontinence Questionnaire; VAS, Visual Analog Scale; PPI, Present Pain Intensity; PRI, Pain Rating Index; DRA, diastasis recti abdominis.

Table 4 Binary Logistic Regression Model for DRA

Variable	OR (95% CI)	P
Age	0.678 (0.383–1.202)	0.184
Pre-pregnancy BMI	0.995 (0.91–1.089)	0.917
Number of pregnancies	0.922 (0.686–1.24)	0.592
Number of births	0.752(0.19–2.975)	0.685
Gestational weeks at delivery	0.969 (0.825–1.137)	0.696
Fetal birth weight	1.479 (0.926–2.36)	0.101
Waist-to-hip circumference ratio	2.547 (0.018–369.476)	0.713
History of abdominal surgery		0.028*
Cesarean delivery	2.297 (1.327–3.978)	0.003*
Other abdominal operation	1.304 (0.55–3.092)	0.547
Both	2.483 (0.282–21.858)	0.412
Parity	2.27 (0.491–10.485)	0.294
Twin/multiple births	0.584 (0.037–9.243)	0.703
Exercise frequency	0.635 (0.365–1.107)	0.11
Pre-pregnancy weight-bearing frequency	3.21 (0.338–30.499)	0.31
Weight-bearing frequency during pregnancy	0.355 (0.022–5.795)	0.467
Postpartum weight-bearing frequency	1.051 (0.575–1.92)	0.872
SF-MPQ-2 VAS	1.116 (0.955–1.305)	0.169
SF-MPQ-2 PPI	1.455 (1.02–2.076)	0.038*
PGP during pregnancy	1.7 (0.82–3.526)	0.154
SF-ICIQ total score	1.036 (0.962–1.114)	0.35
Constant	0.86	0.972

Note: *P < 0.05.

Abbreviations: DRA, diastasis recti abdominis; OR, odds ratio; CI, confidence interval; BMI, body mass index; VAS, visual analog scale; PPI, present pain intensity; SF-MPQ, Short-Form McGill Pain Questionnaire; PGP, pelvic girdle pain; SF-ICIQ, Short-Form International Consultation on Incontinence Questionnaire.

Table 5 Comparison of PROs of DRA

Score	Non-DRA Group	DRA Group	Z	P
LDQ	6 (0)	6 (0)	−0.537	0.592
EPDS	6 (8)	6 (6)	−0.344	0.731
MBIS	6 (7)	8 (9)	−3.573	0**
HerQles	14 (9)	18 (16)	−3.45	0.001**
SF-36
PF	85.71 (28.57)	78.57 (28.57)	−2.086	0.037*
RP	80 (20)	60 (60)	−3.756	0**
BP	76.81 (14.49)	62.32 (28.99)	−3.475	0.001**
GH	67 (27)	65 (30)	−1.548	0.122
VT	72.22 (27.78)	66.67 (25)	−2.306	0.021*
SF	88.89 (22.22)	88.89 (33.33)	−1.186	0.236
RE	100 (33.33)	100 (66.67)	−1.316	0.188
MH	69.57 (26.09)	69.57 (21.74)	−1.188	0.235
HT	25 (25)	25 (25)	−1.993	0.046*

Notes: The above skewed quantitative data are expressed as median (interquartile range) and were evaluated using the Mann–Whitney U-test. *P < 0.05. **P < 0.01.

Abbreviations: PRO, patient-reported outcome; DRA, diastasis recti abdominis; LDQ, Leeds Dyspepsia Questionnaire; EPDS, the 10-item Edinburgh Postnatal Depression Scale; MBIS, the Modified Body Image Scale; HerQles, Hernia-Related Quality-of-Life Survey; SF-36, the 36-Item Short-Form Health Survey; PF, physical functioning; RP, role-physical; BP, bodily pain; GH, general health; VT, vitality; SF, social functioning; RE, role-emotional; MH, mental health; HT, health transition.