Smoking and pregnancy-related pelvic pain

Pelvic Girdle Pain in Pregnancy: A Review

Importance

Pelvic girdle pain is often thought to be a recent phenomenon, but this condition was described as early as 400 BC by Hippocrates. Despite being identified for years, confusion continues about the definition and management of this ailment affecting many pregnancies.

Objective

The purpose of the review is to assess the incidence, etiology, pathophysiology, risk factors, diagnosis, management, and pregnancy outcomes/recovery of current pregnancies, and outcomes of future pregnancies complicated by pelvic girdle pain.

Evidence Acquisition

Electronic databases (PubMed and Embase) were searched from 1980 to 2021 with the only limitation being that the articles were in English. Studies were selected that examined associations between pelvic pain/pelvic girdle pain and pregnancy.

Results

There were 343 articles identified. After reviewing the abstracts, 88 were used in this review. Pelvic girdle pain is a common condition of pregnancy, affecting a reported 20% of pregnant women. The pathophysiology is poorly understood and likely multifactorial, involving both hormonal and biomechanical changes that occur during pregnancy. Several risk factors have been identified. This diagnosis is most commonly made based on symptoms related to pelvic pain during pregnancy. Treatment should be multimodal, including pelvic girdle support, stabilizing exercises, analgesia, and potentially complementary therapies. The effects on future pregnancies are uncertain, although some limited information suggests an increased risk of recurrent PGP in subsequent pregnancies.

Conclusions

Pelvic girdle pain in pregnancy is a common condition that is often overlooked as a normal part of pregnancy but has a significant impact on quality of life during, after, and in subsequent pregnancies. Multimodal therapies are available and are largely low cost and noninvasive.

Relevance

Our aim is to increase the awareness of pelvic girdle pain in pregnancy as a common but often underdiagnosed and undertreated condition.

Smoking Is Associated with Pain in All Body Regions, with Greatest Influence on Spinal Pain

OBJECTIVE

Examine the interrelationship between smoking and pain in the US population.

DESIGN

A cross-sectional population-based study.

SETTING

Nationwide survey.

METHODS

Comprehensive pain reports categorically defined as head, spine, trunk, and limb pain; smoking history; demographics; medical history from a total of 2,307 subjects from the 2003-2004 National Health and Nutrition Examination Survey obtained from the Centers for Disease Control were analyzed. Unpaired t tests were used to analyze independent continuous variables, and chi-square tests were used to analyze categorical variables between smoker and nonsmoker groups. Weighted multivariate logistic regression analyses determined the association of current smoking with the presence of pain in various body regions.

RESULTS

Smoking is most strongly associated with spine pain (odds ratio [OR] = 2.89, 95% confidence interval [CI] = 2.21-3.77), followed by headache (OR = 2.47, 95% CI = 1.73-3.53), trunk pain (OR = 2.17, 95% CI = 1.45-2.74), and limb pain (OR = 1.99, 95% CI = 1.45-2.73).

CONCLUSIONS

Current smoking is associated with pain in every region of the body. This association is strongest for spine and head pain. Given that pain is a strong motivator and that current smoking was associated with pain in all body regions, we recommend that these results be used to further raise public awareness about the potential harms of smoking.

Nausea and vomiting in pregnancy - association with pelvic girdle pain during pregnancy and 4-6 months post-partum

Background

To better understand previous associations reported regarding nausea and vomiting in pregnancy (NVP) and pelvic girdle pain (PGP), an investigation into timing of symptom onset for NVP and PGP in pregnancy, as well as the association of NVP with PGP 4-6 months post-partum was performed. We hypothesised that women with NVP symptoms would be most susceptible to experiencing persistence of PGP post-partum.

Methods

Fifty two thousand six hundred seventy-eight pregnancies from the Norwegian Mother and Child Cohort Study were analysed regarding nausea, vomiting, pelvic girdle pain, and health outcome data collected from questionnaires answered between gestation weeks 15, 20, 30, and 6 months post-partum. Logistic regression was used.

Results

Women experiencing NVP and PGP together (6.9%) were heaviest in the sample, youngest at menarche and had highest proportion with education ≤12 years. The primiparous women in this group had the lowest timespan from menarche to pregnancy. Women with nausea alone (NP) and NVP had higher odds of PGP 4-6 months post-partum (adjusted odds ratio, aOR = 2.14, 95% CI 1.70–2.71, and aOR = 2.83, 95% CI 2.25–3.57, respectively), compared to symptom-free women. NP/NVP symptoms appeared early in the first trimester, while PGP symptoms appeared later in pregnancy. Women with longer durations of nausea and/or vomiting had a higher proportion of PGP compared to shorter duration women.

Conclusions

Women with NP and NVP had increased odds of PGP 4-6 months post-partum, and women with a long duration of nausea and/or vomiting had a higher proportion of PGP than women with shorter duration, both during pregnancy and 4-6 months post-partum. This finding suggests a synergistic relationship between NP/NVP and PGP.

Electronic supplementary material

The online version of this article (10.1186/s12884-018-1764-7) contains supplementary material, which is available to authorized users.

Age at menarche and pregnancy-related pelvic pain

AIM

Menarcheal age is a predictor of several complications related to pregnancy and diseases later in life. We aimed to study if menarcheal age is a risk factor for pregnancy-related pelvic pain.

MATERIAL AND METHODS

A nested case-control study was conducted within the Danish National Birth Cohort, a cohort of pregnant women, recruited during 1996-2002, and their children. In the second trimester of pregnancy the women provided information about age at menarche and potential confounders. Selection of cases (n = 2227) was based on self-reported pelvic pain during pregnancy from an interview done 6 months post-partum. The controls (n = 2588) were randomly selected among women who did not report pelvic pain. We used logistic regression analysis to calculate odds ratios (OR) for pregnancy-related pelvic pain according to age at menarche.

RESULTS

In the cohort, 18.5% of all pregnant women reported pregnancy-related pelvic pain. Compared to women who were 12-14 years old at menarche, the adjusted OR for overall pelvic pain were 1.4 (95% confidence interval [CI] 1.1-1.7) in women 11 years or younger and 0.8 (95%CI 0.6-0.9) in women 15 years or older. The corresponding adjusted OR for severe pelvic pain were 1.6 (95%CI 1.3-2.0) and 0.7 (95%CI 0.6-0.9). When age was analyzed as a continuous variable, the odds for overall and severe pelvic pain decreased with 14% and 16%, respectively, for each increasing year.

CONCLUSIONS

The risk of pregnancy-related pelvic pain decreased with increasing menarcheal age in an 'exposure-response' pattern. A low menarcheal age is a risk indicator and may be a risk factor for pregnancy-related pelvic pain.

Is pregnancy related pelvic girdle pain associated with altered kinematic, kinetic and motor control of the pelvis? A systematic review

PURPOSE

To determine the level of evidence for altered mechanical and motor control of the pelvis being associated with pregnancy-related pelvic girdle pain (PPGP).

METHODS

This systematic review was undertaken by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six different databases were used for the electronic search. Observational cohorts, cross sectional or case-control studies focused on the association between altered kinematic/kinetic and motor control of the pelvis and PPGP during pregnancy were included. Study selection was conducted by two reviewers who firstly screened for titles, then for abstracts and finally for full articles. The Newcastle-Ottawa scale and the guidelines proposed by the Cochrane back review group were used to assess risk of bias and quality of evidence, respectively.

RESULTS

354 references were identified, and after excluding unwanted articles, 10 studies met the final inclusion criteria. Studies not related to motor control or pelvic mobility were the main reason for exclusion. Seven studies were case-control and three were prospective cohort studies. Seven studies were ranked as high while three were ranked as low quality. Among the high quality studies, six found association between PPGP and altered motor control and mobility of the pelvis.

CONCLUSIONS

The level of evidence for an association between PPGP and altered motor control and kinematic or kinetic parameters of the pelvis was found to be moderate.

Pain, nicotine, and smoking: research findings and mechanistic considerations

Tobacco addiction and chronic pain represent 2 highly prevalent and comorbid conditions that engender substantial burdens upon individuals and systems. Interrelations between pain and smoking have been of clinical and empirical interest for decades, and research in this area has increased dramatically over the past 5 years. We conceptualize the interaction of pain and smoking as a prototypical example of the biopsychosocial model. Accordingly, we extrapolated from behavioral, cognitive, affective, biomedical, and social perspectives to propose causal mechanisms that may contribute to the observed comorbidity between these 2 conditions. The extant literature was 1st dichotomized into investigations of either effects of smoking on pain or effects of pain on smoking. We then integrated these findings to present a reciprocal model of pain and smoking that is hypothesized to interact in the manner of a positive feedback loop, resulting in greater pain and increased smoking. Finally, we proposed directions for future research and discussed clinical implications for smokers with comorbid pain disorders. We observed modest evidence that smoking may be a risk factor in the multifactorial etiology of some chronically painful conditions and that pain may come to serve as a potent motivator of smoking. We also found that whereas animal studies yielded consistent support for direct pain-inhibitory effects of nicotine and tobacco, results from human studies were much less consistent. Future research in the emerging area of pain and smoking has the potential to inform theoretical and clinical applications with respect to tobacco smoking, chronic pain, and their comorbid presentation. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

Pregnancy-related pelvic girdle pain and its relationship with relaxin levels during pregnancy: a systematic review

PURPOSE

The present systematic review assessed the level of evidence for the association between relaxin levels and pregnancy-related pelvic girdle pain (PPGP) during pregnancy.

METHODS

PRISMA guidelines were followed to conduct this systematic review. Electronic search was carried out using six different databases. Observational cohorts, cross-sectional or case-control studies focused on the association between relaxin levels and PPGP during pregnancy were included. Studies selection was conducted by two reviewers who screened firstly for titles, then for abstracts and finally for full articles. Risk of bias was assessed using the Newcastle-Ottawa scale and the quality of evidence by the guidelines proposed by the Cochrane back review group.

RESULTS

731 references were identified. Six articles met the inclusion criteria and were considered for this systematic review. The main reason for the studies exclusion was PPGP related to gynaecological reasons. Five studies were case-control and one study was a prospective cohort. Four studies were ranked as high while two were ranked as low quality. Among the high quality studies, three found no association between PPGP and relaxin levels.

CONCLUSIONS

Based on these findings, the level of evidence for the association between PPGP and relaxin levels was found to be low. PPGP assessment and controlling for risk factors were found to increase bias leaving uncertainty in interpretation of these findings and a need for further research.

Pregnancy-related pelvic pain is more frequent in women with increased body mass index

OBJECTIVE

To investigate the association between pre-pregnancy overweight/obesity and pregnancy-related pelvic pain.

DESIGN

Nested case-control study.

SETTING AND POPULATION

The Danish National Birth Cohort, a cohort of pregnant women and their children recruited 1996-2002.

METHODS

The women were interviewed twice during pregnancy and twice after childbirth. The first pregnancy interview provided information on self-reported pre-pregnancy body mass index (BMI) and possible confounders, while data on pregnancy-related pelvic pain came from an interview six months postpartum. Cases (n=2 271) were selected on the basis of self-reported pelvic pain, and controls were randomly selected among women who did not report pelvic pain (n=2 649). We used logistic regression analysis to calculate pregnancy-related pelvic pain odds ratios (OR (95% confidence intervals)) according to pre-pregnant BMI.

MAIN OUTCOME MEASURE

Self-reported pregnancy-related pelvic pain. Results. In the total cohort, 18.5% of all pregnant women reported pregnancy-related pelvic pain. In the nested case-control study, the adjusted ORs for overall pelvic pain were 0.9 (0.7-1.2) in underweight women, 1.2 (1.1-1.4) in overweight women, 1.5 (1.2-2.0) in obese women Class 1 (30≤BMI<35), and 1.9 (1.3-2.8) in obese women Class 2 + 3 (BMI≥35), all relative to normal weight women. The correspondent ORs for severe pelvic pain were 0.8 (0.6-1.2), 1.4 (1.2-1.7), 1.7 (1.3-2.2), and 2.3 (1.6-3.4). The associations were stronger among women who had not given birth before.

CONCLUSION

The risk of pregnancy-related pelvic pain increased with pre-pregnancy BMI in an exposure-response relation and potentially adds another maternal complication to obesity.