The influence of psychosocial factors on pregnancy related pelvic symptoms

Abstract

This thesis encloses studies which are separate analyses of the PRIMIS Study. In the PRIMIS Study a cohort of healthy women who expected their first child was followed up from early pregnancy to one year after delivery. Self-report questionnaires regarding psychosocial factors, urogenital symptoms and pregnancy related back and pelvic girdle pain were distributed to participants at 12, 24 and 36 weeks gestation, and 3 and 12 months after delivery. Obstetric data were obtained from midwifes and gynecologists/obstetricians. Pregnancy and childbirth are both physically and emotionally impressive life events. Pregnancy related symptoms such as back and pelvic girdle pain and depressive and urogenital symptoms are highly prevalent during pregnancy. The investigation of the interaction of physical symptoms and childbirth with psychosocial factors could improve our understanding of pregnancy related problems. Firstly, an overview of the literature on pregnancy related back and pelvic girdle pain led us to the conclusion that its etiology is multicausal and risk factors need further investigation. Therefore, we set out to examine the influence of psychosocial factors on pregnancy related back and pelvic girdle pain. We confirmed that the most predictive risk factor for back pain in and after pregnancy is history of back pain. We found no clear association between psychosocial factors and the occurrence of back pain during and after pregnancy. In addition we made an inventory of the Dutch situation regarding self reported so called “pelvic instability” and presented a mobility scale, designed for use in pregnancy: the Pregnancy Mobility Index (PMI). Pregnancy Mobility Index has been shown to be a reliable and valid questionnaire well suited for use during and after pregnancy. Using this questionnaire, we found that women reporting pelvic instability are less mobile than women without pain or women suffering from back pain only. No association was found between delivery-related factors and pelvic instability. Secondly is it important to identify factors that are associated with the risk of emergency cesarean and instrumental vaginal birth because they impose greater physical and emotional morbidity on both mother and infant than normal vaginal delivery. We examined what psychosocial factors are associated with the risk for instrumental and surgical delivery. We found that social support from the woman's partner in pregnancy, lack of depressive symptoms and specific personality traits are not protective against instrumentally assisted vaginal birth or emergency cesarean section. Finally, we assessed the association between depressive symptoms and overactive bladder (OAB) syndrome and urge and stress urinary incontinence (UUI and SUI), controlling for confounding socioeconomic, psychosocial, behavioral and biomedical factors.In univariate analysis urinary incontinence as well as OAB syndrome were significant associated with depressive symptoms. However, after adjusting for possible confounding factors, only OAB syndrome remained significantly associated. All finding are discussed and recommendations are given for clinical practice.