Interventions for preventing and treating low-back and pelvic pain during pregnancy

Liddle SD, Pennick V · Cochrane Database of Systematic Reviews · 2015 September 30

Objective

To update the evidence assessing the effects of any intervention used to prevent and treat low‐back pain, pelvic pain or both during pregnancy.

Conclusions

There is low‐quality evidence that exercise (any exercise on land or in water), may reduce pregnancy‐related low‐back pain and moderate‐ to low‐quality evidence suggesting that any exercise improves functional disability and reduces sick leave more than usual prenatal care. Evidence from single studies suggests that acupuncture or craniosacral therapy improves pregnancy‐related pelvic pain, and osteomanipulative therapy or a multi‐modal intervention (manual therapy, exercise and education) may also be of benefit. Clinical heterogeneity precluded pooling of results in many cases. Statistical heterogeneity was substantial in all but three meta‐analyses, which did not improve following sensitivity analyses. Publication bias and selective reporting cannot be ruled out. Further evidence is very likely to have an important impact on our confidence in the estimates of effect and change the estimates. Studies would benefit from the introduction of an agreed classification system that can be used to categorise women according to their presenting symptoms, so that treatment can be tailored accordingly.

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Insights

There is moderate‐quality evidence from individual studies suggesting that acupuncture improved pelvic pain more than usual prenatal care.

The evidence is current to 19 January 2015. We included 34 randomised studies in this updated review, with 5121 pregnant women, aged 16 to 45 years. Women were from 12 to 38 weeks’ pregnant. Studies looked at different treatments for pregnant women with low‐back pain, pelvic pain or both types of pain. All treatments were added to usual prenatal care, and were compared with usual prenatal care alone in 23 studies. Studies measured women's symptoms in different ways, ranging from self‐reported pain and sick leave to the results of specific tests.