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      Gestational diabetes is associated with alteration on pelvic floor muscle activation pattern during pregnancy and postpartum: Prospective cohort using electromyography assessment

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          Abstract

          Background and objective

          Gestational diabetes mellitus (GDM) is a comorbidity which may cause acute and lifelong disorders to mother and child. Alterations in muscular and connective tissues have been associated with GDM in translation studies, characterizing gestational diabetic myopathy. Pregnancy-specific urinary incontinence and sexual disabilities, disorders that depend on the pelvic floor muscle (PFM) integrity, are also associated with GDM both during and after pregnancy. The aim was to compare PFM activation patterns between GDM and non-GDM women from 24–30 gestational weeks to 18–24 months postpartum during a standard clinical test during gestation and postpartum.

          Methods

          We conducted a prospective three-time-point cohort study from gestation (24–30 weeks—T1, and 36–38 weeks—T2) to 18–24 months postpartum (T3). PFM electromyography was recorded in primigravida or primiparous women with one previous elective c-section with or without the diagnosis of GDM according to the American Diabetes Association criteria. A careful explanation of the muscle anatomy and functionality of the PFM was given to participants before EMG assessment. The outcome measures were PFM activation patterns assessed during pregnancy and postpartum, comparing intra and between groups. PFM activation patterns were assessed by normalized electromyography signal at rest and during 1-second (sec) phasic, 10-sec hold, and 60-sec sustained contractions.

          Results

          Demographic and obstetric data showed homogeneity between groups. The GDM group achieved peak PFM EMG amplitudes similarly to the non-GDM group, but they took longer to return to baseline levels during the ~1-sec contraction (flicks). During 10-sec hold contractions, the GDM group sustained lower levels of PFM activation than the non-GDM group at both 36–38 weeks of gestation and 18–24 months postpartum when compared to the non-GDM group.

          Conclusion

          The results suggest that GDM impaired PFM control mainly on 1-sec flicks and 10-sec hold contraction, which appears to develop during late pregnancy and extends long-term postpartum. This motor behavior may play a role on pelvic floor dysfunctions.

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          Most cited references56

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          Pelvic Floor Muscle Assessment: The PERFECT Scheme

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            Consensus for experimental design in electromyography (CEDE) project: Amplitude normalization matrix

            The general purpose of normalization of EMG amplitude is to enable comparisons between participants, muscles, measurement sessions or electrode positions. Normalization is necessary to reduce the impact of differences in physiological and anatomical characteristics of muscles and surrounding tissues. Normalization of the EMG amplitude provides information about the magnitude of muscle activation relative to a reference value. It is essential to select an appropriate method for normalization with specific reference to how the EMG signal will be interpreted, and to consider how the normalized EMG amplitude may change when interpreting it under specific conditions. This matrix, developed by the Consensus for Experimental Design in Electromyography (CEDE) project, presents six approaches to EMG normalization: (1) Maximal voluntary contraction (MVC) in same task/context as the task of interest, (2) Standardized isometric MVC (which is not necessarily matched to the contraction type in the task of interest), (3) Standardized submaximal task (isometric/dynamic) that can be task-specific, (4) Peak/mean EMG amplitude in task, (5) Non-normalized, and (6) Maximal M-wave. General considerations for normalization, features that should be reported, definitions, and "pros and cons" of each normalization approach are presented first. This information is followed by recommendations for specific experimental contexts, along with an explanation of the factors that determine the suitability of a method, and frequently asked questions. This matrix is intended to help researchers when selecting, reporting and interpreting EMG amplitude data.
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              Analysis of motor units with high-density surface electromyography.

              Although the behaviour of individual motor units is classically studied with intramuscular EMG, recently developed techniques allow its analysis also from EMG recorded in multiple locations over the skin surface (high-density surface EMG). The analysis of motor units from the surface EMG is useful when the insertion of needles is not desirable or not possible. Moreover, surface EMG allows the measure of motor unit properties which are difficult to assess with invasive technology (e.g., muscle fiber conduction velocity or location of innervation zones) and may increase the number of detectable motor units with respect to selective intramuscular recordings. Although some limitations remain, both the discharge pattern and muscle fiber properties of individual motor units can currently be analyzed non-invasively. This review presents the conditions and methodologies which allow the investigation of motor units with surface EMG.
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                Author and article information

                Contributors
                URI : https://loop.frontiersin.org/people/1023471
                URI : https://loop.frontiersin.org/people/1463370
                URI : https://loop.frontiersin.org/people/1104239
                URI : https://loop.frontiersin.org/people/1844678
                Journal
                Front Endocrinol (Lausanne)
                Front Endocrinol (Lausanne)
                Front. Endocrinol.
                Frontiers in Endocrinology
                Frontiers Media S.A.
                1664-2392
                06 October 2022
                2022
                : 13
                : 958909
                Affiliations
                [1] 1 São Paulo State University (Unesp), Postgraduate Program on Tocogynecology, Botucatu Medical School , Botucatu, Brazil
                [2] 2 Human Development and Technologies, Institute of Biosciences, São Paulo State University (UNESP) , Rio Claro, Brazil
                [3] 3 Independent Researcher , Hobart, TAS, Australia
                [4] 4 São Paulo State University (Unesp), School of Philosophy and Sciences , Marilia, Brazil
                Author notes

                Edited by: Eric Siegel, University of Arkansas for Medical Sciences, United States

                Reviewed by: Luis Mercado, University of Arkansas for Medical Sciences, United States; Diana Escalona-Vargas, University of Arkansas for Medical Sciences, United States

                *Correspondence: Angélica Mércia Pascon Barbosa, angelicapascon@ 123456gmail.com

                †These authors share first authorship

                ‡These authors share last authorship

                §These authors have contributed equally to this work

                This article was submitted to Clinical Diabetes, a section of the journal Frontiers in Endocrinology

                Article
                10.3389/fendo.2022.958909
                9582526
                36277705
                df0cf5df-b2ac-4d5f-8080-542225a4dfb9
                Copyright © 2022 Prudencio, Nunes, Pinheiro, Sartorão Filho, Nava, Salomoni, Pedroni, Rudge, Barbosa and Diamater Study Group

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 01 June 2022
                : 31 August 2022
                Page count
                Figures: 4, Tables: 2, Equations: 0, References: 56, Pages: 14, Words: 7810
                Funding
                Funded by: Fundação de Amparo à Pesquisa do Estado de São Paulo , doi 10.13039/501100001807;
                Award ID: 2016/01743-5, 2021/10665-6
                Funded by: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior , doi 10.13039/501100002322;
                Award ID: DS
                Categories
                Endocrinology
                Original Research

                Endocrinology & Diabetes
                gestational diabetes,pelvic floor,pregnant,electromyography,postpartum
                Endocrinology & Diabetes
                gestational diabetes, pelvic floor, pregnant, electromyography, postpartum

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