The Watching Pregnancy Project: LBP occurrence, symptoms and healthcare use from 20-weeks’ gestation until 6-months after birth

Introduction: Many pregnant women experience low back pain (LBP)1 with symptoms usually increasing as pregnancy advances, and often continuing after birth. Some studies indicate that women often feel frustrated that their symptoms are not taken seriously with limited availability of treatments to meet their needs2. In the UK, in particular, women are typically informed that LBP is ‘a normal part of pregnancy’ with input from physiotherapy no longer part of routine ante-natal care.

Purpose: To our knowledge, no UK-based prospective studies have investigated the extent of LBP as a problem for women during pregnancy and after birth. Therefore, we needed to establish the feasibility of recruiting women from routine midwifery care and collecting information from them over a number of pre-defined time points.

Materials and Methods: A prospective observational cohort study was employed to follow a sample of pregnant women living in the UK, from their routine anomaly scan until six months after delivery. A bespoke online questionnaire was designed to collect data about LBP history, presentation, progression, types of treatment and subsequent patient reported outcomes at four pre-defined study time-points, two during pregnancy and two after delivery. The study objectives were to test the feasibility of the proposed methods of recruitment and data collection, to describe changes in outcomes and healthcare use at each study time-point.

Results: Within a 7-month recruitment period, 477 eligible women were identified. All data were collected remotely; email (56%) or text (44%) were women’s preferred methods of communication with the study, with 73% preferring a maximum of one reminder. 307 women completed the first questionnaire, with 50% attrition over the course of the study; 121 completed all four questionnaires. Clinically important changes were observed in quality of life and functional disability with high fear-avoidance beliefs between 31 to 33 weeks’ gestation. Women with a history of LBP were more likely to have symptoms persisting 6-weeks after delivery. Over 50% did not receive any treatment for their LBP. A significant proportion opted to self-medicate with painkillers, and many of those receiving physiotherapy for their LBP chose to self-refer.

Conclusion(s): The sole use of remote data collection appears to have contributed to a number of women not returning the first questionnaire, and therefore dropping out of the study. A future study of this kind could achieve a larger sample size by implementing; a longer recruitment period, a full-time researcher dedicated to recruitment and adequate financial support for text reminders and offline access to the questionnaire. The changes observed in functional disability and health-related quality of life, along with high fear-avoidance beliefs about physical activity between 31 to 33 weeks’ gestation, are in keeping with current evidence. Women’s use of painkillers for their LBP is of particular concern, given the considerable uncertainty about the effects of these on the unborn child3.

Keywords: pregnancy-related low back pain; online questionnaire; outcome measures; self-management; feasibility

Reference(s):
1. Liddle SD, Pennick V. Interventions for preventing and treating low-back and pelvic pain during pregnancy. Cochrane Database of Systematic Reviews 2015, issue 9. Art. No.: CD001139. DOI: 10.1002/14651858.CD001139.pub4.
2. Close C, Sinclair M, Liddle D, McCullough J, Hughes C. Women's experience of low back and / or pelvic pain (LBPP) during pregnancy. Midwifery 2016; 37; 1-8.
3. Sinclair M, Close C, McCullough J, Hughes C, Liddle SD. How do women manage pregnancy-related low back and/or pelvic pain? Descriptive findings from an online survey. Evidence based Midwifery 2014; 12(3); 76-82.