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Published in: BMC Musculoskeletal Disorders 1/2020

01-12-2020 | Research article

The Association of Self-Reported Generalized Joint Hypermobility with pelvic girdle pain during pregnancy: a retrospective cohort study

Authors: Kerstin Ahlqvist, Elisabeth Krefting Bjelland, Ronnie Pingel, Angela Schlager, Lena Nilsson-Wikmar, Per Kristiansson

Published in: BMC Musculoskeletal Disorders | Issue 1/2020

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Abstract

Background

Pelvic girdle pain (PGP) is common during pregnancy but the causes remain poorly understood. Generalized joint hypermobility (GJH) is an inherited trait, with joint mobility beyond normal limits and is assumed to be related with PGP. The aim of this project was to study the association between self-reported GJH and the presence of PGP during pregnancy.

Methods

In this cohort study, 4884 Swedish-speaking women were consecutively recruited at their first visit for registration in the national antenatal screening programme in Sweden. We used the five-part questionnaire (5PQ) to assess GJH and pain drawings to identify PGP. Our primary outcome was the presence of PGP during the entire pregnancy and secondary outcomes were PGP in each trimesters. We tested the associations with logistic regression analysis, and adjusted for age and ethnicity.

Results

In all, 2455 (50.3%) women responded to both questionnaires. The prevalence of self-reported GJH was 28.7%. A higher proportion of women with GJH than women without GJH reported PGP during the entire pregnancy (47.9% vs. 41.0%), particularly in trimester 1 (31.6% vs. 22.0%). Thus, women with GJH also had higher odds of PGP during the entire pregnancy (adjusted odds ratio (aOR) 1.27: 95% CI 1.11–1.47) and in trimester 1 (aOR 1.54: 95% CI 1.20–1.96), but the associations were not statistically significant in trimester 2 (aOR 1.24: 95% CI 0.82–1.88) or trimester 3 (aOR 1.20: 95% CI 0.99–1.45). The odds of PGP in pregnancy increased with increasing numbers of positive answers to the 5PQ (p for linear trend < 0.001) for the entire pregnancy and in trimester 1 (p for linear trend < 0.001), but not in trimesters 2 or 3 (p = 0.13 and p = 0.06, respectively).

Conclusions

Compared to women with normal joint mobility, women with GJH had higher odds of reporting PGP during pregnancy and the odds increased with number of positive responses to the 5PQ. The associations were present in trimester 1 but did not reach statistical significance in trimester 2 and 3.
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Literature
1.
go back to reference Bjorklund K, Bergstrom S. Is pelvic pain in pregnancy a welfare complaint? Acta Obstet Gynecol Scand. 2000;79(1):24–30.PubMed Bjorklund K, Bergstrom S. Is pelvic pain in pregnancy a welfare complaint? Acta Obstet Gynecol Scand. 2000;79(1):24–30.PubMed
2.
go back to reference 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(6):794–819.PubMedPubMedCentralCrossRef 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(6):794–819.PubMedPubMedCentralCrossRef
3.
go back to reference Wu WH, Meijer OG, Uegaki K, Mens JM, van Dieen JH, Wuisman PI, et al. Pregnancy-related pelvic girdle pain (PPP), I: terminology, clinical presentation, and prevalence. Eur Spine J. 2004;13(7):575–89.PubMedPubMedCentralCrossRef Wu WH, Meijer OG, Uegaki K, Mens JM, van Dieen JH, Wuisman PI, et al. Pregnancy-related pelvic girdle pain (PPP), I: terminology, clinical presentation, and prevalence. Eur Spine J. 2004;13(7):575–89.PubMedPubMedCentralCrossRef
4.
go back to reference Kristiansson P, Svardsudd K, von Schoultz B. Back pain during pregnancy: a prospective study. Spine. 1996;21(6):702–9.PubMedCrossRef Kristiansson P, Svardsudd K, von Schoultz B. Back pain during pregnancy: a prospective study. Spine. 1996;21(6):702–9.PubMedCrossRef
5.
go back to reference Ostgaard HC, Andersson GB, Karlsson K. Prevalence of back pain in pregnancy. Spine. 1991;16(5):549–52.PubMedCrossRef Ostgaard HC, Andersson GB, Karlsson K. Prevalence of back pain in pregnancy. Spine. 1991;16(5):549–52.PubMedCrossRef
6.
go back to reference Mens JM. Huis in 't veld YH, Pool-Goudzwaard a. severity of signs and symptoms in lumbopelvic pain during pregnancy. Man Ther. 2012;17(2):175–9.PubMedCrossRef Mens JM. Huis in 't veld YH, Pool-Goudzwaard a. severity of signs and symptoms in lumbopelvic pain during pregnancy. Man Ther. 2012;17(2):175–9.PubMedCrossRef
7.
go back to reference Malmqvist S, Kjaermann I, Andersen K, Okland I, Bronnick K, Larsen JP. Prevalence of low back and pelvic pain during pregnancy in a Norwegian population. J Manip Physiol Ther. 2012;35(4):272–8.CrossRef Malmqvist S, Kjaermann I, Andersen K, Okland I, Bronnick K, Larsen JP. Prevalence of low back and pelvic pain during pregnancy in a Norwegian population. J Manip Physiol Ther. 2012;35(4):272–8.CrossRef
8.
go back to reference 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(5):468–74.PubMedCrossRef 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(5):468–74.PubMedCrossRef
9.
go back to reference Bjelland EK, Eskild A, Johansen R, Eberhard-Gran M. Pelvic girdle pain in pregnancy: the impact of parity. Am J Obstet Gynecol. 2010;203(2):146.e1–6.CrossRef Bjelland EK, Eskild A, Johansen R, Eberhard-Gran M. Pelvic girdle pain in pregnancy: the impact of parity. Am J Obstet Gynecol. 2010;203(2):146.e1–6.CrossRef
10.
go back to reference Bjelland EK, Eberhard-Gran M, Nielsen CS, Eskild A. Age at menarche and pelvic girdle syndrome in pregnancy: a population study of 74 973 women. BJOG. 2011;118(13):1646–52.PubMedCrossRef Bjelland EK, Eberhard-Gran M, Nielsen CS, Eskild A. Age at menarche and pelvic girdle syndrome in pregnancy: a population study of 74 973 women. BJOG. 2011;118(13):1646–52.PubMedCrossRef
11.
go back to reference Aldabe D, Ribeiro DC, Milosavljevic S, Dawn BM. Pregnancy-related pelvic girdle pain and its relationship with relaxin levels during pregnancy: a systematic review. Eur Spine J. 2012;21(9):1769–76.PubMedPubMedCentralCrossRef Aldabe D, Ribeiro DC, Milosavljevic S, Dawn BM. Pregnancy-related pelvic girdle pain and its relationship with relaxin levels during pregnancy: a systematic review. Eur Spine J. 2012;21(9):1769–76.PubMedPubMedCentralCrossRef
12.
go back to reference Casagrande D, Gugala Z, Clark SM, Lindsey RW. Low Back pain and pelvic girdle pain in pregnancy. Am Acad Orthopaedic Surg. 2015;23(9):539–49.CrossRef Casagrande D, Gugala Z, Clark SM, Lindsey RW. Low Back pain and pelvic girdle pain in pregnancy. Am Acad Orthopaedic Surg. 2015;23(9):539–49.CrossRef
13.
go back to reference Kristiansson P, Svardsudd K, von Schoultz B. Reproductive hormones and aminoterminal propeptide of type III procollagen in serum as early markers of pelvic pain during late pregnancy. Am J Obstet Gynecol. 1999;180(1 Pt 1):128–34.PubMedCrossRef Kristiansson P, Svardsudd K, von Schoultz B. Reproductive hormones and aminoterminal propeptide of type III procollagen in serum as early markers of pelvic pain during late pregnancy. Am J Obstet Gynecol. 1999;180(1 Pt 1):128–34.PubMedCrossRef
14.
go back to reference Mogren IM, Pohjanen AI. Low back pain and pelvic pain during pregnancy: prevalence and risk factors. Spine. 2005;30(8):983–91.PubMedCrossRef Mogren IM, Pohjanen AI. Low back pain and pelvic pain during pregnancy: prevalence and risk factors. Spine. 2005;30(8):983–91.PubMedCrossRef
15.
go back to reference Eichenseer PH, Sybert DR, Cotton JR. A finite element analysis of sacroiliac joint ligaments in response to different loading conditions. Spine. 2011;36(22):E1446–52.PubMedCrossRef Eichenseer PH, Sybert DR, Cotton JR. A finite element analysis of sacroiliac joint ligaments in response to different loading conditions. Spine. 2011;36(22):E1446–52.PubMedCrossRef
16.
go back to reference Child AH. Joint hypermobility syndrome: inherited disorder of collagen synthesis. J Rheumatol. 1986;13(2):239–43.PubMed Child AH. Joint hypermobility syndrome: inherited disorder of collagen synthesis. J Rheumatol. 1986;13(2):239–43.PubMed
17.
go back to reference Lindgren A, Kristiansson P. Finger joint laxity, number of previous pregnancies and pregnancy induced back pain in a cohort study. BMC Pregnancy Childbirth. 2014;14:61.PubMedPubMedCentralCrossRef Lindgren A, Kristiansson P. Finger joint laxity, number of previous pregnancies and pregnancy induced back pain in a cohort study. BMC Pregnancy Childbirth. 2014;14:61.PubMedPubMedCentralCrossRef
18.
go back to reference Schauberger CW, Rooney BL, Goldsmith L, Shenton D, Silva PD, Schaper A. Peripheral joint laxity increases in pregnancy but does not correlate with serum relaxin levels. Am J Obstet Gynecol. 1996;174(2):667–71.PubMedCrossRef Schauberger CW, Rooney BL, Goldsmith L, Shenton D, Silva PD, Schaper A. Peripheral joint laxity increases in pregnancy but does not correlate with serum relaxin levels. Am J Obstet Gynecol. 1996;174(2):667–71.PubMedCrossRef
19.
go back to reference Mens JM, Pool-Goudzwaard A, Stam HJ. Mobility of the pelvic joints in pregnancy-related lumbopelvic pain: a systematic review. Obstet Gynecol Surv. 2009;64(3):200–8.PubMedCrossRef Mens JM, Pool-Goudzwaard A, Stam HJ. Mobility of the pelvic joints in pregnancy-related lumbopelvic pain: a systematic review. Obstet Gynecol Surv. 2009;64(3):200–8.PubMedCrossRef
20.
go back to reference Syx D, De Wandele I, Rombaut L, Malfait F. Hypermobility, the Ehlers-Danlos syndromes and chronic pain. Clin Exp Rheumatol. 2017;35 Suppl 107(5):116–22.PubMed Syx D, De Wandele I, Rombaut L, Malfait F. Hypermobility, the Ehlers-Danlos syndromes and chronic pain. Clin Exp Rheumatol. 2017;35 Suppl 107(5):116–22.PubMed
21.
go back to reference Gazit Y, Jacob G, Grahame R. Ehlers-Danlos Syndrome-Hypermobility Type: A Much Neglected Multisystemic Disorder. Rambam Maimonides Med J. 2016;7(4). Gazit Y, Jacob G, Grahame R. Ehlers-Danlos Syndrome-Hypermobility Type: A Much Neglected Multisystemic Disorder. Rambam Maimonides Med J. 2016;7(4).
22.
go back to reference Malfait F, Francomano C, Byers P, Belmont J, Berglund B, Black J, et al. The 2017 international classification of the Ehlers-Danlos syndromes. Am J Med Genet C: Semin Med Genet. 2017;175(1):8–26.CrossRef Malfait F, Francomano C, Byers P, Belmont J, Berglund B, Black J, et al. The 2017 international classification of the Ehlers-Danlos syndromes. Am J Med Genet C: Semin Med Genet. 2017;175(1):8–26.CrossRef
23.
go back to reference Castori M, Tinkle B, Levy H, Grahame R, Malfait F, Hakim A. A framework for the classification of joint hypermobility and related conditions. Am J Med Genet C: Semin Med Genet. 2017;175(1):148–57.CrossRef Castori M, Tinkle B, Levy H, Grahame R, Malfait F, Hakim A. A framework for the classification of joint hypermobility and related conditions. Am J Med Genet C: Semin Med Genet. 2017;175(1):148–57.CrossRef
24.
go back to reference Castori M, Hakim A. Contemporary approach to joint hypermobility and related disorders. Curr Opin Pediatr. 2017;29(6):640–9.PubMedCrossRef Castori M, Hakim A. Contemporary approach to joint hypermobility and related disorders. Curr Opin Pediatr. 2017;29(6):640–9.PubMedCrossRef
26.
go back to reference Remvig L, Jensen DV, Ward RC. Epidemiology of general joint hypermobility and basis for the proposed criteria for benign joint hypermobility syndrome: review of the literature. J Rheumatol. 2007;34(4):804–9.PubMed Remvig L, Jensen DV, Ward RC. Epidemiology of general joint hypermobility and basis for the proposed criteria for benign joint hypermobility syndrome: review of the literature. J Rheumatol. 2007;34(4):804–9.PubMed
27.
28.
go back to reference Remvig L, Flycht L, Christensen KB, Juul-Kristensen B. Lack of consensus on tests and criteria for generalized joint hypermobility, Ehlers-Danlos syndrome: hypermobile type and joint hypermobility syndrome. Am J Med Genet A. 2014;164a(3):591–6.PubMedCrossRef Remvig L, Flycht L, Christensen KB, Juul-Kristensen B. Lack of consensus on tests and criteria for generalized joint hypermobility, Ehlers-Danlos syndrome: hypermobile type and joint hypermobility syndrome. Am J Med Genet A. 2014;164a(3):591–6.PubMedCrossRef
29.
go back to reference Juul-Kristensen B, Schmedling K, Rombaut L, Lund H, Engelbert RH. Measurement properties of clinical assessment methods for classifying generalized joint hypermobility-a systematic review. Am J Med Genet C: Semin Med Genet. 2017;175(1):116–47.CrossRef Juul-Kristensen B, Schmedling K, Rombaut L, Lund H, Engelbert RH. Measurement properties of clinical assessment methods for classifying generalized joint hypermobility-a systematic review. Am J Med Genet C: Semin Med Genet. 2017;175(1):116–47.CrossRef
31.
go back to reference Hakim AJ, Grahame R. A simple questionnaire to detect hypermobility: an adjunct to the assessment of patients with diffuse musculoskeletal pain. Int J Clin Pract. 2003;57(3):163–6.PubMed Hakim AJ, Grahame R. A simple questionnaire to detect hypermobility: an adjunct to the assessment of patients with diffuse musculoskeletal pain. Int J Clin Pract. 2003;57(3):163–6.PubMed
32.
go back to reference Moraes DA, Baptista CA, Crippa JA, Louzada-Junior P. Translation into Brazilian Portuguese and validation of the five-part questionnaire for identifying hypermobility. Rev Bras Reumatol Engl Ed. 2011;51(1):53–69. Moraes DA, Baptista CA, Crippa JA, Louzada-Junior P. Translation into Brazilian Portuguese and validation of the five-part questionnaire for identifying hypermobility. Rev Bras Reumatol Engl Ed. 2011;51(1):53–69.
33.
go back to reference Sohrbeck-Nohr O, Kristensen JH, Boyle E, Remvig L, Juul-Kristensen B. Generalized joint hypermobility in childhood is a possible risk for the development of joint pain in adolescence: a cohort study. BMC Pediatr. 2014;14:302.PubMedPubMedCentralCrossRef Sohrbeck-Nohr O, Kristensen JH, Boyle E, Remvig L, Juul-Kristensen B. Generalized joint hypermobility in childhood is a possible risk for the development of joint pain in adolescence: a cohort study. BMC Pediatr. 2014;14:302.PubMedPubMedCentralCrossRef
35.
go back to reference Hastings J, Forster JE. Witzeman K. PM R: Joint Hypermobility among Female Patients Presenting with Chronic Myofascial Pelvic Pain; 2019. Hastings J, Forster JE. Witzeman K. PM R: Joint Hypermobility among Female Patients Presenting with Chronic Myofascial Pelvic Pain; 2019.
36.
go back to reference van Dongen PW, de Boer M, Lemmens WA, Theron GB. Hypermobility and peripartum pelvic pain syndrome in pregnant south African women. Eur J Obstet Gynecol Reprod Biol X. 1999;84(1):77–82.CrossRef van Dongen PW, de Boer M, Lemmens WA, Theron GB. Hypermobility and peripartum pelvic pain syndrome in pregnant south African women. Eur J Obstet Gynecol Reprod Biol X. 1999;84(1):77–82.CrossRef
37.
go back to reference Stern J, Salih Joelsson L, Tyden T, Berglund A, Ekstrand M, Hegaard H, et al. Is pregnancy planning associated with background characteristics and pregnancy-planning behavior? Acta Obstet Gynecol Scand. 2016;95(2):182–9.PubMedCrossRef Stern J, Salih Joelsson L, Tyden T, Berglund A, Ekstrand M, Hegaard H, et al. Is pregnancy planning associated with background characteristics and pregnancy-planning behavior? Acta Obstet Gynecol Scand. 2016;95(2):182–9.PubMedCrossRef
38.
go back to reference Juul-Kristensen B, Ostengaard L, Hansen S, Boyle E, Junge T, Hestbaek L. Generalised joint hypermobility and shoulder joint hypermobility, − risk of upper body musculoskeletal symptoms and reduced quality of life in the general population. BMC Musculoskelet Disord. 2017;18(1):226.PubMedPubMedCentralCrossRef Juul-Kristensen B, Ostengaard L, Hansen S, Boyle E, Junge T, Hestbaek L. Generalised joint hypermobility and shoulder joint hypermobility, − risk of upper body musculoskeletal symptoms and reduced quality of life in the general population. BMC Musculoskelet Disord. 2017;18(1):226.PubMedPubMedCentralCrossRef
39.
go back to reference Mulvey MR, Macfarlane GJ, Beasley M, Symmons DP, Lovell K, Keeley P, et al. Modest association of joint hypermobility with disabling and limiting musculoskeletal pain: results from a large-scale general population-based survey. Arthritis Care Res. 2013;65(8):1325–33.CrossRef Mulvey MR, Macfarlane GJ, Beasley M, Symmons DP, Lovell K, Keeley P, et al. Modest association of joint hypermobility with disabling and limiting musculoskeletal pain: results from a large-scale general population-based survey. Arthritis Care Res. 2013;65(8):1325–33.CrossRef
40.
go back to reference Farmer AD, Douthwaite H, Gardiner S, Aziz Q, Grahame R. A novel in vivo skin extensibility test for joint hypermobility. J Rheumatol. 2010;37(7):1513–8.PubMedCrossRef Farmer AD, Douthwaite H, Gardiner S, Aziz Q, Grahame R. A novel in vivo skin extensibility test for joint hypermobility. J Rheumatol. 2010;37(7):1513–8.PubMedCrossRef
41.
go back to reference Glans M, Humble MB, Elwin M, Bejerot S. Self-rated joint hypermobility: the five-part questionnaire evaluated in a Swedish non-clinical adult population. BMC Musculoskelet Disord. 2020;21(1):174.PubMedPubMedCentralCrossRef Glans M, Humble MB, Elwin M, Bejerot S. Self-rated joint hypermobility: the five-part questionnaire evaluated in a Swedish non-clinical adult population. BMC Musculoskelet Disord. 2020;21(1):174.PubMedPubMedCentralCrossRef
42.
go back to reference Larsson LG, Baum J, Mudholkar GS, Srivastava DK. Hypermobility: prevalence and features in a Swedish population. Br J Rheumatol. 1993;32(2):116–9.PubMedCrossRef Larsson LG, Baum J, Mudholkar GS, Srivastava DK. Hypermobility: prevalence and features in a Swedish population. Br J Rheumatol. 1993;32(2):116–9.PubMedCrossRef
43.
go back to reference Klemp P, Williams SM, Stansfield SA. Articular mobility in Maori and European New Zealanders. Rheumatol (Oxford, England). 2002;41(5):554–7.CrossRef Klemp P, Williams SM, Stansfield SA. Articular mobility in Maori and European New Zealanders. Rheumatol (Oxford, England). 2002;41(5):554–7.CrossRef
44.
go back to reference O'Neill S, Manniche C, Graven-Nielsen T, Arendt-Nielsen L. Generalized deep-tissue hyperalgesia in patients with chronic low-back pain. Eur J Pain (London, England). 2007;11(4):415–20.CrossRef O'Neill S, Manniche C, Graven-Nielsen T, Arendt-Nielsen L. Generalized deep-tissue hyperalgesia in patients with chronic low-back pain. Eur J Pain (London, England). 2007;11(4):415–20.CrossRef
45.
go back to reference Bergstrom C, Persson M, Nergard KA, Mogren I. Prevalence and predictors of persistent pelvic girdle pain 12 years postpartum. BMC Musculoskelet Disord. 2017;18(1):399.PubMedPubMedCentralCrossRef Bergstrom C, Persson M, Nergard KA, Mogren I. Prevalence and predictors of persistent pelvic girdle pain 12 years postpartum. BMC Musculoskelet Disord. 2017;18(1):399.PubMedPubMedCentralCrossRef
46.
go back to reference Margolis RB, Chibnall JT, Tait RC. Test-retest reliability of the pain drawing instrument. Pain. 1988;33(1):49–51.PubMedCrossRef Margolis RB, Chibnall JT, Tait RC. Test-retest reliability of the pain drawing instrument. Pain. 1988;33(1):49–51.PubMedCrossRef
47.
go back to reference Leoni D, Falla D, Heitz C, Capra G, Clijsen R, Egloff M, et al. Test-retest reliability in reporting the pain induced by a pain provocation test: further validation of a novel approach for pain drawing acquisition and analysis. Pain Pract. 2017;17(2):176–84.PubMedCrossRef Leoni D, Falla D, Heitz C, Capra G, Clijsen R, Egloff M, et al. Test-retest reliability in reporting the pain induced by a pain provocation test: further validation of a novel approach for pain drawing acquisition and analysis. Pain Pract. 2017;17(2):176–84.PubMedCrossRef
48.
go back to reference Boudreau SA, Badsberg S, Christensen SW, Egsgaard LL. Digital pain drawings: assessing touch-screen technology and 3D body schemas. Clin J Pain. 2016;32(2):139–45.PubMedCrossRef Boudreau SA, Badsberg S, Christensen SW, Egsgaard LL. Digital pain drawings: assessing touch-screen technology and 3D body schemas. Clin J Pain. 2016;32(2):139–45.PubMedCrossRef
Metadata
Title
The Association of Self-Reported Generalized Joint Hypermobility with pelvic girdle pain during pregnancy: a retrospective cohort study
Authors
Kerstin Ahlqvist
Elisabeth Krefting Bjelland
Ronnie Pingel
Angela Schlager
Lena Nilsson-Wikmar
Per Kristiansson
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2020
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-020-03486-w

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