Falls and Balance During Pregnancy
Falling is a common cause of injury during pregnancy, with the rate of hospitalization after a fall being 2.3 times higher compared to non-pregnant women of a similar age. It may be considered the second most common cause of trauma during pregnancy, after car accidents. In a study by Bhattacharya et al. (2010), about 25% of pregnant women reported falling at least once during their pregnancy. Falls most commonly occurred in the later stages of pregnancy (6-8 months). Falls during pregnancy can lead to injuries such as fractures or joint sprains and increase the risk of preterm delivery or injury to the placenta.
What are the reasons for increased fall risk during pregnancy?
Joint/Myofascial Laxity - Due to normal hormonal changes during pregnancy, women experience an increase in laxity, or decreased stiffness, of connective tissues such as ligaments, tendons, and fascia. This can reduce the passive support provided by these structures, potentially leading to decreased stability.
Postural Changes - Starting in the second trimester and progressing towards the end of pregnancy, changes in the abdomen as the fetus grows become more prominent. This causes the center of mass to shift forward, which in turn leads to an increase in lordosis (inward curve of the lower back). These changes in posture can lead to several adaptations:
Relying on leg muscles to support upright posture more than core itself - decreased control of torso and limiting ability to maintain certain posture/position.
Smaller steps during gait due to decrease hip flexibility which in turn decreases the base of support.
Postural sway -This refers to the natural, slight shifting or movement of the body as it maintains an upright position. This movement is often subtle and occurs when a person stands still, especially if they are not holding onto anything for support. It's a normal part of the body's balance control system, involving adjustments made by the muscles and joints to stay steady. During pregnancy, postural sway becomes more pronounced, increasing the risk of falls.
Fall Prevention Stategies
Exercise - is one of the main strategies to reduce risk of falling during pregnancy. A study Redfern M. et al (2010) found that sedentary women experienced higher fall incidence compared to pregnant women who were physically active. Exercise that focuses on strengthening, balance, hip flexibility and some agility can prepare the body for the changes and adaptations that come with the pregnancy. Learning to control changes in center of mass and improving muscle mass may be a key factor as these can provide better support for the changes described above. In addition, maintain hip flexibility and gait training can help improve base of support that will increase the overall stability with the movement.
Support Belts - Support belts are another potential strategy for reducing the risk of falls during pregnancy. A study by Cakmak et al. (2013) found that pregnant women who wore support belts had improved balance scores compared to those who did not. These belts help provide additional support to the lower back and pelvis, areas often affected by the increasing weight and changes in posture during pregnancy. By stabilizing these areas, a support belt can reduce discomfort, help improve posture, and make it easier for women to maintain better balance. While not a substitute for exercise, support belts can be a helpful tool in conjunction with physical activity to further reduce the risk of falls and improve overall postural stability during pregnancy.
References
Dunning K, LeMasters G, Bhattacharya A. A major public health issue: the high incidence of falls during pregnancy. Matern Child Health J. 2010;14(5):720-725. doi:10.1007/s10995-009-0511-0
Cakmak B, Ribeiro AP, Inanir A. Postural balance and the risk of falling during pregnancy. J Matern Fetal Neonatal Med. 2016;29(10):1623-1625. doi:10.3109/14767058.2015.1057490
Cakmak B, Inanir A, Nacar MC, Filiz B. The effect of maternity support belts on postural balance in pregnancy. PM R. 2014;6(7):624-628. doi:10.1016/j.pmrj.2013.12.012
Hrvatin I, Rugelj D. Risk factors for accidental falls during pregnancy - a systematic literature review. J Matern Fetal Neonatal Med. 2022;35(25):7015-7024. doi:10.1080/14767058.2021.1935849
