Theoretical and experimental indicators of falls during pregnancy as assessed by postural perturbations

- Pregnancy is often accompanied by decrements in postural control and falls.
- Postural responses of self-identified pregnant fallers and nonfallers were compared.
- Pregnant fallers had smaller peak COP-COG values in response to perturbations.
- A two-segmented model indicated that pregnant nonfallers had higher ankle stiffness.
- Increasing ankle stiffness could be a strategy to prevent falls in pregnant women.

Throughout pregnancy, women experience physical, physiological, and hormonal alterations that are often accompanied by decreased postural control. According to one study, nearly 27% of pregnant women fell while pregnant. This study had two objectives: (1) to characterize the postural responses of pregnant fallers, nonfallers, and controls to surface perturbations, and (2) to develop a mathematical model to gain insights into the postural control strategies of each group. This retrospective analysis used experimental data obtained from 15 women with a fall history during pregnancy, 14 women without a fall history during pregnancy, and 40 nonpregnant controls. Small, medium, and large translational support surface perturbations in the anterior and posterior directions were performed during the pregnant participants' second and third trimesters. A two-segmented mathematical model of bipedal stance was developed and parameterized, and optimization tools were used to identify ankle and hip stiffness, viscosity, and the feedback time delay by searching for the best fits to experimental COP data. The peak differences between the center of pressure and center of gravity (COP-COG) values were significantly smaller for the pregnant fallers compared with the pregnant nonfallers and controls (p < 0.01). Perturbation magnitude was a significant factor (p < 0.01), but perturbation direction was not (p = 0.24). Model fits were obtained with a mean goodness of fit value of R2 = 0.92. Theoretical results indicated that pregnant nonfallers had higher ankle stiffness compared with the pregnant fallers and the controls, which suggests that ankle stiffness itself may be the dominant reason for the different dynamic response characteristics (e.g., peak COP-COG) observed. We conclude that increasing ankle stiffness could be an important strategy to prevent falling by pregnant women.