{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T02:09:47Z","timestamp":1747188587926,"version":"3.40.5"},"reference-count":32,"publisher":"Human Kinetics","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,12,1]]},"abstract":"<jats:p>Gait asymmetry is a predictor of fall risk and may contribute to increased falls during pregnancy. Previous work indicates that pregnant women experience asymmetric joint laxity and pelvic tilt during standing and asymmetric joint moments and angles during walking. How these changes translate to other measures of gait asymmetry remains unclear. Thus, the purpose of this case study was to determine the relationships between pregnancy progression, subsequent pregnancies, and gait asymmetry. Walking data were collected from an individual during 2 consecutive pregnancies during the second and third trimesters and 6 months postpartum of her first pregnancy and the first, second, and third trimesters and 6 months postpartum of her second pregnancy. Existing asymmetries in step length, anterior\u2013posterior (AP) impulses, AP peak ground reaction forces, lateral impulses, and joint work systematically increased as her pregnancy progressed. These changes in asymmetry may be attributed to pelvic asymmetry, leading to asymmetric hip flexor and extensor length, or due to asymmetric plantar flexor strength, as suggested by her ankle work asymmetry. Relative to her first pregnancy, she had greater asymmetry in step length, step width, braking AP impulse, propulsive AP impulse, and peak braking AP ground reaction force during her second pregnancy, which may have resulted from increased joint laxity.<\/jats:p>","DOI":"10.1123\/jab.2023-0013","type":"journal-article","created":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T16:05:34Z","timestamp":1694621134000},"page":"403-413","source":"Crossref","is-referenced-by-count":0,"title":["The Influence of Multiple Pregnancies on Gait Asymmetry: A Case Study"],"prefix":"10.1123","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1071-9548","authenticated-orcid":true,"given":"Aude S.","family":"Lefranc","sequence":"first","affiliation":[{"name":"Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9527-9590","authenticated-orcid":true,"given":"Glenn K.","family":"Klute","sequence":"additional","affiliation":[{"name":"Department of Veteran Affairs, Center for Limb Loss and MoBility, Seattle, WA, USA"},{"name":"Department of Mechanical Engineering, University of Washington, Seattle, WA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2425-004X","authenticated-orcid":true,"given":"Richard R.","family":"Neptune","sequence":"additional","affiliation":[{"name":"Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"100","reference":[{"issue":"6","key":"r1","series-title":"Am J Ind Med","first-page":"664","article-title":"Falls in workers during pregnancy: risk factors, job hazards, and high risk occupations","volume":"44","author":"Dunning K","year":"2003","unstructured":"Dunning K, LeMasters G, Levin L, Bhattacharya A, Alterman T, Lordo K. Falls in workers during pregnancy: risk factors, job hazards, and high risk occupations. Am J Ind Med. 2003;44(6):664\u2013672. PubMed ID: 14635243 doi:10.1002\/ajim.10318"},{"issue":"6","key":"r2","series-title":"Am J Perinatol","first-page":"331","article-title":"Trauma and pregnancy","volume":"14","author":"Connolly AM","year":"1997","unstructured":"Connolly AM, Katz VL, Bash KL, McMahon MJ, Hansen WF. Trauma and pregnancy. Am J Perinatol. 1997;14(6):331\u2013336. PubMed ID: 9217953 doi:10.1055\/s-2007-994155"},{"issue":"3","key":"r3","series-title":"Emerg Med Clin North Am","first-page":"623","article-title":"Trauma in pregnancy","volume":"5","author":"Neufeld JDG","year":"1987","unstructured":"Neufeld JDG, Moore EE, Marx JA, Rosen P. Trauma in pregnancy. Emerg Med Clin North Am. 1987;5(3):623\u2013640. PubMed ID: 3308431 doi:10.1016\/S0733-8627(20)31063-4"},{"issue":"5","key":"r4","series-title":"Ann Emerg Med","first-page":"626","article-title":"Pregnancy-associated injury hospitalizations in Pennsylvania, 1995","volume":"34","author":"Weiss HB","year":"1999","unstructured":"Weiss HB. Pregnancy-associated injury hospitalizations in Pennsylvania, 1995. Ann Emerg Med. 1999;34(5):626\u2013636. PubMed ID: 10533011 doi:10.1016\/S0196-0644(99)70165-4"},{"key":"r5","series-title":"Gait Posture","first-page":"33","article-title":"Lower extremity kinetics and muscle activation during gait are significantly different during and after pregnancy compared to nulliparous females","volume":"81","author":"Bagwell JJ","year":"2020","unstructured":"Bagwell JJ, Reynolds N, Walaszek M, et\u00a0al. Lower extremity kinetics and muscle activation during gait are significantly different during and after pregnancy compared to nulliparous females. Gait Posture. 2020;81:33\u201340. PubMed ID: 32659459 doi:10.1016\/j.gaitpost.2020.07.002"},{"key":"r6","series-title":"J Pregnancy","first-page":"1","article-title":"Kinematic analysis of gait in the second and third trimesters of pregnancy","volume":"2013","author":"Branco M","year":"2013","unstructured":"Branco M, Santos-Rocha R, Aguiar L, Vieira F, Veloso A. Kinematic analysis of gait in the second and third trimesters of pregnancy. J Pregnancy. 2013;2013:1\u20139. doi:10.1155\/2013\/718095"},{"issue":"4","key":"r7","series-title":"Gait Posture","first-page":"524","article-title":"Ground reaction forces during gait in pregnant fallers and non-fallers","volume":"34","author":"McCrory JL","year":"2011","unstructured":"McCrory JL, Chambers AJ, Daftary A, Redfern MS. Ground reaction forces during gait in pregnant fallers and non-fallers. Gait Posture. 2011;34(4):524\u2013528. PubMed ID: 21820902 doi:10.1016\/j.gaitpost.2011.07.007"},{"key":"r8","series-title":"Gait Posture","first-page":"160","article-title":"Adaptive changes in spatiotemporal gait characteristics in women during pregnancy","volume":"43","author":"B\u0142aszczyk JW","year":"2016","unstructured":"B\u0142aszczyk JW, Opala-Berdzik A, Plewa M. Adaptive changes in spatiotemporal gait characteristics in women during pregnancy. Gait Posture. 2016;43:160\u2013164. PubMed ID: 26480840 doi:10.1016\/j.gaitpost.2015.09.016"},{"issue":"3","key":"r9","series-title":"Exp Brain Res","first-page":"336","article-title":"Gait asymmetry in patients with Parkinson\u2019s disease and elderly fallers: when does the bilateral coordination of gait require attention?","volume":"177","author":"Yogev G","year":"2007","unstructured":"Yogev G, Plotnik M, Peretz C, Giladi N, Hausdorff JM. Gait asymmetry in patients with Parkinson\u2019s disease and elderly fallers: when does the bilateral coordination of gait require attention? Exp Brain Res. 2007;177(3):336\u2013346. PubMed ID: 16972073 doi:10.1007\/s00221-006-0676-3"},{"issue":"3","key":"r10","series-title":"Gait Posture","first-page":"366","article-title":"Reliability and clinical correlates of 3D-accelerometry based gait analysis outcomes according to age and fall-risk","volume":"33","author":"Bautmans I","year":"2011","unstructured":"Bautmans I, Jansen B, van Keymolen B, Mets T. Reliability and clinical correlates of 3D-accelerometry based gait analysis outcomes according to age and fall-risk. Gait Posture. 2011;33(3):366\u2013372. PubMed ID: 21227697 doi:10.1016\/j.gaitpost.2010.12.003"},{"issue":"8","key":"r11","series-title":"Aging Clin Exp Res","first-page":"1057","article-title":"Gait symmetry in the dual task condition as a predictor of future falls among independent older adults: a 2-year longitudinal study","volume":"31","author":"Gillain S","year":"2019","unstructured":"Gillain S, Boutaayamou M, Schwartz C, et\u00a0al. Gait symmetry in the dual task condition as a predictor of future falls among independent older adults: a 2-year longitudinal study. Aging Clin Exp Res. 2019;31(8):1057\u20131067. PubMed ID: 31069697 doi:10.1007\/s40520-019-01210-w"},{"issue":"2","key":"r12","series-title":"Gait Posture","first-page":"142","article-title":"Adjustments in gait symmetry with walking speed in trans-femoral and trans-tibial amputees","volume":"17","author":"Nolan L","year":"2003","unstructured":"Nolan L, Wit A, Dudzi\u00f1ski K, Lees A, Lake M, Wychowa\u00f1ski M. 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