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Prevalence and Factors Associated With Low Back Pain and Pelvic Girdle Pain During Pregnancy: A Multicenter Study Conducted in the Spanish National Health Service

Kovacs, Francisco M., MD, PhD*,†; Garcia, Emma, MD†,‡; Royuela, Ana, MSc†,§,¶; González, Lourdes, MD†,‖; Abraira, Víctor, PhD†,§,¶ the Spanish Back Pain Research Network

doi: 10.1097/BRS.0b013e31824dcb74
Health Services Research

Study Design. A cross-sectional, multicenter study.

Objective. To determine the prevalence of low back pain (LBP), leg pain (LP), and pelvic girdle pain (PGP) in pregnant Spanish women and to identify the factors associated with a higher risk.

Summary of Background Data. Previous studies on the prevalence and risk factors for LBP and PGP have shown inconsistent results.

Methods. Sixty-one clinicians across 5 regions in Spain recruited 1158 women with a median (interquartile range) pregnancy of 35 (range, 31–38) weeks. Validated methods were used to gather data on the prevalence of LBP, LP, and PGP, anthropometric and sociodemographic characteristics, history of LBP, obstetrical history, physical activity before and during pregnancy, mattress and sleep characteristics, disability, anxiety, and depression. Separate multiple logistic regression models were developed to identify the variables associated with LBP, LP, and PGP.

Results. The 4-week prevalence of LBP, LP, and PGP was 71.3%, 46.2%, and 64.7%, respectively. Main factors associated with a higher likelihood of reporting pain for LBP were history of LBP related and unrelated to previous pregnancy and postpartum, pain augmenting with time spent in bed, and anxiety. Previous lumbar surgery was associated with a lower risk. The factors associated with a higher likelihood of reporting LP were reporting LBP, lower academic level, younger age, depression, a lower number of hours of sleep per day, and a higher BMI, and for PGP were higher score for depression, a higher body mass index, and a more advanced stage of pregnancy.

Conclusion. Factors associated with a higher risk vary between LBP and PGP. History of LBP, related or not to previous pregnancy or postpartum, LBP surgery, and anxiety were the factors more strongly associated with pregnancy-related LBP. When these variables are taken into account, obstetrical data from current or previous pregnancies and other variables do not show a significant association with LBP. Stage of pregnancy and depression were associated with PGP.

Low back pain and pelvic girdle pain affected 71.3% and 64.7% of pregnant Spanish women, respectively. Pelvic girdle pain was associated with stage of pregnancy, body mass index, and depression. When accounting for anxiety and history of low back pain, related and unrelated to pregnancy, current and previous obstetrical data were not associated with low back pain.

*Departamento Científico, Fundación Kovacs, Palma de Mallorca, Spain

Spanish Back Pain Research Network, Fundación Kovacs, Palma de Mallorca, Spain

Servicio de Ginecología y Obstetricia, Corporació Sanitària Parc Taulí, Sabadell, Spain

§CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain

Unidad de Bioestadística Clínica, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain

Servicio de Ginecología y Obstetricia, Hospital Universitari Son Espases, Palma de Mallorca, Spain

**Other members of the Spanish Back Pain Research who authored this study, are:

Address correspondence and reprint requests to Francisco M. Kovacs, MD, PhD, Departamento Científico, Fundación Kovacs, Paseo Mallorca 36, 3º, 1º, 07012 Palma de Mallorca, Spain; E-mail:

Jesús Seco Calvo (Departamento de Enfermería y Fisioterapia, Instituto de Biomedicina (IBIOMED), Universidad de León, Ponferrada, Spain), Lucía Zamora Delmás (PASSIR, CAP Numancia, Barcelona, Spain); Catalina Serra Calafat (C. S. Llucmajor, Llucmajor, Spain); Esther Montoliu‖; Saturnina Cillero Carrera‖; Carmen Piorno Hernández (PASSIR, CAP Manso, Barcelona, Spain); Ma José Pons Martínez‖; María José Pita (Servicio de Medicina Preventiva, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain); Alfonso Muriel§¶; María Nieves Plana§¶; Javier Zamora§¶; Concha Manzanares Mir (C. S. Rafal Nou, Palma, Spain); Francisca Llinás Alzina (C .S. Andratx, Andratx, Spain); Consuelo Fernández Yagüe (C.S. Campos, Campos, Spain); Sergio Giménez Basallote (C. S. El Limonar, Málaga, Spain); Anna Payaró Llisterri (PASSIR, CAP Numància, Barcelona, Spain); María Antonia Villalón Vidal (PASSIR, CAP Adrià, Barcelona, Spain); Luis Álvarez Galovich (Fundación Jiménez Díaz, Madrid, Spain); Ma Teresa de Juan Socías (C.S. Camp Redó, Palma de Mallorca, Spain); Marián García Baratas (C.S. Son Pisá, Palma de Mallorca, Spain); María Maimó (C. S. Escorxador, Palma de Mallorca, Spain); Julia Cid Vaquero (PASSIR, CAP Manso, Barcelona, Spain); Eva Picola Isern (PASSIR, CAP Manso, Barcelona, Spain); Esther Crespo Mirasol (PASSIR, CAP Adrià, Barcelona, Spain); Begoña Carral (PASSIR, C. S. Castell, Castelldefels, Spain); Sara Tornel Fabré (PASSIR, CAP Adrià, Barcelona, Spain); Alicia Martínez Navarro (PASSIR, CAP Manso, Barcelona, Spain); Mathew Taylor (C.S. Santa Catalina, Palma de Mallorca, Spain); Ma Anselma Blanco García (C. S. Son Serra/La vileta, Palma de Mallorca, Spain); Michelle Della Volte (ASSIR, C. S. Castell, Castelldefels, Spain); Encarnación Casas‖; Francisco V. Martínez García (Atención Primaria, C.S. Ponferrada III, Ponferrada, Spain); Lina Álvarez Olivares‖; Esther Recarte Ortega (Fundación Jiménez Díaz, Madrid, Spain); Cristina Braña Pelayo (Fundación Jiménez Díaz, Madrid, Spain); Gloria Colina Valero (PASSIR, CAP Numancia, Barcelona, Spain); Carolina Vesga González‖; Paz Nadal Casasnovas‖; Inmaculada Sauquillo‖; Sylvia Miralles (C. S. Son Rullán, Palma de Mallorca, Spain); Ma Dolores Basté Portabella (PASSIR, C. S. Castell, Castelldefels, Spain); Catalina Torrens Grau (C.S. Valldargent, Palma de Mallorca, Spain); Leovigildo Ginel (C.S. Ciudad Jardín, Málaga, Spain); Inés Hernández‖; Isabel Coca Camín (PASSIR, CAP Numancia, Barcelona, Spain); Ma Ana Garcés (C. S. Pedro Garau, Palma de Mallorca, Spain); Carmen Seguí Santana (PASSIR, CAP Numancia, Barcelona, Spain); Matilde Cifre Gómez‖; Carmen Bilbao Artal‖; M Magdalena Nadal Riera‖; Catalina Tomás Fornari‖; Mercedes Torrecilla Mozo‖; Elisabet Grau Civit (PASSIR, CAP Manso, Barcelona, Spain); Ana M de la Zerda‖; Ana Belén Castel Seguí‖; Mirian Trujillo Rodríguez (PASSIR, CAP Adrià, Barcelona, Spain); Cynthia Martínez‖; M Elena Montes de Oca Arjona‖; Ilaria Bianchi (PASSIR, CAP Manso, Barcelona, Spain); Jenny Moix (Departamento de Psicología Básica, Evolutiva y de la Educación. Universidad Autónoma de Barcelona. Bellaterra. Spain), Francisca Rebassa Cantallops‖; Joana Amengual‖; Mercedes Genovés‖; Ma Elena Castellanos Fernández (PASSIR, CAP Manso, C/de Manso 19, 08015 Barcelona, Spain), Mario Gestoso.*†

Acknowledgment date: July 25, 2011. First revision date: December 11, 2011. Acceptance date: January 31, 2012.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Foundation funds were received to support this work.

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2012 Lippincott Williams & Wilkins, Inc.