MANAGEMENT OF PREGNANCY-RELATED LOW BACK AND PELVIC GIRDLE PAIN IN PRIMARY CARE: A SYSTEMATIC REVIEW OF ASSESSMENT AND TREATMENT BY FAMILY DOCTORS AND MIDWIVES

Abstract

Background: Pregnancy-related LBP and pelvic girdle pain are common musculoskeletal conditions found to affect between 50-85% and 20%, respectively, of pregnant women. The conditions impact significantly on the functional abilities, quality of life, and working conditions of pregnant women. Family physicians and midwives act as important first contact carers within this context. However, the practice is challenged within the context of training, practice guidelines, and contact with other allied health practitioners. Unfortunately, the state of current practice practice is characterized by a large discrepancy concerning diagnosis and treatment approaches. Methods:A systematic review using peer-reviewed studies published between 2020 and 2025 was performed. The searches included multiple databases (PubMed, Cochrane, CINAHL, and Embase), using the keywords “pregnancy-related low back pain,” “pelvic girdle pain,” “pregnancy pain,” “primary care,” “family medicine,” and “midwifery.” The inclusion criteria included systematic review, meta-analysis, randomized controlled trials, prospective cohort studies, and narrative systematic reviews of at least 5 studies. Studies exploring the assessment tools, management strategies, or outcome tools for LBP and PGP in a family or clinical practice setting were included. The critical appraisal using the included studies was done in partnership with PRISMA. Conclusion: Twenty-three meta-analyses/comparative reviews/clinical guidelines were identified; 10 articles were selected for more profound analysis concerning relevance for assessment and treatment in a family practice. In analysis of 23 studies (total N=4831 pregnant women), multimodal treatment methods including patient education, exercise, and physiotherapy reduced VAS pain measurements between 10-50mm when compared to control groups. Exercise Therapy was associated with a 60-75% reduction in failure rates in pain reduction. Recommendations for manipulative and massage therapy were made by 93% midwives and 64% physicians. The effectiveness of patient education increased by 45% when introduced along with exercise compared to patient education alone. Improvement was seen in 70/85% of patients using Pelvic Girdle Belts for patients with PGP concerning pain and functional improvement for women suffering from PGP/PGS/PGDD. Symptoms persisted in puerperium stage was seen in 30% women; more concerning was pregnancy severity, depression, and catastrophic views towards pain rather than others. In effect, it becomes imperative that family practitioners must be active early in pregnancy irrespective of what implications may possibly be suggested concerning prognosis concerning Pelvic Girdle Pain Syndrome/ Lower Back Pain, as differentiation concerning both is imperative for successful management. Conclusion: Pregnancy-related lower back and pelvic girdle pain in primary health care can be managed in an interdisciplinary or multifaceted manner. Family physicians and midwives are encouraged to incorporate thoughts on assessments and early outpatient education and referrals to physiotherapy or other health care institutions. For future studies on similar issues, researchers are encouraged to focus on cost-effectiveness analyses within primary health care institutions.