DOI: 10.21251/a4072bc1-fae4-49f0-85e0-82df675bed7c
title: The Watching Pregnancy Project: an exploration of low back pain occurrence, symptoms and healthcare use in pregnant women

description: Introduction 
Many women experience low back pain (LBP) during pregnancy, which often persists after birth. Those affected have reported frustration that their symptoms are not taken seriously, along with limited availability of treatments to meet their needs. To our knowledge, no UK-based studies have prospectively investigated the extent of LBP as a problem for women both during pregnancy and after birth. Therefore, this study aimed to explore the extent and current management of this problem in a UK healthcare setting over four pre-defined study time points; two during pregnancy and two after birth.
Materials and Methods
A prospective observational cohort study followed a sample of pregnant women living in the UK, from 20 to 22-weeks’ gestation until six months after birth. All women attending their routine anomaly scan were informed of the study. Those with red flags, inflammatory / neurological disease, urinary tract infection (UTI) or otherwise deemed ineligible by their treating midwife, were excluded. A bespoke online questionnaire was distributed to consenting women to remotely collect demographic data and self-reported LBP history, symptom presentation, healthcare use and outcomes at four pre-defined study time-points, (i) 20 to 22-weeks’ and (ii) 31 to 34-weeks’ gestation, (iii) six weeks and (iv) six months after birth. At the end of the study women provided feedback about their experiences and an evaluation of the methods of recruitment and online data collection was carried out to inform a future, fully powered study.
Results
307 women, from middle and upper socioeconomic groups, consented to participate and completed the first questionnaire. Women found the study procedures easy to follow with 50% completing the final questionnaire and 121 completing all four questionnaires. In the first questionnaire, 43% of women (N=132) reported having a history of LBP, with 46% of these currently experiencing LBP. Average composite pain scores ranged from 6.4 to 7.1/10 over the course of the study and were highest during the third trimester. Between 20 and 34 weeks´ gestation women reported a clinically important deterioration in health-related quality of life and back-specific function, along with high fear-avoidance beliefs between 31 to 34 weeks’ gestation. Women with a history of LBP were more likely to report symptoms 6-weeks after birth. 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. 
Conclusions
Pregnant women, predominantly from affluent socioeconomic groups, were interested in taking part in this study and found the procedures easy to follow. A significant proportion had a history of LBP. The deterioration observed in function and health-related quality of life, along with high fear-avoidance beliefs about physical activity when pain symptoms were at their worst, could be contributing to the increasing socioeconomic burden of LBP. In addition, women’s use of over-the-counter painkillers for their LBP is concerning, given the considerable uncertainty about the effects of these on the unborn child. These findings would suggest that more research should be directed at ways of preventing LBP from becoming a problem for pregnant women, in particular reducing the risk factors for chronicity that may be perpetuating this often ‘trivialised’ problem.