Prevalence of Low Back and Pelvic Pain During Pregnancy in a Norwegian Population

doi:10.1016/j.jmpt.2012.04.004

Journal of Manipulative and Physiological Therapeutics

Volume 35, Issue 4, May 2012, Pages 272-278

https://doi.org/10.1016/j.jmpt.2012.04.004 Get rights and content

Abstract

Objective

The purpose of this study was to investigate the cumulative prevalence of low back pain (LBP), pelvic pain (PP), and lumbopelvic pain during pregnancy, including features possibly associated with development of pregnancy-related PP, in an unselected population of women.

Methods

A retrospective cohort study was conducted in which all women giving birth at Stavanger University hospital in a 4-month period were asked to participate and to fill in a questionnaire on demographic features, pain, disability, and Oswestry Disability Index. Inclusion criteria were singleton pregnancy of at least 36 weeks and competence in the Norwegian language.

Results

Nearly 50% of the women experienced moderate and severe PP during pregnancy. Approximately 50% of them had PP syndrome, whereas the other half experienced lumbopelvic pain. Ten percent of the women experienced moderate and severe LBP alone. These pain syndromes increased sick leave and impaired general level of function during pregnancy. Approximately 50% of women with PP had pain in the area of the symphysis. The analysis of risk factors did not present a unidirectional and clear picture.

Conclusions

Pelvic pain in pregnant women is a health care challenge in which moderate and severe pain develops rather early and has important implications for society. The observed associations between possible causative factors and moderate and severe LBP and PP in this study may, together with results from other studies, bring some valuable insights into their multifactorial influences and provide background information for future studies.

Section snippets

Methods

This study is a retrospective longitudinal cohort study, with data collection over the period of March to June 2009, at the maternity ward of Stavanger University Hospital, Norway. All women giving birth at the hospital during this period were asked to participate and to fill in the questionnaire. Inclusion criteria were a term singleton pregnancy of at least 36 weeks and good competence in the Norwegian language. The hospital has the only birth department in the southern part of the county of

Study Population

Women who gave birth at Stavanger University Hospital during the inclusion period (n = 1204) were invited to participate in the study. After exclusions, there were 994 women eligible for the study. In addition, 336 women did not return a questionnaire, and 89 did not complete a received questionnaire. The final study population thus consisted of 569 women, which was 58% of the total possible sample.

To examine if the study population was representative, we compared age and parity variables from

Discussion

This study shows that nearly 50% of Norwegian women experience moderate and severe PP during pregnancy. Approximately half of them had only PP syndrome, whereas the other half experienced PP combined with LBP. In addition, 10% of the women experienced moderate and severe LBP alone. These pain syndromes increased the number of weeks of sick leave and impaired the general level of function during pregnancy. Approximately 50% of women with PP had pain in the area of the symphysis. Analysis of risk

Conclusion

Our study has shown that PP is a major health care challenge in pregnant women with implications for society. Our results may provide important background information on potential risk factors for PP, which in future studies should be investigated in a prospective study, controlling for confounders, and include clinical examinations of subgroups of pregnant women who are offered therapeutic interventions in a blinded design.

Funding Sources and Potential Conflicts of Interest

No funding sources or conflicts of interest were reported for this study.

Practical Applications

•
Nearly 50% of the women in this study experienced moderate and severe PP during pregnancy.
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Pelvic pain and LBPP increased the number of weeks of sick leave and impaired the general level of function during pregnancy.
•
Analysis of risk factors did not present a unidirectional and clear picture.

Acknowledgment

The authors acknowledge the assistance of the midwives at the Stavanger University Hospital in collecting the data.

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Relationship Between Location of Pregnancy-Related and Postpartum-Related Back Pain and Limitations of Daily Activities and Work Participation
2024, Journal of Manipulative and Physiological Therapeutics
The aims of this study were to (1) examine if the location of pregnancy-related back pain impacts activities of daily living and absence from work and (2) determine which types of pain were more likely to persist postpartum.
This was a secondary analysis of data from an observational cohort study. Data were collected in Ontario between 2013 and 2014. Four pain location groups were identified, including low back pain (LBP), pelvic girdle pain (PGP), combined pain, and mixed pain. Logistic regression models were used to examine the impact of pain location on activity and absence from work. Descriptive analyses explored the association between pregnancy pain location and postpartum pain patterns.
We surveyed 305 pregnant participants and followed up with 80 of these participants up to 6 months postpartum. Data analysis showed approximately a 2-fold increase in interference with employment (outside the home) and self-grooming for those with combined pain compared to those only experiencing LBP. Respondents with PGP and combined PGP and LBP had approximately a 5-fold increased likelihood of absence from work compared to respondents with only LBP; those with a mixture of LBP and PGP had a 13-fold increase in likelihood. Approximately 50% of respondents reported being pain-free, 16% experienced lingering pain, and 38% experienced persistent pain within 6 months postpartum. Those with combined pain during pregnancy continued to have persistent pain up to 6 months postpartum.
The results suggest that the location of pregnancy-related back pain is associated with interference in daily activities, an increase in absence from work, and the persistence of postpartum pain. For this cohort, back pain did not always resolve after delivery, and those experiencing pregnancy-related combined pain continued to experience symptoms postpartum.
Low back pain, ultrasonographic muscle thickness measurements and biopsychosocial factors at different trimesters of pregnancy
2023, Journal of Orthopaedic Science
Pregnancy-related low back pain is a multifactorial problem and its assosiation with pain intensity and biopsycosocial factors can not be fully explained. This study aimed to determine the psychosocial as well as biological/physical risk factors associated with self-reported low back pain (LBP) intensity during different trimesters of pregnancy.
This cross-sectional study comprised 107 pregnant women. An introductory information form for physical and medical characteristics, Visual Analog Scale (VAS) for low back pain intensity and Oswestry Disability Index (ODI) for degree of loss of functionality, Short Form-36 (SF-36) for quality of life and Pregnancy Physical Activity Questionnaire (PPAQ) for physical activity were applied. Abdominal muscle thicknesses and diastasis recti were measured by ultrasonography. Univariate regression was used to analyse associations between each plausible independent variable and low back pain intensity.
Mean LBP intensity during 1st, 2nd ve 3rd trimesters were 26.8 $\pm$ 20.9, 27.3 $\pm$ 19.8, 21.6 $\pm$ 20.1 mm, respectively. ODI scores were associated with LBP intensity, explaining 11%, 13% and 26% of LBP severity during the 1st, 2nd ve 3rd trimesters, respectively. Other biological/physical variables like age, body mass index, muscle thickness and diastasis recti were not associated with pain intensity. SF-36 emotional role limitation (coef = −0.03, R2 = 0.20, p = 0.01) in the 3rd trimester and SF-36 pain score in the 1st (coef = −0.04, R2 = 0.12, p = 0.02) and 3rd (coef = −0.05, R2 = 0.26, p = 0.004) trimesters and PPAQ-sedentary was associated during the 2nd trimester (coef = 0.17, R2 = 0.17, p = 0.02) with pain intensity.
ODI scores were associated with LBP intensity in all three trimesters, with SF-36 pain domain in the 1st and 3rd trimesters, with SF-36 emotional role limitation only in the 3rd trimester and with sedentary activity level only in the 2nd trimester. İncreased pain intensity was surprisingly associated with a small number of biopsychosocial factors in all the trimesters. There is need for further large-sample studies.
Best-Practice Recommendations for Chiropractic Care for Pregnant and Postpartum Patients: Results of a Consensus Process
2022, Journal of Manipulative and Physiological Therapeutics
The purpose of this project was to develop a best-practices document on chiropractic care for pregnant and postpartum patients with low back pain (LBP), pelvic girdle pain (PGP), or a combination.
A modified Delphi consensus process was conducted. A multidisciplinary steering committee of 11 health care professionals developed 71 seed statements based on their clinical experience and relevant literature. A total of 78 panelists from 7 countries were asked to rate the recommendations (70 chiropractors and representatives from 4 other health professions). Consensus was reached when at least 80% of the panelists deemed the statement to be appropriate along with a median response of at least 7 on a 9-point scale.
Consensus was reached on 71 statements after 3 rounds of distribution. Statements included informed consent and risks, multidisciplinary care, key components regarding LBP during pregnancy, PGP during pregnancy and combined pain during pregnancy, as well as key components regarding postpartum LBP, PGP, and combined pain. Examination, diagnostic imaging, interventions, and lifestyle factors statements are included.
An expert panel convened to develop the first best-practice consensus document on chiropractic care for pregnant and postpartum patients with LBP or PGP. The document consists of 71 statements on chiropractic care for pregnant and postpartum patients with LBP and PGP.
Chiropractic Care for Adults With Pregnancy-Related Low Back, Pelvic Girdle Pain, or Combination Pain: A Systematic Review
2020, Journal of Manipulative and Physiological Therapeutics
Citation Excerpt :
Women frequently experience low back pain (LBP), pelvic girdle pain (PGP), or a combination of the 2 during pregnancy1-5 and postpartum.
The purpose of this study was to conduct a systematic review (SR) of the literature to assess the effectiveness of chiropractic care options commonly used for pregnancy-related low back pain (LBP), pelvic girdle pain (PGP), or combination pain for both experienced practitioners and students of chiropractic.
We included procedures that were commonly used by chiropractors and not requiring additional certifications. Outcomes were self-reported changes in pain or disability. We used the Scottish Intercollegiate Guideline Network checklists to assess outcomes. For strength of evidence, we used the adapted version of the US Preventive Services Task Force criteria as described in the UK report.
Fifty articles were included from 18 SRs, 30 randomized controlled trials (RCTs), and 2 cohort studies. Pregnancy LBP (7 SRs and 12 RCTs): moderate, favorable evidence for electrotherapy and osteopathic manipulative therapy; inconclusive, favorable strength for chiropractic care, exercise, and support devices; and inconclusive, unclear strength for spinal manipulative therapy. Pregnancy PGP (4 SRs and 4 RCTs): inconclusive, favorable strength for exercise; and inconclusive, unclear evidence for patient education, information, and support devices. Pregnancy LBP or PGP (13 SRs and 12 RCTs): moderate, unclear evidence for complementary and alternative medicine; moderate, unclear evidence for exercise; inconclusive, favorable evidence for multimodal care, patient education, and physiotherapy; and inconclusive, unclear strength for spinal manipulative therapy, osteopathic manipulative therapy, and support devices.
Although there is a lack of conclusive evidence, many of the interventions have moderate or unclear but favorable evidence.
Chiropractic Care of Adults With Postpartum-Related Low Back, Pelvic Girdle, or Combination Pain: A Systematic Review
2020, Journal of Manipulative and Physiological Therapeutics
The purpose of this study was to conduct a systematic review (SR) of the literature to assess the effectiveness of specific chiropractic care options commonly used for postpartum low back pain (LBP), pelvic girdle pain (PGP), or combination (LBP and PGP) pain.
A search strategy was developed. Interventions were those manual or other nonpharmacologic therapies commonly used by chiropractors (not requiring additional certifications). The outcomes were self-reported changes in pain or disability self-reported outcomes. We used the Scottish Intercollegiate Guideline Network checklists. Strength of the evidence (excluding cohort studies) was determined using an adapted version of the US Preventive Services Task Force criteria as described in the UK report.
Of the 1611 published articles, 16 were included. These were 5 SRs, 10 randomized controlled trials (RCTs), and 1 cohort study. Postpartum LBP (1 RCT): moderate, favorable strength for spinal manipulation therapy/mobilization. Postpartum PGP (4 RCTs): moderate, unclear strength for exercise; and inconclusive, unclear strength for patient education. Postpartum LBP or PGP (3 SRs and 4 RCTs): inconclusive, unclear strength for exercise, self-management, and physiotherapy; while osteopathic manipulative therapy was inconclusive, favorable.
No treatment option was identified as having sufficient evidence to make a clear recommendation. This SR identified a scarcity of literature regarding chiropractic care and back pain for postpartum women, as well as inconsistency among the terms LBP, PGP, and combination pain.
Association Between Physical Activity, Weight Loss, Anxiety, and Lumbopelvic Pain in Postpartum Women
2020, Journal of Manipulative and Physiological Therapeutics
Citation Excerpt :
PGP is localized between the posterior iliac crest and the gluteal fold, particularly in the vicinity of the sacroiliac joints (SIJ), and can also occur in conjunction with or separately at the symphysis,1 whereas LBP is usually defined as any ache or muscle tension located below the costal margin and above the inferior gluteal folds.2 LBPP is a frequent condition during pregnancy, affecting 44% to 72% of pregnant women,3-8 whereas its prevalence before pregnancy is estimated at 18%.7 Women who report PGP or LBP often have disabling pain and functional limitations during pregnancy.8-10
Lumbopelvic pain (LBPP) affects 45% to 81% of pregnant women, and 25% to 43% of these women report persistent LBPP beyond 3 months after giving birth. The objective of this study was to investigate the association of physical activity, weight status, anxiety, and evolution of LBPP symptoms in postpartum women.
This was a prospective observational cohort study with 3 time-point assessments: baseline (T0), 3 months (T3), and 6 months (T6). Women with persistent LBPP 3 to 12 months after delivery were recruited. At each time point, pain disability was assessed with the Pelvic Girdle Questionnaire and the Oswestry Disability Index (ODI), physical activity with Fitbit Flex monitors, and anxiety with the French-Canadian version of the State-Trait Anxiety Inventory. Weight was recorded using a standardized method. Pain intensity (numerical rating scale, 0-100) and frequency were assessed using a standardized text message on a weekly basis throughout the study.
Thirty-two women were included (time postpartum: 6.6 ± 2.0 months; maternal age: 28.3 ± 3.8 years; body weight: 72.9 ± 19.1 kg), and 27 completed the T6 follow-up. Disability, pain intensity, and pain frequency improved at T6 (P < .001). Participants lost a mean of 1.9 ± 4.5 kg at T6, and this weight loss was correlated with reduction in LBPP intensity (r = 0.479, P = .011) and LBPP frequency (r = 0.386, P = .047), Pelvic Girdle Questionnaire score (r = 0.554, P = .003), and ODI score (r = 0.494, P = .009). Improvement in ODI score at T6 was correlated with the number of inactive minutes at T3 (r = −0.453, P = .026) and T6 (r = −0.457, P = .019), and with daily steps at T6 (r = 0.512, P = .006).
Weight loss is associated with positive LBPP symptom evolution beyond 3 months postpartum, and physical activity is associated with reduction in pain disability.

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Original ArticlePrevalence of Low Back and Pelvic Pain During Pregnancy in a Norwegian Population

Abstract

Objective

Methods

Results

Conclusions

Section snippets

Methods

Study Population

Discussion

Conclusion

Funding Sources and Potential Conflicts of Interest

Practical Applications

Acknowledgment

J Manipulative Physiol Ther

J Manipulative Physiol Ther

Arch Phys Med Rehabil

Am J Obstet Gynecol

Man Ther

J Clin Epidemiol

Pelvic girdle pain and lumbar pain in pregnancy: a cohort study of the consequences in terms of health and functioning

Spine

Low back pain and pelvic pain during pregnancy: prevalence and risk factors

Spine

Pregnancy related pelvic girdle pain and low back pain in an Iranian population

Spine

Is pelvic pain in pregnancy a welfare complaint?

Acta Obstet Gynecol Scand

The prevalence of recalled low back pain during and after pregnancy: a South Australian population survey

Aust N Z J Obstet Gynaecol

Incidence of four syndromes of pregnancy-related pelvic joint pain

Spine

The relationship of low-back pain to pregnancy and gynecologic factors

Spine

Low-back pain of pregnancy

Acta Obstet Gynecol Scan

Pregnancy-related pelvic girdle pain (PPP), 1: terminology, clinical presentation, and prevalence

Eur Spine J

Original Article
Prevalence of Low Back and Pelvic Pain During Pregnancy in a Norwegian Population