Preconception, prenatal, and postpartum psychological risk factors for pregnancy-related lumbopelvic pain: a systematic review

Abstract

Introduction: Pregnancy-related lumbopelvic pain (PLPP) affects up to 86% of pregnant women. This condition can significantly impact daily functioning and work ability, and may persist for years after childbirth. Psychological factors are thought to contribute to PLPP, yet their role throughout the preconception, prenatal, and postpartum stages is not well understood. This systematic review aimed to identify psychological risk factors for PLPP during each of these stages.

Methods: After PROSPERO registration (CRD42025630798), we systematically searched five databases up to July 2025 for observational studies examining longitudinal associations between psychological factors and PLPP outcomes (presence, intensity, and disability) in women during the preconception, prenatal, and postpartum stages. Study quality was assessed using the Quality in Prognosis Studies tool, and certainty of evidence was evaluated with the GRADE approach. Due to heterogeneity in outcome measures and incomplete reporting, results were synthesized narratively.

Results: Thirteen studies were included, with nine showing moderate risk of bias and four high risk of bias. No studies investigated preconception psychological risk factors. During pregnancy, higher levels of perceived stress, depression, and pain catastrophising, and the presence of emotional distress were associated with worse PLPP outcomes at a later time point in pregnancy. Higher prenatal neuroticism and lower extraversion and conscientiousness were associated with the presence of postpartum PLPP. No significant associations were found between postpartum psychological factors and PLPP in a later postpartum stage. The certainty of evidence for most factors was rated very low.

Process evaluation: Due to considerable methodological heterogeneity, the limited number of studies per psychological factor and time point, along with generally low study quality, careful decisions were needed regarding data synthesis and interpretation.

Conclusion: Current evidence regarding prenatal and postpartum psychological risk factors for PLPP is limited and inconsistent, with no available data for the preconception stage. Future research should use standardised measures, assess psychological factors prior to conception and symptom onset, and explore broader psychological profiles to enable stronger causal inferences. Strengthening this evidence may inform more targeted prevention and care for PLPP.