Psychological risk factors for lumbopelvic pain before, during, and after pregnancy: a systematic review

Abstract

Background: Pregnancy-related lumbopelvic pain (PLPP) affects up to 86% of pregnant women and may persist for many years postpartum. This condition can significantly impact daily activities and the ability to work. While psychological factors may contribute to PLPP, their role during the preconception, prenatal, and postpartum periods remains unclear. This systematic review aimed to identify psychological risk factors for PLPP outcomes across these periods. Methods: We systematically searched five databases until July 2025 to identify observational studies that report longitudinal associations between psychological factors and PLPP outcomes (e.g., the presence of PLPP, PLPP intensity, and related disability) in women during the preconception, prenatal, and postpartum periods. We assessed the quality of the studies with the Quality in Prognosis Studies tool and the certainty of evidence with the GRADE criteria. Due to heterogeneity in outcome measures and incomplete data reporting, a narrative synthesis was conducted. Results: Thirteen prospective, observational studies were included, of which nine showed a moderate risk of bias, and four a high risk. No studies explored preconception psychological risk factors. Limited evidence of low to very low certainty suggests that higher levels of prenatal perceived stress, depression and pain catastrophising, and the presence of emotional distress are associated with worse prenatal PLPP outcomes. Additionally, higher prenatal neuroticism and lower levels of extraversion and conscientiousness may be associated with a greater likelihood of experiencing postpartum PLPP. Postpartum psychological factors did not appear to be associated with postpartum PLPP outcomes. Overall, the certainty of evidence was very low. Conclusion: Current evidence regarding psychological risk factors for PLPP outcomes during the prenatal and postpartum periods is limited and inconsistent, and no data are available for the preconception period. Future research should use standardised assessment tools, evaluate psychological factors before conception and prior to symptom onset, and investigate broader psychological profiles while considering known risk factors for PLPP to reach stronger conclusions. Strengthening this evidence may lead to more effective care for PLPP. Trial registration: PROSPERO CRD42025630798