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孕期相关激素变化、神经力学适应及整个孕期的临床疼痛状况:一项前瞻性队列研究。

Changes in pregnancy-related hormones, neuromechanical adaptations and clinical pain status throughout pregnancy: A prospective cohort study.

作者信息

Daneau Catherine, Nougarou François, Abboud Jacques, Ruchat Stephanie-May, Descarreaux Martin

机构信息

Department of Anatomy, Université du Québec à Trois-Rivières, Québec, Canada.

Department of Electrical and Computer Engineering, Université du Québec à Trois-Rivières, Québec, Canada.

出版信息

PLoS One. 2025 Feb 21;20(2):e0314158. doi: 10.1371/journal.pone.0314158. eCollection 2025.

Abstract

During pregnancy, increased hormonal levels contribute to ligament laxity of the pelvis and could predispose to lumbopelvic pain. The main objective of this study was to assess changes in pregnancy-related hormones, neuromechanical adaptations and clinical pain status throughout pregnancy. An exploratory objective was to examine the possible association between those variables. Twenty-eight pregnant women participated in the study. At each trimester, they provided a blood sample (to measure relaxin, estrogen and progesterone), completed questionnaires assessing clinical status (functional disability, risk of poor prognosis of prolonged lumbar disability, avoidance behaviors, anxiety and pain catastrophizing), and were asked to perform a flexion-relaxation task (erector spinae electromyography and trunk kinematics). Results showed that throughout pregnancy, nocturnal and diurnal lumbopelvic pain intensity and related-disability, risk of poor lumbopelvic pain prognosis as well as avoidance behaviors increased, while pain catastrophizing decreased. Neuromechanical characteristics of flexion-relaxation task, including low back muscle activity and trunk kinematics, were similar across the three trimesters. Positive correlations were found between disability and estrogen levels (changes between first and second trimester, p = 0.05), and estrogen and diurnal lumbopelvic pain intensity (change between second and third trimester, p = 0.02). A positive correlation was also found between weight and the Pelvic Girdle Questionnaire score (changes between second and third trimester, p = 0.05). Negative correlations were found between weight (change between first and second trimester) and lumbopelvic maximal angle (p = 0.003), FRP onset for pelvic (p = 0.04) and lumbopelvic (p = 0.003) angles as well as FRP cessation for lumbopelvic angle (p = 0.001). These results show that, in pregnant women, pain and disability are associated with hormonal changes rather than trunk neuromechanical characteristics during a flexion-relaxation task. These results suggest that the flexion-relaxation task may not be an appropriate proxy to study vertebral and pelvic muscle control in pregnant women.

摘要

在怀孕期间,激素水平升高会导致骨盆韧带松弛,并可能引发腰骶部疼痛。本研究的主要目的是评估整个孕期与妊娠相关的激素变化、神经力学适应性和临床疼痛状况。一个探索性目的是检验这些变量之间可能存在的关联。28名孕妇参与了该研究。在每个孕期,她们提供血样(用于测量松弛素、雌激素和孕酮),完成评估临床状况的问卷(功能障碍、长期腰部残疾预后不良风险、回避行为、焦虑和疼痛灾难化),并被要求执行屈伸放松任务(竖脊肌肌电图和躯干运动学)。结果显示,在整个孕期,夜间和日间腰骶部疼痛强度及相关残疾、腰骶部疼痛预后不良风险以及回避行为均增加,而疼痛灾难化程度降低。屈伸放松任务的神经力学特征,包括下背部肌肉活动和躯干运动学,在三个孕期相似。在残疾与雌激素水平之间(孕早期和孕中期之间的变化,p = 0.05)、雌激素与日间腰骶部疼痛强度之间(孕中期和孕晚期之间的变化,p = 0.02)发现正相关。在体重与骨盆带问卷得分之间(孕中期和孕晚期之间的变化,p = 0.05)也发现正相关。在体重(孕早期和孕中期之间的变化)与腰骶部最大角度(p = 0.003)、骨盆(p = 0.04)和腰骶部(p = 0.003)角度的屈伸放松开始以及腰骶部角度的屈伸放松停止(p = 0.001)之间发现负相关。这些结果表明,在孕妇中,疼痛和残疾与激素变化有关,而非屈伸放松任务期间的躯干神经力学特征。这些结果表明,屈伸放松任务可能不是研究孕妇脊柱和骨盆肌肉控制的合适替代指标。

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