Risk factors and interaction analysis of severe diastasis recti abdominis within 6 months postpartum.

OBJECTIVES: Severe diastasis recti abdominis (DRA) in the postpartum period may lead to long‑term functional impairment in women. However, the independent effects and interactions of perinatal risk factors during the early postpartum recovery window have not been fully elucidated. This study aims to analyze the risk factors and interaction effects associated with severe postpartum DRA and to identify characteristics of high‑risk populations. METHODS: This retrospective cohort study included postpartum women who underwent postpartum rehabilitation treatment at Hengyang Maternal and Child Health Hospital between January 2019 and August 2022, with a postpartum interval of 42 to 180 d. The inter-rectus distance was measured using palpation combined with caliper assessment. According to the inter-rectus distance, participants were divided into 4 groups: A severe DRA group (separation distance ≥4 cm), a moderate DRA group (3.0 to 3.9 cm), a mild DRA group (2.0 to 2.9 cm), and a normal group (<2 cm). The moderate DRA, mild DRA, and normal groups were combined as the control group. Receiver operating characteristic (ROC) curve analysis was used to evaluate continuous variables and determine optimal cutoff values for stratification. The chi-square test was used to compare differences in influencing factors between the severe DRA group and the control group. Binary Logistic regression analysis was further performed to investigate the effects of various factors on severe DRA, and interaction analysis within the binary Logistic regression model was used to identify high-risk populations. RESULTS: 3.43 to 14.71). When all 3 risk factors were present simultaneously, the incidence of severe DRA reached 61.76%. CONCLUSIONS: Neonatal birth weight ≥3 350 g, gestational weight gain ≥12.25 kg, cesarean delivery, and multiparity are important independent risk factors for severe postpartum DRA, and significant synergistic amplification effects exist among these factors. This study clarified the characteristics of high-risk populations and may provide a basis for targeted early screening and intervention.