Background Diastasis recti abdominis (DRA) is a common musculoskeletal problem, which is defined as a separation of the inter-recti distance between the two bellies of the rectus abdominis muscle at the linea alba.1 Due to the hormonal, postural and musculoskeletal changes, and mechanical strain, the anterior abdominal wall becomes stretched and elongated during pregnancy. Studies have shown that DRA may occur between 27% and 100% in the second and third trimesters of pregnancy2. Although it has been reported that imbalance in the strength of the abdominal wall muscles altered with the facial tension, the role of abdominal muscle strength on DRA has not been clarified yet.
Objectives The present study assessed the relation between the severity/amount of DRA and the degree of abdominal muscle (rectus abdominis (RA), external and internal oblique muscles) strength in pregnant women.
Methods A total of 153 pregnant women between 14 and 35 weeks of a singleton pregnancy were included in the present study. The finger width method was used to measure the amount of DRA. The amount of separation was determined by the palpation of the medial sides of RA at three reference points: on the umbilicus, 4.5 cm above and 4.5 cm below of the umbilicus. After the subject contracts RA in hook lying position when her arms were in extended position, the size of the diastasis was measured by the number of finger.3 The strength of abdominal muscles was assessed by the manual muscle test in supine hook lying position. The correlation between the amount of DRA and the degree of abdominal muscle strength was analyzed by the Spearmans correlation.
Results The mean age was 28.40±3.69 years, mean Body Mass Index was 27.01±1.26 kg/m2, and mean gestational age was 28.12±5.03 weeks. A negative correlation was found between the amount of the diastasis at 4.5 cm below of the umbilicus and the strength of the RA (r=0.219, p=0.007), right (r=0.296, p=0.015) and left external oblique muscles (r=0.293, p=0.017).
Conclusion Based on the findings of the present study, the separation of RA on the lower level of umbilicus may be negatively associated with the strength of RA and oblique abdominal muscles. Therefore, to decrease the severity of DRA, abdominal strengthening programs should be provided to pregnant women.
References  Van de Water, A. T. M., & Benjamin, D. R. (2016). Measurement methods to assess diastasis of the rectus abdominis muscle (DRAM): a systematic review of their measurement properties and meta-analytic reliability generalisation. Manual therapy, 21, 41-53.
 B, K., Hilde, G., Tennfjord, M. K., Sperstad, J. B., & Engh, M. E. (2017). Pelvic floor muscle function, pelvic floor dysfunction and diastasis recti abdominis: prospective cohort study. Neurourology and urodynamics, 36(3), 716-721.
 Michalska, A., Rokita, W., Wolder, D., Pogorzelska, J., & Kaczmarczyk, K. (2018). Diastasis recti abdominisa review of treatment methods. Ginekologia polska, 89(2), 97-101.
Disclosure of Interests None declared
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