scholarly journals Discovery of metabolic biomarkers for gestational diabetes mellitus in a Chinese population

2020 ◽  
Author(s):  
Wenqian Lu ◽  
Mingjuan Luo ◽  
Xiangnan Fang ◽  
Rong Zhang ◽  
Mengyang Tang ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Pregnant Women ◽  
Clinical Relevance ◽  
Chinese Population ◽  
Regression Models ◽  
Second Trimester ◽  
Third Trimester ◽  
Logistic Regression Models ◽  
The Third ◽  
New Findings

Abstract Background Metabolomics has provided new insights into the pathology of GDM and has revealed potential biomarkers related to GDM; however, previous findings lack consistency, and systemic analysis of GDM with metabolites is required for providing more clues for GDM diagnosis and mechanism research. This study aims to reveal metabolic differences between normal pregnant women and GDM patients in the second- and third-trimester stages and to confirm the clinical relevance of these new findings.Methods Using ultra-performance liquid chromatography coupled to tandem mass spectrometry system, metabolites were quantitated with the serum samples of GDM and normal pregnancies in second- and third-trimester stages in a Chinese population. Samples were obtained from 200 healthy pregnant women and 200 GDM women in the second trimester, 199 normal controls, and 199 GDM patients in the third trimester at the University of Hong Kong-Shenzhen Hospital. Both function and pathway analyses were applied to find biological roles involved in the two sets of metabolites. We then identified the trimester stage-specific GDM metabolite biomarkers by combining a few machine learning approaches, and the logistic regression models based on selected biomarkers were constructed to evaluate predictive efficiency. Finally, the weighted gene co-expression network analysis method was used to further capture the associations between metabolite modules with biomarkers and clinical indices.Results The associations of metabolites with GDM were evaluated, with 57 differentially expressed metabolites (DEMs) in the second-trimester group and 72 DEMs in the third-trimester group. The DEMs, functions, and pathways showed remarkable differences between second- and third-trimester groups. Thus, stage specific GDM biomarkers were further identified, and the logistic regression models for these metabolite biomarkers achieved the area under the curve values of 0.807 and 0.81 for the second- and third-trimester groups, respectively. The significant associations between the discovered DEMs/biomarkers and GDM-related indices suggest their clinical relevance with GDM and hyperglycemia in pregnant women.Conclusions The present study shows the metabolomics profile in the second- and third-trimester stages in pregnant women with and without GDM. Pathways, DEMs and their associations with GDM related indices have been found. Indeed, further studies are warranted to confirm our findings.

scholarly journals Discovery of metabolic biomarkers for gestational diabetes mellitus in a Chinese population

2021 ◽  
Author(s):  
Wenqian Lu ◽  
Mingjuan Luo ◽  
Xiangnan Fang ◽  
Rong Zhang ◽  
Mengyang Tang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Logistic Regression ◽  
Gestational Diabetes ◽  
Pregnant Women ◽  
Regression Models ◽  
Second Trimester ◽  
Third Trimester ◽  
Logistic Regression Models ◽  
The Third ◽  
Clinical Indices

Abstract Background: Gestational diabetes mellitus (GDM), one of the most common pregnancy complications, can lead to morbidity and mortality in both the mother and the infant. Metabolomics has provided new insights into the pathology of GDM and systemic analysis of GDM with metabolites is required for providing more clues for GDM diagnosis and mechanism research. This study aims to reveal metabolic differences between normal pregnant women and GDM patients in the second- and third-trimester stages and to confirm the clinical relevance of these new findings.Methods: Metabolites were quantitated with the serum samples of 200 healthy pregnant women and 200 GDM women in the second trimester, 199 normal controls, and 199 GDM patients in the third trimester. Both function and pathway analyses were applied to explore biological roles involved in the two sets of metabolites. Then the trimester stage-specific GDM metabolite biomarkers were identified by combining machine learning approaches, and the logistic regression models were constructed to evaluate predictive efficiency. Finally, the weighted gene co-expression network analysis method was used to further capture the associations between metabolite modules with biomarkers and clinical indices. Results: This study revealed that 57 differentially expressed metabolites (DEMs) were discovered in the second-trimester group, among which the most significant one was 3-methyl-2-oxovaleric acid. Similarly, 72 DEMs were found in the third-trimester group, and the most significant metabolites were ketoleucine and alpha-ketoisovaleric acid. These DEMs were mainly involved in the metabolism pathway of amino acids, fatty acids and bile acids. The logistic regression models for selected metabolite biomarkers achieved the area under the curve values of 0.807 and 0.81 for the second- and third-trimester groups. Furthermore, significant associations were found between DEMs/biomarkers and GDM-related indices. Conclusions: Metabolic differences between healthy pregnant women and GDM patients were found. Associations between biomarkers and clinical indices were also investigated, which may provide insights into pathology of GDM.

scholarly journals Discovery of metabolic biomarkers for gestational diabetes mellitus in a Chinese population

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Wenqian Lu ◽  
Mingjuan Luo ◽  
Xiangnan Fang ◽  
Rong Zhang ◽  
Shanshan Li ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Logistic Regression ◽  
Gestational Diabetes ◽  
Pregnant Women ◽  
Regression Models ◽  
Second Trimester ◽  
Third Trimester ◽  
Logistic Regression Models ◽  
The Third ◽  
Clinical Indices

Abstract Background Gestational diabetes mellitus (GDM), one of the most common pregnancy complications, can lead to morbidity and mortality in both the mother and the infant. Metabolomics has provided new insights into the pathology of GDM and systemic analysis of GDM with metabolites is required for providing more clues for GDM diagnosis and mechanism research. This study aims to reveal metabolic differences between normal pregnant women and GDM patients in the second- and third-trimester stages and to confirm the clinical relevance of these new findings. Methods Metabolites were quantitated with the serum samples of 200 healthy pregnant women and 200 GDM women in the second trimester, 199 normal controls, and 199 GDM patients in the third trimester. Both function and pathway analyses were applied to explore biological roles involved in the two sets of metabolites. Then the trimester stage-specific GDM metabolite biomarkers were identified by combining machine learning approaches, and the logistic regression models were constructed to evaluate predictive efficiency. Finally, the weighted gene co-expression network analysis method was used to further capture the associations between metabolite modules with biomarkers and clinical indices. Results This study revealed that 57 differentially expressed metabolites (DEMs) were discovered in the second-trimester group, among which the most significant one was 3-methyl-2-oxovaleric acid. Similarly, 72 DEMs were found in the third-trimester group, and the most significant metabolites were ketoleucine and alpha-ketoisovaleric acid. These DEMs were mainly involved in the metabolism pathway of amino acids, fatty acids and bile acids. The logistic regression models for selected metabolite biomarkers achieved the area under the curve values of 0.807 and 0.81 for the second- and third-trimester groups. Furthermore, significant associations were found between DEMs/biomarkers and GDM-related indices. Conclusions Metabolic differences between healthy pregnant women and GDM patients were found. Associations between biomarkers and clinical indices were also investigated, which may provide insights into pathology of GDM.

Trends in Heart Rate and Heart Rate Variability during Pregnancy and Three Months Postpartum: Continuous Monitoring in a Free-Living Context (Preprint)

2021 ◽  
Author(s):  
Fatemeh Sarhaddi ◽  
Iman Azimi ◽  
Anna Axelin ◽  
Hannakaisa Niela-Vilen ◽  
Pasi Liljeberg ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Pregnant Women ◽  
Time Domain ◽  
Second Trimester ◽  
Third Trimester ◽  
Non Invasive ◽  
The Third ◽  
Invasive Method ◽  
Frequency Power

BACKGROUND Heart rate variability (HRV) is a non-invasive method reflecting autonomic nervous system (ANS) regulations. Altered HRV is associated with adverse mental or physical health complications. ANS also has a central role in physiological adaption during pregnancy causing normal changes in HRV. OBJECTIVE Assessing trends in heart rate (HR) and HRV parameters as a non-invasive method for remote maternal health monitoring during pregnancy and three months postpartum. METHODS Fifty-eight pregnant women were monitored using an Internet-of-Things (IoT)-based remote monitoring system during pregnancy and 3-months postpartum. Pregnant women were asked to continuously wear Gear sport smartwatch to monitor their HR and HRV. In addition, a cross-platform mobile application was utilized for collecting pregnancy-related information. The trends of HR and HRV parameters were extracted using reliable data. We also analyzed the trends of normalized HRV parameters based on HR to remove the effect of HR changes on HRV trends. Finally, we exploited hierarchical linear mixed models to analyze the trends of HR, HRV, and normalized HRV parameters. RESULTS HR increased significantly during the second trimester (P<.001) and decreased significantly during the third trimester (P<.01). Time-domain HRV parameters, average normal interbeat intervals (AVNN), standard deviation of normal interbeat intervals (SDNN), root mean square of the successive difference of normal interbeat intervals (RMSSD), normalized SDNN (nSDNN), and normalized RMSSD (nRMSSD) decreased significantly during the second trimester (P<.001) then increased significantly during the third trimester (P<.01). Some of the frequency domain parameters, low-frequency power (LF), high-frequency power (HF), and normalized HF (nHF) decreased significantly during the second trimester (P<.01), and HF increased significantly during the third trimester (P<.01). In the postpartum period, nRMSSD decreased (P<.05), and the LF to HF ratio (LF/HF) increased significantly (P<.01). CONCLUSIONS Our study showed that HR increased and HRV parameters decreased as the pregnancy proceeded, and the values returned to normal after the delivery. Moreover, our results show that HR started to decrease while time-domain HRV parameters and HF started to increase during the third trimester. Our results also demonstrate the possibility of continuous HRV monitoring in everyday life settings.

Gestation specific reference intervals for thyroid function tests in pregnancy

2016 ◽  
Vol 54 (8) ◽  
Author(s):  
Süleyman Akarsu ◽  
Filiz Akbiyik ◽  
Eda Karaismailoglu ◽  
Zeliha Gunnur Dikmen
Keyword(s):  
Pregnant Women ◽  
Thyroid Function ◽  
First Trimester ◽  
Reference Intervals ◽  
Specific Reference ◽  
Thyroid Function Tests ◽  
Second Trimester ◽  
Third Trimester ◽  
The Third ◽  
Function Tests

AbstractThyroid function tests are frequently assessed during pregnancy to evaluate thyroid dysfunction or to monitor pre-existing thyroid disease. However, using non-pregnant reference intervals can lead to misclassification. International guidelines recommended that institutions should calculate their own pregnancy-specific reference intervals for free thyroxine (FT4), free triiodothyronine (FT3) and thyroid-stimulating hormone (TSH). The objective of this study is to establish gestation-specific reference intervals (GRIs) for thyroid function tests in pregnant Turkish women and to compare these with the age-matched non-pregnant women.Serum samples were collected from 220 non-pregnant women (age: 18–48), and 2460 pregnant women (age: 18–45) with 945 (39%) in the first trimester, 1120 (45%) in the second trimester, and 395 (16%) in the third trimester. TSH, FT4 and FT3 were measured using the Abbott Architect i2000SR analyzer.GRIs of TSH, FT4 and FT3 for first trimester pregnancies were 0.49–2.33 mIU/L, 10.30–18.11 pmol/L and 3.80–5.81 pmol/L, respectively. GRIs for second trimester pregnancies were 0.51–3.44 mIU/L, 10.30–18.15 pmol/L and 3.69–5.90 pmol/L. GRIs for third trimester pregnancies were 0.58–4.31 mIU/L, 10.30–17.89 pmol/L and 3.67–5.81 pmol/L. GRIs for TSH, FT4 and FT3 were different from non-pregnant normal reference intervals.TSH levels showed an increasing trend from the first trimester to the third trimester, whereas both FT4 and FT3 levels were uniform throughout gestation. GRIs may help in the diagnosis and appropriate management of thyroid dysfunction during pregnancy which will prevent both maternal and fetal complications.

scholarly journals Association of Sodium, Potassium and Sodium-to-Potassium Ratio with Urine Albumin Excretion among the General Chinese Population

Nutrients ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 3456
Author(s):  
Yuewen Sun ◽  
Puhong Zhang ◽  
Yuan Li ◽  
Feng J. He ◽  
Jing Wu ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Renal Function ◽  
Chinese Population ◽  
Regression Models ◽  
Mixed Effects ◽  
Sodium Potassium ◽  
Logistic Regression Models ◽  
Albumin Excretion ◽  
Renal Function Impairment ◽  
Function Impairment

Mixed evidence was published regarding the association of sodium, potassium and sodium-to-potassium ratio (Na/K ratio) with renal function impairment. This study was conducted to further explore the relationship between sodium, potassium, NA/K ratio and kidney function in the general adult Chinese population. We performed a cross-sectional analysis using the baseline data from the Action on Salt China (ASC) study. 5185 eligible general adult participants from the baseline investigation of the ASC study were included in this analysis. Sodium, potassium and albumin excretion were examined from 24-h urine collection. Albuminuria was defined as albumin excretion rate (AER) greater than or equal to 30 mg/24-h. Mixed linear regression models, adjusted for confounders, were fitted to analyze the association between sodium, potassium and Na/K ratio, and natural log transformed AER. Mixed effects logistic regression models were performed to analyze the odds ratio of albuminuria at each quintile of sodium, potassium and Na/K ratio. The mean age of the participants was 49.5 ± 12.8 years, and 48.2% were male. The proportion of albuminuria was 7.5%.The adjusted mixed linear models indicated that sodium and Na/K ratio was positively associated with natural log transformed AER (Sodium: β = 0.069, 95%CI [0.050, 0.087], p < 0.001; Na/K ratio: β = 0.026, 95%CI [0.012, 0.040], p < 0.001). Mixed effects logistic regression models showed that the odds of albuminuria significantly increased with the quintiles of sodium (p < 0.001) and Na/K ratio (p = 0.001). No significant association was found between potassium and the outcome indicators. Higher sodium intake and higher Na/K ratio are associated with early renal function impairment, while potassium intake was not associated with kidney function measured by albumin excretion.

scholarly journals Glycaemic profile in the second and third trimesters of normal pregnancy compared to non-pregnant adult females

2019 ◽  
Vol 13 (1) ◽  
pp. 30-36 ◽  
Author(s):  
Aruna Nigam ◽  
Neha Varun ◽  
Sumedha Sharma ◽  
YP Munjal ◽  
Anupam Prakash
Keyword(s):  
Blood Glucose ◽  
Pregnant Women ◽  
Normal Pregnancy ◽  
Postprandial Blood Glucose ◽  
Second Trimester ◽  
Third Trimester ◽  
Glycaemic Variability ◽  
The Third ◽  
Data Points ◽  
Mean Blood Glucose

Aim To assess the glycaemic profile and glycaemic variation in the second and third trimesters of normal pregnancies. Methodology Healthy pregnant women aged 19–35 years between 24 and 36 weeks of gestation were recruited for ambulatory glucose profile monitoring. A total of 18 women in the second trimester, 15 women in the third trimester and 9 healthy non-pregnant women were recruited providing, respectively, 205 days (19,680 data points), 147 days (14,112 data points) and 100 days (9,600 data points) for analysis. Results Mean blood glucose level was 20.2% lower in the second trimester and 10.6% lower in the third trimester than non-pregnant women (p < 0.001). In pregnancy, it took 15 to 20 minutes more to reach peak postprandial blood glucose levels compared to non-pregnant women (p = 0.003). Glycaemic variability was more in the third trimester (p < 0.001). Conclusion There is tight blood sugar control along with lower mean blood glucose in healthy pregnant women compared to non-pregnant women. Despite this tight glycaemic control, glycaemic variability is higher during pregnancy.

scholarly journals Association of Ambient Air Pollution with Perceived Stress in Pregnant Women: A Prospective Cohort Study

2021 ◽  
Author(s):  
Dirga Kumar Lamichhane ◽  
Dal-Young Jung ◽  
Yee-Jin Shin ◽  
Kyung-Sook Lee ◽  
So-Yeon Lee ◽  
...  
Keyword(s):  
Air Pollution ◽  
Pregnant Women ◽  
Perceived Stress ◽  
Regression Models ◽  
Ambient Air ◽  
Air Pollutant ◽  
Ambient Air Pollution ◽  
Linear Regression Models ◽  
Third Trimester ◽  
The Third

Abstract Background: Air pollution is associated with perceived stress in the general population, but its influence on maternal perceived stress during pregnancy has not been investigated.We aimed to investigate the relationship between air pollution and non-specific perceived stress among pregnant women.Methods: Our analysis included2162 pregnant women who had participated in the cohort for childhood origin of asthma and allergic disease study between 2008 and 2015. Maternal exposures to particulate matter with an aerodynamic diameter < 2.5 µm (PM2.5) and < 10 µm (PM10), as well as to nitrogen dioxide (NO2) and ozone (O3) for each trimesterand the entire pregnancy were determined using land-use regression models. Maternal perceived stress during the third trimester was assessed using the 14-item Perceived Stress Scale (PSS): scores ranged from 0-56 with higher scores indicating increased stress. Linear regression models were applied to estimate associations between PSS scores and each air pollutant, after adjusting for socio-demographic and behavioral covariates.Results: In single-pollutant models,after adjustment, an IQR increase in the whole pregnancy exposure to PM2.5 and PM10 and O3 in the third trimester was related to 0.37 (95% confidence interval [CI]: 0.01, 0.74) and 0.55 (95% CI: 0.12, 0.98) and 0.29 (95% CI: 0.05, 0.52) points increase in the PSS score, respectively.This association was more evident in women with child-bearing age and lower levelofeducation, and the association of PM10was stronger in thespring season.In multi-pollutant models, exposures to PM10 and O3 were associated with higher perceived stress. Conclusion:Our findings suggest that pregnancy exposure to PM2.5, PM10and O3 is positively associated with maternal PSS score during the third trimester.

scholarly journals Relationships between Physical Activity and Quality of Life in Pregnant Women in the Second and Third Trimester

2018 ◽  
Vol 15 (12) ◽  
pp. 2745 ◽  
Author(s):  
Justyna Krzepota ◽  
Dorota Sadowska ◽  
Elżbieta Biernat
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Pregnant Women ◽  
Occupational Activity ◽  
Second Trimester ◽  
Third Trimester ◽  
The Third ◽  
Exercise Activity ◽  
Physical Health Domain

Background: The problem of an inadequate level of physical activity (PA) is important in the context of its relationship with the quality of life (QoL) of pregnant women. The aim of this study was to analyze the relationships between PA and QoL among pregnant women. Methods: The study analyzed 346 questionnaires filled in by pregnant women (157 in the second trimester and 189 in the third). The tool used for assessment of PA was the Pregnancy Physical Activity Questionnaire-Polish version (PPAQ-PL). The quality of life (QoL) was assessed by the World Health Organization Quality of Life Questionnaire-short form (WHOQoL-Bref). The results obtained from the PPAQ-PL and WHOQoL-Bref questionnaires for women in the second and third trimesters of pregnancy and intergroup differences were analyzed. Results: There was a significant correlation in the group of women in the second trimester of pregnancy between quality of life in the physical health domain and the intensity and type of physical activity. The women who rated their quality of life higher in this domain declared higher energy expenditures (EE) associated with vigorous activity (R = 0.159, p ≤ 0.05), as well as with occupational activity (R = 0.166; p ≤ 0.05) and sport/exercise activity (R = 0.187; p ≤ 0.05). In women in the third trimester, higher EE related to sport/exercise activity coincided with higher assessments of the overall quality of life (R = 0.149, p ≤ 0.05) and general health (R = 0.170, p ≤ 0.05). In the case of the psychological domain (R = 0.161, p ≤ 0.05) and social relationship domain (R = 0.188; p ≤ 0.05) of QoL, positive correlations occurred with EE related to vigorous activity. In contrast, high assessment of physical health domain coincided with higher EE related to occupational activity (R = 0.174; p ≤ 0.05). Conclusions: Our study makes an important contribution to knowledge concerning the correlations between PA and QoL in pregnancy. The results suggest the need for improvement in prenatal care and promotion of PA programs for pregnant women.

scholarly journals FOR HIGHLY PATHOGENIC INFLUENZA A(H1N1) IN PREGNANCY AND IMPACT ON BIRTH OUTCOMES

2018 ◽  
Vol 23 (3) ◽  
pp. 119-125
Author(s):  
M. G. Avdeeva ◽  
O. R. Gafurova
Keyword(s):  
Nervous System ◽  
Pregnant Women ◽  
Influenza A ◽  
Intrauterine Infection ◽  
First Trimester ◽  
Second Trimester ◽  
Third Trimester ◽  
Highly Pathogenic ◽  
The Third ◽  
Influenza A H1n1

The purpose of this study was to improve the diagnosis of influenza A (H1N1) in pregnant women and to determine the risk of developing various types of pathology in newborns, depending on the gestation period at which the infection influenza occured. Materials and methods. A total of 94 pregnant women, an average age of 28.7 ± 0.48, who were on treatment with influenza diagnosis in the Specialized Infectious Disease Clinical Hospital of the Ministry of Health of the Krasnodar Territory during the epidemic rise of influenza A (H1N1) from December 2015 to February 2016. The diagnosis of influenza A (H1N1) was confirmed in all cases by the isolation of RNA of influenza A (H1N1) virus by PCR in a nasopharyngeal scrap. Patients applied for medical care on average 2.74 ± 0.16 days of illness. Pregnancy at the gestational age corresponding to the first trimester was in 20 (21.3%), in the term of the second trimester - in 36 (38.3%), and in the third trimester - in 38 (40.4 %) of women. The results of the laboratory examination were evaluated. Pregnancy outcomes were traced in 94 women, a telephone questioning of women was conducted 3-6 months after childbirth, the state of children at birth was analyzed based on the results of a retrospective analysis of 91 neonatal card in the maternity hospital. Results. Highly pathogenic influenza A (H1N1) in pregnant women during early treatment and prescription of antiviral therapy was mainly in medium-heavy form (96.81%). In the first day of the disease, subfebrile fever predominated - 63.3%, febrile fever subsequently developed in 53.33%, headache, and other intoxication manifestations were less than in the case of epidemical influenza A. Catarrhal syndrome is not bright, often characterized by early joint cough. The main complication of influenza, determining the severity of the patient state, was pneumonia, developed in one third of patients. Early antibacterial and antiviral therapy in most cases prevented the formation of severe lung lesions and abortion. Pregnancy ended with urgent deliveries in 89 women (94.68%); in three cases, in women who had influenza at 6, 15 and 29 weeks of gestation, abortion with fetal death (3.19%) occurred. Premature delivery at 28 and 33 weeks of gestation with the birth of a viable child occurred in two cases (2.13%). The development of influenza in the first trimester resulted in complications in 42% of cases, increasing the risk of abortion and developmental anomalies, mainly from the cardiovascular system (26.31%). Infection of pregnant women with influenza in the second trimester led to a different pathology of newborns in 49% cases. Among them, acute intranatal asphyxia prevailed (14.29%), pathology of the nervous system (11.43%), less frequently developed intrauterine infection, pneumonia (5.71%). Special attention is required by women with influenza in the third trimester of pregnancy, in this group, the pathology of the newborns was noted in 54% of cases, mainly in the form of acute intranatal asphyxia (29.73%) against the background of intrauterine infection, pneumonia (16.22%), central nervous system pathology (8.11%). The conclusion. Despite the medium-heavy course, the woman’s influenza had an adverse effect on the formation of the fetus and the condition of the newborn at birth. On the background of influenza infection, the degree and nature of exposure depended on the gestation period.

Midwifery Care for Pregnant Women With Back Pain Discomfort in Trimester III Pregnancy at the Karunia Birth Clinic, Sidoarjo.

Academia Open ◽  
2021 ◽  
Vol 5 ◽  
Author(s):  
Anggraeni Kriswidya Putri ◽  
Hanik Machfudloh
Keyword(s):  
Back Pain ◽  
Data Collection ◽  
Pregnant Women ◽  
Gestational Age ◽  
Analysis Data ◽  
Second Trimester ◽  
Third Trimester ◽  
Midwifery Care ◽  
The Third ◽  
Maternity Clinic

Pregnancy is a process that begins with the unification of spermatozoa with ovum called fertilization and then continued with implantation. Normal pregnancies generally last for 9 months, and are divided into the first 3 trimesters 1-12 weeks, the second trimester 13-27 weeks, the third trimester 28-40 weeks. Various complaints felt by pregnant women, one of which is back pain that causes pregnant women discomfort. This aerikel was written taken from the place of Maternity Clinic Karunia Sidoarjo on January 05, 2020. The way of data collection is by means of anamnesa, examination of analysis, data then documenting by comparing between the data that has been obtained with existing theories. Mrs. .m 40 weeks gestational age, with complaints of physiological back pain with good maternal and fetal conditions.

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