Low back pain (LBP) is one of the most commonly reported musculoskeletal complaints during pregnancy, with global prevalence estimates ranging from 45% to 75% among pregnant women [1,2]. It is a multifactorial condition that can significantly disrupt daily functioning, reduce quality of life, and increase both physical and emotional burden during gestation [3]. Despite its widespread occurrence, LBP in pregnancy often remains underrecognized and inadequately managed in routine antenatal care settings, leading many women to suffer in silence without appropriate intervention [1,4].

The etiology of pregnancy-related LBP is complex, involving a combination of physiological, anatomical, and hormonal changes. Factors such as maternal weight gain, increased lumbar lordosis, ligamentous laxity induced by relaxin, and altered biomechanics and posture are believed to contribute significantly to its development [4,5]. Moreover, modifiable risk factors including high body mass index (BMI), poor physical activity, inadequate sleep, high parity, and a pre-existing history of musculoskeletal issues may further influence the onset, intensity, and persistence of LBP [2,6].

The prevalence of LBP tends to increase with advancing gestational age, peaking in the third trimester as mechanical and hormonal influences intensify [5]. Clinically, it may present as lumbosacral pain, pelvic girdle pain, or both, often impairing mobility, sleep, occupational performance, and domestic responsibilities [3]. However, due to its frequent dismissal as a "normal" pregnancy symptom, many cases go unreported, resulting in suboptimal management and reduced maternal well-being [6].

Understanding the prevalence and associated risk factors of LBP in pregnancy is crucial for early identification and intervention. This study aims to assess the prevalence of LBP among pregnant women attending a tertiary care hospital and to identify the demographic and obstetric risk factors associated with its occurrence.

Study Design and Setting:

This was a cross-sectional observational study conducted at the Department of Obstetrics and Gynaecology, Government Medical College, Srikakulam, a tertiary care teaching hospital in Andhra Pradesh, India.

Study Period:

The study was carried out over a period of six months, from January 2024 to June 2024.

Study Population:

The study included pregnant women attending the antenatal outpatient department and inpatient services during the study period, irrespective of gestational age.

Inclusion Criteria:

• Pregnant women aged between 18 and 40 years
• Willing to give informed consent
• Gestational age from first to third trimester

Exclusion Criteria:

• Women with known spinal deformities or neurological disorders
• History of trauma to the back or lower limbs
• Chronic musculoskeletal disorders or systemic diseases affecting posture or mobility (e.g., rheumatoid arthritis, ankylosing spondylitis)
• Women with multiple pregnancies

Sample Size:

A total of 100 pregnant women were enrolled using convenience sampling.

Data Collection:

After obtaining written informed consent, data were collected using a pretested structured questionnaire. Information was gathered on demographic details, obstetric history, lifestyle factors, and history of back pain. The presence and severity of low back pain were assessed using a Visual Analog Scale (VAS). Clinical parameters such as BMI were measured, and relevant physical examination findings were noted.

Statistical Analysis:

Data were entered in Microsoft Excel and analyzed using SPSS version 25.0. Descriptive statistics (mean, standard deviation, frequencies, percentages) were calculated. Associations between risk factors and low back pain were analyzed using the Chi-square test, with a p-value <0.05 considered statistically significant.

Ethical Considerations:

Prior permission was obtained from the relevant authorities before initiating the study. All participants provided informed consent, and confidentiality was maintained throughout the study.

A total of 100 pregnant women participated in the study. Of these, 62% (n = 62) reported experiencing low back pain (LBP), yielding a prevalence of 62% (Table 1).

Table 1: Demographics and Prevalence of Low Back Pain (LBP)

The mean age of the study population was 26.8 ± 4.3 years, and the mean body mass index (BMI) was 25.2 ± 3.1 kg/m². The cohort consisted of 38% primigravida and 62% multigravida women.

Prevalence Across Gestational Age

The prevalence of LBP increased with advancing gestation. Among women in the first trimester, 6 of 18 (33.3%) reported LBP, compared to 22 of 40 (55%) in the second trimester, and 34 of 42 (81%) in the third trimester, demonstrating a statistically notable upward trend (Table 2).

Table 2: Prevalence of LBP by Gestational Age

Figure 1. Prevalence of LBP by Gestational Age

Risk Factors for Pregnancy-Associated LBP

Key risk factors found to be significantly associated with the presence of LBP included BMI >25 kg/m² (p = 0.002), sedentary lifestyle (p = 0.006), multigravidity (p = 0.004), history of pre-pregnancy back pain (p = 0.001), and poor sleep quality (p = 0.012) (Table 3).

Table 3: Risk Factors Associated with Low Back Pain

Figure 2. Risk Factors Associated with Low Back Pain

Pain Characteristics

Among the 62 participants with LBP, the majority experienced lumbosacral region pain (77.4%), while pelvic girdle pain was reported by 22.6%. Pain intensity, measured using the Visual Analog Scale (VAS), was mild in 33.9%, moderate in 48.4%, and severe in 17.7% of the affected individuals (Table 4).

Table 4: Pain Characteristics in Participants with LBP

Figure 3. Pain Characteristics in Participants with LBP

Impact on Daily Functioning

Low back pain significantly affected the participants' quality of life. 46.8% of women reported interference with daily household tasks, 29% experienced difficulty in walking or standing for prolonged periods, and 16.1% required analgesics or support devices for symptom relief (Table 5).

Table 5: Impact of LBP on Daily Activities

Figure 4. Impact of LBP on Daily Activities

This study observed a high prevalence of low back pain (LBP) among pregnant women, affecting 62% of the participants. This finding is consistent with prior global data, including the systematic review by Salari et al. [7], which reported a global prevalence range of 45% to 75% for pregnancy-related LBP. The increasing prevalence across trimesters in our study—33.3% in the first, 55% in the second, and 81% in the third trimester—is in line with previous findings that suggest the progression of pregnancy contributes to the intensification of mechanical stress on the lumbopelvic region due to postural changes and hormone-mediated ligament laxity [8,10].

Several risk factors were significantly associated with LBP in our cohort, including high BMI, sedentary lifestyle, multigravidity, poor sleep quality, and a history of pre-pregnancy back pain. These results are in agreement with studies from both local and international settings, which have identified similar associations. Saxena et al. [8] found a significant correlation between high BMI and increased incidence of LBP in Indian women, while Miladi et al. [9] reported the persistence of back pain into the postpartum period, further highlighting the importance of early identification and intervention. Additionally, findings from Kizito et al. [10] reinforce the influence of parity and gestational age on LBP, particularly in the third trimester.

In our study, 77.4% of women reported lumbosacral pain, with moderate pain severity being the most frequent. Functional limitations were significant, with nearly 47% of women reporting interference in household activities. Similar findings were reported by Fruscalzo et al. [11], who emphasized the impact of antenatal back pain on maternal function and delivery outcomes. Furthermore, a study by Ansari et al. [12] in Iranian women underscored that back pain during pregnancy leads to decreased mobility, discomfort in daily life, and sleep disturbances.

Despite the high burden, LBP in pregnancy is often perceived as a “normal” symptom and remains underdiagnosed and undertreated. These findings underscore the urgent need for routine screening, antenatal counseling, and early physiotherapeutic and ergonomic interventions to minimize the impact of LBP on maternal well-being and quality of life.

This study highlights that low back pain is a highly prevalent condition among pregnant women, affecting 62% of the participants, with the highest occurrence in the third trimester. Several modifiable risk factors such as elevated BMI, sedentary lifestyle, multigravidity, poor sleep quality, and prior history of back pain were significantly associated with its occurrence. The pain not only varied in intensity but also impacted the women’s daily functioning and quality of life. Despite its frequency, pregnancy-associated low back pain remains under-addressed in routine antenatal care. Therefore, timely identification, appropriate counseling, and targeted interventions are essential to reduce its burden and improve maternal comfort during pregnancy.

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