Comparative Effectiveness of Nonpharmacological Therapies for Pregnancy-Related Low Back and Pelvic Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Abstract

Background: Pregnancy-associated low back and pelvic pain is a common musculoskeletal condition associated with substantial pain, impaired mobility, and functional limitation during pregnancy. Pharmacologic pain management is constrained by maternal and fetal safety considerations, increasing reliance on conservative musculoskeletal interventions.

Methods: A systematic review and meta-analysis of randomized controlled trials was conducted in accordance with PRISMA 2020. PubMed/MEDLINE, Scopus, and Web of Science were searched from database inception through February 2026. Eligible studies included pregnant women with pregnancy-associated low back pain, pelvic girdle pain, or mixed lumbopelvic pain syndromes receiving conservative musculoskeletal interventions. Primary outcomes were pain intensity and functional disability assessed using validated instruments. Random-effects meta-analysis using standardized mean differences with Hedges g correction and 95% confidence intervals was performed.

Results: Six randomized controlled trials met inclusion criteria for qualitative synthesis, of which four studies involving 254 participants contributed directly extractable data for the primary quantitative meta-analyses. Conservative musculoskeletal interventions were associated with significant reductions in pain intensity (SMD -0.85, 95% CI -1.18 to -0.53; P < 0.001; I² = 34%) and functional disability (SMD -0.84, 95% CI -1.31 to -0.37; P < 0.001; I² = 66%). Subgroup analysis demonstrated numerically larger pain effects for device-assisted interventions, followed by acupuncture-based and manual or manipulative approaches, although subgroup differences were not statistically significant (P = 0.26). One trial was judged at high risk of bias, while the remaining studies were classified as having some concerns.

Conclusions: Conservative musculoskeletal interventions were associated with improvements in pain intensity and functional disability among women with pregnancy-associated low back and pelvic pain. However, limited trial numbers, methodological heterogeneity, and risk of bias constrain treatment-specific conclusions. Larger, adequately powered, methodologically rigorous randomized controlled trials are needed to inform higher-confidence clinical recommendations.