Elsevier

Obstetrics & Gynecology

Volume 101, Issue 2, February 2003, Pages 331-335
Obstetrics & Gynecology

Original research
Characterization of the relationship between joint laxity and maternal hormones in pregnancy

https://doi.org/10.1016/S0029-7844(02)02447-XGet rights and content

Abstract

Objective

To evaluate peripheral joint laxity during pregnancy and to correlate changes with serum cortisol, estradiol, progesterone, and relaxin.

Methods

Forty-six women with first-trimester singleton gestations consented to participate in this longitudinal observational study. Bilateral wrist laxity measurements (flexion-extension and medial-lateral deviation) were made using a clinical goniometer, and serum levels of cortisol, estradiol, progesterone, and relaxin were determined during each trimester of pregnancy and postpartum. Patients were also screened for subjective joint complaints. Statistical analysis included Student t test, analysis of variance, and linear regression analysis.

Results

Eleven women (24%) were excluded from the study after spontaneous first-trimester pregnancy loss. Fifty-four percent (19 of 35) demonstrated increased laxity (10% or higher) in either wrist from the first to the third trimester. Although serum levels of cortisol, estradiol, progesterone, and relaxin were significantly elevated during pregnancy, no significant differences in these levels were noted between those who became lax during gestation and those who did not. Linear regression analysis of wrist joint laxity and level of serum estradiol, progesterone, and relaxin demonstrated no significant correlation. Wrist flexion-extension laxity, however, did significantly correlate with level of maternal cortisol (r = 0.18, P = .03). Fifty-seven percent of women developed subjective joint pain during pregnancy, which was not associated with increased joint laxity, but was associated with significantly increased levels of estradiol and progesterone.

Conclusion

Peripheral joint laxity increases during pregnancy; however, these changes do not correlate well with maternal estradiol, progesterone, or relaxin levels.

Section snippets

Materials and methods

Forty-six healthy low-risk pregnant women presenting to the Mayo Medical Center prenatal clinic in the first trimester with a documented singleton intrauterine pregnancy were prospectively recruited for this Institutional Review Board-approved longitudinal observational study of peripheral joint laxity between April 1997 and April 1998. Women with a history of joint problems (systemic lupus erythematosus, rheumatoid arthritis, Ehlers-Danlos syndrome, wrist fracture, etc) or with subsequent

Results

Forty-six women were initially enrolled for this prospective investigation of joint laxity. Of the initial women, 11 (24%) women were excluded from the longitudinal investigation after first-trimester pregnancy loss. Table 1 depicts the patient demographics for the study cohort. Mean delivery gestational age for the study cohort was 39.7 ± 0.2 weeks. Mean wrist flexion-extension (Figure 1, top) and medial-lateral deviation (Figure 1, bottom) joint laxity increased as gestation progressed, with

Discussion

This study, along with several previous investigations,12, 14, 15 confirms that peripheral joint laxity generally increases over the course of pregnancy and in the postpartum period. We did not confirm a significant association between increasing laxity and parity, maternal age, gestational age at birth, or race. Unique to this study is the use of a laxitometer designed and tested by the Mayo Orthopedics Biomechanics Department. This device is accurate in detecting minimal changes in wrist

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