QUESTION: What is the effect of a 12-week abdominal and pelvic floor muscle exercise program during pregnancy on the inter-recti distance (IRD) in women with diastasis recti abdominis immediately after the 12-week intervention period and at follow-up 6 weeks postpartum? DESIGN: An exploratory, parallel-group, randomised controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis. PARTICIPANTS: Ninety-six pregnant women aged >= 18 years, either primigravida or multigravida, in gestation week 24 with an IRD of >= 28 mm measured at rest and/or a protrusion on initial assessment. INTERVENTION: The experimental group participated in a 12-week abdominal and pelvic floor muscle exercise program during pregnancy. The control group received no intervention. OUTCOME MEASURES: Change (mm) in IRD 2 cm above and below the umbilicus at rest from pre-intervention to immediately post-intervention and to 6 weeks follow-up measured with ultrasonography. RESULTS: The IRD increased for both groups from baseline to immediately after the intervention and decreased from after the intervention to the follow-up at 6 weeks postpartum. The IRD was smallest for both groups at the follow-up. At 2 cm above the umbilicus, the intervention effect was 2 mm (95% CI -2 to 7) immediately after the intervention and -1 mm (95% CI -4 to 3) at follow-up. At 2 cm below the umbilicus, the intervention effect was -5 mm (95% CI -10 to 0) immediately after the intervention and 0 mm (95% CI -4 to 4) at follow-up. CONCLUSION: Abdominal and pelvic floor muscle training during pregnancy have a negligible effect on the IRD immediately after 12 weeks of intervention and at 6 weeks post-partum. REGISTRATION: NCT04960800.

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