Finger joint laxity, number of previous pregnancies and pregnancy induced back pain in a cohort study

Anne Lindgren,Per Kristiansson

doi:10.1186/1471-2393-14-61

Anne Lindgren, Per Kristiansson

Open Access

https://doi.org/10.1186/1471-2393-14-61

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Abstract

BackgroundGeneral joint hypermobility is estimated to affect about 10% of the population and is a prerequisite of heritable connective tissue disorders where fragile connective tissue is a prominent feature. Pregnancy induced back pain is common whereas about 10% of women still have disabling pain several years after childbirth. The pathogenesis of the pain condition is uncertain, although several risk factors are suggested including general joint hypermobility. In the present study, the possible association of peripheral joint mobility in early pregnancy on the incidence of back pain with onset during pregnancy and persisting after childbirth was explored.MethodsA cohort of 200 pregnant women recruited from antenatal health care clinics was assessed by questionnaire and clinical examination, including measurement of passive abduction of the left fourth finger, throughout pregnancy and at 13 weeks postpartum. Comparisons were made between women with and without back pain. Statistical tests used were χ2-test, t-test, Spearman correlation and multiple logistic regression.ResultsIn the cohort, the mean passive abduction angle of the left fourth finger increased from 40.1° in early pregnancy to 41.8° at the postpartum appointment. At the postpartum appointment, women in the back pain group had a significantly larger mean passive abduction angle of the left fourth finger of 4.4°, twice as many previous pregnancies and deliveries, and more than twice as frequent back pain in previous pregnancy, as compared with women with no persistent back pain. A similar pattern was displayed in late pregnancy. In a multiple regression analysis, the passive abduction angle of the left fourth finger in early pregnancy and the number of previous pregnancies were positively, significantly and independently associated to the incidence of back pain in late pregnancy and postpartum.ConclusionsFinger joint laxity as a reflection of constitutional weakness of connective tissue and number of previous pregnancies were associated with the development of back pain induced in pregnancy and persisting after childbirth. These factors may provide a foundation for development of targeted prevention strategies, but this have to be confirmed in future research including measurement of general joint laxity.

Highlights

General joint hypermobility is estimated to affect about 10% of the population and is a prerequisite of heritable connective tissue disorders where fragile connective tissue is a prominent feature
The mean passive abduction angle of the left fourth finger increased from 40.1° in early pregnancy to 41.8° at the postpartum appointment (1.7°) (p < 0.0001), Table 2
The point prevalence rate of women reporting back pain with onset during the present pregnancy increased from 19% in gestational week 11, to 47% and 49% in gestational weeks 24 and 36, respectively, with a clear decline to 9% (16 women) at the postpartum appointment

Summary

Introduction

General joint hypermobility is estimated to affect about 10% of the population and is a prerequisite of heritable connective tissue disorders where fragile connective tissue is a prominent feature. The pathogenesis of the pain condition is uncertain, several risk factors are suggested including general joint hypermobility. The possible association of peripheral joint mobility in early pregnancy on the incidence of back pain with onset during pregnancy and persisting after childbirth was explored. The cause of the higher prevalence of general joint hypermobility among women is uncertain suggested to be related to sex-specific adaptations of the connective tissue [5]. One in three women in the world experience back pain induced during pregnancy with the number of previous deliveries as a strong determinant [9]. Other known determinants of pregnancy induced back pain include early menarche, hormone contraceptive use before first pregnancy, physically demanding work and emotional distress [10,11,12]. Hormonal and reproductive factors have been associated with risk of chronic low back pain [13]

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