Back Pain Risk Continues After Pregnancy

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

NEW YORK (Reuters) –– Women with severe low back pain during pregnancy are at high risk for back pain for more than 10 years after the pregnancy –– and the problem is likely to recur in a subsequent pregnancy, according to a new study in the journal Obstetrics & Gynecology.

Swedish researchers also report that about 20% of 79 women who had experienced severe low back pain during pregnancy said they refrained from having another child because of fear the back pain would recur in another pregnancy.

The findings come from a new survey of women who had low back pain during pregnancy in 1983–1984, and who participated in a study at that time. In the original survey, the women had reported low back pain severe enough to require sick leave from work. In the new study, a research team led by Dr. Jan Brynhildsen of the University Hospital Linkoping in Sweden sent these women a follow–up questionnaire 12 years later to ascertain the long–term risk of having severe back pain in pregnancy. The team also re–contacted the women who had acted as a control group in the original study –– these were women who had not suffered from back pain during pregnancy.

The researchers found that 63% of the women who had experienced severe back pain in pregnancy had given birth to one or more children in the intervening years. A similar percentage of women (58%) in the control group had also had at least one more child. "Almost all women (94%) with previous disabling low back pain during pregnancy in 1983–1984 also developed low back pain during... (a) subsequent pregnancy," write the researchers. In contrast, less than half (44%) of the control group had back pain in a later pregnancy.

The study findings show that the location of the back pain (sacroiliac joint of lumbar region) "did not affect the long–term prognosis."

The researchers also note that women who worked in physically demanding jobs were at no greater risk for disabling low back pain during subsequent pregnancies. But physically demanding work, together with previous low back pain during pregnancy, increased the risk of low back pain even when not pregnant.

"These facts, together with the economic costs for the society, make further studies of both mechanisms and preventive therapy necessary," the authors conclude.

FROM: Follow-up of Patients with Low Back Pain During Pregnancy

Obstetrics & Gynecology 1998 (Feb); 91 (2): 182–186

The Abstract

OBJECTIVE:   To identify the long-term risk for low back pain among women with previous severe low back pain during pregnancy.

METHODS:   In a previous prospective study, 79 pregnant women developed low back pain severe enough to require sick leave. Twelve years later a questionnaire was sent to 62 of these women and 84 controls who did not develop severe low back pain during pregnancy. The questionnaire asked about occupation, low back pain in general and during later pregnancies, and sick leave due to low back pain. There were also questions regarding use of oral contraceptives and its possible relation to low back pain.

RESULTS:   The response rate was 84% in the back pain group and 80% among controls. The two groups were similar according to the percentage of women having had another pregnancy (33 of 52 [63%] versus 39 of 67 [58%]) but ten (19%) of the women with previous low back pain stated they had refrained from another pregnancy because of their fear of low back pain compared with only one control. Almost all women (31 of 33) with previous severe low back pain experienced the same symptoms in a subsequent pregnancy, compared with 17 of 39 (44%) controls. Even when they were not pregnant, women with previous low back pain suffered more often and used more sick leave due to low back pain (44 of 52 versus 43 of 67, chi2 = 5.68, P < .05). The location (sacroiliac joint or lumbar affection) of the previous low back pain did not affect the long-term prognosis. In a logistic regression model, previous low back pain during pregnancy was the only independent risk factor for low back pain during a subsequent pregnancy, whereas an occupation involving physical demand did not affect the results. However, together with previous low back pain during pregnancy, heavy occupation increased the risk for current nonpregnant low back pain.

CONCLUSION:   Women with severe low back pain during pregnancy have an extremely high risk for experiencing a new episode of severe low back pain during another pregnancy and when not pregnant.

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