Neuromusculoskeletal disorders in pregnancy revisited: Insights and clinical implications.

Abstract

Women face a higher risk of musculoskeletal disorders, particularly during and after pregnancy, due to complex hormonal and biomechanical changes. Pregnancy-associated hormonal fluctuations, primarily involving estrogen, progesterone, and relaxin, contribute to increased joint laxity, altered collagen dynamics, and ligamentous instability. Simultaneously, anatomical adaptations, including shifts in the center of gravity, increased lumbar lordosis, and altered gait mechanics, further strain the musculoskeletal system. These changes predispose pregnant women to conditions such as low back pain, pelvic girdle dysfunction, hip pathologies, and peripheral neuropathies, significantly impacting daily function and quality of life. While many of those disorders resolve postpartum, their long-term effects remain inadequately studied, raising concerns about potential chronic musculoskeletal complications, including osteoarthritis and persistent joint instability. Despite the prevalence of these conditions, there is a lack of standardized, evidence-based clinical pathways for assessment, early intervention, and postpartum rehabilitation. Current management strategies tend to focus on short-term symptomatic relief, such as analgesic use and activity modification, while often overlooking preventive strategies like routine musculoskeletal screening during prenatal visits, structured exercise programs tailored to pregnancy, and postpartum rehabilitation protocols. A well-tailored interdisciplinary collaboration is critical to address this gap. Obstetricians are well-positioned to identify early signs of musculoskeletal problems and initiate referrals. Physiatrists can develop and implement nonpharmacological treatment plans, including therapeutic exercise, physical therapy, and posture correction. They are also able to initiate targeted injections for musculoskeletal problems. Orthopedic surgeons provide expertise in diagnosing and managing structural abnormalities or persistent biomechanical dysfunction. Together, these disciplines can design comprehensive, longitudinal care models that prioritize both prevention and recovery. Research is still needed to delineate the long-term consequences of pregnancy on the musculoskeletal system and to establish preventive measures that enhance maternal health beyond the perinatal period. In this review, we address this gap by providing a comprehensive discussion regarding the effects of pregnancy and hormonal changes on the musculoskeletal system, as well as the commonplace conditions in daily clinical practice.