Low Back Pain during Pregnancy and Delivery Outcomes

Arrigo Fruscalzo; Paolo Cocco; Ambrogio P. Londero; Markus Gantert

doi:10.1055/a-1553-4856

Zeitschrift für Geburtshilfe und Neonatologie, Table of Contents

Z Geburtshilfe Neonatol 2022; 226(02): 104-111
DOI: 10.1055/a-1553-4856

Original Article

Low Back Pain during Pregnancy and Delivery Outcomes

Arrigo Fruscalzo

¹Gynecology and Obstetrics, St. Franziskus-Hospital Ahlen, Ahlen, Germany

,

Paolo Cocco

²Pediatric Surgery, University of Naples Federico II School of Medicine and Surgery, Napoli, Italy and Pediatric Surgery, San Bortolo Hospital, Vicenza, Italy

,

Ambrogio P. Londero

³Clinic of Gynecology and Obstetrics, University Hospital of Udine, Udine, Italy

,

Markus Gantert

¹Gynecology and Obstetrics, St. Franziskus-Hospital Ahlen, Ahlen, Germany

› Author Affiliations

Abstract

Aim To evaluate low back pain (LBP) incidence and impact throughout pregnancy in terms of women’s well-being and delivery outcomes.

Material and methods Cross-sectional prospective study conducted on singleton pregnancies at ≥37th gestational age admitted for delivery. Localization of LBP, intensity and frequency as well as derived functional disability status were assessed with a self-reported questionnaire. Main delivery outcomes including mode of delivery, and maternal or neonatal complications were recorded.

Results A total of 229 women participated in the study. LBP prevalence amounted to 55.9%, with the pain already present before pregnancy in 14.0% of the cases. The pain was mostly localized in the lower back (40.6%), symphysis (23.3%), and coccyx (20.5%). Both the frequency and intensity of pain gradually increased significantly during pregnancy, reaching 20 days/month (IQR=10–30) and 6/10 points (IQR=5–8) on a visual analog scale in the 3rd trimester (p<0.05). The extent of functional impairment also progressively increased up to 39/100 points (IQR=25–55, p<0.05). Women affected by LBP during pregnancy had a higher cesarean section rate during labor than women without LBP (11.9% vs. 28.9%, p<0.05). The risk was also significant in the multivariate analysis (OR=4.0, 95%CI=1.1–15.0, p<0.05). There was no difference in the rate of operative vaginal births or in the other outcomes considered.

Conclusions LBP is a common issue in pregnant women, accounting for increasing morbidity and invalidity, and leading to an increased cesarean section risk during labor.

Key words

pregnancy - parturition - delivery - pain - low back pain - girdle pain

Full Text

References

References
1 Koes BW, van Tulder MW, Thomas S. Diagnosis and treatment of low back pain. BMJ 2006; 332: 1430-1434 doi:10.1136/bmj.332.7555.1430
2 Vleeming A, Albert HB, Ostgaard HC. et al European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J 2008; 17: 794-819 doi:10.1007/s00586-008-0602-4
3 Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet 2017; 389: 736-747 doi:10.1016/S0140-6736(16)30970-9
4 Wang SM, Dezinno P, Maranets I. et al Low back pain during pregnancy: prevalence, risk factors, and outcomes. Obstet Gynecol 2004; 104: 65-70 doi:10.1097/01.AOG.0000129403.54061.0e
5 Gutke A, Boissonnault J, Brook G. et al The severity and impact of pelvic girdle pain and low-back pain in pregnancy: a multinational study. J Womens Health Larchmt 2018; 27: 510-517 doi:10.1089/jwh.2017.6342
6 Kovacs FM, Garcia E, Royuela A. et al Prevalence and factors associated with low back pain and pelvic girdle pain during pregnancy: a multicenter study conducted in the Spanish National Health Service. Spine (Phila Pa 1976) 2012; 37: 1516-1533 doi:10.1097/BRS.0b013e31824dcb74
7 Van De Pol G, Van Brummen HJ, Bruinse HW. et al Pregnancy-related pelvic girdle pain in the Netherlands. Acta Obstet Gynecol Scand 2007; 86: 416-422 doi:10.1080/00016340601151683
8 Close C, Sinclair M, Liddle D. et al Women’s experience of low back and/or pelvic pain (LBPP) during pregnancy. Midwifery 2016; 37: 1-8 doi:10.1016/j.midw.2016.03.013
9 Gutke A, Ostgaard HC, Oberg B. Pelvic girdle pain and lumbar pain in pregnancy: a cohort study of the consequences in terms of health and functioning. Spine (Phila Pa 1976) 2006; 31: E149-E155 doi:10.1097/01.brs.0000201259.63363.e1
10 Ostgaard HC, Zetherstrom G, Roos-Hansson E. Back pain in relation to pregnancy: a 6-year follow-up. Spine (Phila Pa 1976) 1997; 22: 2945-2950
11 Elden H, Gutke A, Kjellby-Wendt G. et al Predictors and consequences of long-term pregnancy-related pelvic girdle pain: a longitudinal follow-up study. BMC Musculoskelet Disord 2016; 17: 276 doi:10.1186/s12891-016-1154-0
12 Casagrande D, Gugala Z, Clark SM. et al Low back pain and pelvic girdle pain in pregnancy. J Am Acad Orthop Surg 2015; 23: 539-549 doi:10.5435/JAAOS-D-14-00248
13 Ritchie JR. Orthopedic Considerations During Pregnancy. Clin Obstet Gynecol 2003; 46: 456
14 Albert HB, Godskesen M, Korsholm L. et al Risk factors in developing pregnancy-related pelvic girdle pain. Acta Obstet Gynecol Scand 2006; 85: 539-544 doi:10.1080/00016340600578415
15 Takami M, Tsuchida A, Takamori A. et al Effects of physical activity during pregnancy on preterm delivery and mode of delivery: The Japan Environment and Children’s Study, birth cohort study. PloS One 2018; 13: e0206160 doi:10.1371/journal.pone.0206160
16 Ming WK, Ding W, Zhang CJP. et al The effect of exercise during pregnancy on gestational diabetes mellitus in normal-weight women: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2018; 18: 440 doi:10.1186/s12884-018-2068-7
17 Baena-García L, Ocón-Hernández O, Acosta-Manzano P. et al Association of sedentary time and physical activity during pregnancy with maternal and neonatal birth outcomes. The GESTAFIT Project. Scand J Med Sci Sports 2019; 29: 407-414 doi:10.1111/sms.13337
18 Price BB, Amini SB, Kappeler K. Exercise in pregnancy: effect on fitness and obstetric outcomes – a randomized trial. Med Sci Sports Exerc 2012; 44: 2263-2269 doi:10.1249/MSS.0b013e318267ad67
19 Barakat R, Pelaez M, Lopez C. et al Exercise during pregnancy reduces the rate of cesarean and instrumental deliveries: results of a randomized controlled trial. J Matern Fetal Neonatal Med 2012; 25: 2372-2376 doi:10.3109/14767058.2012.696165
20 Davenport MH, Ruchat S-M, Sobierajski F. et al Impact of prenatal exercise on maternal harms, labour and delivery outcomes: a systematic review and meta-analysis. Br J Sports Med 2019; 53: 99-107 doi:10.1136/bjsports-2018-099821
21 Domenjoz I, Kayser B, Boulvain M. Effect of physical activity during pregnancy on mode of delivery. Am J Obstet Gynecol 2014; 211: e1-e11 doi:10.1016/j.ajog.2014.03.030
22 Sanda B, Vistad I, Sagedal LR. et al What is the effect of physical activity on duration and mode of delivery? Secondary analysis from the Norwegian Fit for Delivery trial. Acta Obstet Gynecol Scand 2018; 97: 861-871 doi:10.1111/aogs.13351
23 Simkin P. The fetal occiput posterior position: state of the science and a new perspective. Birth 2010; 37: 61-71 doi:10.1111/j.1523-536X.2009.00380.x
24 von Elm E, Altman DG, Egger M. et al The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 2007; 147: 573-577 doi:10.7326/0003-4819-147-8-200710160-00010
25 Kopec JA, Esdaile JM, Abrahamowicz M. et al The Quebec Back Pain Disability Scale. Measurement properties. Spine Phila Pa 1976 1995; 20: 341-352
26 Riecke J, Holzapfel S, Rief W. et al Cross-cultural adaption of the German Quebec Back Pain Disability Scale: an exposure-specific measurement for back pain patients. J Pain Res 2016; 9: 9-15 doi:10.2147/JPR.S92615
27 Wu WH, Meijer OG, Uegaki K. et al Pregnancy-related pelvic girdle pain (PPP), I: Terminology, clinical presentation, and prevalence. Eur Spine J 2004; 13: 575-589 doi:10.1007/s00586-003-0615-y
28 Fagevik Olsen M, Elden H, Gutke A. Evaluation of self-administered tests for pelvic girdle pain in pregnancy. BMC Musculoskelet Disord 2014; 15: 138 doi:10.1186/1471-2474-15-138
29 Malmqvist S, Kjaermann I, Andersen K. et al Prevalence of low back and pelvic pain during pregnancy in a Norwegian population. J Manip Physiol Ther 2012; 35: 272-278 doi:10.1016/j.jmpt.2012.04.004
30 Mota MJ, Cardoso M, Carvalho A. et al Women’s experiences of low back pain during pregnancy. J Back Musculoskelet Rehabil 2015; 28: 351-357 doi:10.3233/BMR-140527
31 Kluge J, Hall D, Louw Q. et al Specific exercises to treat pregnancy-related low back pain in a South African population. Int J Gynaecol Obstet 2011; 113: 187-191 doi:10.1016/j.ijgo.2010.10.030
32 Engeset J, Stuge B, Fegran L. Pelvic girdle pain affects the whole life – a qualitative interview study in Norway on women’s experiences with pelvic girdle pain after delivery. BMC Res Notes 2014; 7: 686 doi:10.1186/1756-0500-7-686
33 Betrán AP, Temmerman M, Kingdon C. et al Interventions to reduce unnecessary caesarean sections in healthy women and babies. Lancet 2018; 392: 1358-1368 doi:10.1016/S0140-6736(18)31927-5
34 Lawrence A, Lewis L, Hofmeyr GJ. et al Maternal positions and mobility during first stage labour. Cochrane Database Syst Rev 2013: CD003934. doi:10.1002/14651858.CD003934.pub4
35 Gupta JK, Sood A, Hofmeyr GJ. et al Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database Syst Rev 2017; 5: CD002006 doi:10.1002/14651858.CD002006.pub4
36 Desseauve D, Fradet L, Lacouture P. et al Position for labor and birth: state of knowledge and biomechanical perspectives. Eur J Obstet Gynecol Reprod Biol 2017; 208: 46-54 doi:10.1016/j.ejogrb.2016.11.006
37 Baron R, Binder A, Attal N. et al Neuropathic low back pain in clinical practice. Eur J Pain Lond Engl 2016; 20: 861-873 doi:10.1002/ejp.838
38 Labor S, Maguire S. The Pain of Labour. Rev Pain 2008; 2: 15-19 doi:10.1177/204946370800200205
39 Fruscalzo A, Bertozzi S, Londero AP. et al Menstrual abnormalities and predisposition to pregnancy-related hypertensive disorders: a retrospective study. Gynecol Endocrinol 2010; 26: 445-450 doi:10.3109/09513591003632092
40 Sencan S, Ozcan-Eksi EE, Cuce I. et al Pregnancy-related low back pain in women in Turkey: prevalence and risk factors. Ann Phys Rehabil Med 2018; 61: 33-37 doi:10.1016/j.rehab.2017.09.005
41 Bjelland EK, Stuge B, Vangen S. et al Mode of delivery and persistence of pelvic girdle syndrome 6 months postpartum. Am J Obstet Gynecol 2013; 208: e1-e7 doi:10.1016/j.ajog.2012.12.002
42 Fitzgerald CM. Pregnancy-related lumbopelvic pain: what have we learned?. Am J Obstet Gynecol 2013; 208: 242 doi:10.1016/j.ajog.2013.02.048
43 Brown A, Johnston R. Maternal experience of musculoskeletal pain during pregnancy and birth outcomes: significance of lower back and pelvic pain. Midwifery 2013; 29: 1346-1351 doi:10.1016/j.midw.2013.01.002
44 Ostgaard HC, Andersson GB, Wennergren M. The impact of low back and pelvic pain in pregnancy on the pregnancy outcome. Acta Obstet Gynecol Scand 1991; 70: 21-24
45 Nielsen TF, Olausson PO, Ingemarsson I. The cesarean section rate in Sweden: the end of the rise. Birth 1994; 21: 34-38