Elisabeth Krefting Bjelland

Pelvic girdle pain in pregnancy: the impact of parity

OBJECTIVE The purpose of this study was to estimate the association of parity with pelvic girdle syndrome (PGS; pain in anterior and bilateral posterior pelvis). STUDY DESIGN We included 75,939 pregnant women in the Norwegian Mother and Child Cohort Study. Data were obtained by self-administered questionnaires. RESULTS By pregnancy week 30, 15% of the women had developed PGS. Among first-time mothers, 11% of the women reported PGS, compared with 18% of the women with 1 previous delivery and 21% of women with 2 previous deliveries. The odds ratios for PGS of having had 1 or 2 previous deliveries were 1.9 (95% confidence interval [CI], 1.9-2.0) and 2.4 (95% CI, 2.3-2.6), respectively, after adjustment for other study factors. For PGS with severe pain, the corresponding odds ratios were 2.6 (95% CI, 2.3-2.9) and 3.8 (95% CI, 3.3-4.3). CONCLUSION The risk of the development of PGS increased with number of previous deliveries, which suggests that parity-related factors play a causal role.

The effect of emotional distress on persistent pelvic girdle pain after delivery: a longitudinal population study

Objective  To study the prognosis for pelvic girdle pain, and to explore the association between presence of emotional distress during pregnancy and pelvic girdle syndrome 6 months after delivery.

Is unilateral oophorectomy associated with age at menopause? A population study (the HUNT2 Survey)

STUDY QUESTION Is unilateral oophorectomy associated with age at menopause? SUMMARY ANSWER Women who had undergone unilateral oophorectomy entered menopause 1 year earlier than women with two ovaries intact. WHAT IS ALREADY KNOWN There is substantial variation in age at natural menopause. Unilateral oophorectomy implies a significant reduction of the ovarian follicular reserve. Thus, one might expect that the time to menopause is shortened by several years in women who have undergone unilateral oophorectomy. STUDY DESIGN, SIZE AND DURATION A retrospective cohort study of 23 580 Norwegian women who were included in the population-based HUNT2 Survey during the years 1995-1997. PARTICIPANTS/MATERIALS, SETTING, METHODS Data were obtained by two self-administered questionnaires at study inclusion. Cox proportional hazard models were used to estimate relative risks of menopause according to unilateral oophorectomy status with and without adjustment for birth cohort, parity, smoking, body mass index (BMI) and age at menarche. MAIN RESULTS AND THE ROLE OF CHANCE Women who had undergone unilateral oophorectomy were younger at menopause [mean 49.6 years; 95% confidence interval (CI): 49.2-50.0] than women without unilateral oophorectomy (mean 50.7 years; 95% CI: 50.6-50.8) (P < 0.001). The crude relative risk of menopause was 1.28 (95% CI: 1.15-1.42) and remained similar after adjustment for the study factors above (adjusted relative risk 1.27; 95% CI: 1.14-1.41). In addition, recent birth cohort and high BMI were associated with higher age at menopause. LIMITATIONS, REASONS FOR CAUTION Information on unilateral oophorectomy was based on self-reports. Some women may therefore have been misclassified. WIDER IMPLICATIONS OF THE FINDINGS Although the effect of unilateral oophorectomy on the age at menopause is similar to that of smoking, it is weaker than anticipated from the loss of ovarian follicular reserve. Thus, compensatory mechanisms may occur in the remaining ovary.

Mode of delivery and persistence of pelvic girdle syndrome 6 months postpartum.

OBJECTIVE We sought to study the association between mode of delivery and persistent pelvic girdle syndrome (PGS) (pain in anterior and bilateral posterior pelvis) 6 months postpartum. STUDY DESIGN We followed up 10,400 women with singleton deliveries in the Norwegian Mother and Child Cohort Study who reported PGS in pregnancy week 30 (1999 through 2008). Data were obtained by 3 self-administered questionnaires and linked to the Medical Birth Registry of Norway. RESULTS Planned cesarean section was associated with the presence of severe PGS 6 months postpartum (adjusted odds ratio [OR], 2.3; 95% confidence interval [CI], 1.4-3.9). In women who used crutches during pregnancy, emergency (adjusted OR, 2.0; 95% CI, 1.0-4.0) and planned (adjusted OR, 3.3; 95% CI, 1.9-5.9) cesarean section were each associated with severe PGS. CONCLUSION The results suggest an increased risk of severe PGS 6 months postpartum in women who underwent a cesarean section vs women who had an unassisted vaginal delivery.

Age at menarche and pelvic girdle syndrome in pregnancy: a population study of 74 973 women

Please cite this paper as: Bjelland E, Eberhard‐Gran M, Nielsen C, Eskild A. Age at menarche and pelvic girdle syndrome in pregnancy: a population study of 74 973 women. BJOG 2011;118:1646–1652.

Pelvic pain after childbirth: a longitudinal population study.

Abstract In this longitudinal population study, the aims were to study associations of mode of delivery with new onset of pelvic pain and changes in pelvic pain scores up to 7 to 18 months after childbirth. We included 20,248 participants enrolled in the Norwegian Mother and Child Cohort Study (1999-2008) without preexisting pelvic pain in pregnancy. Data were obtained by 4 self-administered questionnaires and linked to the Medical Birth Registry of Norway. A total of 4.5% of the women reported new onset of pelvic pain 0 to 3 months postpartum. Compared to unassisted vaginal delivery, operative vaginal delivery was associated with increased odds of pelvic pain (adjusted odds ratio [OR]: 1.30; 95% confidence interval [CI]: 1.06-1.59). Planned and emergency cesarean deliveries were associated with reduced odds of pelvic pain (adjusted OR: 0.48; 95% CI: 0.31-0.74 and adjusted OR: 0.65; 95% CI: 0.49-0.87, respectively). Planned cesarean delivery, young maternal age, and low Symptom Checklist-8 scores were associated with low pelvic pain scores after childbirth. A history of pain was the only factor associated with increased pelvic pain scores over time (P = 0.047). We conclude that new onset of pelvic pain after childbirth was not commonly reported, particularly following cesarean delivery. Overall, pelvic pain scores were rather low at all time points and women with a history of pain reported increased pelvic pain scores over time. Hence, clinicians should follow up women with pelvic pain after a difficult childbirth experience, particularly if they have a history of pain.

Exercise level before pregnancy and engaging in high-impact sports reduce the risk of pelvic girdle pain: a population-based cohort study of 39 184 women

Objective To examine whether an association exists between exercise levels pre-pregnancy and pelvic girdle pain in pregnancy. Pelvic girdle pain in pregnancy has been associated with physical inactivity, a risk factor for adverse pregnancy outcomes. Methods We used data from a population-based cohort study including 39 184 nulliparous women with a singleton pregnancy enrolled in the Norwegian Mother and Child Cohort study. Pre-pregnancy exercise frequency and types were assessed by questionnaire in pregnancy week 17. Pelvic girdle pain, defined as combined pain in the anterior pelvis and in the posterior pelvis bilaterally, was self-reported in pregnancy week 30. Multivariable Poisson regression estimated risks of pelvic girdle pain associated with pre-pregnancy exercise. We examined a dose–response association of prepregnancy exercise frequency using restricted cubic splines. A test for non-linearity was also conducted. Final models were adjusted for pre-pregnancy BMI, age, education, history of low back pain and history of depression. Results 4069 women (10.4%) reported pelvic girdle pain in pregnancy and the prevalence among women who were non-exercisers prepregnancy was 12.5%. There was a non-linear association for pre-pregnancy exercise and risk of pelvic girdle pain (test for non-linearity, p=0.003). Compared to non-exercisers, women exercising 3–5 times weekly pre-pregnancy had a 14% lower risk of developing pelvic girdle pain in pregnancy (aRR 0.86, 95% CI 0.77 to 0.96). Taking part in high-impact exercises such as running, jogging, orienteering, ballgames, netball games and high-impact aerobics were associated with less risk of pelvic girdle pain. Summary Women who exercise regularly and engage in high-impact exercises before the first pregnancy may have a reduced risk of pelvic girdle pain in pregnancy.

Hormonal contraception and pelvic girdle pain during pregnancy: a population study of 91 721 pregnancies in the Norwegian Mother and Child Cohort

STUDY QUESTION Is pre-pregnancy hormonal contraception use associated with the development of pelvic girdle pain during pregnancy? SUMMARY ANSWER In contrast to combined oral contraceptive pills, long lifetime exposure to progestin-only contraceptive pills or the use of a progestin intrauterine device during the final year before pregnancy were associated with pelvic girdle pain. WHAT IS ALREADY KNOWN Pelvic girdle pain severely affects many women during pregnancy. Smaller studies have suggested that hormonal contraceptive use is involved in the underlying mechanisms, but evidence is inconclusive. STUDY DESIGN, SIZE, DURATION A population study during the years 1999-2008. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 91,721 pregnancies included in the Norwegian Mother and Child Cohort Study. Data were obtained by two self-administered questionnaires during pregnancy weeks 17 and 30. MAIN RESULTS AND THE ROLE OF CHANCE Pelvic girdle pain was present in 12.9% of women who had used combined oral contraceptive pills during the last pre-pregnancy year, 16.4% of women who had used progestin-only contraceptive pills, 16.7% of women who had progestin injections and 20.7% of women who had used progestin intrauterine devices, compared with 15.3% of women who did not report use of hormonal contraceptives. After adjustment for other study factors, the use of a progestin intrauterine device was the only factor based on the preceding year associated with pelvic girdle pain [adjusted odds ratios (OR) 1.20; 95% confidence interval (CI): 1.11-1.31]. Long lifetime exposure to progestin-only contraceptive pills was also associated with pelvic girdle pain (adjusted OR 1.49; 95% CI: 1.01-2.20). LIMITATIONS, REASONS FOR CAUTION The participation rate was 38.5%. However, a recent study on the potential biases of skewed selection in the Norwegian Mother and Child Cohort Study found the prevalence estimates but not the exposure-outcome associations to be influenced by the selection. WIDER IMPLICATIONS OF THE FINDINGS The results suggest that combined oral contraceptives can be used without fear of developing pelvic girdle pain during pregnancy. However, the influence of progestin intrauterine devices and long-term exposure to progestin-only contraceptive pills requires further study. STUDY FUNDING/COMPETING INTEREST(S) The present study was supported by the Norwegian Research Council. None of the authors has a conflict of interest.

Breastfeeding and pelvic girdle pain: a follow‐up study of 10 603 women 18 months after delivery

To study the associations of patterns and duration of breastfeeding with the persistence of pelvic girdle pain 18 months after delivery.

Exercise in pregnancy: an association with placental weight?

BACKGROUND: Women with high levels of physical exercise have an increased demand for oxygen and nutrients. Thus, in pregnancies of women with high levels of exercise, it is conceivable that the supply of oxygen and nutrients to the placenta is suboptimal, and growth could be impaired. OBJECTIVE: The objective was to study the association of frequency of exercise during pregnancy with placental weight and placental to birthweight ratio. STUDY DESIGN: This was a prospective study of 80,515 singleton pregnancies in the Norwegian Mother and Child Cohort Study. Frequency of exercise was self‐reported by a questionnaire at pregnancy weeks 17 and 30. Information on placental weight and birthweight was obtained by linkage to the Medical Birth Registry of Norway. RESULTS: Placental weight decreased with increasing frequency of exercise (tests for trend, P < .001). For nonexercisers in pregnancy week 17, the crude mean placental weight was 686.1 g compared with 667.3 g in women exercising ≥6 times weekly (difference, 18.8 g; 95% confidence interval, 12.0–25.5). Likewise, in nonexercisers in pregnancy week 30, crude mean placental weight was 684.9 g compared with 661.6 g in women exercising ≥6 times weekly (difference, 23.3 g; 95% confidence interval, 14.9–31.6). The largest difference in crude mean placental weight was seen between nonexercisers at both time points and women exercising ≥6 times weekly at both time points (difference, 31.7 g; 95% confidence interval, 19.2–44.2). Frequency of exercise was not associated with placental to birthweight ratio. CONCLUSION: We found decreasing placental weight with increasing frequency of exercise in pregnancy. The difference in placental weight between nonexercisers and women with exercising ≥6 times weekly was small and may have no clinical implications.