Trajectories of lower back, upper back, and pelvic girdle pain during pregnancy and early postpartum in primiparous women

Guinn Dunn, Marlene J Egger, Janet M Shaw, Jingye Yang, Tyler Bardsley, Emily Powers, Ingrid E Nygaard, Guinn Dunn, Marlene J Egger, Janet M Shaw, Jingye Yang, Tyler Bardsley, Emily Powers, Ingrid E Nygaard

Abstract

Objective: Most studies about truncal pain during and after pregnancy focus on low back pain, few prospectively define change in pain, and even fewer evaluate pain in all three major truncal areas: upper back, lower back, and pelvic girdle. Thus, the objective of this prospective cohort study was to describe, in primiparous women delivered vaginally, prevalence rates and severities of upper back, lower back, and pelvic girdle pain during pregnancy and 6-10 weeks postpartum and to describe the trajectory of pain constellations between time points.

Study design: Participants completed questionnaires at each time point. Pain intensity was rated on a visual analogue scale ranging from 0 to 100.

Results: Of the 288 participants, 94% reported truncal pain during pregnancy, while 75% did so postpartum. Prevalence rates of upper back, lower back, and pelvic girdle pain with or without other types of pain during pregnancy were 42%, 77%, and 74% and postpartum were 43%, 52%, and 41%, respectively. Pain severity was highest for women endorsing pain in three locations (median 55-60). Of women with the most common pain constellation during pregnancy, lower back and pelvic girdle (32%), 18% had persistent low back and pelvic girdle pain postpartum, 20% had no pain, and the remainder had pain in a different location. Of women with pain in all three locations during pregnancy (27%), 34% had persistent pain in three locations postpartum, 13% had no pain, and the remainder had pain in at least one location.

Conclusion: More women experience pain in a constellation of locations than in a single location. Severity increases as number of pain sites increase. Women with pain in three sites during pregnancy are least likely to have pain resolve. Interventions should focus on the entire trunk and not simply one site of pain.

Keywords: back pain; pelvic pain; postpartum; pregnancy.

Conflict of interest statement

Declaration of conflicting interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: IN received an honorarium from Elsevier. The remaining authors had no competing financial interests to disclose.

Figures

Figure 1.
Figure 1.
Illustration of pain distribution provided to participants.
Figure 2.
Figure 2.
Participant flow.
Figure 3.
Figure 3.
Venn diagram demonstrating the overlap between pain locations. Women with one pain location only are represented in the outermost circle slivers (e.g. during pregnancy, 31 women had lower back pain only); women with pain in all three locations are represented in the innermost area (e.g. in the pregnancy, 79 women had upper back, lower back, and pelvic girdle pain).

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