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Wuytack F.1, Curtis E.1, Begley C.1,2, Daly D.1
1Trinity College Dublin, School of Nursing & Midwifery, Dublin, Ireland, 2University of Gothenburg, Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg, Sweden
Background: Pregnancy-related Pelvic Girdle Pain (PPGP) is a common maternal morbidity affecting more than half of pregnant women. The aetiology remains unclear and the management challenging. Knowledge of risk factors can provide insight into the potential causes and can help target prevention and treatment strategies. Studies and information documents are often inconsistent in describing risk factors for PPGP. Therefore, a systematic review of the literature was carried out to provide clarity on the current evidence regarding risk factors for PPGP.
Purpose: To determine the risk factors for PPGP in the first, second, and/or third trimester of pregnancy.
Methods: We ran a comprehensive search of five databases (PubMed, CINAHL, Embase, MIDIRS and PsycINFO). Only studies in English were included but we did not apply any language filters to detect any language bias. Two reviewers independently screened identified studies for inclusion. Studies examining specific diagnostic tests or treatments were excluded. Two reviewers independently assessed risk of bias of included studies using the Quality In Prognosis Studies (QUIPS) tool, and extracted data. Results were presented in evidence tables and forest plots, if meta-analysis was appropriate. We had planned subgroup analysis based on a history of any lumbopelvic pain and by parity, and sensitivity analysis based on risk of bias, but these were impossible due to insufficient data. The quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods for each factor by two independent reviewers.
Results: We identified 3092 records, of which 20 were included, examining 168 factors in total, of which only 14 factors had been assessed in more than one study. Ten of the 20 studies had at least one QUIPS domain of high risk of bias, most commonly the outcome measurement (PPGP) was not clearly defined or the question was open to interpretation. Significant risk factors for PPGP that emerged from the review were a history of low back pain (2 studies, 77809 participants, OR 2.18, 95% CI [1.18; 4.02], random effects, I2=91%, p=0.00006, low quality evidence) or pelvic girdle pain (2 studies, 1822 participants, OR 11.53, 95% CI [7.71; 17.25], random effects, I2=0%, p=0.41, low quality evidence), higher gestational age, being obese, a lower educational level, doing physically demanding work, a history of trauma to the back, diabetes, gestational diabetes, the progestin-intrauterine device, stress, depression, and anxiety. However, we are uncertain about these findings since the evidence was of a low or very low quality for all factors examined.
Conclusion(s): This comprehensive systematic review revealed the uncertainty about factors that contribute to PPGP, with mostly very low/low quality of evidence. It provides an important basis to inform future epidemiological and interventional research regarding PPGP.
Implications: Physical therapists and other healthcare professionals involved in the care of pregnant women should enquire about a history of low back or pelvic girdle pain to target management earlier, since this seems a consistent risk factor, despite the evidence being still low.
Funding acknowledgements: This work was funded by a student stipend from Trinity College Dublin, Ireland.
Topic: Women's & mens pelvic health
Ethics approval: No ethical approval was required due to the nature of systematic reviews (secondary research).
All authors, affiliations and abstracts have been published as submitted.
