To W W K, Wong M W N
Department of Obstetrics and Gynecology, United Christian Hospital, Hong Kong.
Acta Obstet Gynecol Scand. 2003 Dec;82(12):1086-91. doi: 10.1046/j.1600-0412.2003.00235.x.
Factors associated with back pain symptoms in pregnancy and the persistence of pain 2 years after pregnancy.
To determine the prevalence of back pain during pregnancy and to delineate the factors associated with the development and persistence of such symptoms 2 years after delivery.
Prospective observational cohort. Consecutive patients in a low-risk obstetric population with singleton pregnancies were surveyed for back pain symptoms during pregnancy in the early postpartum period by a structured questionnaire. Data from this survey were then correlated with the details of labor and pregnancy outcome, as well as epidemiological, occupation and work data. A follow-up questionnaire survey was administered 24 months after delivery to the group who reported back pain symptoms in the first survey. The absence/presence of persistent symptoms at 24 months was correlated with the characteristics of their pregnancy, as well as their daily life activities at the time of the survey.
A total 326 patients with complete data were recruited. Two hundred and fifty (76.6%) reported one or more significant episodes of back pain during their pregnancy. Significantly more patients with presence of pain in pregnancy had history of previous back pain episodes when not pregnant (48% vs. 19.7%, p < 0.001), as well as during previous pregnancies (66% vs. 40%, p < 0.025), or in the postpartum period (40% vs. 6.6%, p < 0.001). There was no significant difference between those with or without pain in their pregnancy outcome. Complete data on 189 of the 250 study patients (75.6%) were available for analysis at 24 months after delivery. The incidence of persistent back pain symptoms was 21.1% (n = 40). Those with persistent pain were older, had significantly earlier onset of pain symptoms in the index pregnancy compared with those without pain at 24 months, and they also had their worse symptoms at an earlier gestation during the index pregnancy. Moreover, those with persistent pain had a higher weight gain at 24 months compared with their preindex pregnancy weight (6.8 kg, SD3.0) compared with those without further pain (4.0 kg, SD2.8) (p < 0.01), as well as less weight loss compared with their early postpartum weight (8.1 kg, SD4.8 vs. 1.1.5 kg, SD5.6) (p < 0.01).
The main factors associated with development of back pain were previous episodes of back pain while non-pregnant or pregnant. The occurrence of back pain during pregnancy did not affect the pregnancy outcome. The main risk factors associated with persistent back pain at 24 months appeared to be the onset of severe pain at an early gestation in the index pregnancy, as well as the inability to reduce weight to their pre-pregnant level.
与孕期背痛症状及产后2年疼痛持续相关的因素。
确定孕期背痛的患病率，并明确分娩后2年此类症状发生和持续的相关因素。
前瞻性观察队列研究。采用结构化问卷对低风险产科单胎妊娠连续患者在孕期及产后早期进行背痛症状调查。该调查数据随后与分娩及妊娠结局细节、流行病学、职业和工作数据相关联。对首次调查中报告有背痛症状的组在分娩后24个月进行随访问卷调查。24个月时持续性症状的有无与她们的妊娠特征以及调查时的日常生活活动相关。
共招募了326例有完整数据的患者。250例（76.6%）报告在孕期有一次或多次明显的背痛发作。孕期有疼痛的患者既往非孕期有背痛发作史（48%对19.7%，p<0.001）、既往妊娠期间（66%对40%，p<0.025）或产后（40%对6.6%，p<0.001）的比例显著更高。孕期有或无疼痛患者的妊娠结局无显著差异。250例研究患者中有189例（75.6%）在分娩后24个月有完整数据可供分析。持续性背痛症状的发生率为21.1%（n=40）。有持续性疼痛的患者年龄更大，与24个月时无疼痛的患者相比，本次妊娠疼痛症状出现明显更早，且在本次妊娠更早的孕周时症状更严重。此外，有持续性疼痛的患者与无进一步疼痛的患者相比，24个月时体重较妊娠前体重增加更多（6.8kg，标准差3.0）（p<0.01），且较产后早期体重减轻更少（8.1kg，标准差4.8对1.5kg，标准差5.6）（p<0.01）。
与背痛发生相关的主要因素是既往非孕期或孕期的背痛发作。孕期背痛的发生不影响妊娠结局。与产后24个月持续性背痛相关的主要危险因素似乎是本次妊娠早期严重疼痛的发作以及无法将体重减轻至孕前水平。
