Clinical trial NCT06239753: The Impact of Dynamic Neuromuscular Stabilization on Pregnancy
Official title: The Effect of Dynamic Neuromuscular Stabilization Applied in the Second Trimester of Pregnancy on Pregnancy: A Randomized Controlled Study
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Pregnant
Exercise
Keywords: Pregnancy
Stabilization
Exercise
Lead sponsor: Lütfi Kırdar City Hospital
Sponsor class: OTHER
First posted: 2024-02-02
Enrollment: 144
Sex: FEMALE
Minimum age (years): 20
Maximum age (years): 35
Standard ages: ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: PREVENTION

Brief summary: The aim of this randomized controlled study is to determine the pregnancy and childbirth outcomes of using the DNS method to facilitate anatomical and physiological adaptations during pregnancy.

Detailed description: During pregnancy, significant anatomical and physiological changes occur as the baby grows inside the uterus. As pregnancy progresses, body mass index increases, the uterus expands towards the abdominal cavity, and the woman's center of gravity shifts. This change in the center of gravity leads to a backward shift in the trunk, hyperextension of the knees, and the formation of lumbar lordosis, thoracic kyphosis, and pelvic curvature. The increased weight can cause pelvic floor collapse and weakness in pelvic floor muscles, leading to urinary incontinence, pelvic organ prolapse, fecal incontinence, sexual dysfunction, and pelvic pain.

Proper management of the body during this period can not only facilitate childbirth but also reduce potential problems that may arise during pregnancy. Exercises play a crucial role in managing the body correctly during pregnancy. Aerobic exercises, strength training, and specific Kegel exercises are commonly performed during pregnancy. However, despite the frequent occurrence of musculoskeletal and postural changes during pregnancy, it is observed that postural exercises to regulate these changes are not widely implemented. Studies have indicated that stabilization exercises are more effective than traditional strength exercises in reducing complaints during pregnancy.

There is a lack of sufficient research in the literature on core stabilization related to posture alignment during pregnancy. Core stabilization is defined as the ability to control the position and movement of the trunk on the pelvis to allow optimal force production, transfer, and movement of the extremities. It is essential to prevent excessive load on the pelvis, spine, and kinetic chain. When this system functions effectively, loads on the body are distributed evenly, reducing excess load on the joints of the kinetic chain. Core strength training primarily focuses on strengthening deep core muscles, especially the multifidus and transversus abdominis muscles, which may weaken during pregnancy. Current exercise programs for pregnant women include exercises targeting core muscles, such as Pilates, antigravity fitness, birth support belts, stability balls, and Dynamic Neuromuscular Stabilization (DNS). Although studies on the benefits of stabilization exercises during pregnancy are available in the literature, there is no specific research on the application of DNS during pregnancy.

DNS is a system that emphasizes coordination and strength, focusing on the overall harmony of the body and foundational stability. It is based on developmental kinesiology models. DNS encompasses motor patterns and programs that infants inherently possess, allowing them to develop ideal posture, functional joint centering, optimal respiration, and locomotor skills during ontogenesis. The main goal is to restore physiological movement patterns defined by developmental kinesiology DNS has been widely accepted in clinical practice as a method that provides balanced subcortical or reflexive core stabilization, coordinating diaphragm, transversus abdominis, internal oblique, multifidus, and pelvic floor coactivation with intra-abdominal pressure and coordinated activation of superficial abdominal muscles.

Understanding the physiological and anatomical adaptations during pregnancy is crucial for the pregnant woman to cope with the increased metabolic demands vital for the developing fetus and meet the requirements of childbirth. Recognizing pathological deviations in pregnant women and ensuring core stabilization using appropriate methods are essential to optimize outcomes for both the mother and the baby. In the context of critically ill pregnant women, the DNS method can be used effectively during pregnancy, taking into account that different modifications may be needed to optimize their treatment. Well-designed studies are needed to determine the effectiveness of the DNS method.

Eligibility criteria: Inclusion Criteria:

Primiparity

* Singleton Pregnancy
* Gestational Age Between 11-13 Weeks
* Age Between 20-35 Years
* Body Mass Index in the Range of 18-30
* Receiving Pregnancy Check-ups at the Hospital where the Research is Conducted

Exclusion Criteria:

* Presence of a heart condition affecting hemodynamics
* History of restrictive lung disease
* Multiple pregnancies
* Severe anemia
* Movement-restricting musculoskeletal system anomalies

Primary outcomes:
measure: Pelvic Floor Muscle Measurements
timeFrame: Between the 11th and 36th weeks of pregnancy,
measure: The Pittsburgh Sleep Quality Index
timeFrame: Between the 11th and 36th weeks of pregnancy,
measure: State-Trait Anxiety Inventory
timeFrame: Between the 11th and 36th weeks of pregnancy,
measure: Oswestry Skalası
timeFrame: Between the 11th and 36th weeks of pregnancy,
measure: Multidimensional Scale of Perceived Social Support
timeFrame: Between the 11th and 36th weeks of pregnancy,
measure: The Fatigue Severity Scale
timeFrame: Between the 11th and 36th weeks of pregnancy,
measure: Pregnancy Weight Gain
timeFrame: Between the 11th and 36th weeks of pregnancy,
Secondary outcomes:
measure: Blood pressure arterial (mmHg)
timeFrame: Between the 11th and 36th weeks of pregnancy,
measure: pulse rate measurements
timeFrame: Between the 11th and 36th weeks of pregnancy,
Other outcomes:
Locations:
city: Istanbul
country: Turkey
facility: Lütfi Kırdar Şehir Hastanesi
Study officials:
affiliation: KLKŞH
name: Elif Ünlügedik Sayın, Dr.
role: PRINCIPAL_INVESTIGATOR
affiliation: KLKŞH
name: Sunahan Koyuncu, Ftrp
role: STUDY_CHAIR
affiliation: KLKŞH
name: Döndü Kurnaz
role: STUDY_DIRECTOR
affiliation: Sütçü İmam Unıversity
name: Deniz Akyıldız
role: STUDY_CHAIR
References: