Risk factors for diastasis recti abdominis and its correlation with pelvic organ prolapse among postpartum women in southwest China: a retrospective case-control study

TL;DR

This study finds that diastasis recti abdominis is common in postpartum women in southwest China and is linked to factors like high birth weight and multiple pregnancies.

Contribution

The study provides new insights into DRA risk factors and its correlation with pelvic organ prolapse in a large Chinese postpartum population.

Findings

High neonatal birth weight (≥3.5 kg) is an independent risk factor for DRA.

Multiparous women are more than twice as likely to develop DRA compared to nulliparous women.

Vaginal delivery and moderate pelvic floor muscle strength are protective against DRA.

Abstract

Diastasis recti abdominis (DRA) is a prevalent postpartum condition characterized by separation of the rectus abdominis muscles. It has been linked to lumbopelvic pain, pelvic floor dysfunction, and urinary incontinence. However, large-scale epidemiological data from Chinese populations and study investigating its relationship with pelvic organ prolapse (POP) are limited.

This is a retrospective case-control study which analyzed 4,426 women at 6th week postpartum at Chengdu Women's and Children's Central Hospital between January 2019 and January 2025. DRA was diagnosed by ultrasonography, and POP was staged using the POP-Q system. Maternal, obstetric, and pelvic floor variables were collected. Independent risk factors of DRA were identified through ordinal logistic regression analyses. Spearman correlation was used to examine the relationship between DRA severity and POP stage. A two-tailed p value less than 0.05 is regarded as statistically significant.

DRA was detected in 65.6% of participants, with 52.6% classified as mild to moderate. High neonatal birth weight (≥3.5 kg) is independent risk factor for DRA (OR 2.43, 95% CI 1.75–3.35). Multiparas were more than twice as likely to develop DRA compared to their nulliparous counterparts (OR 2.67, 95% CI 1.30–5.45). Vaginal delivery (OR 0.45, 95% CI 0.40–0.51) and type I pelvic floor muscle strength grade II to IV were associated with lower risks for DRA. More than half of women in each age group (20–29, 30–39, and ≥40-year-old) presented with both DRA and POP. Spearman analysis showed a significant negative correlation between DRA severity and POP stage (ρ = –0.220, p < 0.001).

Diastasis recti abdominis is highly prevalent among Chinese postpartum women and is influenced by parity, birth weight, gestational weight gain, and maternal BMI. Vaginal delivery and moderate (Grade II–IV) strength of Type I pelvic floor muscles were found to be protective against Diastasis Recti Abdominis.

Figures