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

Helen Elden, Annelie Gutke, Gunilla Kjellby-Wendt, Monika Fagevik-Olsen, Hans-Christian Ostgaard, Helen Elden, Annelie Gutke, Gunilla Kjellby-Wendt, Monika Fagevik-Olsen, Hans-Christian Ostgaard

Abstract

Background: Pelvic 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/design: A 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.

Results: A 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.

Conclusions: This 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.

Keywords: Anxiety; Depression; Function; Health-related quality of life; Long-term; Pain catastrophizing; Pelvic girdle pain; Predictor; Self-efficacy.

Figures

Fig. 1
Fig. 1
Flow-chart of the study
Fig. 2
Fig. 2
Association between baseline characteristics in pregnancy and the occurrence of PGP 2, 6 and 11 years after pregnancy. Result of the univariable logistic regressions with variables measured in pregnancy

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