Associated factors for the decrease of force of inspiratory muscle in pregnant women of high risk

Main Article Content

Alianny Raphaely Rodrigues Pereira
Helga Cecilia Muniz de Souza
Adryelle Fernandes Duarte
Camila Maria Mendes Nascimento
Juliana Netto Maia
Cyda Maria Albuquerque Reinaux

Abstract

Introduction: The gestational period brings anatomical and physiological changes to women in several systems, especially the respiratory system. Objective: To determine whether there is an association between gestational age (GA), Diabetes, uterine fundal height (UFH), Body Mass Index (BMI), level of dyspnea, and physical activity with maximum respiratory and nasal pressures. Methods: Cross-sectional study that included 55 high-risk pregnant women in the 2nd and 3rd trimester of pregnancy at the Obstetrics Outpatient Clinic of the Hospital das Clínicas in Recife – PE, Brazil, personal, sociodemographic, anthropometric, clinical and Maximal Inspiratory Pressure (MIP) data were described and nasal inspiratory pressure (NIP), that, using regression and multivariate analysis, analyzed the influence of risk factors for high-risk pregnancy with NIP considering a p<0.005. Results: Among the pregnant women, according to the clinical variables, it was observed that 56.4% (n=31) had a gestational age above 28 weeks, 27.3% (n=15) diabetes, 25.5% (n=14) asthma, 43.6% (n=24) Gestational Hypertension, 56.4% (n=31) obesity, 85.5% (n=47) complaints of dyspnea 38.1% (n=21) mild to severe dyspnea and 65.5% (n=36) vigorous physical activity. Low MIP (76.76 cmH2O) and NIP (68.62 cmH2O) values were found for age. An association was observed between an increase in UFH and a decrease of 0.8 cmH2O in NIP, regardless of gestational age. Conclusion: High-risk pregnant women in the second and third trimester of pregnancy have decreased NIP and MIP with a negative association of UFH with NIP regardless of gestational age.

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Pereira, A. R. R., Souza, H. C. M. de, Duarte, A. F., Nascimento, C. M. M., Maia, J. N., & Reinaux, C. M. A. (2024). Associated factors for the decrease of force of inspiratory muscle in pregnant women of high risk. ABCS Health Sciences. https://doi.org/10.7322/abcshs.2022128.2197
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Original Articles

References

Brasil. Ministério da Saúde. Secretaria de Atenção Primária à Saúde. Departamento de Ações Programáticas. Manual de gestação de alto risco. Brasília: Ministério da Saúde, 2022.

Jensen D, Webb KA, Wolfe LA, O’Donnell DE. Effects of human pregnancy and advancing gestation on respiratory discomfort during exercise. Respir Physiol Neurobiol. 2007;156(1):85-93. https://doi.org/10.1016/j.resp.2006.08.004

Fuso L, Pitocco D, Longobardi A, Zaccardi F, Cont C, Pozzuto C, et al. Reduced respiratory muscle strength and endurance in type 2 diabetes mellitus. Diabetes Metab Res Rev 2012;28(4):370-5. https://doi.org/10.1002/dmrr.2284

Pinto AVA, Schleder JC, Penteado C, Gallo RBS. Avaliação da mecânica respiratória em gestantes. Fisioter Pesq. 2015;22(4):348-54. https://doi.org/10.590/1809-2950/13667922042015

Bezerra MAB, Nunes PC, Lemos A. Força muscular respiratória: comparação entre nuligestas e primigestas. Fisioter Pesq. 2011;18(3):235-40. https://doi.org/10.1590/S1809-29502011000300006

Schatz M, Dombrowski MP, Wise R, Momirova V, Landon M, Mabie W, et al. Spirometry is related to perinatal outcomes in pregnant women with asthma. Am J Obstet Gynecol. 2006;194(1):120-6. https://doi.org/10.1016/j.ajog.2005.06.028

Tan EK, Tan EL. Alterations in physiology and anatomy during pregnancy. Best Pract Res Clin Obstet Gynaecol. 2013;27(6):791-802. https://doi.org/10.1016/j.bpobgyn.2013.08.001

Lemos A, Souza AI, Figueroa JN, Cabral-Filho JE, Andrade AD. Respiratory muscle strength in pregnancy. Respir Med. 2010;104(11):1638-44. https://doi.org/10.1016/j.rmed.2010.05.020

Lemos A, Souza AI, Andrade AD, Figueiroa JN, Cabral-Filho JE. Força muscular respiratória: comparação entre primigestas e nuligestas. J Bras Pneumol. 2011;37(2):193-9. https://doi.org/10.1590/S1806-37132011000200009

Dias FAL, Garcia ACM, Benicio KFG, Azevedo IG, Resqueti V, Aliverti A, et al. Effects of diaphragm activation control on sniff nasal-inspiratory pressure and maximum relaxation rate of inspiratory muscles in healthy subjects. Eur Resp J. 2013;42(Suppl 57):1328.

Kamide N, Ogino M, Yamashina N, Fukuda M. Sniff nasal inspiratory pressure in healthy Japanese subjects: Mean values and lower limits of normal. Respiration. 2009;77(1):58-62. https://doi.org/10.1159/000167321

Benício K, Dias FAL, Gualdi LP, Aliverti A, Resqueti VR, Fregonezi GAF. Effects of diaphragmatic control on the assessment of sniff nasal inspiratory pressure and maximum relaxation rate. Braz J Phys Ther. 2016;20(1):96-103. https://doi.org/10.1590/bjpt-rbf.2014.0101er

Onaga FI, Jamami M, Ruas G, Di Lorenzo VAP, Jamami LK. Influência de diferentes tipos de bocais e diâmetros de traqueias na manovacuometria. Fisioter Mov. 2010;23(2):211-19. https://doi.org/10.1590/S0103-51502010000200005

Araújo PRS, Resqueti VR, Nascimento Júnior J, Carvalho LA, Cavalcanti AGL, Silva VC, et al. Valores de referência da pressão inspiratória nasal em indivíduos saudáveis no Brasil: estudo multicêntrico. J Bras Pneumol. 2012;38(6):700-7. https://doi.org/10.1590/S1806-37132012000600004

Severino FG, Resqueti VR, Bruno SS, Azevedo IG, Vieira RHG, Fregonezi GAF. Comparação entre o manovacuômetro nacional e o importado para medida da pressão inspiratória nasal. Braz J Phys Ther. 2010;14(5):426-31. https://doi.org/10.1590/S1413-35552010000500012

Black LF, Hyatt RE. Maximal respiratory pressures: normal values and relationship to age and sex. Rev Respir Dis 1969;99(5):696-702. https://doi.org/10.1164/arrd.1969.99.5.696

Neder JA, Andreoni S, Lerario MC, Nery LE. Reference values for lung function tests. II. Maximal respiratory pressures and voluntary ventilation. J Med Biol Res. 1999;32(6):719-27. https://doi.org/10.1590/S0100-879X1999000600007

Associação Brasileira para o Estudo da Obesidade e da Síndrome Metabólica (ABESO). Diretrizes brasileiras de obesidade. 4 ed. São Paulo: ABESO; 2016.

Almeida IP, Bertucci NR, Lima VP. Variações da pressão inspiratória máxima e pressão expiratória máxima a partir da capacidade residual funcional ou da capacidade pulmonar total e volume residual em indivíduos normais. Mundo Saude. 2008;32(2):176-82. https://doi.org/10.15343/0104-7809.200832.2.7

Brunetto AF, Alves LA. Comparação entre os valores de pico e sustentados das pressões respiratórias máximas em indivíduos saudáveis e pacientes portadores de pneumopatia crônica. J Pneumol. 2003;29(4):208-12.

Martinelli S, Bittar RE, Zugaib M. Proposta de nova curva de altura uterina para gestações entre a 20a e a 42a semana. Rev Bras Ginecol Obstet. 2001;23(4):235-41. https://doi.org/10.1590/S0100-72032001000400006

Silva FT. Avaliação do nível de atividade física durante a gestação. Rev Bras Ginecol Obstet. 2007;29(9). https://doi.org/10.1590/S0100-72032007000900009

Vittinghoff E, Glidden DV, Shiboski SC, McCulloch CE. Regression Methods in Biostatistics: Linear, Logistic, Survival, and Repeated Measures Models. 2nd ed. Springer; 2012.

Azevedo IG, Severino FG, Lucena TA, Resqueti VR, Bruno SS, Fregonezi G. Relação entre pressão inspiratória nasal e pressão inspiratória máxima em pacientes com distrofia miotônica. Rev Ter Man. 2010;8(37):224-30.

Hegewald MJ, Crapo RO. Respiratory Physiology in Pregnancy. Clin Chest Med. 2011;32(1):1-13. https://doi.org/10.1016/j.ccm.2010.11.001

Wells CE, Polkey MI, Baker EH. Insulin resistance is associated with skeletal muscle weakness in COPD. Respirology. 2016;21(4):689-96. https://doi.org/10.1111/resp.12716

Edwards AM, Graham D, Bloxham S, Maguire GP. Efficacy of inspiratory muscle training as a practical and minimally intrusive technique to aid functional fitness among adults with obesity. Respir Physiol Neurobiol. 2016;234:85-8. https://doi.org/10.1016/j.resp.2016.09.007

Heinzmann-Filho JP, Vendrusculo FM, Woszezenki CT, Piva TC, Santos AN, Barcellos AB, et al. Inspiratory muscle function in asthmatic and healthy subjects: influence of age, nutrition and physical activity. J Asthma. 2016;53(9):893-9. https://doi.org/10.3109/02770903.2016.1165698

Gilleard WL, Brown JM. Structure and function of the abdominal muscles in primigravid subjects during pregnancy and the immediate postbirth period. Phys Ther. 1996;76(7):750-62. https://doi.org/10.1093/ptj/76.7.750

Field SK, Bell SG, Cenaiko DF, Whitelaw WA. Relationship between inspiratory effort and breathlessness in pregnancy. J Appl Physiol (1985). 1991;71(5):897-902. https://doi.org/10.1152/jappl.1991.71.5.1897

Melo LC, Silva MAMS, Calles ACN. Obesidade e função pulmonar: uma revisão sistemática. Einstein (Sao Paulo). 2014;12(1):120-5. https://doi.org/10.1590/S1679-45082014RW2691

Melo A, Amorim MMR, Belo MCF, Pinto MC, Sena ASS, Martins FD. Respiratory muscle strength during pregnancy: a cohort study. Obstetr Gynecol. 2015;125:71s. https://doi.org/10.1097/01.AOG.0000463121.86172.25

SantAnna Junior M, Oliveira JEP, Carneiro JRI, Guimarães FS, Magalhães DF, Mafra AM, et al. Força muscular respiratória de mulheres obesas mórbidas e eutróficas. Fisioter Pesq. 2011;18(2):122-6. https://doi.org/10.1590/S1809-29502011000200004

Castello V, Simões RP, Bassi D, Mendes RG, Borghi-Silva A. Força muscular respiratória é marcantemente reduzida em mulheres obesas mórbidas. Arq Med ABC. 2007;32(2):74-7.

Aguiar MM, Rizzo JA, Lima MELS, Melo Junior EF, Sarinho ESC. Asma na gravidez: atualização no manejo. Braz J Allergy Immunol. 2013;1(3):138-42. https://doi.org/10.10.5935/2318-5015.20130013

Pouwels S, Buise MP, Smeenk FWJM, Teijink JA, Nienhuijs SW. Comparative analysis of respiratory muscle strength before and after bariatric surgery using 5 different predictive equations. J Clin Anesth. 2016;32:172-80. https://doi.org/10.1016/j.jclinane.2016.03.005

Junqueira MSR, Sette CVM, Sette CS, Souza JHK. Asma e gravidez: uma abordagem completa. Rev Med Minas Gerais. 2014;24(3):367-73. http://www.dx.doi.org/10.5935/2238-3182.20140104

Carvalhaes MABL, Martiniano ACA, Malta MB, Takito MY, Benício MHD. Physical activity in pregnant women receiving care in primary health care units. Rev Saude Publica. 2013;47(5):958-67. https://doi.org/10.1590/rsp.v47i5.76707