Back Pain During Pregnancy in Indonesia: Characteristics, Prevalence, and Impact on Quality of Life

doi:10.21203/rs.3.rs-3374701/v1

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Research Article

Back Pain During Pregnancy in Indonesia: Characteristics, Prevalence, and Impact on Quality of Life

https://doi.org/10.21203/rs.3.rs-3374701/v1

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Background: Back pain is one of the most common musculoskeletal disorders experienced during certain periods of pregnancy. Though not life-threatening, pregnancy-related LBP and PGP may affect daily activities and impact quality of life. Our study aims to identify the risk factors linked with LBP and PGP and gauge the level of disability experienced by expectant mothers.

Methods: A cross-sectional study was conducted throughout Indonesia. Data for this study were collected through self-administered questionnaires, with 341 women participating. The study required participants to answer a series of questionnaires that covered socio-demographics, medical information, characteristics of back pain, and quality of life. To evaluate the severity of pain and physical limitations, the study utilized the VAS and Indonesian versions of the Oswestry Disability Index (ODI), respectively.

Results: There is no significant difference in the incidence of back pain among individuals with varying backgrounds in education and occupation. The odds ratio value of the age variable is 0.932, indicating that with each year's increase in age, there is a 6.8% decrease in the probability of developing back pain. A person who has had three pregnancies has a 0.2084 chance of experiencing back pain compared to those who are pregnant more than three times. Pregnant women who experience back pain have a disability level of 0.190645 (19.0645%), while those who do not experience back pain have an average of 0.013139 (1.3139%). This suggests that expectant mothers who experience back pain have a lower quality of life than those who do not.

Conclusion: Pregnant women in Indonesia experience a high occurrence of back pain, which can significantly reduce their quality of life. Younger age and number of pregnancy is associated with the incidence of back pain.

back pain in pregnancy

quality of life

epidemiology

Pregnancy is an exciting period for women, but it can come with challenges, including musculoskeletal discomfort such as low-back pain (LBP) and pelvic girdle pain (PGP). These issues are relatively common and can impact a woman's well-being during pregnancy. LBP typically results in discomfort between the 12th rib and the gluteal fold, while PGP affects the region between the posterior iliac crest and the gluteal fold, usually near the sacroiliac joints or symphysis pubis. (1–7)

The prevalence of low back pain during pregnancy ranges from 20–90%, and most studies report that it is more than 50%. (3, 4, 8, 9) Other studies in the United States of America, Europe, and some parts of Africa have reported a prevalence of LBP ranging from 30–78%. (10) During pregnancy, PGP can range from 4–76%, often accompanied by LBP. (3, 7) When defined as pain located at the level of the posterior iliac crest and the gluteal fold over the anterior and posterior elements of the bony pelvis, the prevalence ranges from 16–25%.(3)

Research has revealed that many pregnant women experience low back pain (LBP), with a significant number reporting it during their second trimester, typically around the 22nd week of pregnancy. (3, 4, 11) However, LBP can also occur during the first trimester. Pelvic Girdle Pain (PGP) is another common occurrence, with symptoms typically starting in the first trimester and peaking between weeks 24 and 36. Studies indicate that roughly 50% of pregnant women experience PGP and LBP during their first trimester. This percentage increases to 40–70% in the second trimester and 70–80% in the third trimester (3).

The etiology of LBP and PGP during pregnancy remains elusive, with evidence suggesting hormonal changes, altered blood flow, and changes in body mechanics such as increased pelvic mobility, changes in spinal curvature, and muscle problems are believed to cause musculoskeletal pain that affects the quality of life of pregnant women.(10–12) Contributing factors may include pelvic trauma, metabolic influences, muscle control difficulties, stress, weight gain, a sedentary lifestyle, muscle function loss, smoking, younger maternal age, joint hypermobility, chronic LBP, previous history of LBP during pregnancy, and infection.(10–13) Research indicates that 85% of women who experienced low back pain in their initial pregnancy were likely to experience it again in subsequent pregnancies. (11)

Additionally, certain factors can increase the likelihood of experiencing low back pain (LBP) and pelvic girdle pain (PGP) during pregnancy. These may include having a higher pre-pregnancy BMI, multiple pregnancies, strenuous workloads, and prolonged torso flexion. (10, 12, 13) Expectant mothers are generally advised to gain between 11 and 16 kilograms throughout their pregnancy, with roughly half of this weight added to the abdominal region. However, this weight gain can lead to postural changes that may cause low back pain (LBP) and pelvic girdle pain (PGP). (3)

Though not life-threatening, pregnancy-related LBP and PGP may affect daily activities, including challenges of standing, walking, sitting, and working. (10, 12, 14) This discomfort can also disrupt sleep patterns and daily routines, ultimately affecting health and wellness. (10) Furthermore, back pain can limit mobility and lead to social difficulties, significantly impacting their quality of life. (11, 14) This reduction in productivity in daily routine activities can be concerning. Notably, many women experience LBP for the first time during pregnancy. Regrettably, despite its disabling effects, LBP is often left untreated and considered a normal and inevitable part of pregnancy among women. (10)

Numerous studies have explored pregnancy-related lower back pain (LBP) and pelvic girdle pain (PGP) in developed nations, yet these conditions tend to be neglected in developing countries. To our knowledge, no research has investigated pregnancy-related LBP and PGP in Indonesia. As a result, our study intends to identify the risk factors linked with LBP and PGP and gauge the level of disability experienced by expectant mothers.

Study design and setting

Between November 2022 and January 2023, an extensive cross-sectional study was conducted throughout Indonesia. The study enrolled pregnant women willing to participate and could understand Bahasa. Data for this study were collected through self-administered questionnaires. Informed consent was obtained from all subjects prior to this study.

The study received ethical approval from the Research and Community Engagement Ethical Committee Faculty of Public Health Universitas Indonesia, under the registration number Ket-544/UN2.F10.D11/PPM.00.02/2022.

Measurements

The study required participants to answer a series of questionnaires that covered various topics. The first part of the questionnaire was devoted to pregnant women's sociodemographics, medical information, and the characteristics of back pain. The sociodemographic information collected included age in years, height in centimeters, weight in kilograms, area of residence, educational background ranging from elementary to master's degree, and occupation ranging from housewife to entrepreneur. Additionally, participants were asked to provide information on their general health status, including any chronic conditions such as high blood pressure, obesity, anemia, diabetes, heart disease, and regular drug consumption such as vitamins or prescription medications. Pregnancy characteristics included the number of pregnancies and details about previous pregnancies such as gestational weeks, childbirth history, parity in weeks, baby's weight, miscarriage history, and number of miscarriages. Workload information gathered included the type of work performed, duration of work in hours, frequency of work per week, and whether the work involved prolonged sitting or standing.(1, 2, 9, 11, 14, 15)

To accurately capture the location of the discomfort, a visual representation of the human body was utilized to document the occurrence of musculoskeletal pain, such as LBP and PGP. Those who reported experiencing pain were asked to choose the affected area on the chart to indicate the lower back and/or pelvis region; as a result, the complaint would be classified as either LBP, PGP, or both. (16)

A second part was devoted to the measurement of the quality of life. Women who reported experiencing lower back pain (LBP) and/or pelvic girdle pain (PGP) were asked about their back pain characteristics. The Visual Analogue Scale was used to obtain pregnant women’s self-assessment of pain level on a scale of 0 (no pain) to 10 (most severe pain). In addition, the duration of their pain in weeks, how often they experienced pain (on some days, most days, or every day), and what treatment options they have utilized (no treatment, painkillers, massage, yoga/Pilates, or physiotherapy).(1, 2, 8, 10, 14–16)

To properly evaluate physical activity limitations and lower back and pelvic pain symptoms during pregnancy, reliable Indonesian versions of the Oswestry Disability Index (ODI) were used. (17, 18) The self-completed questionnaire was designed to capture how back pain affects individuals' ability to manage in everyday life. The ODI contains 10 items concerning pain intensity, lifting, ability to care for oneself, ability to walk, ability to sit, ability to do work/household, ability to stand, social life, sleep quality, and ability to travel. Each item is answered with six statements and scored between 0 and 5, with 0 indicating the least disability and 5 indicating the most disability. The scores for all questions answered are summed and then multiplied by 2 to obtain the index (range 0–100). Zero is equated with no disability, and 100 is the maximum disability. Scores are interpreted as minimal disability (0–20); moderate disability (21–40); severe disability (41–60); crippling back pain (61–80); and the patient is either bed-bound or is exaggerating their symptoms (81–100). (8, 15, 18–20)

Statistical Analysis

Statistical analyses were performed using IBM SPSS 23. To assess the associations between independent variables and LBP and/or PGP, multivariate logistic regression with odds ratios (OR) and 95% confidence intervals (CIs) were used. The non-parametric method for comparing the two groups is the Wilcoxon Sum Rank Test, used to examine the differences in the quality of life (level of disability) of participants based on the incidence of back pain.

The study included 341 participants, whose average age was 29 years (with a standard deviation of 5) and average BMI was 26 (with a standard deviation of 4). Among the female participants, 43% held a bachelor's degree, 29.20% had completed high school, and 17.40% had a diploma. Most participants were housewives, with one-fourth working in an office. Most participants had been pregnant three times or more, while the rest had never been pregnant. The average gestation period was 23 weeks (with a standard deviation of 8).

Regarding birth history, among the surveyed individuals, 108 had a normal delivery, while 73 underwent a cesarean delivery. A small proportion of the respondents had experienced a miscarriage in the past. Most participants engage in household work, followed by office work using computers. Only a small percentage of respondents do manual work. Most respondents work more than 4 hours daily, more than five days a week. The majority of respondents (59%) do not work in a sitting position, while over 72% do not work in a standing position. Most respondents reside in West Java, the Special Capital Region of Jakarta, and Sumatra (as seen in Table 1).

Table 1

Respondent Characteristic
Variables	Value
Age, years, mean (SD)	29 (5)
Height, cm, mean (SD)	157 (6)
Body Weight, kg, mean (SD)	65 (11)
BMI, kg/m², mean (SD)	26 (4)
BMI, kg/m², n (%)
• < 18.5	3 (0.89%)
• 18.5–24.9	131 (38.76%)
• 25.0-29.9	135 (39.94%)
• 30.0- 34.9	60 (17.75%)
• 35.0- 39.9	7 (2.07%)
• > 40	2 (0.59%)
Education, n (%)
• Elementary	5 (1.47%)
• Junior High School	17 (5.01%)
• High School	99 (29.20%)
• Diploma	59 (17.40%)
• Bachelor	147 (43.36%)
• Master	12 (3.54%)
Occupation, n (%)
• Housewife	172 (50.74%)
• Office worker	88 (25.96%)
• Healthcare Professional	45 (13.27%)
• Educator	24 (7.08%)
• Entrepreneur	10 (2.95%)
Pregnancy history, n (%)
• Never	149 (43.95%)
• Ever been	190 (56.05%)
Number of pregnancies, n (%)
• Never	149 (43.95%)
• 1 time	95 (28.02%)
• 2 times	61 (17.99%)
• 3 times	23 (6.78%)
• > 3 times	11 (3.24%)
Gestational weeks, mean (SD)	23 (8)
Childbirth history, n (%)
• Never	156 (46.29%)
• Per abdomen (surgery)	73 (21.66%)
• Per vaginum (spontaneous)	108 (32.05%)
Miscarriage history, n (%)
• Ever	53 (15.63%)
• Never	286 (84.37%)
Number of miscarriages, n (%)
• > 3 times	1 (0.29%)
• 3 times	41 (12.09%)
• 2 times	7 (2.06%)
• 1 time	3 (0.88%)
• Never	287 (84.66%)
Daily activities, n (%)
• Working with computer	57 (16.81%)
• Manual work	13 (3.83%)
• House chores	269 (79.35%)
Duration of Activity
• < 1 hour	38 (11.18%)
• 1–2 hours	94 (27.65%)
• 2–3 hours	60 (17.65%)
• > 4 hours	148 (43.53%)
Activity Frequency, n (%)
• 1–2 days	19 (5.60%)
• 2–3 days	21 (86.19%)
• 3–4 days	28 (8.26%)
• 4–5 days	78 (23.01%)
• > 5 days	193 (56.93%)
Sitting position, n (%)
• No	200 (59%)
• Yes	139 (41%)
Standing position, n (%)
• No	245 (72.27%)
• Yes	94 (27.73%)
Residency Area, n (%)
• Central Java	18 (5,34%)
• West Java	113 (33,53%)
• East Java	35 (10,39%)
• Capital District of Jakarta	83 (24,63%)
• Banten	28 (8,31%)
• Special Region Yogyakarta	2 (0,59%)
• Sumatera	50 (14,84%)
• Papua	2 (0,59%)
• Sulawesi	2 (0,59%)
• Kalimantan	4 (1.19%)

According to the information presented in Table 2, it was found that most of respondents had not previously experienced back pain but were currently experiencing it during pregnancy. Most pain was located in the lumbar region (LBP), with nearly equal occurrences of pelvic girdle pain (PGP) and combinations. The pain persisted for over four weeks and several days per week for most respondents. When it came to managing their pain, many chose to leave it untreated, with only a small percentage opting for physiotherapy treatment. On average, respondents reported a VAS score of 5, with a standard deviation of 2. The ODI score for disability was 22 (SD 0.15). The main complaints from respondents were difficulty lifting, followed by challenges with work/household activities and standing positions.

Table 2

Back Pain Characteristic
Variables	Value
Current condition of back pain, n (%)
• Yes	248 (73.16%)
• No	91 (26.83%)
History of back pain, n (%)
• Ever, current pain	63 (18.86%)
• Ever, no current pain	15 (4.49%)
• Never, current pain	185 (55.39%)
• Never, no current pain	71 (21.26%)
Location, n (%)
• Low Back Pain (LBP)	136 (54.84%)
• Pelvic Girdle Pain (PGP)	52 (20.97%)
• Combination	60 (24.19%)
Duration, n (%)
• < 1 week	52 (21.05%)
• 1–2 week	36 (14.57%)
• 2–3 week	26 (10.53%)
• 3–4 week	22 (8.91%)
• > 4 week	111 (44.94%)
Frequency, n (%)
• Some days	36 (14.52%)
• Most days	145 (58.47%)
• Everyday	67 (27.02%)
Treatment options, n (%)
• No treatment	119 (47.98%)
• Painkillers	12 (4.84%)
• Massage	85 (34.27%)
• Yoga/Pilates	21 (8.47%)
• Physiotherapy	11 (4.44%)
Visual Analogue Scale, mean (SD)	5 (2)
Visual Analogue Scale, n (%)
• Scale 1–4	92 (37.10%)
• Scale 5–7	121 (48.79%)
• Scale 8–10	35 (14.11%)
Oswestry Disability Index (0-100), mean (SD)	22 (0.15)
Oswestry Disability Index, n (%)
• 0–20 (minimal disability)	143 (57.66%)
• 21–40 (moderate disability)	80 (32.26%)
• 41–60 (severe disability)	21 (8.47%)
• 61–80 (crippled)	4 (1.61%)
• 81–100 (bed bound)	0
Oswestry Disability Index
• Personal care, n (%)	51 (17.96%)
• Lifting, n (%)	171 (60.21%)
• Walking, n (%)	109 (38.38%)
• Sitting, n (%)	99 (34.86%)
• Standing, n (%)	145 (51.06%)
• Sleep, n (%)	92 (32.39%)
• Social life, n (%)	74 (26.06%)
• Travel, n (%)	108 (38.03%)
• Work/Household, n (%)	148 (52.11%)

It has been observed that the occurrence of back pain is not influenced by a person's level of education or occupation, as there is no significant difference in its incidence among individuals with varying backgrounds in these areas. However, age contributes to the likelihood of experiencing back pain. The odds ratio value of the age variable is 0.932, indicating that with each year increase in age, there is a 6.8% decrease in the probability of developing back pain (Table 3).

The height of the respondent does not have an impact on the occurrence of back pain. Likewise, an increase in height does not significantly alter the incidence of back pain. Similarly, the respondent's weight does not affect the incidence of back pain. An increase in body weight also does not significantly change the occurrence of back pain. The occurrence of back pain remains unaffected by the height of the respondent. Similarly, an increase in height does not significantly impact its incidence. Likewise, the incidence of back pain is not influenced by the respondent's weight. An increase in body weight also does not significantly alter its occurrence.

Table 3

Multivariate Analysis
Variables	Back Pain		OR (CI 95%)	P-value
Variables	No	Yes	OR (CI 95%)	P-value
Age	30.582	28.714	0.932 (0.889,0.978)	0.004
Height	157.890	157.117	0.977 (0.932,1.025)	0.338
Body weight	65.264	64.434	1.006 (0.981,1.031)	0.653
Education
• Elementary	2 (0.40)	3 (0.60)
• Junior High School	3 (0.18)	14 (0.82)	2.534 (0.264,24.366)	0.421
• High School	28 (0.28)	71 (0.72)	1.214 (0.174,8.474)	0.845
• Diploma	15 (0.25)	44 (0.75)	1.353 (0.182,10.057)	0.768
• Bachelor	40 (0.27)	107 (0.73)	1.447 (0.210,9.950)	0.707
• Master	3 (0.25)	9 (0.75)	2.125 (0.203,22.189)	0.529
Occupation
• Housewife	48 (0.28)	124 (0.72)
• Office worker	24 (0.27)	64 (0.73)	1.098 (0.578,2.088)	0.775
• Health Professional	9 (0.20)	36 (0.80)	1.619 (0.650,4.034)	0.301
• Educator	7 (0.29)	17 (0.71)	0.803 (0.291,2.211)	0.671
• Entrepreneur	3 (0.30)	7 (0.70)	0.966 (0.228,4.093)	0.963
High blood pressure
• No	81 (0.25)	231 (0.74)
• Yes	10 (0.37)	17 (0.62)	0.437 (0.176,1.086)	0.075
Low Blood Pressure
• No	59 (0.26)	164 (0.73)
• Yes	32 (0.27)	84 (0.72)	0.738 (0.430,1.269)	0.272
Anemia
• No	84 (0.28)	210 (0.71)
• Yes	7 (0.15)	38 (0.84)	2.251 (0.932,5.442)	0.071
Diabetes
• No	87 (0.26)	242 (0.73)
• Yes	4 (0.4)	6 (0.6)	0.465 (0.107,2.016)	0.306
Obesity
• No	88 (0.27)	233 (0.72)
• Yes	3 (0.16)	15 (0.83)	4.491 (0.935,21.566)	0.061
Heart disease
• No	87 (0.26)	245 (0.73)
• Yes	4 (0.57)	3 (0.42)	0.123 (0.019,0.797)	0.028
Regular Drug Consumption
• No	49 (0.34)	93 (0.65)
• Yes	42 (0.21)	155 (0.78)	1.929 (1.173,3.171)	0.010
Previous Pregnancy
• Yes	28 (0.1879)	121 (0.812)
• No	63 (0.3315)	127 (0.668)	0.8197 (0.05,12.84)	0.150
Number of pregnancies
• Never	28 (0.1824)	121 (0.817)
• 1 time	30 (0.3125)	65 (0.687)	0.2942 (0.02,4.273)	0.472
• 2 times	17 (0.2786)	44 (0.721)	0.3489 (0.01,6.156)	0.293
• 3 times	9 (0.3913)	14 (0.608)	0.2084 (0.01,3.875)	0.039
• > 3 times	8 (0.7272)	3 (0.272)	0.0240 (0.00,0.822)	0.072
Gestational Weeks	20.7912	23.4919	1.0277 (0.99,1.058)	0.565
Previous Childbirth
• Never	32 (0.2051)	124 (0.794)
• Per abdomen (surgery)	24 (0.3287)	49 (0.671)	2.3368 (0.30,18.08)	0.319
• Per vaginum (spontaneous)	35 (0.3181)	75 (0.681)	2.8477 (0.36,22.33)	0.320
Age of delivery	38.0702	37.6207	0.9807 (0.94,1.019)	0.440
Baby's Weight at Birth	3185,5172	3158.8525	1.000 (0.99,1.000)	1.000
Miscarriage history
• Yes	20 (0.3773)	33 (0.622)
• No	71 (0.2482)	215 (0.751)	0.000	0.963
Total Miscarriage
• > 3 times	1 (1.0)	0		1.000
• 3 times	18 (0.4390)	23 (0.560)	1414421410.025	0.999
• 2 times	0	7 (1.0)	0.000	1.000
• 1 time	2 (0.6666)	1 (0.333)	379878258.456	0.999
• Never	70 (0.2439)	217 (0.756)	851938379221626000	0.999
Daily activities
• Working with computer	14 (0.245)	43 (0.754)
• Working without the computer	3 (0.230)	10 (0.769)	1.267 (0.293,5.475)	0.751
• House chores	74 (0.275)	195 (0.724)	0.776 (0.360,1.674)	0.518
Duration of Activity
• < 1 hour	12 (0.324)	25 (0.675)
• 1–2 hours	24 (0.255)	70 (0.744)	1.220 (0.517,2.875)	0.650
• 2–3 hours	14 (0.233)	46 (0.766)	1.247 (0.481,3.228)	0.650
• > 4 hours	41 (0.277)	107 (0.722)	0.828 (0.334,2.054)	0.684
Activity Frequency
• 1–2 days	8 (0.421)	11 (0.578)
• 2–3 days	5 (0.238)	16 (0.761)	2.097 (0.526,8.366)	0.294
• 3–4 days	9 (0.321)	19 (0.678)	1.381 (0.403,4.739)	0.607
• 4–5 days	23 (0.294)	55 (0.705)	1.634 (0.550,4.857)	0.377
• > 5 days	46 (0.238)	147 (0.761)	2.359 (0.857,6.493)	0.097
Sitting Job
• No	57 (0.285)	143 (0.715)
• Yes	34 (0.244)	105 (0.755)	1.372 (0.761,2.472)	0.293
Standing Job
• No	67 (0.273)	178 (0.726)
• Yes	24 (0.255)	70 (0.744)	1.068 (0.609,1.874)	0.818

This study found no connection between back pain and high or low blood pressure, anemia, diabetes, or obesity. However, it is interesting to note that people who have had heart disease in the past appear to have a lower chance of experiencing back pain. In fact, they have an odds ratio of 0.123, meaning their likelihood of back pain is decreased compared to those without a history of heart disease. This suggests that individuals without a previous heart condition may be more vulnerable to back pain.

There is no correlation between pregnancy history and the likelihood of experiencing back pain. A person who has had three pregnancies has a 0.2084 chance of experiencing back pain compared to those who are pregnant more than three times. As gestational age increases, there is no significant change in the incidence of back pain. Additionally, the number of births a person has does not affect the occurrence of back pain. The gestational age at the delivery also does not significantly impact the incidence of back pain. Similarly, a baby’s weight doesn't affect whether someone experiences back pain. Lastly, a history of miscarriage does not impact the incidence of back pain, and the number of miscarriages does not affect the likelihood of experiencing back pain.

This study delves into the effects of various occupational factors on the prevalence of back pain. Upon analyzing the data, the authors have discovered that there is no correlation between daily activities, duration, frequency, and the occurrence of back pain. Furthermore, our research shows that having a job that involves prolonged sitting or standing does not impact the incidence of back pain.

Through statistical analysis, it was discovered that there is a significant difference in the quality of life, particularly the level of disability, of pregnant women who experience back pain compared to those who do not experience it (Table 4). Moreover, according to data from Table 5, pregnant women who experience back pain have a disability level of 0.190645 (19.0645%), while those who do not experience back pain have an average of 0.013139 (1.3139%). This suggests that there are differences in the quality of life of expectant mothers who experience back pain compared to those who do not. The average disability level of mothers who experience back pain is much higher than those who do not. Therefore, it can be concluded that back pain has a negative impact on the quality of life of expectant mothers who experience it.

Table 4

*Wilcoxon Sum Rank Test*
Statistics Test	Value
Mann-Whitney U	2560.000
Wilcoxon W	6746.000
WITH	-11.164
Asymp. Sig. (2-tailed)	.000

Table 5

Descriptive Comparison of Quality of Life (disability level) on Back Pain
Back Pain	N	Mean	Std. Deviation
Yes	248	0.190645	0.156972
No	91	0.013139	0.042081

Our research findings indicate that age is a significant factor in the likelihood of experiencing back pain. The age variable's odds ratio score of 0.932 indicates that with each year's increase in age, there is a 6.8% decrease in the probability of developing back pain. Prior investigations have explored the connection between maternal age during pregnancies and the risk of back pain, revealing that younger age at first childbirth is linked with a higher prevalence of LBP. (21, 22) While some studies, such as Kristiansson et al., found no correlation between age and back pain, others, such as Kovacs et al. and Wang et al., observed that younger mothers were more susceptible to back pain than older mothers. In general, our findings align with earlier findings that younger age is a risk factor for back pain during pregnancy. (15, 23, 24)

It appears that the height or weight of the respondent does not influence back pain. This means that even if there is an increase in these factors, the incidence of back pain remains largely unaffected. In other words, height does not seem to play a significant role in the occurrence of back pain. Likewise, the incidence of back pain is not influenced by the respondent's weight. An increase in body weight also does not significantly alter its occurrence. This finding is consistent with other studies that suggest factors such as weight, height, age, and smoking are not associated with PGP. (4, 21) Although some reports do not establish a link between a pregnant woman's body weight and back pain, other researchers have identified body mass as a significant risk factor, especially when it increases substantially, for back pain during pregnancy. (3)

Research has shown that a person's level of education or occupation does not affect their likelihood of experiencing back pain. There is no significant difference in the occurrence of back pain among people with varying backgrounds in these areas. However, this study did find that women with a high level of education reported a higher prevalence of LBP. Another study also found no correlation between the number of years of education and the incidence of back pain.(6) However, previous research showed significant associations of LBP and/or PGP with women with higher education and income. In addition, studies have shown women with a long duration of education had a lower prevalence of LBP and tended to experience their first childbirth at a late age, and those with lower levels of education are more likely to experience LBP.(21) More studies in developing countries are needed to increase the knowledge related to these factors.

We investigated the relationship between chronic diseases and back pain incidence but found no correlation in our study. This finding is supported by other studies that report no association between somatic diseases and pelvic girdle syndrome.(25) However, we did find that pregnant women in Indonesia commonly reported experiencing lower back pain (LBP) and/or pregnancy-related pelvic girdle pain (PGP). The prevalence of back pain during pregnancy in our study was 73.16%, with LBP at 54.84% and PGP at 20.97%. Similar studies from developing countries have also reported high rates of LBP and PGP during pregnancy. For instance, studies conducted in Australia and Sweden found incidence rates of 71% and 72%, respectively. (18, 26) In the US, a study of 950 pregnant women in New Haven, Connecticut, found that 68.5% of them experienced back pain, with 54% reporting pain mainly in the lumbar region.(24) Meanwhile, in Nepal, 45.5% of women experienced back pain, with most of them experiencing it in the lumbar region.(8) Moreover, women commonly experience PGP during pregnancy, with studies reporting prevalence rates ranging from 23–65%, depending on the study methods used.(6) Generally, the prevalence of back pain during pregnancy in our study is consistent with rates reported in other countries. However, one study found that 62% of patients with back pain also experienced PGP, while another found that 50% of gestational lumbopelvic pain was caused by PGP.(27, 28) At around 35 weeks, the prevalence of LBP and PGP were 71.3% and 64.7%, respectively.(4, 23) It's worth noting that prevalence rates may be influenced by the method of data collection. Ideally, LBP and PGP should be classified through a thorough clinical examination, but we were unable to examine all women in our study.

Research indicates that there is no connection between a woman's pregnancy history and the likelihood of experiencing back pain. Even as the pregnancy progresses, the frequency of back pain does not significantly change. The number of births a person has had also does not affect the occurrence of back pain. Further, the gestational age at delivery and the birth weight of the baby do not have any significant impact on whether someone experiences back pain. Additionally, a history of miscarriage does not increase the probability of back pain, nor does the number of miscarriages. This aligns with previous studies that suggest multiparity and gravidity are not associated with back pain. (15) However, the study also found that experiencing pregnancy-related LBP or PGP in the past is a strong predictor of lumbopelvic pain. Furthermore, there was no statistical relationship between the severity of back pain and gestational week during pregnancy, nor with the height or birth weight of the baby. (4, 29)

Through our research, we have found that expecting mothers who suffer from back pain tend to experience a greater degree of disability than those who do not. This strongly suggests that back pain can significantly disrupt the quality of life for these mothers. This correlates with findings in a study that mentioned the quality of life of women suffering from back pain was poorer than that of women without back pain. (30) Our own research has found similar results to studies conducted in other countries, where women reported difficulties in performing daily activities and a decrease in quality of life due to pregnancy-related LBP. (10, 24, 31) In Norway, it was found that approximately 73% of pregnant women experienced mobility issues due to LBP and PGP. (1) Back pain during pregnancy is a significant issue due to the high number of affected individuals and the discomfort it causes. It negatively impacts various aspects of life, such as sleep quality, physical well-being, work performance, social life, household activities, and leisure time. (14, 24, 32, 33) Additionally, it can result in economic losses if it leads to absenteeism. (34)

According to our research, pregnant women in Indonesia experience a high occurrence of back pain, which can significantly reduce their quality of life. Healthcare professionals should, therefore, take an active approach to inquire about back pain experiences and provide proper education as well as clinical care. Future investigations should also consider various settings to ensure comprehensive results.

LBP: Low back pain; PGP: Pelvic girdle pain; VAS: Visual analogue scale, ODI: Oswestry Disability Index: BMI: Body mass index; CI: Confidence interval; OR: Odds ratio

Ethics approval

Availability of Data and Materials

The datasets generated and/or analyzed during the current study are not publicly available due to respondents' privacy but are available from the corresponding author upon reasonable request.

Competing interests

The authors declare that they have no competing interests

Funding

The study was supported by the International Indexed Publication Grant, the Directorate of Research and Development, Universitas Indonesia

Authors contributions

FAD, MN, RP, ADP, and SRA contributed to the study design. FAD, MN, RP, and ADP contributed to the analysis and interpretation of data. FAD wrote the paper. MN, RP, ADP, and SRA revised the manuscript.

Acknowledgment

We would like to acknowledge the following funding source: The International Indexed Publication Grant, the Directorate of Research and Development, Universitas Indonesia [grant number NKB-723/UN2.RST/HKP.05.00/2022].

Authors Details

¹Physiotherapy Study Program, Vocational Education Program, Universitas Indonesia, Indonesia

²Physiotherapy School, Facultad de Medicina, Clínica Alemana-Universidad del Desarrollo, Chile

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No competing interests reported.

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Back Pain During Pregnancy in Indonesia: Characteristics, Prevalence, and Impact on Quality of Life

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