Predictors and consequences of long-term pregnancy-related pelvic girdle pain: a longitudinal follow-up study

Abstract

BackgroundPelvic girdle pain (PGP) is a multifactorial condition, which can be mentally and physically compromising both during and after pregnancy. However, long-term pregnancy-related PGP has been poorly investigated. This longitudinal follow-up study uniquely aimed to describe prevalence and predictors of PGP and its consequences on women’s health and function up to 11 years after pregnancy.Methods/DesignA postal questionnaire was sent to 530 women who participated in 1 of 3 randomized controlled studies for PGP in pregnancy. Women who reported experiencing lumbopelvic pain were offered a clinical examination. Main outcome measure was the presence of long term PGP as assessed by an independent examiner. Secondary outcomes were: working hours/week, function (the Disability Rating Index, and Oswestry Disability Index), self-efficacy (the General Self-Efficacy Scale), HRQL (Euro-Qol 5D and EQ-Visual scale), anxiety and depression, (Hospital anxiety and depression scale,) and pain-catastrophizing (Pain Catastrophizing Scale), in women with PGP compared to women with no PGP.ResultsA total of 371/530 (70 %) women responded and 37/ 371 (10 %) were classified with long-term PGP. Pregnancy-related predictors for long-term PGP were number of positive pain provocation tests (OR = 1.79), history of low back pain (LBP) (OR = 2.28), positive symphysis pressure test (OR = 2.01), positive Faber (Patrick’s) test (OR = 2.22), and positive modified Trendelenburg test (OR = 2.20). Women with PGP had significantly decreased ability to perform daily activities (p < .001), lower self-efficacy (p = 0.046), decreased HRQL (p < .001), higher levels of anxiety and depression (p < .001), were more prone to pain catastrophizing, and worked significantly fewer hours/week (p = 0.032) compared to women with no PGP.ConclusionsThis unique long-term follow up of PGP highlights the importance of assessment of pain in the lumbopelvic area early in pregnancy and postpartum in order to identify women with risk of long term pain. One of 10 women with PGP in pregnancy has severe consequences up to 11 years later. They could be identified by number of positive pain provocation tests and experience of previous LBP. Access to evidence based treatments are important for individual and socioeconomic reasons.

The Swedish version of the pelvic girdle questionnaire, cross-cultural adaptation and validation

“…The nine pregnant women with PGP were in mean gestational week 30 (range 14-36) and in their first or second pregnancy. The seven non-pregnant women had experienced PGP between 2 and 11 years after pregnancy, and participated in a longitudinal follow-up study of PGP [20]. All women were clinically examined and found to have PGP according to recommendations from the European guidelines [4].…”

Incidence, pain, and mobility assessment of pregnant women with sacroiliac dysfunction

“…Sacroiliac dysfunction during pregnancy has been attributed to several mechanical and biological mechanisms. These include altered posture, increased body weight, relaxation of supporting structures of the spine and pelvis, pressure changes in the abdominal cavity, and intrauterine pressure . The position and weight of the enlarging uterus also alters the center of gravity and hormonal changes in pregnancy results in ligament laxity and fluid retention .…”

“…These include altered posture, increased body weight, relaxation of supporting structures of the spine and pelvis, pressure changes in the abdominal cavity, and intrauterine pressure. 4,5 The position and weight of the enlarging uterus also alters the center of gravity and hormonal changes in pregnancy results in ligament laxity and fluid retention. 6 These mechanisms result in increased pressure on the lumbosacral spine and sacroiliac joint, causing sacroiliac dysfunction.…”

Building a Collaborative Model of Sacroiliac Joint Dysfunction and Pelvic Girdle Pain to Understand the Diverse Perspectives of Experts

“…Fifth, the greater emphasis on psychosocial rather than biomechanical features in LBP is likely to be largely explained by the limited success of interventions that target the latter . Although it is possible that a mechanical interpretation of PGP is accurate, this does not reflect recent work that has identified associations between several psychological features and persistence of PGP (eg, self‐efficacy; anxiety and depression; pain catastrophizing) …”

“…41 Although it is possible that a mechanical interpretation of PGP is accurate, this does not reflect recent work that has identified associations between several psychological features and persistence of PGP (eg, self-efficacy; anxiety and depression; pain catastrophizing). 42…”