Association between striae gravidarum and pelvic floor dysfunction symptoms during pregnancy

• Published in: International Urogynecology Journal 2022-12, Vol.33 (12), p.3441-3447
• Main Authors: Lichtman, Yael, Horev, Amir, Matyashov, Tamar, Rotem, Reut, Katz, Maayan Elnir, Eshkoli, Tamar, Weintraub, Adi Y.
• Format: Article
• Language: English
• Subjects: Connective tissue; Female; Gynecology; Humans; Hypotheses; Infant, Newborn; Medicine; Medicine & Public Health; Original Article; Pelvic Floor; Pelvic Floor Disorders - epidemiology; Pelvic Floor Disorders - etiology; Pelvis; Pregnancy; Prospective Studies; Striae Distensae - etiology; Surveys and Questionnaires; Urology
• ISSN: 0937-3462; 1433-3023
• DOI: 10.1007/s00192-022-05249-8

Introduction and hypothesis Striae gravidarum are linear atrophic scars appearing on the abdomen of pregnant women reported to be related to pregnancy-induced changes in the connective tissue. Pelvic floor distress symptoms are also known to be linked to connective tissue weakness. Given that common pathophysiological pathways may play a role in both striae gravidarum and pelvic floor dysfunction symptoms, we sought to examine whether there is a correlation between them during pregnancy. Methods A prospective observational study among third-trimester pregnant women who visited a tertiary medical center for routine pregnancy follow-up was conducted by using the Pelvic Floor Distress Inventory (PFDI-20) questionnaire to evaluate pelvic floor distress symptoms and the Davey method for evaluating striae gravidarum severity. Obstetrical characteristics as well as pelvic floor distress symptoms were compared between two groups according to the severity of striae gravidarum. Univariate analysis was carried out using appropriate tests; PFDI scores were compared between the groups using the Mann-Whitney test. Results Women with striae gravidarum were significantly older (31.06 vs. 28.83 years, p < 0.01), had a lower body mass index (27.5 vs. 30.98, p < 0.01), and gave birth to smaller neonates (3155 vs. 3389 g, p < 0.01). In addition, the overall and median PFDI-20 scores differed between the groups (with severe SG having the highest median score of 20 and those with milder SG having a score of 16 compared to 14 in those without SG). A distinct association between the PFDI-20 score and SG severity was not demonstrated ( p = 0.63). Conclusions In our population, an association was demonstrated between pelvic floor distress symptoms and the presence of striae gravidarum. However, following a linear regression model, no statistically significant association between SG severity and total PFD-20 score was seen. Our findings strengthen the hypothesis of common connective tissue involvement in the pathophysiology of both conditions.