Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2016

Open Access 01-12-2016 | Research article

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

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

Published in: BMC Musculoskeletal Disorders | Issue 1/2016

Login to get access

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.
Literature
1.
Pennick V, Liddle SD. Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database Syst Rev. 2013;8:CD001139.
2.
Wu WH, Meijer O, Uegaki K, Mens J, van Dieen J, Wuisman PI, Ostgaard H. Pregnancy-related pelvic girdle pain (PPP), I: Terminology, clinical presentation, and prevalence. Eur Spine J. 2004;13:575–89.CrossRefPubMedPubMedCentral
3.
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:E149–155.CrossRef
4.
Skaggs C, Prather H, Gross G, George J, Thompson P, Nelson D. Back and pelvic pain in an underserved United States pregnant population: a preliminary descriptive survey. Journal of manipulative and physiological therapeutics. 2007;30:130–4.CrossRefPubMed
5.
Vleeming A, Albert HB, Ostgaard HC, Sturesson B, Stuge B. European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J. 2008;17:794–819.CrossRefPubMedPubMedCentral
6.
Vermani E, Mittal R, Weeks A. Pelvic girdle pain and low back pain in pregnancy: a review. Pain Pract. 2010;10:60–71.CrossRefPubMed
7.
8.
Elden H, Lundgren I, Robertson E. Life’s pregnant pause of pain: pregnant women’s experiences of pelvic girdle pain related to daily life: a Swedish interview study. Sex Reprod Healthc. 2013;4:29–34.CrossRefPubMed
9.
Bergstrom C, Persson M, Mogren I. Pregnancy-related low back pain and pelvic girdle pain approximately 14 months after pregnancy - pain status, self-rated health and family situation. BMC pregnancy and childbirth. 2014;14:48.CrossRefPubMedPubMedCentral
10.
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.CrossRefPubMedPubMedCentral
11.
Wuytack F, Curtis E, Begley C. Experiences of First-Time Mothers With Persistent Pelvic Girdle Pain After Childbirth: Descriptive Qualitative Study. Phys Ther. 2015;95:1354–64.CrossRefPubMed
12.
Gutke A, Lundberg M, Ostgaard HC, Oberg B. Impact of postpartum lumbopelvic pain on disability, pain intensity, health-related quality of life, activity level, kinesiophobia, and depressive symptoms. Eur Spine J. 2011;20:440–8.CrossRefPubMed
13.
Albert H, Godskesen M, Westergaard J. Prognosis in four syndromes of pregnancy-related pelvic pain. Acta Obstet Gynecol Scand. 2001;80:505–10.CrossRefPubMed
14.
Noren L, Ostgaard S, Johansson G, HC O: Lumbar back and posterior pelvic pain during pregnancy: a 3-year follow-up. Eur Spine J. 2002, 11:267-71.
15.
Rost CC, Jacqueline J, Kaiser A, Verhagen AP, Koes BW. Prognosis of women with pelvic pain during pregnancy: a long-term follow-up study. Acta Obstet Gynecol Scand. 2006;85:771–7.CrossRefPubMed
16.
Mogren IM. BMI, pain and hyper-mobility are determinants of long-term outcome for women with low back pain and pelvic pain during pregnancy. Eur Spine J. 2006;15:1093–102.CrossRefPubMedPubMedCentral
17.
Ostgaard HC, Zetherstrom G, Roos-Hansson E. Back pain in relation to pregnancy: a 6-year follow-up. Spine (Phila Pa 1976). 1997;22:2945–50.CrossRef
18.
Mogren I. Perceived health, sick leave, psychosocial situation, and sexual life in women with low-back pain and pelvic pain during pregnancy. Acta Obstet Gynecol Scand. 2006;85:647–56.CrossRefPubMed
19.
Gutke A, Olsson CB, Vollestad N, Oberg B, Wikmar LN, Robinson HS. Association between lumbopelvic pain, disability and sick leave during pregnancy - a comparison of three Scandinavian cohorts. J Rehabil Med. 2014;46:468–74.CrossRefPubMed
20.
den Berg SG S-v, Hendriksen IJ, Bruinvels DJ, Twisk JW, van Mechelen W, van Poppel MN. Predictors for postpartum pelvic girdle pain in working women: the Mom@Work cohort study. Pain. 2012;153:2370–9.CrossRef
21.
Mogren I. 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.CrossRefPubMed
22.
Gutke A, Ostgaard H, Oberg B. Predicting persistent pregnancy-related low back pain. Spine. 2008;33:E386–393.CrossRefPubMed
23.
Sjodahl J, Gutke A, Oberg B. Predictors for long-term disability in women with persistent postpartum pelvic girdle pain. Eur Spine J. 2013;22:1665–73.CrossRefPubMedPubMedCentral
24.
Bjelland EK, Owe KM, Stuge B, Vangen S, Eberhard-Gran M. Breastfeeding and pelvic girdle pain: a follow-up study of 10 603 women 18 months after delivery. BJOG. 2014;122:1765–71.CrossRefPubMed
25.
Bjelland EK, Stuge B, Engdahl B, Eberhard-Gran M. The effect of emotional distress on persistent pelvic girdle pain after delivery: a longitudinal population study. BJOG. 2013;120:32–40.CrossRefPubMed
26.
Bjelland EK, Stuge B, Vangen S, Stray-Pedersen B, Eberhard-Gran M. Mode of delivery and persistence of pelvic girdle syndrome 6 months postpartum. Am J Obstet Gynecol. 2013;208(298):e291–297.
27.
Turgut F, Turgut M, Cetinsahi M. A prospective study of persistent back pain after pregnancy. Eur J Obstet Gynecol Reprod Biol. 1998;80:45–8.CrossRefPubMed
28.
Ostgaard HC, Andersson GB. Postpartum low-back pain. Spine (Phila Pa 1976). 1992;17:53–5.CrossRef
29.
Ansara D, Cohen MM, Gallop R, Kung R, Schei B. Predictors of women’s physical health problems after childbirth. Journal of psychosomatic obstetrics and gynaecology. 2005;26:115–25.CrossRefPubMed
30.
Mukkannavar P, Desai BR, Mohanty U, Kulkarni S, Parvatikar V, Daiwajna S. Pelvic girdle pain in Indian postpartum women: a cross-sectional study. Physiother Theory Pract. 2013;30:123–30.CrossRefPubMed
31.
Robinson H, Mengshoel A, Veierod M, Vollestad N. Pelvic girdle pain: potential risk factors in pregnancy in relation to disability and pain intensity three months postpartum. Man Ther. 2010;15:522–8.CrossRefPubMed
32.
Verstraete EH, Vanderstraeten G, Parewijck W. Pelvic Girdle Pain during or after Pregnancy: a review of recent evidence and a clinical care path proposal. Facts Views Vis Obgyn. 2013;5:33–43.PubMedPubMedCentral
33.
34.
Ronchetti I, Vleeming A, van Wingerden JP. Physical characteristics of women with severe pelvic girdle pain after pregnancy: a descriptive cohort study. Spine (Phila Pa 1976). 2008;33:E145–151.CrossRef
35.
Biering K, Nohr EA, Olsen J, Andersen AM, Hjollund NH, Juhl M. Pregnancy-related pelvic pain is more frequent in women with increased body mass index. Acta Obstet Gynecol Scand. 2011;90:1132–9.CrossRefPubMed
36.
Gutke A, Sjodahl J, Oberg B. Specific muscle stabilizing as home exercises for persistent pelvic girdle pain after pregnancy: a randomized, controlled clinical trial. J Rehabil Med. 2010;42:929–35.CrossRefPubMed
37.
Stuge B, Laerum E, Kirkesola G, Vollestad N. The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy: a randomized controlled trial. Spine. 2004;29:351–9.CrossRefPubMed
38.
Ferreira P. Specific stabilising exercise improves pain and function in women with pelvic girdle pain following pregnancy. Aust J Physiother. 2004;50:259.CrossRefPubMed
39.
Robinson H, Mengshoel A, Veierod M, Vollestad N. Pelvic girdle pain, clinical tests and disability in late pregnancy. Man Ther. 2010;15:280–5.CrossRefPubMed
40.
Dionne CE, Dunn KM, Croft PR, Nachemson AL, Buchbinder R, Walker BF, Wyatt M, Cassidy J, Rossignol M, Leboeuf-Yde C, et al. A consensus approach toward the standardization of back pain definitions for use in prevalence studies. Spine. 2008;33:95–103.CrossRefPubMed
41.
Salen BA, Spangfort E, Nygren AL, Nordemar R. The Disability Rating Index: an instrument for the assessment of disability in clinical settings. J Clin Epidemiol. 1994;47:1423–35.CrossRefPubMed
42.
Fairbank J, Couper J, Davies J, O’Brien J. The Oswestery low back pain disability questionnaire. Physiotherapy. 1994;66:271–3.
43.
Huskinsson E. Measurement of pain. Lancet. 1974;2(7889):1127–31.
44.
Elden H, Ladfors L, Olsen MF, Ostgaard HC, Hagberg H. Effects of acupuncture and stabilising exercises as adjunct to standard treatment in pregnant women with pelvic girdle pain: randomised single blind controlled trial. BMJ. 2005;330:761–4.CrossRefPubMedPubMedCentral
45.
Elden H, Fagevik-Olsen M, Ostgaard HC, Stener-Victorin E, Hagberg H. Acupuncture as an adjunct to standard treatment for pelvic girdle pain in pregnant women: randomised double-blinded controlled trial comparing acupuncture with non-penetrating sham acupuncture. BJOG. 2008;115:1655–68.CrossRefPubMed
46.
Elden H, Ostgaard HC, Glantz A, Marciniak P, Linner AC, Olsen MF. Effects of craniosacral therapy as adjunct to standard treatment for pelvic girdle pain in pregnant women: a multicenter, single blind, randomized controlled trial. Acta Obstet Gynecol Scand. 2013;92:775–82.CrossRefPubMed
47.
Rabin R, De Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med. 2001;33:337–43.CrossRefPubMed
48.
Burstrom K, Johannesson M, Rehnberg C. Deteriorating health status in Stockholm 1998-2002: results from repeated population surveys using the EQ-5D. Qual Life Res. 2007;16:1547–53.CrossRefPubMed
49.
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.CrossRefPubMed
50.
Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res. 2002;52:69–77.CrossRefPubMed
51.
Love J, Moore CD, Hensing G: S Validation of the Swedish translation of the General Self-Efficacy scale. 2012, 21:1249-53.
52.
Sullivan MJL, Bishop SR, Pivic J: The Pain Catastrophizing scale Psychol Assess. 1995, 524-532.
53.
Gutke A, Kjellby-Wendt G, Oberg B. The inter-rater reliability of a standardised classification system for pregnancy-related lumbopelvic pain. Man Ther. 2010;15:13–8.CrossRefPubMed
54.
Ostgaard HC, Zetherstrom G, Roos-Hansson E. The posterior pelvic pain provocation test in pregnant women. Eur Spine J. 1994;3:258–60.CrossRefPubMed
55.
56.
Fagevik Olsen M, Gutke A, Elden H, Nordenman C, Fabricius L, Gravesen M, Lind A, Kjellby-Wendt G. Self-administered tests as a screening procedure for pregnancy-related pelvic girdle pain. Eur Spine J. 2009;18:1121–9.CrossRefPubMedPubMedCentral
57.
Albert H, Godskesen M, Westergaard J. Evaluation of clinical tests used in classification procedures in pregnancy-related pelvic joint pain. Eur Spine J. 2000;9:161–6.CrossRefPubMedPubMedCentral
58.
Mens JM, Vleeming A, Snijders CJ, Koes BW, Stam HJ. Validity of the active straight leg raise test for measuring disease severity in patients with posterior pelvic pain after pregnancy. Spine (Phila Pa 1976). 2002;27:196–200.CrossRef
59.
Mens JM, Vleeming A, Snijders C, Koes BW, Stam HJ. Reliability and validity of the active straight leg raise test in posterior pelvic pain since pregnancy. Spine. 2001;26:1167–71.CrossRefPubMed
60.
Stuge B, Garratt A, Krogstad Jenssen H, Grotle M. The pelvic girdle questionnaire: a condition-specific instrument for assessing activity limitations and symptoms in people with pelvic girdle pain. Phys Ther. 2011;91:1096–108.CrossRefPubMed
61.
Linton SJ, Nicholas MK, MacDonald S, Boersma K, Bergbom S, Maher C, Refshauge K. The role of depression and catastrophizing in musculoskeletal pain. Eur J Pain. 2011; 15(4):416-22. doi:10.​1016/​j.​ejpain.​2010.​08.​009. Epub 2010 Sep 29.
62.
Linton SJ. A review of psychological risk factors in back and neck pain. Spine (Phila Pa 1976). 2000;25(9):1148-56.
63.
64.
Wuytack F, Curtis E, Begley C. The health-seeking behaviours of first-time mothers with persistent pelvic girdle pain after childbirth in Ireland: A descriptive qualitative study. Midwifery. 2015;31:1104–9.CrossRefPubMed
65.
Mens JM, Vleeming A, Stoeckart R, Stam HJ, Snijders CJ: Understanding peripartum pelvic pain. Implications of a patient survey. Spine (Phila Pa 1976). 1996, 21:1363-1369; discussion 1369-1370.
66.
Elden H, Lundgren I, Robertson E: The pelvic ring of pain: Pregnant women’s experiences of severe pelvic girdle pain. Clinical Nursing Studies: 2014, 2 (2): ISSN 2014; 2.
67.
Persson M, Winkvist A, Dahlgren L, Mogren I: “Struggling with daily life and enduring pain”: a qualitative study of the experiences of pregnant women living with pelvic girdle pain BMC pregnancy and childbirth. 2013 May, 13:111.
68.
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.
69.
Elden H, Lundgren I, Robertson E. Demanding and challenging: Men’s experiences of living with a pregnant woman with pelvic girdle pain: An interview study. Clinical Nursing Studies. 2014;2:17–29.
70.
Laslett M, Young SB, Aprill CN, McDonald B. Diagnosing painful sacroiliac joints: A validity study of a McKenzie evaluation and sacroiliac provocation tests. Aust J Physiother. 2003;49:89–97.CrossRefPubMed
71.
Grotle M, Garratt AM, Krogstad Jenssen H, Stuge B. Reliability and construct validity of self-report questionnaires for patients with pelvic girdle pain. Phys Ther. 2012;92:111–23.CrossRefPubMed
72.
Elden H, Hagberg H, Olsen MF, Ladfors L, Ostgaard HC. Regression of pelvic girdle pain after delivery: follow-up of a randomised single blind controlled trial with different treatment modalities. Acta Obstet Gynecol Scand. 2008;87:201–8.CrossRefPubMed
73.
Gutke A, Betten C, Degerskar K, Pousette S, Fagevik Olsen M. Treatments for pregnancy-related lumbopelvic pain: a systematic review of physiotherapy modalities. Acta Obstet Gynecol Scand. 2015;94:1156–7.
74.
Ostgaard HC, Roos-Hansson E, Zetherstrom G: Regression of back and posterior pelvic pain after pregnancy. Spine (Phila Pa 1976). 1996, 21:2777-2780.
75.
Lund I, Lundeberg T, Lonnberg L, Svensson E: Decrease of pregnant women's pelvic pain after acupuncture: a randomized controlled single-blind study. Acta Obstet Gynecol Scand. 2006;85:12-19.
76.
Chou R, Deyo R, Friedly J, Skelly A, Hashimoto R, Weimer M, Fu R, Dana T, Kraegel P, Griffin J et al. In: Noninvasive Treatments for Low Back Pain. edn. Rockville (MD); 2016.
Metadata
Title
Predictors and consequences of long-term pregnancy-related pelvic girdle pain: a longitudinal follow-up study
Authors
Helen Elden
Annelie Gutke
Gunilla Kjellby-Wendt
Monika Fagevik-Olsen
Hans-Christian Ostgaard
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2016
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-016-1154-0

Other articles of this Issue 1/2016

BMC Musculoskeletal Disorders 1/2016 Go to the issue

Research article

EGR1 controls divergent cellular responses of distinctive nucleus pulposus cell types

Research article

Combination of intramedullary rod, wrapping bone grafting and Ilizarov’s fixator for the treatment of Crawford type IV congenital pseudarthrosis of the tibia: mid-term follow up of 56 cases

Study protocol

Does walking after lumbar spinal surgery predict recovery of function at six months? Protocol for a prospective cohort study

Research article

Impairment-targeted exercises for older adults with knee pain: a proof-of-principle study (TargET-Knee-Pain)

Research article

Regenerate bone stimulation following limb lengthening: a meta-analysis

Research article

Macrophage migration inhibitory factor enhances lipopolysaccharide-induced fibroblast proliferation by inducing toll-like receptor 4