Prevention of low back and pelvic girdle pain during pregnancy: a systematic review and meta-analysis of randomised controlled trials with GRADE recommendations

Abstract

BackgroundLow back (LBP) and pelvic girdle pain (PGP) during pregnancy are related to high direct and indirect costs. It is important to clarify evidence regarding interventions to manage and prevent these conditions. ObjectiveInvestigate the efficacy and acceptability of the interventions to prevent LBP and PGP during pregnancy. Data sourcesSearches were conducted up to January 6th, 2021 in the MEDLINE, PEDro, Cochrane Library, SPORTDiscus, CINAHL, AMED, Embase and PsycInfo databases Study eligibility criteria(1) Pregnant women without LBP and/or PGP; (2) any prevention strategy on incidence of LBP and PGP and sick leave; (3) comparison to control; (4) quasi and randomised controlled trial. Study appraisal and synthesis methodsTwo reviewers performed screening, data extraction and methodological quality assessments. Meta-analysis was performed and Relative Risks (RRs) and 95% confidence intervals (CIs) were reported. ResultsSix randomised controlled trials involving 2231 participants were included in the review. Evidence of moderate quality was found that “stand-alone” exercise is acceptable to pregnant women with lumbopelvic pain (LBPP) (RR 0.60 [95%CI 0.42–0.84]) and prevents episodes of LBP (RR 0.92 [95%CI 0.85–0.99]) in the long-term. Moderate to very-low quality evidence was found detailing the lack of efficacy of other interventions in the prevention of these problems in the short and long-term. LimitationsSmall number of trials included. ConclusionsEfficacy of prevention strategies for episodes of LBPP and the use of sick leave during pregnancy is not supported by evidence of high quality. Current evidence suggests that exercise is acceptable and promising for the prevention of LBP in the long-term. However, further high-quality trials with larger samples are needed. Contribution on paper•Low back pain and pelvic girdle pain are widespread problems during pregnancy that cause distress and disability in many women. However, knowledge regarding primary and secondary prevention is scarce.•“Stand-alone” exercise is acceptable and promising for the prevention of episodes of low back pain in the long term. Education combined with exercise did not reduce the risk of low back pain or pelvic girdle pain in pregnant women.•Exercise can be recommended during pregnancy for its general health benefits, but is not supported by high-quality evidence for preventing lumbopelvic pain.