Diastasis of the rectus abdominis muscle in women with gestational diabetes mellitus measured by two-dimensional ultrasonography

Abstract

The Gestational Diabetes Mellitus (DMG) implies higher frequency of abnormalities, including functional muscle physiology decrement, when compared to non-gestational diabetic (Non-GDM) pregnancy, which evince the connection between metabolism and mechanical muscle function. The RAM (rectus abdominis muscle) have been focus of research of many groups by the synergic action between abdominal and pelvic floor muscles (PFM) on urinary incontinence mechanisms. There are evidences of cocontraction of MAP and abdominal muscles during pelvic floor contractions and functional abdominal activities. During pregnancy the RAM could be stretched vertically more than 20 cm from the original size and horizontally a progressive separation of the muscles fibers in relation to alba line occurs to allow uterine growth. This progressive separation is named abdominal muscle diastasis and it is presented in 66% of pregnant. The diastasis greater than 3 cm is considered pathologic and could interfere in torque generation probably because the misalignment of the force vector and the negative impact extended from pregnancy and postpartum to life longer. The ultrasonography is an excellent tool to evaluate RAM because of the easy management and its safety during pregnancy. Our hypothesis is that in GDM group the US RAM measurements will be different from Non-GDM during rest and functional activities.Aim:The aim of this study is to evaluate the RAM diastasis during rest and functional activities in pregnant with GDM and without GDM between 24-28 and 36-38 weeks of gestation by US2D.Methods:This prospective cohort study was approved by the Institutional Ethical Committee of Botucatu Medical School of São Paulo State University (CAAE 82225617.0.0000.5411). The data collection will be developed at Specialized Center for Rehabilitation of the Faculty of Philosophy and Sciences, Unesp, Marília. 10 pregnant women with GDM and 10 pregnant without GDM will be included and they will be queried about personal, clinical and obstetrical data. The scholarship student trained by an expert will perform evaluation of the RAM using a portable GE® US2D machine. Four images from RAM diastasis will be recorded, two during rest and 2 during functional activities. To guarantee the blinded process of the images to clinical status, all images will be codified by numbers and will be analyzed offline in a specific software from GE® US.Data Analysis:After data collection, all data from different groups and moments will be analyzed. Concerning statistical analyzes the comparison between groups will be performed by ANOVA for quantitative variables followed by Tukey's multiple comparison test for data with normal distribution and with gamma distribution for variables with asymmetric distribution. Associations between qualitative variables will be made using contingency tables using chi-square or Fisher's exact test. In all tests, the significance level of 5% will be set. For all analyzes, the SAS program for Windows, version 9.13 will be used.