Osteopathic Manipulative Medicine in Pregnancy: Physiologic and Clinical Effects

描述（由申请人提供）：整骨手法医学（OMM）是一种补充和替代的基于身体的治疗方法，其中对患者进行评估和治疗，包括肌肉骨骼系统，以改善生理功能并消除最佳健康和功能的障碍。在怀孕期间，妇女的身体受到重大和广泛的生理和生物力学变化的挑战，这些变化影响到她的所有身体系统和生活的各个方面。许多这些变化反映在她的肌肉骨骼系统，并能够受到OMM的影响。该提案将通过在五年内进行三项研究来调查OMM影响与妊娠，分娩和分娩相关的选定条件的有效性和假设的生理机制。研究1将讨论妊娠晚期连续OMM治疗在改善几种临床结局方面的疗效，而研究2和3将讨论可能有助于这些临床获益的潜在生理和生物力学机制。研究假设和目的包括：研究一假设OMM改善了妊娠期的选定临床结局。目的：确定OMM是否可以减轻产前和产后的腰痛目的：确定OMM是否可以改善产前和产后的功能状态目的：为了确定OMM是否可以降低分娩和分娩中羊水胎粪污染的发生率作为胎儿应激的指标，研究两个假设与改善自主神经和外周血流动力学调节相关的生理变化，部分是，负责研究一中OMM的假设临床效应。目的：为了研究OMM如何影响妊娠期间的自主平衡，目的：为了确定OMM如何影响妊娠晚期下肢水肿研究三假设与改善步态相关的生物力学变化部分负责研究一中OMM的假设临床效果。目的：评估妊娠晚期步态的功能和生物力学变化，以及OMM如何影响步态。这3项研究将采用安慰剂对照、随机、设盲设计，以检测OMM干预对选定结局的影响。如果发现OMM在治疗妊娠、分娩和分娩的特定结局方面有效，则应将其视为常规产前护理的补充部分，作为改善母胎健康的一种方式。

DESCRIPTION (provided by applicant): Osteopathic manipulative medicine (OMM) is a complementary and alternative body-based treatment method in which the patient is evaluated and treated including the musculoskeletal system to improve physiologic functioning and remove impediments to optimal health and functioning. During pregnancy, a woman's body is challenged by significant and extensive physiological and biomechanical changes that impact all her body systems and all aspects of her life. Many of these changes are reflected in her musculoskeletal system, and are able to be affected by OMM. This proposal will investigate the efficacy and hypothesized physiological mechanisms by which OMM affects selected conditions related to pregnancy, labor and delivery by conducting three studies over five years. Study One will address the efficacy of adjunctive OMM therapy during 3rd trimester of pregnancy in improving several clinical outcomes whereas Studies Two and Three will address potential physiological and biomechanical mechanisms that may contribute to these clinical benefits. Study hypotheses and aims include: Study One Hypothesis OMM improves selected clinical outcomes in pregnancy. Aim: To determine if OMM can decrease low back pain in the pre and post-partum period Aim: To determine if OMM can improve functional status in the pre and post-partum period Aim: To determine if OMM can decrease the incidence of meconium-stained amniotic fluid in labor and delivery as an index of fetal stress Study Two Hypothesis Physiological changes related to improved autonomic and peripheral hemodynamic regulation are, in part, responsible for the hypothesized clinical effects of OMM in Study One. Aim: To examine how OMM affects autonomic balance during pregnancy, Aim: To determine how OMM impacts lower extremity edema in the third trimester of pregnancy Study Three Hypothesis Biomechanical changes related to improved gait are, in part, responsible for the hypothesized clinical effects of OMM in Study One. Aim: To evaluate functional and biomechanical changes in gait in the third trimester of pregnancy, and how OMM may affect gait. These 3 studies will use a placebo-controlled, randomized, blinded design to test the impact of the OMM intervention on the selected outcomes. If OMM is found to be efficacious in the treatment of the selected outcomes of pregnancy, labor, and delivery, it should be considered a complementary part of routine prenatal care as a way to improve maternal-fetal health.