GET THE APP

The Association between Pregnancy-Related Discomforts and Pre-Pre
Journal of Women's Health Care

Journal of Women's Health Care
Open Access

ISSN: 2167-0420

+44-7360-538437

Research Article - (2015) Volume 4, Issue 1

The Association between Pregnancy-Related Discomforts and Pre-Pregnancy Body Mass Index in Japanese Women

Saori Morino1*, Mika Ishihara2, Shu Nishiguchi1,3, Naoto Fukutani1, Daiki Adachi1, Yuto Tashiro1, Takayuki Hotta1, Minoru Yamada4, Mamoru Yamashita2 and Tomoki Aoyama1
1Department of Physical Therapy, Human Health Sciences, Kyoto University Graduate School of Medicine Kawahara-cho 53,, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
2Kishokai Medical Corporation Koike 4-122, Inazawa, Aichi 492-8144, Japan
3Japan Society for the Promotion of Science Kojimachi 5-3-1, Chiyoda-ku, Tokyo 102-0083, Japan
4Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki 305-0006, Japan
*Corresponding Author: Saori Morino, Department of Physical Therapy, Human Health Sciences, Kyoto University Graduate School of Medicine Kawahara-cho 53, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan, Tel: +81-75-751-3935, Fax: +81-75-751-3909 Email:

Abstract

Objective: To determine the association between pregnancy-related discomforts and pre-pregnancy body mass index in a longitudinal study.

Methods: The study included 355 pregnant women (age, 31.1 ± 4.1 years). Participants were divided into three groups according to their pre-pregnancy body mass index: the low body mass index group, normal body mass index group, and high body mass index group. The occurrence of pregnancy-related discomforts during the second and third trimesters was investigated. Binomial logistic regression analysis was used to examine the association between pre-pregnancy body mass index and pregnancy-related discomforts experienced during the last two trimesters.

Results: The occurrence of most pregnancy-related discomforts increased in the third trimester, while that of constipation and shoulder stiffness or headache decreased. Based on logistic regression analysis, pre-pregnancy body mass index was significantly associated with various discomforts. The occurrence of hip joint or pubis pain (odds ratio/95% confidence interval = 2.38/1.14–4.95) during the second trimester, and sleeping difficulty (2.00/1.09–3.67), hand or finger stiffness (3.00/1.36–6.45), leg cramps (2.29/1.32–3.98), low back pain (2.20/1.29– 3.75), hip joint or pubis pain (2.14/1.23–3.73), and shoulder stiffness or headache (2.01/1.06–3.82) during the third trimester was significantly higher in the high body mass index group than in the normal body mass index group. The low body mass index group exhibited a significantly a higher occurrence of shoulder stiffness or headache (2.84/1.35–5.96) during the second trimester and constipation (2.28/1.08–4.82) during the third trimester than the normal body mass index group.

Conclusion: The occurrence of discomforts decreased or increased during pregnancy. Furthermore, both prepregnancy high and low body mass index represent important risk factors for many pregnancy-related discomforts, compared with a pre-pregnancy normal body mass index.

Keywords: Health promotion; Pregnancy; Pregnancy-related discomforts; Pre-Pregnancy BMI; Prevention

Introduction

Methods

Anatomical, physiological, hormonal, and psychological changes occur in woman during pregnancy [1,2], causing a variety of discomforts such as low back pain, ligament pain, fatigue, and headache [3]. These pregnancy-related discomforts negatively impact mother and child health and affect the quality of life and limit the daily activities of mothers [4,5]. Despite a number of researchers investigating the management of pregnancy-related discomforts [6,7], there are several limitations to the treatments available during pregnancy. For example, non-prescribed medicines are usually unsuitable because of their adverse effects on pregnant women themselves and on the developing fetus [8,9]. Therefore, a longitudinal study is necessary to collect information on the prevalence of discomforts through the stages of pregnancy. Such information will increase the knowledge of the measures that can be taken to protect women from pregnancy-related discomfort and will be essential to prevent their onset.

Before pregnancy, it is important for women to maintain an appropriate body mass index (BMI) to avoid hormone imbalance and its negative impact on fertility [10]. Furthermore, some research indicates that the pre-pregnancy BMI is a predicting factor for conditions such as gestational diabetes, and thus for adverse pregnancy outcomes [11,12]. Pre-pregnancy obesity may also be a modifiable risk factor for intellectual disability in children [13]. On the other hand, women with pre-pregnancy low weight are at an increased risk of intrauterine growth restriction, perineal tears, preterm birth (spontaneous and induced), and low birth weight [14,15]. These results suggest that both pre-pregnancy high and low BMI negatively affect the progress of the pregnancy. Information about the occurrence of discomforts at each gestational period is necessary for their prevention. Moreover, a normal BMI before pregnancy promotes an uneventful progress through pregnancy. However, to date, very few studies have been conducted on the association between pre-pregnancy BMI and pregnancy-related discomforts. Accordingly, we conducted a longitudinal study aimed to identify pregnancy-related discomforts throughout pregnancy and to identify possible associations between these discomforts and the pre-pregnancy BMI.

Settings

We collected information from 355 women (age, 31.1 ± 4.1 years) at the obstetrics and gynecology clinics in the Aichi Prefecture, Japan, between 2009 and 2013. When the pregnant women visited the clinic for their periodic health examination, the information was collected by the hospital staff such as nurses. The inclusion criteria for the survey were the lack of serious orthopedic disorders, neurological diseases, and high-risk pregnancy. At the first medical examination, we recorded the personal information (age and BMI before pregnancy) of each participant by using a questionnaire.

Questionnaire about Pregnancy-Related Discomforts

The subjects of this study were asked to complete a questionnaire during the second trimester (22.4 ± 2.1 weeks of gestation) and third trimester (33.7 ± 2.1 weeks of gestation). We used the Medical Check Sheet to track pregnancy-related discomforts during gestation. The sheet, developed by the Japan Maternity Fitness Association, is a self-entry questionnaire for the management of physical conditions, to be completed before exercise. Questions were related to the expected date of birth, weeks of gestation, blood pressure, and 10 different pregnancy-related discomforts (i.e., sleeping difficulty, constipation, hand or finger stiffness, swelling, leg cramps, low back pain, hip joint or pubis pain, shoulder stiffness or headache, rib pain, and anorexia or heartburn), reported to commonly occur and to have an adverse effect on pregnancy. If the participants had felt discomfort due to any of the items on the list, those items were checked.

Ethical Considerations

After the purpose of the study had been explained, written informed consent was obtained from each participant in accordance with the guidelines approved by the Kyoto University Graduate School of Medicine and the Declaration of Human Rights, Helsinki, 1975. The protocol was approved by the Ethics Committee of Kyoto University Graduate School of Medicine (protocol approval E-2110).

Statistical Analyses

Participants were divided into three groups (low BMI group, normal BMI group, and high BMI group) according to their pre-pregnancy BMI (<18 kg/m2, ≥18 kg/m2, and <22 kg/m2 or ≥22 kg/m2, respectively). We statistically calculated the differences in age between these three groups using analysis of variance. Based on the Medical Check Sheet completed during the second and third trimester, we determined the occurrence of each symptom during the second and third trimesters and analyzed this using descriptive statistics. Binomial logistic regression analysis was used to examine the association between each discomfort and the pre-pregnancy BMI for each trimester. We referred to discomforts as the dependent variables, to low and high BMI groups as the independent variables (with the normal BMI group as reference), and to age as the adjustment variable. Data were entered and analyzed using the Statistical Package for the Social Sciences (Windows version 20.0; SPSS Inc., Chicago, IL, USA). For all analyses, p<0.05 was considered statistically significant.

Result

Information on 355 women (pre-pregnancy BMI= 20.3±2.1 kg/m2) who met the inclusion criteria was collected. We assigned 37 women to the low BMI group (BMI= 17.4±0.6 kg/m2), 246 women to the normal BMI group (BMI= 19.8 ± 1.0 kg/m2), and 72 women to the high BMI group (BMI= 23.5±1.8 kg/m2). There were no significant differences between the three groups (low, normal, and high BMI groups) in age (30.4 ± 4.2 years, 31.2 ± 4.0 years, and 31.2 ± 4.2 years, respectively).

The occurrence of most of the pregnancy-related discomforts analyzed increased from the second to third trimester, in contrast to that of constipation and shoulder stiffness or headache that showed a decrease (Figure 1).

womens-health-care-discomforts

Figure 1: The prevalence of pregnancy-related discomforts during second and third trimester.

Multivariate analysis revealed that pre-pregnancy BMI was significantly associated with some of the discomforts during pregnancy (Table 1). The occurrence of hip joint or pubis pain (odds ratio/95% confidence interval=2.38/1.14–4.95) during the second trimester, and sleeping difficulty (2.00/1.09–3.67), hand or finger stiffness (3.00/1.36–6.45), leg cramps (2.29/1.32–3.98), low back pain (2.20/1.29–3.75), hip joint or pubis pain (2.14/1.23–3.73), and shoulder stiffness or headache (2.01/1.06–3.82) during the third trimester was significantly higher in the high BMI group than in the normal BMI group (p<0.05). The occurrence of shoulder stiffness or headache (2.84/1.35–5.96) during the second trimester, and constipation (2.28/1.08–4.82) during the third trimester was significantly higher in the low BMI group than in the normal BMI group (p < 0.05). No significant differences were observed in swelling, rib pain, and anorexia or heartburn.

    Second trimester Third trimester
Discomforts BMI group Odds ratio 95%CI Odds ratio 95%CI
Sleeping difficulty low BMI 1.13 0.32-4.01 1.32 0.57-3.11
normal BMI 1[reference]   1[reference]  
high BMI 1.15 0.44-3.02 2.00* 1.09-3.67
Constipation low BMI 1.92 0.95-3.91 2.28* 1.08-4.82
normal BMI 1[reference]   1[reference]  
high BMI 1.13 0.64-2.00 1.38 0.74-2.56
Hand or finger stiffness low BMI 0.6 0.08-4.81 1.61 0.51-5.09
normal BMI 1[reference]   1[reference]  
high BMI 0.93 0.25-3.43 2.97* 1.36-6.45
Swelling low BMI 0.68 0.25-1.84 1.25 0.60-2.58
normal BMI 1[reference]   1[reference]  
high BMI 0.51 0.38-1.61 1.45 0.84-2.51
Leg cramps low BMI 1 0.39-2.55 1.1 0.50-2.40
normal BMI 1[reference]   1[reference]  
high BMI 1.14 0.57-2.26 2.29* 1.32-3.98
Low back pain low BMI 1.15 0.54-2.45 1.98 0.99-3.98
normal BMI 1[reference]   1[reference]  
high BMI 1.74 1.00-3.01 2.20* 1.29-3.75
Hip joint or pubis pain low BMI 1.27 0.41-3.94 1.95 0.94-4.03
normal BMI 1[reference]   1[reference]  
high BMI 2.38* 1.14-4.95 2.14* 1.23-3.73
Shoulder stiffness or headache low BMI 2.84* 1.35-5.96 1.63 0.69-3.86
normal BMI 1[reference]   1[reference]  
high BMI 1.21 0.63-2.33 2.01* 1.06-3.82
Rib pain low BMI 0.83 0.10-6.86 1.32 0.28-6.31
normal BMI 1[reference]   1[reference]  
high BMI 0 0 2.14 0.75-6.11
Anorexia or heartburn low BMI 1.24 0.51-3.03 1.97 0.95-4.08
normal BMI 1[reference]   1[reference]  
high BMI 1.56 0.81-3.01 1.62 0.92-2.87
Note: The analysis for discomforts was adjusted for age. *: p < 0.05

Table 1: The influence of pre-pregnancy BMI on pregnancy related discomforts (logistic regression analysis).

Discussion

We analyzed the changes in the occurrence of pregnancy-related discomforts throughout pregnancy and whether their occurrence was significantly associated with pre-pregnancy BMI. We observed a different trend in the occurrence of the pregnancy-related discomforts analyzed; in fact, while some of them tended to decrease, others appeared to increase during pregnancy progression. Furthermore, we found that both low and high BMI before pregnancy represent important risk factors for many pregnancy-related discomforts, compared with normal BMI.

The occurrence of most pregnancy-related discomforts increased from the second to third trimester, while the occurrence of constipation and shoulder stiffness or headache decreased. The tendency for the occurrence of the two discomforts of current study was almost equivalent to previous reports. A previous study in the United States showed that the occurrence of constipation decreased (26.3% to 15.7%) from the second to the third trimester [16], and in another cross-sectional study, the occurrence of headache decreased (44.9% to 37.6%) and that of constipation increased (38.6 to 45.2%) from the second to the third trimester [3]. Here, we observed a difference when compared with the previous study of Nazik and Eryilmaz, where the prevalence of constipation decreased in our study but increased in that study. However, it is worth noting that ours is a longitudinal study, and thus, we collected information during each trimester from the same participants, and that found that some discomforts might improve during the course of pregnancy. Therefore, pregnant women should pay attention to constipation and shoulder stiffness or headache during the early stages of pregnancy, especially during the second trimester, and of other discomforts thereafter.

We found significant differences in the occurrence of analyzed discomforts according to pre-pregnancy BMI. The occurrence of hip joint or pubis pain was higher during the second trimester, and the occurrence of sleeping difficulty, hand or finger stiffness, leg cramps, low back pain, hip joint or pubis pain, and shoulder stiffness or headache during the third trimester was higher in the high BMI group than in the normal BMI group. These discomforts are related to changes in the musculoskeletal and cardiovascular systems, common during pregnancy [17-21]. Overweight exposes the musculoskeletal system to excessive loads, resulting in conditions such as low back pain and hand pain (22,23). Overweight might also affect the cardiovascular system [24,25], leading to leg cramps and hand or finger stiffness. Accordingly, discomforts, especially those related to the musculoskeletal and cardiovascular systems, might occur in the high BMI group. The occurrence of shoulder stiffness or headache during the second trimester, and constipation during the third trimester, was higher in the low BMI group than in the normal BMI group. These discomforts are related to fluctuations in hormones such as estrogen, occurring during pregnancy [26,27], and low weight might determine hormone imbalance, in particular by decreasing the effects of female hormones [28]. Therefore, pre-pregnancy low BMI might hamper the hormonal balance and lead to the observed pregnancy-related discomforts.

In recent years, the occurrence of obesity has increased worldwide [29],while women, especially young adults, attempt to lose weight despite being of normal weight or underweight [30,31]. In this respect, our study showed that both women with high or low pre-pregnancy BMI have a high risk of pregnancy-related discomforts that not only affect their quality of life and limit their daily activities, but might also have a negative impact on their children’s health [4,5]. Hence, our findings suggest that young women should maintain an appropriate BMI before getting pregnant, in order to have a good pregnancy progression.

This study has several limitations. First, we could not obtain information on some factors that could affect pregnancy-related discomforts (e.g. living environment, parity, and hormonal fluctuations during pregnancy). These factors may have affected our results. Second, we could not investigate the occurrence of additional discomforts that occur during pregnancy: it is known that more than 30 discomforts might be experienced by pregnant women [3]. In the future, a similar study investigating various pregnancy-related discomforts should be conducted, taking into account the different factors related to the discomforts.

Conclusion

The current study showed that pregnancy-related discomforts have different trends in occurrence from the second to the third trimester. Therefore, pregnant women should pay attention to different discomforts depending on the pregnancy period. Moreover, pre-pregnancy low or high BMI might be a risk factor for pregnancy-related discomforts, regardless of age. These findings indicate that women should maintain an appropriate BMI before pregnancy to prevent potential discomforts during pregnancy.

References

  1. Borg-Stein J, Dugan SA, Gruber J (2005) Musculoskeletal aspects of pregnancy. Am J Phys Med Rehabil 84: 180-92
  2. Grigoriadis S, VonderPorten EH, Mamisashvili L, Tomlinson G, Dennis CL, et al. (2013) The impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta-analysis. J Clin Psychiatry 74: e321-41
  3. Nazik E, Eryilmaz G (2014) Incidence of pregnancy-related discomforts and management approaches to relieve them among pregnant women. J ClinNurs 23: 1736-50
  4. Smith SA, Michel Y (2006) A pilot study on the effects of aquatic exercises on discomforts of pregnancy. J ObstetGynecol Neonatal Nurs 35: 315-23
  5. Katonis P, Kampouroglou A, Aggelopoulos A, Kakavelakis K, Lykoudis S, et al. (2011) Pregnancy-related low back pain. Hippokratia 15: 205-10
  6. Nazik E, Eryilmaz G (2013) Incidence of pregnancy-related discomforts and management approaches to relieve them among pregnant women. J ClinNurs
  7. Nascimento SL, Surita FG, Cecatti JG (2012) Physical exercise during pregnancy: a systematic review. CurrOpinObstetGynecol 24: 387-94
  8. Fugh-Berman A, Kronenberg F (2003) Complementary and alternative medicine (CAM) in reproductive-age women: a review of randomized controlled trials. ReprodToxicol 17: 137-52
  9. Costantine MM (2014) Physiologicandpharmacokineticchangesinpregnancy.FrontPharmacol5: 65
  10. Rooney KL, Domar AD (2014) The impact of lifestyle behaviors on infertility treatment outcome. CurrOpinObstetGynecol 26: 181-5
  11. Huang L, Liu J, Feng L, Chen Y, Zhang J, et al. (2014) Maternal prepregnancy obesity is associated with higher risk of placental pathological lesions. Placenta
  12. Begum KS, Sachchithanantham K, De Somsubhra S (2011) Maternal obesity and pregnancy outcome. ClinExpObstetGynecol 38: 14-20
  13. Mann JR, McDermott SW, Hardin J, Pan C, Zhang Z (2013) Pre-pregnancy body mass index, weight change during pregnancy, and risk of intellectual disability in children. Bjog 120: 309-19
  14. Han Z, Mulla S, Beyene J, Liao G, McDonald SD (2011) Maternal underweight and the risk of preterm birth and low birth weight: a systematic review and meta-analyses. Int J Epidemiol 40: 65-101
  15. Ehrenberg HM, Dierker L, Milluzzi C, Mercer BM (2003) Low maternal weight, failure to thrive in pregnancy, and adverse pregnancy outcomes. Am J ObstetGynecol 189: 1726-30
  16. Bradley CS, Kennedy CM, Turcea AM, Rao SS, Nygaard IE (2007) Constipation in pregnancy: prevalence, symptoms, and risk factors. ObstetGynecol 110: 1351-7
  17. Vermani E, Mittal R, Weeks A (2010) Pelvic girdle pain and low back pain in pregnancy: a review. Pain Pract 10: 60-71
  18. Supakatisant C, Phupong V (2012) Oral magnesium for relief in pregnancy-induced leg cramps: a randomised controlled trial. Matern Child Nutr
  19. Driver HS, Shapiro CM (1992) A longitudinal study of sleep stages in young women during pregnancy and postpartum. Sleep 15: 449-53
  20. Kanakaris NK, Roberts CS, Giannoudis PV (2011) Pregnancy-related pelvic girdle pain: an update. BMC Med 9: 15
  21. Balik G, SabriBalik M, Ustuner I, Kagitci M, Sahin FK, et al. (2014) Hand and wrist complaints in pregnancy. Arch GynecolObstet
  22. Heuch I, Hagen K, Nygaard O, Zwart JA (2010) The impact of body mass index on the prevalence of low back pain: the HUNT study. Spine (Phila Pa 1976) 35: 764-8
  23. Hooper MM, Stellato TA, Hallowell PT, Seitz BA, Moskowitz RW (2007) Musculoskeletal findings in obese subjects before and after weight loss following bariatric surgery. Int J Obes (Lond) 31: 114-20
  24. Magriples U, Boynton MH, Kershaw TS, Duffany KO, Rising SS, et al. (2013) Blood pressure changes during pregnancy: impact of race, body mass index, and weight gain. Am J Perinatol 30: 415-24
  25. Wirth A (2014) [Cardiovascular risk is elevated in overweight pregnant patients]. MMW Fortschr Med 156: 34
  26. Keller J, Frederking D, Layer P (2008) The spectrum and treatment of gastrointestinal disorders during pregnancy. Nat ClinPractGastroenterolHepatol 5: 430-43
  27. Dixit A, Bhardwaj M, Sharma B (2012) Headache in pregnancy: a nuisance or a new sense? ObstetGynecolInt 2012: 697697
  28. Ramoz N, Versini A, Gorwood P (2013) Anorexia nervosa and estrogen receptors. VitamHorm 92: 141-63
  29. Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, et al. (2011) National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet 377: 557-67
  30. Sugawara A, Sato M, Totsuka K, Saito K, Kodama S, et al. (2011) Factors associated with inappropriate weight loss attempts by early adolescent girls in Japan. Eat Weight Disord 16: e157-63
  31. Choi OJ, Cho YG, Kang JH, Park HA, Kim KW, et al. (2013) Weight control attempts in underweight korean adults: Korea national health and nutrition examination survey, 2007-2010. Korean J Fam Med 34: 393-402
Citation: Morino S, Ishihara M, Nishiguchi S, Fukutani N, Adachi D, et al. (2015) The Association between Pregnancy-Related Discomforts and Pre-Pregnancy Body Mass Index in Japanese Women . J Women’s Health Care 4:222.

Copyright: © 2015 Morino, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use,distribution, and reproduction in any medium, provided the original author and source are credited.
Top