| dc.description.abstract | Background: Pregnancy-related pelvic girdle pain (PPGP) is a common condition and may persist postpartum, but its prevalence, risk and prognostic factors were not known in an Irish setting. Moreover, the impact of persistent PPGP on women’s lives had not yet been explored. Design: A longitudinal mixed methods study. Aim: To identify the prevalence and factors associated with PPGP antenatally and up to 12 months postpartum in nulliparous women in Ireland, and to explore the experiences and health-seeking behaviours of women with persistent PPGP postpartum.
Setting: One large urban maternity hospital in Ireland. (This is one of the three MAMMI study sites.)
Sample: A preliminary sample of 1478 women (of the final sample of 2600 women) were recruited in early pregnancy, of whom 23 women also took part in an interview. Methods: Site hospital and university ethical approval were granted. This partially mixed, sequential, equal status design study had an initial quantitative phase (1), followed by a qualitative phase (2). Women aged 18 years or older who were able to read and understand English were recruited to phase 1 of the study, which involved completing a self-administered survey in early pregnancy, and 3, 6, 9 and 12 months postpartum. PPGP was assessed using a pain diagram, and the Pelvic Girdle Questionnaire was included in the final two surveys. The prevalence of PPGP and persistent PPGP were examined at each follow-up point. Risk factors and prognostic factors for PPGP were assessed using multivariable logistic regression. From the sample of phase 1, 23 women who had persistent PPGP for at least three months postpartum took part in an individual semi-structured interview in phase 2 of this study. The interview data were analysed using thematic analysis. Results: Period prevalence of PPGP was 60.1% in early/mid pregnancy and 69.7% in the last month of pregnancy, with posterior PPGP being most common, followed by combined anterior and posterior PPGP, and anterior PPGP. In the first three months postpartum, 68.8% of women had persistent PPGP. This dropped to 51.2%, 3 to 6 months postpartum, 40.5%, 6 to 9 months postpartum, and 33.3%, 9 to 12 months postpartum. Women aged 35 or older were less likely to have PPGP in early/mid pregnancy (OR 0.7, 95% CI 0.5-0.9, p=0.02) and in the last month of pregnancy (OR 0.4, 95% CI 0.2-0.8, p=0.04). Women who were obese or very obese were at greater risk of having PPGP (OR 2.1, 95% CI 1.4-3.3, p=0.001). A history of any lumbopelvic pain in the year before becoming pregnant was also strongly associated with PPGP in early/mid pregnancy (OR 5.6, 95% CI 4.3-7.2, p<0.001) and in the last month pregnancy (OR 2.6, 95% CI 2.0-3.4, p<0.001). Women who were obese or very obese were more likely to have persistent PPGP in the first three months postpartum (OR 2.3, 95% CI 1.2-4.4, p=0.01), 3 to 6 months postpartum (OR 1.9, 95% CI 1.1-3.4, p=0.02), 6 to 9 months postpartum (OR 2.5, 95% 1.4-4.5, p=0.003), and 9 to 12 months postpartum (OR 3.1, 95% CI 1.7-6.0, p<0.001). Women with a history of any lumbopelvic pain before pregnancy were also significantly more likely to have persistent PPGP 0 to 3 months after the birth (OR 2.4, 95% CI 1.7-3.4, p<0.001), and women with any pelvic girdle pain in the year before pregnancy were more likely to have persistent PPGP 3 to 6 months postpartum (OR 2.5, 95% CI 1.7-3.5, p<0.001), 6 to 9 months (OR 3.5, 95% CI 2.4-5.1, p<0.001), and 9 to 12 months postpartum (OR 3.7, 95% CI 2.4-5.8, p<0.001). Compared to women who had anterior PPGP during pregnancy, women with posterior PPGP were more likely to have persistent PPGP 0 to 3 months (OR 2.0, 95% CI 1.0-3.9, p=0.04) and 3 to 6 months postpartum (OR 2.4, 95% CI 1.1-5.1, p=0.02). Women with combined anterior and posterior PPGP during pregnancy were more likely to have persistent PPGP at all four follow-up periods (0-3 months (OR 3.4, 95% CI 1.6-7.3, p=0.001); 3-6 months (OR 4.0, 95% CI 1.8-9.4, p=0.001); 6-9 months (OR 4.2, 95% CI 1.4-12.5, p=0.009); 9-12 months postpartum (OR 4.5, 1.0-21.6, p=0.05)). Women with a history of severe period pain before pregnancy were more likely to have persistent PPGP in the first three months after birth (OR 1.5, 95% CI 1.0-2.1, p=0.04), and not having a university qualification was associated with persistent PPGP 6 to 9 months postpartum (OR 1.6, 95% CI 1.0-2.6, p=0.04). Stress in the first three months postpartum was associated with persistent PPGP 6 to 9 months (OR 2.4, 95% 1.2-4.8, p=0.01) and 9 to 12 months postpartum (OR 3.4, 95% CI 1.6-7.2, p=0.001). On the other hand, women who gave birth by vacuum/kiwi were less likely to have persistent PPGP in the first three months postpartum (OR 0.5, 95% CI 0.3-0.9, p=0.02) and 3 to 6 months postpartum (OR 0.4, 95% CI 0.3-0.8, p=0.004). Women on unpaid maternity leave were also less likely to experience persistent PPGP 9 to 12 months postpartum (OR 0.3, 95% CI 0.09-1.0, p=0.04). In phase 2, six themes emerged about the experiences of women with persistent PPGP. Women ‘put up with the pain’ but had to balance activities and were grateful for support from family and friends to face everyday challenges. They described different strategies they used to deal with their symptoms, although many were not sure about what to do or who to see. They ‘did not feel back to normal’ and described feelings of physical limitations, frustration, and a negative impact on their mood. ‘They didn't ask, I didn't tell’ was another theme, in which they expressed a perceived lack of follow-up postpartum, and feelings of being ignored by healthcare professionals. The theme ‘Seeking advice and support’ described women's role of talking to others, and triggers and barriers to getting help. Persistent symptoms were ‘unexpected’ for women due to a lack of information given about PPGP postpartum. Finally, women were uncertain about how their symptoms would progress, and they expressed worry about having another baby in the theme ‘What next?’. Conclusion: PPGP is a common maternal morbidity affecting more than half of women during pregnancy. Findings call into question the length of postnatal care, since about a third of women with PPGP continued to have persistent symptoms a year after the birth. In Ireland, PPGP is underreported during pregnancy and postpartum. Including questions concerning PPGP in routine antenatal and postnatal care, and adequate information and advice throughout, may identify women at increased risk and address the perceived lack of follow-up. Summary of contribution of the study to knowledge about PPGP: This study contributed to knowledge concerning PPGP in several ways: (1) The systematic review that was undertaken in preparation of this study provides a unique rigorous overview of existing literature on risk and prognostic factors for PPGP; (2) This study is the first to provide national data in Ireland about the prevalence of, and risk and prognostic factors for, PPGP; (3) This study gives an in-depth account of the experiences and health-seeking behaviours of women with persistent PPGP. | |
