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Follow-up of pregnancy-related carpal tunnel syndrome symptoms at 12 months postpartum: A prospective study

      Dear Editor,
      Carpal tunnel syndrome (CTS) is a common condition among pregnant women. In a previous study, we found a prevalence of 34% during the last trimester in a large cohort of pregnant women [
      • Meems M.
      • Truijens S.
      • Spek V.
      • Visser L.H.
      • Prevalence Pop V.
      course and determinants of carpal tunnel syndrome symptoms during pregnancy: a prospective study.
      ]. Severity of CTS symptoms generally decreases quickly after childbirth. Only few studies have investigated persisting pregnancy-related CTS symptoms in the postpartum period. According to the current literature, 4% to 54% of women with CTS symptoms during pregnancy still report symptoms at one year postpartum [
      • Padua L.
      • Aprile I.
      • Caliandro P.
      • Mondelli M.
      • Pasqualetti P.
      • Tonali P.A.
      • et al.
      Carpal tunnel syndrome in pregnancy: multiperspective follow-up of untreated cases.
      ,
      • Turgut F.
      • Cetinsahinahin M.
      • Turgut M.
      • Bolukbasi O.
      The management of carpal tunnel syndrome in pregnancy.
      ]. We have investigated the persistence of CTS symptoms in a large cohort of pregnant women (N = 1044), who were followed from 12 weeks gestation up until 12 months postpartum. Criteria for participation and the procedure for this study were described in detail elsewhere [
      • Meems M.
      • Truijens S.
      • Spek V.
      • Visser L.H.
      • Prevalence Pop V.
      course and determinants of carpal tunnel syndrome symptoms during pregnancy: a prospective study.
      ]. Women with CTS symptoms during pregnancy completed the Boston Carpal Tunnel Questionnaire (BCTQ), a disease specific questionnaire to evaluate the severity of symptoms and hand function impairment. Women also filled out the Edinburgh Depression Scale (EDS) at 6 weeks, 4, 6 and 12 months postpartum to evaluate depressive symptoms. In the present study, 34% (354 of 1044 women) reported CTS symptoms during pregnancy, which dropped to 11% at 6 weeks postpartum and further to 6% at 4 months postpartum, to remain more or less stable until 12 months postpartum: 5% of the total sample still reported CTS symptoms at 12 months postpartum, which is 15% of women who reported CTS symptoms during pregnancy (n = 354). Mean BCTQ scores during pregnancy of women with persisting symptoms at 12 months postpartum (n = 54) were significantly higher compared to the mean pregnancy BCTQ scores of those women (n = 300) who did no longer report symptoms at 12 months postpartum (t-test; 1.65 (0.63) vs. 1.44 (0.44), P = .026). As can be seen in Table 1, a multiple logistic regression analysis within the group of women who reported CTS symptoms during pregnancy (n = 354) showed that higher BCTQ scores during pregnancy (OR = 1.93, 95% CI [1.08, 3.45], P = .028), early onset of symptoms during pregnancy (OR = 2.88, 95% CI [1.45, 5.72], P = .003) and higher mean EDS scores postpartum (OR = 1.11, 95% CI [1.03, 1.19], P = .009) were significantly related to persistence of CTS symptoms at 12 months postpartum (dependent variable). In line with the study by Padua et al. [
      • Padua L.
      • Aprile I.
      • Caliandro P.
      • Mondelli M.
      • Pasqualetti P.
      • Tonali P.A.
      • et al.
      Carpal tunnel syndrome in pregnancy: multiperspective follow-up of untreated cases.
      ], earlier onset of symptoms was also a predictive factor in the current study for persistent CTS symptoms at follow-up. However, their reported prevalence of persisting CTS symptoms at 12 months postpartum was much higher (54% vs. 15% in the current study), but their sample size was much smaller (n = 37) compared to the current study and they did not report the time of onset of symptoms during pregnancy in their sample. Higher postpartum EDS depression scores were also significantly related to long lasting CTS symptoms. It is well known that patients with depression in general report higher levels of somatic symptoms. Especially patients who report chronic pain also experience problems in a range of psychological domains, such as depression, anxiety and general emotional functioning [
      • Burke A.L.
      • Mathias J.L.
      • Denson L.A.
      Psychological functioning of people living with chronic pain: a meta-analytic review.
      ]. Therefore, in women with long lasting CTS symptoms, the existence of depression should be considered given the known negative impact of maternal depression on child development [
      • Stein A.
      • Pearson R.M.
      • Goodman S.H.
      • Rapa E.
      • Rahman A.
      • McCallum M.
      • et al.
      Effects of perinatal mental disorders on the fetus and child.
      ].
      Table 1Multiple logistic regression analysis results with the persistence of CTS as dependent variable within the group of women who reported CTS symptoms during pregnancy (n = 354).
      VariableORCI
      LowerUpperP
      BCTQ score during pregnancy1.931.083.45.028*
      Bilateral CTS symptoms0.900.441.83.762
      Early onset of CTS symptoms
      Before third trimester of pregnancy.
      2.881.455.72.003*
      Multiparity1.450.762.77.258
      Age0.960.881.05.341
      Mean EDS score postpartum1.111.031.19.009*
      *P-value < .05.
      a Before third trimester of pregnancy.
      In conclusion, pregnancy-related CTS symptoms do not resolve in all women: one out of six women with CTS symptoms during pregnancy still report symptoms at 12 months postpartum, especially those with an early onset of CTS symptoms and more severe CTS symptoms during pregnancy, as well as women with higher depression scores postpartum.

      References

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        Carpal tunnel syndrome in pregnancy: multiperspective follow-up of untreated cases.
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