Pregnancy-related pelvic girdle pain: Prognosis, risk factors, consequences, and chiropractic management

Background Pelvic girdle pain (PGP) is a common musculoskeletal disorder during pregnancy; affected women experience various degrees of pain, disability, and reduced quality of life. In addition, PGP is a frequent cause of sick leave during pregnancy. Although most women recover from PGP after delivery, some women struggle with persistent PGP for months and years. There is still limited knowledge about etiology, occurrence, risk factors, consequences, and treatment options for PGP during pregnancy and after delivery. Objectives The overall aim of this thesis was to provide more knowledge about the recovery and persistence of PGP, including risk factors and consequences of persistent PGP. Furthermore, to investigate the effect of chiropractic management for women with PGP during pregnancy and after delivery. Methods The four papers in this thesis are based on two separate data collections at Stavanger University Hospital. Paper I and II originate from a retrospective cohort study conducted in 2009. In Paper I, women with persistent PGP 3–6 months after delivery (n=330), underwent a clinical examination and filled in questionnaires to examine the frequency of persistent PGP, its influence on the women´s daily life, and potential risk factors for persistent PGP. The pilot study, Paper II, aimed to investigate the feasibility of conducting a randomized clinical trial for women with persistent dominating one-sided PGP. The study included 11 women. Six women received individualized rehabilitation and chiropractic treatment, and five women were offered individualized rehabilitation alone. Papers III and IV originate from a prospective longitudinal cohort study carried out in 2010. Inclusions took place at the second-trimester routine ultrasound examination. All eligible women (n=503) filled in questionnaires and answered a weekly SMS question during pregnancy and up to six weeks after delivery. Women with pain in the pelvic area underwent a clinical examination. Those who were diagnosed with dominating one-sided PGP during pregnancy were included in a randomized clinical trial to investigate the effect of chiropractic treatment compared to conventional health care, presented in Paper III. In Paper IV, we included women that reported PGP during pregnancy and met for a clinical examination six weeks after delivery. We investigated the subjective recovery from pregnancy-related PGP and detected possible risk factors for a poor recovery. The SMS replies from the final 10 weeks of pregnancy and first six weeks after delivery were used to analyze the proportions of women with substantial recovery and women with either no, transitory or incomplete recovery, based on individual graphs of weekly number of bothersome days due to PGP. Results In Paper I, we found that 16% of women reporting pelvic pain (PP) during pregnancy were diagnosed with persistent PGP 3‒6 months after delivery. Women with persistent PGP reported mild and moderate pain, and minor disability, but a reduced quality of life. Risk factors for persistent PGP were age ≥ 30 years, moderate or high disability during pregnancy, and combined PP and low back pain (LBP) during pregnancy. In Paper II, the small number of women with persistent dominating onesided PGP, and the additional drop-outs, resulted in a low number of women in the clinical trial. Both groups reported improvement in disability and pain after 20 weeks of intervention. The randomized controlled trial (RCT) study (Paper III) showed no statistically significant differences in sick leave, pain intensity of PGP, disability, and health related quality of life between the treatment group and the control group during pregnancy or after delivery. In Paper IV, four out of five women experienced a substantial recovery from PGP within six weeks after delivery. Evident risk factors for a poor recovery were multiparity, PGP the year before pregnancy, and a high pain intensity of PGP during pregnancy. Conclusions Most women recovered from pregnancy-related PGP after delivery. However, six weeks after delivery, one out of five women reported persisting PGP, and 3–6 months after delivery, one of out of six women were diagnosed with persistent PGP after a clinical examination. Several risk factors for a poor recovery were found. Women with persistent PGP after delivery reported mild and moderate pain and a reduced quality of life, but seemed to cope fairly well with their daily activities. The results from the clinical trials were inconclusive