Which psychological risk factors are associated with pregnancy-related lumbopelvic pain? A systematic review

Abstract

Background Up to 86% of pregnant women experience pregnancy-related lumbopelvic pain (PLPP), which may persist for years after childbirth. PLPP can significantly impair daily functioning and work capacity. While psychological factors may influence PLPP, their roles across the preconception, prenatal, and postpartum periods remain poorly understood. This systematic review aimed to identify psychological risk factors for PLPP during these periods.

Methods Following registration in PROSPERO (CRD42025630798), we conducted a comprehensive systematic search across five databases until July 2025, focusing on observational studies reporting longitudinal associations between psychological factors and PLPP outcomes (PLPP presence, intensity, and related disability) in women during the preconception, prenatal, and postpartum periods. We assessed study quality with the Quality in Prognosis Studies tool and certainty of evidence with the Grading of Recommendations, Assessment, Development, and Evaluations criteria. Due to heterogeneity in outcome measures and incomplete data reporting, a narrative synthesis was performed.

Results Thirteen studies were included, with nine exhibiting a moderate risk of bias and four a high risk. No studies examined preconception psychological risk factors. Higher levels of prenatal perceived stress, depression, and pain catastrophising, and the presence of emotional distress were associated with worse PLPP outcomes later in pregnancy. Higher prenatal neuroticism and lower prenatal extraversion and conscientiousness were associated with the presence of postpartum PLPP. Postpartum psychological factors showed no association with PLPP in a later postpartum phase. The certainty of evidence was rated very low for most psychological factors.

Conclusion Evidence regarding psychological risk factors for PLPP outcomes during the prenatal and postpartum periods is limited and inconsistent. No data were available for the preconception phase. Future research should use standardised assessments, measure psychological factors prior to conception and symptom onset, and explore broader psychological profiles to draw stronger conclusions. Strengthening this evidence may enhance care for PLPP.