Pregnancy-related lumbopelvic pain in early postpartum period and risk factorr
Keywords:Lumbopelvic pain, Pregnancy-related pain, Postpartum period
Background: Pregnancy-related lumbopelvic pain is known as lower back and pelvic girdle pain of unclear etiology, which affects almost half of pregnant women, often starts at 18 weeks and decreases at 6 months postpartum. The purpose of this study is to identify the risk factors in patients with pregnancy-related lumbopelvic pain in early postpartum period and determine the factors associated with pain in patients suffering from lumbopelvic pain at 1 month postpartum.
Methods: 339 women of 18-40 years of age who were in the 1st month of postpartum period were included in the study. Socio-demographic data, gynecological history and method of delivery were recorded for all subjects. All subjects were evaluated for pregnancy-related lumbopelvic pain. The Oswestry disability index was used for functional evaluation and the Beck depression inventory was used for assessment of depression.
Results: 114 (33.6%) patients had a history of pregnancy-related lumbopelvic pain. 59 (18.9%) patients had ongoing pain at 1 month postpartum. When patients were divided into two groups, consisting of women with and without lumbopelvic pain at 1 month postpartum, no statistical difference was observed between two groups in terms of age, parity, employment status, smoking status, depression score, method of delivery, type of anesthesia, and emergency or elective cesarean section. When the risk factors affecting postpartum lumbopelvic pain were evaluated by using the Stepwise Logistic regression analysis, weight gain during pregnancy, body mass index and presence of lumbopelvic pain during previous pregnancy were found to be independent risk factors (p<0.05).
Conclusion: Pregnancy-related lumbopelvic pain is a significant cause of disability that affects many pregnant women. Control of weight gain during pregnancy could be important in avoiding the development of lumbopelvic pain. In patients experiencing lumbopelvic pain in previous pregnancies, necessary measures should be taken against development of lumbopelvic pain during a new pregnancy.
Wu WH, Meijer OG, Uegaki K, Mens JM, van Dieën JH, Wuisman PI, et al. Pregnancy-related pelvic girdle pain (PPP), I: Terminology, clinical presentation, and prevalence. Eur Spine J. 2004;13:575-89.
Gutke A, Ostgaard HC, Oberg B. Pelvic girdle pain andlumbar pain in pregnancy: a cohort study of the consequences in terms of health and functioning. Spine. 2006;31:149–55.
Ostgaard HC, Roos-Hansson E, Zetherstrom G. Regression of back and posterior pelvic pain after pregnancy. Spine. 1996;21:2777– 80.
Sipko T, Grygier D, Barczyk K, Eliasz G. The occurrence of strain symptoms in the lumbosacral region and pelvis during pregnancy an d after childbirth. J Manipulative Physiol Ther. 2010;33:370-7. doi: 10.1016/j.jmpt.2010.05.006.
Darwich AA, Diwan SA. Management of back pain in pregnancy. Techniques in Regional Anesthesia and Pain Management. 2009;13(4),251-4.
Botsford DJ, Esses SI, Oglivie-Harris DJ. In vivo indurnal variationin intervertebral volume and morphology. Spine. 1994;19:935–40.
Ostgaard HC, Andersson GB, Karlsson K. Prevalence of back pain in pregnancy. Spine. 1991;16:549-52.
Bakker EC, van Nimwegen-Matzinger CW, Ekkel-van der Voorden W, Nijkamp MD, Völlink T. Psychological determinants of pregnancy-related lumbopelvic pain: a prospective cohort study. Acta Obstet Gynecol Scand. 2013;92:797-803. doi: 10.1111/aogs.12131.
Sabino J, Grauer JN. Pregnancy and low back pain. Curr Rev Musculoskelet Med. 2008;1:137-41. doi: 10.1007/s12178-008-9021-8.
Norén L, Ostgaard S, Johansson G, Ostgaard HC. Lumbar back and posterior pelvic pain during pregnancy: a 3-year follow-up. Eur Spine J. 2002;11(3):267-71.
Mogren I.M. Previous physical activity decreases the risk of low back pain and pelvic pain during pregnancy. Scandinavian J Public Health. 2005;33:300–6.
Yılmaz A, Altuğ F, Coşkun E. Pain, Disability Status and Psychological Factors in Patients with Chronic Low Back Pain. Turkiye Klinikleri J Med Sci. 2012;32:1278-83.
Yakut E, Duger T, Oksuz C, Yorukan S, Ureten K, Turan D, et al. Validation of the Turkish version of the Oswestry Disability Index for patients with low back pain. Spine. 2004;29:581-5.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561-71.
Mogren IM, Pohjanen AI. Low back pain and pelvic pain during pregnancy: prevalence and risk factors. Spine. 2005;30:983–91.
MacLennan AH, Nicolson R, Green RC, Bath M. Serum relaxin and pelvic pain of pregnancy. Lancet. 1986;ii:243–5.
Orvieto R, Achiron A, Ben-Rafael Z, Gelernter I, Achiron R. Low back pain of pregnancy. Acta Obstet Gynecol Scand. 1994;73:209–14.
Mens JM, Vleeming A, Stoeckart R, Stam HJ, Snijders CJ. Understanding peripartum pelvic pain. Implications of a patient survey. Spine. 1996;21(11):1363–70.
Kashanian M, Akbari Z, Alizadeh MH: The effect of exercise on back painand lordosis in pregnant women. Int J Gynaecol Obstet 2009;107:160–161.
Endresen EH. Pelvic pain and low back pain in pregnant women--an epidemiological study. Scand J Rheumatol. 1995;24(3):135-141.
Nwuga VC. Pregnancy and back pain among upper class nigerian women. Aust J Physiother. 1982;28:8-11. doi: 10.1016/S0004-9514(14)60772-8.
Kristiansson P, Svärdsudd K, von Schoultz B. Back pain during pregnancy: a prospective study. Spine. 1996;15;21:702-9.
Thompson JF, Roberts CL, Currie M, Ellwood DA. Prevalence and persistence of health problems after childbirth: associations with parity and method of birth. Birth. 2002;29:83-94.
Ostgaard HC, Andersson GB. Previous back pain and risk of developing back pain in a future pregnancy. Spine (Phila Pa 1976). 1991;16:432-6.
Mogren IM. Does caesarean section negatively influence the post-partum prognosis of low back pain and pelvic pain during pregnancy? Eur Spine J. 2007;16:115-21.
Macarthur A, Macarthur C, Weeks S.Epidural anaesthesia and low back pain after delivery: a prospective cohort study. BMJ. 1995;18;311(7016):1336-9.
Wang CH, Cheng KW, Neoh CA, Tang S, Jawan B, Lee JH.Comparison of the incidence of postpartum low back pain in natural childbirth and cesarean section with spinal anesthesia. Acta Anaesthesiol Sin. 1994;32:243-6.