In 2021, over three and a half million women entered the postpartum period in the United States [1]. Despite their prevalence, postpartum health is a largely overlooked area. After delivery, 25% of women within this population experience lumbopelvic or pelvic pain during the typical postpartum period [3], up to 8 weeks post-delivery, and research has found these women may continue to experience pain years after delivery [4]. Persistent pelvic region pain in postpartum women may result in lower limb load asymmetry. Additionally, external loading from carrying a child may alter the degree of asymmetric loading that exists in the lower limbs. Therefore, the first purpose of this study was to investigate the effect of daily tasks on lower extremity load symmetry using metrics that have successfully identified load asymmetry in other populations. Load symmetry was found to differ between task, with the largest asymmetry occurring between limbs during the sit-to-stand task for the peak impact force (PIF = 9.08% symmetry) and during the stair descent task for the average loading rate (ALR = 15.43% symmetry). The increase in asymmetry during these tasks may be attributed to increased muscle activation and force production. The second purpose of this study was to investigate the effect of an external child load on lower extremity load asymmetry during a 14-meter level walking task. A significant increase was found between the no load and both child load conditions for PIF and ALR (p <0.001 for both metrics). No statistically significant differences in symmetry were found between carrying the child centrally in a carrier and carrying on one side of the body without a carrier. The lack of difference in asymmetry during child carrying conditions may indicate mothers naturally compensate for the external child load as both ALR and PIF values increased during these conditions, but asymmetry was not impacted. Our results indicate the need to continue to examine different carrying conditions in postpartum women to better understand risk factors for pain or injury and provide evidence-based recommendations for postpartum activity progression. / Master of Science / In 2021, over three and a half million women entered the postpartum period in the United States [1]. Despite their prevalence, postpartum health is a largely overlooked area and 25% of women experience low back or pelvic pain past the typical postpartum period of 8 weeks post delivery [3]. Research has found women may continue to experience this pain years after delivery and result from the lower limbs being loaded unequally. The extra weight from carrying a child may also impact the amount of unequal loading placed onto the lower limbs. The first purpose of this study was to investigate the effect of daily tasks on load symmetry in the lower limbs using measures that have successfully identified unequal load distribution in non-pregnant individuals. Load symmetry was found to differ between task, with the largest asymmetry occurring between limbs during the sit-to-stand task for the force applied to lower limbs during initial contact of the feet and during the stair descent task for the rate that force was applied to lower limbs. The second purpose of this study was to investigate the effect of an external child load on lower extremity load asymmetry during a 14-meter level walking task. A significant increase was found between the no load and both baby load conditions for force applied during initial contact of the feet and rate this force was applied. No difference was found between child carrying external loading condition when evaluating asymmetry. Our results indicate the need to continue to investigate the unique loading patterns of postpartum women to better understand the specific risk factors for pain or injury development within this population.

Background: The childbearing years place socioeconomically disadvantaged African American women at increased risk for poor diet quality, excess weight gain, and cardiometabolic complications. Little is known about the attitudes, beliefs, values, and contextual constraints that shape these high risk mothers’ dietary and physical activity behaviors. Objective: The purpose of this study was to examine health perceptions of diet quality and physical activity among low-income African American women in the early postpartum period, and how these perceptions manifest as barriers or facilitators to health. Additionally, we examined how they may differ by known predictors of health, such as education, age, parity, and BMI. Methods: We conducted semi-structured, individual interviews with 20 women who were between 3-6 months postpartum. Mothers were approached and recruited in the waiting room of a university-affiliated, outpatient prenatal care clinic in Philadelphia, PA. Enrollment in the study was restricted to women who self-identified as African American, were at least 18 years old, and met the federal income guidelines to qualify for assistance (Medicaid, WIC). Individual interviews were audio recorded and transcribed verbatim, with transcripts verified by research staff. Thematic coding and content analysis were performed by 3 researchers using NVivo 10 software to assist with data management. Results: Barriers and facilitators of healthy eating and physical activity after childbirth fell into 4 major themes of mothers’ lives: 1) new structural reality in the postpartum period; 2) physiologic changes after delivery; 3) correct/incorrect perceptions of healthy eating and activity; and 4) social determinants influencing behaviors. Mothers described the transition from pregnancy to the early postpartum period as having a significant negative impact on their eating and activity behaviors due to heightened fatigue, time constraints, and the monotony of daily life with a newborn. We found more than double the number of perceived barriers to engaging in healthy eating than facilitators with regard to fluctuations in food supply, cost of food, and the built environment. Mothers with obesity and less education were more likely to have misperceptions; these misperceptions additionally served as strong barriers to making healthy lifestyle choices. Changes in mothers’ physical symptoms and health status (e.g., developing diabetes, hypertension), on the other hand, facilitated healthy behaviors. Conclusion: This research deepens our understanding of the primary drivers of health behaviors among low-income African American women in the postpartum period. We identified barriers which limit and facilitators which support these mothers’ ability to engage in healthy behaviors, though there were far fewer facilitators of healthy eating and physical activity. Interventions designed to overcome these barriers and capitalize on these facilitators have the potential to improve health outcomes for this population. / Urban Bioethics

Every year, over 3.5 million women give birth in the United States, with about 67.9% delivering vaginally. Over 80% of postpartum (PP) women experience chronic pain in the pelvis, lower back, hip, and legs at 24 weeks after birth, and 20% continue to experience these issues 3 years later. PP women often face pelvic instability and weakness, which disturb balance and lead to asymmetric loading in the pelvis and legs. This imbalance makes daily tasks, such as lifting and carrying a car seat during childcare, more difficult, and increases the risk of chronic pain and injury. This study aimed to explore how different groups – PP and nulliparous (NP) women – and different ways of holding a car seat while standing – no holding, symmetrical holding with two hands in front, and asymmetrical holding with one arm by the side – affect balance and limb loading symmetry. Results showed that postpartum women struggled more with balance as the task became more challenging, with asymmetrical holding showing large differences between groups. PP women also exhibited greater asymmetric limb loading compared to NP women with asymmetrical holding creating the greatest level of asymmetric limb loading. The study also aimed to explore how the two groups – PP and NP – and the different ways of lifting a car seat – symmetrically and asymmetrically – affect balance and limb loading. Both groups had more asymmetric limb loading and worse balance with asymmetrical lifting, though NP women showed larger movements during asymmetrical lifting, likely reflecting the movement of the body during the condition. These results highlight the importance to further research balance and limb loading in PP compared to NP women. Understanding whether pelvic instability and weakness may contribute to differences in balance and limb loading is crucial as it may help explain how and why postpartum women face higher risk of injury and chronic pain. Ultimately, such work may find ways to improve postpartum health during daily activities. / VT Engineering Faculty Organization-Opportunity (EFO-O) Seed Investment / Master of Science / Every year, over 3.5 million women give birth in the United States, with about 67.9% delivering vaginally. Over 80% of postpartum (PP) women experience chronic pain in the pelvis, lower back, hip, and legs at 24 weeks after birth, and 20% continue to experience these issues 3 years later. PP women often face pelvic instability and weakness, which disturb balance and lead to asymmetric loading in the pelvis and legs. This imbalance makes daily tasks, such as lifting and carrying a car seat during childcare, more difficult, and increase the risk of chronic pain and injury. This study aimed to explore how different groups – PP and nulliparous (NP) women – and different ways of holding a car seat while standing – no holding, symmetrical holding with two hands in front, and asymmetrical holding with one arm by the side – affect balance and limb loading symmetry. Results showed that postpartum women struggled more with balance as the task became more challenging, with asymmetrical holding showing large differences between groups. PP women also exhibited greater asymmetric limb loading compared to NP women with asymmetrical holding creating the greatest level asymmetric limb loading. The study also aimed to explore how the two groups – PP and NP – and the different ways of lifting a car seat – symmetrically and asymmetrically – affect balance and limb loading. Both groups had more asymmetric limb loading and worse balance with asymmetrical lifting, though NP women showed larger movements during asymmetrical lifting, likely reflecting the movement of the body during the condition. These results highlight the importance to further research balance and limb loading in PP compared to NP women. Understanding whether pelvic instability and weakness may contribute to differences in balance and limb loading is crucial as it may help explain how and why postpartum women face higher risk of injury and chronic pain. Ultimately, such work may find ways to improve postpartum health during daily activities.

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