Author(s): Sara Dykowski, MD, Reina Nakamura, DO
Originally published: December 2, 2013 Last updated: April 30, 2025
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Disease/Disorder

Definition

Pregnancy-related complications include a multitude of topics from spine and musculoskeletal disorders to potentially life-threatening vascular conditions. The most common issues faced by physiatrists include musculoskeletal, neurologic, endocrine, and cardiovascular issues. The most concerning complications can threaten the health of both the pregnant woman and the fetus.

Etiology

Pregnancy results in hormonal, vascular, and physical changes, all of which have varying effects on the body. Labor and delivery can also result in musculoskeletal and neurologic injuries that are important for physiatrists to consider.

There can be multiple pain generators in pregnancy that result in lower back, pelvic girdle, and joint pain. Weight gain and a growing gravid abdomen are examples of increased biomechanical stressors that can contribute to symptoms. Chronic pelvic pain, pelvic floor dysfunction, and incontinence are also possible sequelae of pregnancy. Soft-tissue edema can put one at risk for tenosynovitis or nerve entrapment, such as in De Quervain’s Tenosynovitis or carpal tunnel syndrome, respectively. Other neurologic concerns include meralgia paresthetica, neuropathy, and plexopathy. Meralgia paresthetica is a result of anatomical changes resulting in compressive forces on the lateral femoral cutaneous nerve.  Median, femoral, obturator, and peroneal neuropathies, as well as lumbosacral plexopathy, are a few examples of compressive or traction nerve injuries that may occur during pregnancy or the peri-partum period. The etiology of leg cramps in pregnancy is not fully known but is hypothesized to be the result of the accumulation of lactic and other acids.

Endocrine complications, including hyperemesis gravidarum, gestational diabetes mellitus (GDM), transient osteoporosis, joint laxity, and tumor growth are all possible sequelae of hormonal changes in pregnancy. Hyperemesis, and the more severe hyperemesis gravidarum, are related to hormonal changes with gastrointestinal dysmotility The origin of transient osteoporosis related to pregnancy is unknown, and perhaps underdiagnosed.1  Transient osteoporosis typically presents in the third trimester and gradually resolves in the postpartum.1  Transient osteoporosis, in addition to increased relaxin levels, weight gain, and rapid fetal head descent, all may contribute to various musculoskeletal sequelae including hip pain, osteonecrosis, sacroiliac dysfunction, pubic symphysis separation, and pelvic insufficiency fracture. Physiologic ligamentous laxity is a vital antepartum change, however, increased laxity can cause excessive joint mobility increasing pain, such as in pubic symphysis dysfunction. There are rare case reports of hormone-mediated tumor growth in pregnancy as a result of hormonal fluctuations in pregnancy.2,3

Cardiovascular events, including venous thromboembolism (VTE), pulmonary embolism, and stroke, are the result of hypercoagulability in pregnancy. The etiology of preeclampsia is still debated, though more recent literature suggests placental implantation and angiogenic factors contribute to the pathophysiology.4

Epidemiology including risk factors and primary prevention

Studies evaluating low back and pelvic girdle pain in pregnancy have estimated varying prevalences from 25-90% and up to 50% of pregnant women, respectively.5,6 Risk factors for low back and pelvic girdle pain during pregnancy include history of non-gestational and gestational-related back pain, back pain during menses, trauma, and depression.5,6

Risk factors for persistent pelvic girdle pain postpartum include a history of lumbopelvic pain, hypermobility, asymmetric SI joint laxity, and increased disability score during pregnancy.5 Pregnancy, and increasing numbers of parity, are both risk factors for the development of diastasis recti abdominis (DRA), with literature estimating 39-45.5% persistent rate of DRA at 6 months postpartum, and up to 32.6% at one year.7,8

Gestation number and vaginal birth are risk factors for the development of peripartum urinary and fecal incontinence.9 One study estimated an incidence of urinary incontinence at nearly 40% and up to 10% for fecal incontinence during pregnancy.9

Hip pain is also common in pregnant women, which may be related to transient osteoporosis or the development of osteonecrosis.10

Soft tissue swelling at some point in pregnancy is reported by up to 80% of pregnant women.11 Soft tissue swelling can lead to compressive or traction neuropathies.

Carpal tunnel syndrome (CTS) is common in pregnancy with a prevalence as high as 25%.10

GDM is estimated to affect 16.5% of pregnancies globally.12

Hypercoagulability results in an increased risk of arterial and venous events. Risk factors for thromboembolic events are age older than 35 years, thrombophilia, history of thrombosis, and medical conditions that place the non-pregnant population at risk for similar events.13 Certain populations may require anticoagulation during pregnancy and the postpartum period as a method of primary prevention.

Preeclampsia risk factors have been heavily studied. Some of these factors include chronic hypertension, prior preeclampsia, obesity, diabetes mellitus, multi-gestation pregnancy, family history, and some systemic diseases.4 Certain risk factors may lead to obstetricians recommending delivery before 40 weeks.14

Hormone-mediated tumors in pregnancy are a rare entity and limited to case reports in the literature. 

Patho-anatomy/physiology

Pregnancy-related low back and pelvic pain may be the result of postural changes with abdominal weight gain. This results in shifting of the center of gravity and increased lumbar lordosis, or hyperlordosis. A growing gravid abdomen can also place direct pressure on the bladder, leading to stress incontinence. Abdominal wall stretching and separation further strain the lumbar spine and result in DRA. Hormonal changes cause ligaments to relax in the pelvis, resulting in increased mobility in the sacroiliac joints, pubic symphysis, and lumbar spine. This is in preparation for delivery, but this laxity may result in both low back and pelvic pain. Hormonal changes possibly responsible for the increased laxity and pain are relaxin, estradiol, and progesterone.  Relaxin exerts collagenolytic properties increasing ligamentous laxity though there has been evidence refuting the correlation between relaxin levels alone and the incidence of pelvic girdle pain in pregnancy.15

Relaxin has also been further implicated in the remodeling of multiple tissues in the musculoskeletal system. It is an osteoclast-activating factor which plays an integral role in bone resorption.  As an anti-inflammatory modulator, relaxin downregulates neutrophil function.  In combination with estrogen, relaxin provides anti-inflammatory effects in rheumatoid arthritis patients through the downregulation of tumor necrosis factor-alpha in animal models and increase IL-10 (anti-inflammatory cytokine in humans), which could potentially explain some of the benefits of pregnancy in autoimmune conditions.16–18

Compression nerve injuries in pregnancy often occur at superficial locations due to local soft tissue edema.10 For example, pregnancy-associated CTS may be related to hormonal changes and increasing peripheral edema, causing median nerve compression. Fluid retention in upper limbs may also result in stenosing tenosynovitis, such as De Quervain’s Tenosynovitis.

The mechanics of labor and delivery can result in traction and compressive neuropathies. The lateral femoral cutaneous nerve may be injured from wide C-section excision or certain positioning during labor, such as protracted hip flexion positioning.10 The femoral nerve may be injured by direct compression under the inguinal ligament, stretching, or ischemia. One study found nulliparity and prolonged pushing risk factors for femoral nerve injury.19 As the obturator nerve crosses the pelvic brim, it is susceptible to compressive injury from obstetrical instrumentation and the fetus. The fetal head may also directly compress the lumbosacral plexus or pudendal nerve resulting in plexopathy or pudendal neuralgia. Additional studies have shown focal peroneal nerve compression at the fibular head related to hand positioning, squatting, and improper footrest placement during labor.10

The pathophysiology of transient osteoporosis in pregnancy is not well understood. Bony resorption at the pubic symphysis can put pregnant and postpartum women at risk for osteitis pubis. Osteoarthritic joints also put patients at risk for pregnancy-related musculoskeletal pain.

Leg cramps are frequent in the late second and third trimesters, in the evening or night. This may be due to vascular changes and increased weight.

GDM arises from a combination of inadequate insulin response and increased insulin resistance.12

Cardiovascular events, such as venous thromboembolism (VTE) and stroke, are the result of hypercoagulability, a state in which there is an increase in clotting factors and fibrinogen.13 It is thought that this is a protective mechanism against excessive bleeding in childbirth or miscarriage. The risk of VTE is 4 to 5 times greater in pregnant women than in nonpregnant women.13 The etiology of preeclampsia is still debated, but this, and hypercoagulability, increase the risk of stroke.4,13

Although rare, the presence of a tumor with hormone-sensitive receptors can be susceptible to growth during pregnancy. Case reports highlight the development of hormone-sensitive neuroendocrine tumors, including medulloblastoma, meningioma, and other glial tumors, as well as functional pituitary tumors, and other malignancies during pregnancy.2,3,20,21

Disease progression including natural history, disease phases or stages, disease trajectory (clinical features and presentation over time)

In most cases, low back pain, pelvic girdle pain, meralgia paresthetica, and CTS resolve spontaneously within the postpartum period. Traction neuropathy and plexopathies can take up to several months to recover. DRA and pelvic floor dysfunction resulting in incontinence can persist after pregnancy.8,9

Insulin resistance typically increases as pregnancy progresses, and GDM usually resolves after delivery.12 Women with gestational diabetes have an increased risk of developing diabetes in the future. There is concern for miscarriage, birth defects, and excessive fetal growth with poorly controlled blood glucose levels. Both babies and mothers with GDM have an increased risk of diabetes mellitus later in life.

VTE risk is elevated throughout pregnancy and even higher in the immediate postpartum with an increased risk of VTE 20- to 80-fold higher in the first 6 weeks.13

Preeclampsia results in hypertension, proteinuria, and lower limb edema. If untreated, it may progress to life-threatening eclampsia and other syndromes.

Depending on the type of hormone-mediated tumor and pathophysiology, the patient can present with a wide constellation of symptomology and require drastically different treatment options to navigate the complexity of caring for both mother and fetus. For instance, one article cited a patient with medulloblastoma presenting with seizure, requiring emergent surgical debulking, while a literature review completed by these authors showed other patients with the same diagnosis presenting with dizziness, headache, ataxia, vomiting, and other neurologic symptoms.2 

Specific secondary or associated conditions and complications

Autonomic dysreflexia is a potentially life-threatening complication in pregnant women with spinal cord injuries at the T6 level or higher. Triggering events include labor, pelvic exams, bowel or bladder irritation, decubitus ulcers, and sexual activity. Spasticity may also be increased in pregnancy and trigger autonomic dysreflexia, but other causes should be considered.

Women treated for hydrocephalus with a ventriculoperitoneal shunt have a higher risk for shunt malfunction during pregnancy, possibly because of increasing intraperitoneal pressure.

Cerebral arteriovenous malformation (AVM) is a complicated co-morbidity in pregnancy without a risk and treatment consensus. Some studies have shown equal bleeding risk in the pregnant population compared to the general population, while others have shown an odds ratio of 7.91 in pregnancy with 28% mortality.22

Essentials of Assessment

History

Patients complain of low back pain with or without leg pain, which worsens with weight-bearing and activity and is typically relieved with rest. Patients with pelvic pain may describe pain in the suprapubic, groin, inner thighs, or lumbosacral spine. Examiners should also triage patients for symptoms of pelvic floor dysfunction, as well as bowel and bladder incontinence.

Patients with hip pain typically present with acute onset of pain, worsened by weight-bearing and relieved with rest, and functional disability. Hip pain may also be associated with lumbar or pelvic girdle pain.

Patients with CTS may complain of tingling, numbness, pain, or weakness in the hand and wrist, primarily in the thumb, index, and middle fingers, which may involve the forearm.

Patients with meralgia paresthesia may experience burning, pain, or numbness along the anterolateral thigh.

Patients with lumbosacral plexopathy typically present with lower extremity pain, paresthesias, and/or weakness.

Patients with possible VTE may complain of pain and swelling in a lower limb. Patients with pulmonary embolism may complain of shortness of breath and chest pain.

Patients developing stroke may present with speech, motor, and/or sensory deficits similar to a nonpregnant patient. Patients may complain of headaches, visual changes, edema, excessive weight gain, vomiting, and decreased urine output.

Physical examination

A full set of vital signs, including blood pressure and pulse, should be taken.

A complete musculoskeletal and neurologic examination should be performed consisting of inspection, palpation, range of motion, and provocative maneuvers. For patients with low back and pelvic girdle pain, there may be tenderness to palpation in the lumbosacral spine, sacroiliac joints (SIJ), paraspinals, or suprapubic area.  Three or more positive pain provocation SIJ tests on exam had a sensitivity of 91% and specificity of 78% for SIJ-mediated pain.23

Providers with specialized training in pelvic floor health may perform intra-pelvic manual exam to identify possible trigger points and/or pain referral patterns contributing to the patient’s persistent symptoms. If a provider does not have the background training to perform this exam, referral to a pelvic floor specialist should be performed. Attention to the abdomen regardless of mechanism of childbirth is also important to evaluate for persistent DRA.

A complete neurologic exam with manual muscle testing, sensory testing, reflex testing, and provocative maneuvers should be completed to assess for any neurologic compromise, indicating possibilities of radiculopathy, lumbosacral plexopathy, or mononeuropathy.  Gait assessment is an instrumental part of the neuromuscular examination. Any upper motor neuron findings, such as spasticity, hyperreflexia or asymmetric reflexes, positive Hoffmann’s, positive Babinski’s, and clonus, should raise concern for a central nervous system process, such as hormone-mediated tumor resulting in focal brain or spinal cord compression, or stroke.

The upper limbs and lower limbs should be examined for tenderness, edema, and erythema. Distal pulses should also be checked. If there is concern for a PE, stroke, or preeclampsia, the patient should be referred immediately to the emergency department.

Additionally, the patient should have an abdominal and gynecologic exam by her obstetrician.

Functional assessment

Depression and anxiety before, during, and in the postpartum period are serious issues needing assessment by the treating clinician because they can be debilitating and result in poor self-care and detrimental behavior for the patient and fetus. Antidepressants and anxiolytic medication adjustments may be necessary in relation to pregnancy. Pain thresholds may also be affected by depression and anxiety.

Laboratory studies

Electromyogram and nerve conduction testing may be done to delineate mononeuropathies or plexopathies, but they are not absolutely necessary.  A glucose tolerance test is done to assess for gestational diabetes. If there is concern for a functional hormonal tumor, additional endocrinologic laboratory studies can be performed.

Imaging

Diagnostic imaging is typically not needed. If x-ray imaging of the lumbar spine or pelvis is required, it should be discussed with the obstetrician. Radiographs are not performed unless medically necessary. In certain circumstances, in the third trimester, an obstetrician may allow a medically necessary radiograph. Magnetic resonance imaging (MRI) may be performed if advanced treatments, such as epidural steroid injection or surgery, are being considered.

Diagnostic ultrasound is an attractive imaging modality due to its relative safety during pregnancy.  Ultrasound can be useful in diagnosing musculoskeletal conditions such as tenosynovitis as well as mononeuropathies such as CTS with known diagnostic criteria by ultrasound.

A lower limb compression ultrasound can be completed to assess for DVT. Computed tomography angiography may be done to evaluate for PE.

MRI of the brain may be done for clinical suspicion of stroke, distinguishing osteoporosis versus osteonecrosis, AVM, or aneurysm assessment.

Early predictions of outcomes

There is a wide spectrum of potential musculoskeletal, neurologic, cardiovascular, and endocrinologic conditions experienced by pregnant women.  Early identification, facilitation of appropriate management, and coordination of care are important to optimize function and quality of life. The prognosis is generally good as many conditions are self-limited.10

Social role and social support system

A strong support system helps patients with gestational diabetes adhere to dietary and activity modifications. A good support system also provides aid in activities such as lifting large objects, carrying children, or acting as a primary caregiver in a physically demanding way. This support with strenuous activities may help reduce exacerbations of low back or pelvic pain.

Rehabilitation Management and Treatments

Available or current treatment guidelines

Treatment of pregnancy-related low back and pelvic girdle pain includes lifestyle modifications, physical therapy, aqua therapy, support binders and belts, medications, injections, and alternative treatments.6 Lifestyle modifications include discontinuing activities that aggravate the pain, if possible. This may require wearing proper footwear, bending with knees instead of the back, avoiding lifting heavy objects, and other similar strategies for proper body biomechanics and ergonomics. Walking and exercise, similar to the pre-pregnancy level, should be encouraged.

Physical therapy may include massage, heat, or ice with the development of a home stretching program and the use of a transcutaneous electrical nerve stimulator if cleared by the obstetrician. For pelvic floor pain and dysfunction with or without accompanying incontinence symptoms, referral to a pelvic floor physical therapist should be offered to the patient.

Therapist-assisted exercises may not improve pelvic pain, but a consult may be valuable.24 A sacroiliac belt or maternity support belt may be helpful for pelvic girdle and low back pain. Acetaminophen may be used as an analgesic. With clearance from the obstetrician, if there is tenderness on exam, topical treatments, such as lidocaine ointments or patches, and trigger point injections may be considered. Acupuncture has been shown to be effective in decreasing pregnancy-related pain. Massage, relaxation, yoga, and chiropractic care are additional alternative therapies prenatal health care and pregnant women utilize for low back pain.10Lumbar and pelvic surgery is avoided, if possible, during pregnancy. In rare instances, surgical intervention for pubic symphysis rupture or diastasis may be warranted if symptoms persist post-partum.

The 2020 ACOG Committee Opinion on physical activity and exercise during pregnancy and the postpartum period notes that obstetrical providers should evaluate patients carefully to ensure there are no medical or obstetric complications or contraindications before starting an exercise routine.25 Exercise prescriptions for obese patients may require special considerations and assessment of their pre-pregnancy activity levels. If cleared by an obstetrician, pregnant women with obesity should start with low-intensity, short periods of exercise and gradually increase the period or intensity of exercise as a patient is able.25 If no contraindications to exercise are present, ACOG Committee Opinion recommends 150 minutes of moderate exercise per week, such as 30-60 minutes of moderate-intensity 3 to 4 times a week in thermoneutral conditions.25

Treatment for CTS and De Quervain’s Tenosynovitis is similar to that in nonpregnant patients, with lifestyle modification, splinting, therapy, medications, injections, and surgical considerations.

Meralgia paresthetica typically resolves in the postpartum period. Avoiding tight clothing along the pelvis and carrying younger children along the affected hip can help prevent exacerbating symptoms further. Consideration of prolonged hip flexion and shortening pushing time during labor and delivery may also help the patient.10

Individuals who sustain a neuropathy in labor and delivery should undergo physical therapy evaluation and assistive device training before discharge.

Treatment of transient osteoporosis is conservative with symptom management as the condition typically regresses spontaneously over 6-8 months.1 Using an assistive device to offload the painful joint and reduce the risk for pathologic fracture is important. Analgesics may be used as needed. Consultation with orthopedics surgery for management of osteonecrosis is warranted.

Leg cramps may be treated with hydration, movement, and magnesium.26

Treatment for GDM includes dietary modifications with nutritional counseling, exercise, and insulin or oral medications. Blood sugars must be checked and reviewed regularly by a physician who will adjust medication based on blood sugar control. There may be additional fetal monitoring as well. Exercise, a healthy diet, and breastfeeding can reduce the incidence of type 2 diabetes for the mother and child.12

Treatment for VTE is typically with anticoagulation medications, such as heparin. Warfarin is contraindicated in pregnancy. Other treatments for this and a stroke, such as physical and/or occupational therapy, are similar to non-pregnant patients.

The ultimate treatment for preeclampsia is delivery.

Patients who develop a hormone-mediated tumor may require a multimodal, multidisciplinary treatment approach including surgical resection, systemic medication treatment, and/or radiation. Rehabilitation should be tailored to address persistent deficits after acute medical treatment.

At different disease stages

ACOG guidelines recommend a pre-pregnancy evaluation for patients with a history of spinal cord injury. The risk of autonomic dysreflexia in cervical and thoracic spinal cord injury is high during labor and a pre-labor treatment plan is recommended to be coordinated ahead of time with the medical team for optimization of care. Some conditions that may experience cyclical flares, such as multiple sclerosis, are known to be better controlled during pregnancy with fewer exacerbations. Patients with rheumatoid arthritis and autoimmune disorders often have less severe symptoms during pregnancy and may not require immunosuppressive or opioid medications during this period. Immunosuppressive medications can cause birth defects, and coordination between rheumatology and obstetrics is required to care for these patients and to develop an appropriate treatment plan. Muscular dystrophies include a variety of conditions with unique potential challenges during pregnancy, including worsening of weakness and cardiac and respiratory difficulties.

Coordination of care

Care for the pregnant patient should be coordinated between the physiatrist, obstetrician, and physical therapist if involved. In cases of VTE and gestational diabetes, coordination with maternal fetal medicine for high-risk pregnancies is recommended.

Translation into practice: practice “pearls”/performance improvement in practice (PIPs)/changes in clinical practice behaviors and skills

If cleared by the patient’s obstetrician, topical treatments, support belts/braces, acetaminophen, cyclobenzaprine, local corticosteroid injections, and physical therapy may be used in combination to treat most musculoskeletal issues.

Exercise appropriate for the patient may help with blood sugar control and minimize excessive weight gain and related complications.

Cutting Edge/Emerging and Unique Concepts and Practice

Sacroiliac joint and other injections to treat local painful syndromes are more frequently being performed under ultrasound guidance because of the contraindicated radiation exposure with fluoroscopically guided injections. Ultrasound-guided lumbar or sacroiliac joint injections may be performed with anesthetic and corticosteroid only if cleared by the obstetrician. Even with clearance, the risk-benefit ratio must be considered because corticosteroids are classified as category C in pregnancy.

Gaps in the Evidence-Based Knowledge

There are many knowledge gaps in the etiology of spine and musculoskeletal disorders and complications of pregnancy. They are the result of a complex combination of several hormonal changes and shifts in multiple endocrine axes. A single hormone, such as relaxin, has not been found to independently cause specific complications, such as pelvic girdle pain.16 Further research is needed to clarify etiologies of complications to develop targeted treatments.

References

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  2. Valarezo Chuchuca A, Wong-Achi X, Ullauri Torres L. Medulloblastoma during pregnancy: Hormone-mediated association? Report of 2 cases. Neurochirurgie. 2021;67(2):140-144. doi:10.1016/j.neuchi.2020.04.135
  3. Cherian KE, Kapoor N, Paul TV, Asha HS. Functioning Endocrine Tumors in Pregnancy: Diagnostic and Therapeutic Challenges. Indian J Endocrinol Metab. 2021;25(4):299-304. doi:10.4103/ijem.ijem_310_21
  4. Torres-Torres J, Espino-Y-Sosa S, Martinez-Portilla R, et al. A Narrative Review on the Pathophysiology of Preeclampsia. Int J Mol Sci. 2024;25(14):7569. doi:10.3390/ijms25147569
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  6. Eapen BC, Cifu DX, eds. Braddom’s Physical Medicine and Rehabilitation. Sixth edition. Elsevier; 2021.
  7. Cavalli M, Aiolfi A, Bruni PG, et al. Prevalence and risk factors for diastasis recti abdominis: a review and proposal of a new anatomical variation. Hernia. 2021;25(4):883-890. doi:10.1007/s10029-021-02468-8
  8. Fuentes Aparicio L, Rejano-Campo M, Donnelly GM, Vicente-Campos V. Self-reported symptoms in women with diastasis rectus abdominis: A systematic review. J Gynecol Obstet Hum Reprod. 2021;50(7):101995. doi:10.1016/j.jogoh.2020.101995
  9. Solans-Domènech M, Sánchez E, Espuña-Pons M. Urinary and Anal Incontinence During Pregnancy and Postpartum: Incidence, Severity, and Risk Factors. Obstet Gynecol. 2010;115(3):618-628. doi:10.1097/AOG.0b013e3181d04dff
  10. Borg-Stein J, Dugan SA. Musculoskeletal Disorders of Pregnancy, Delivery and Postpartum. Phys Med Rehabil Clin N Am. 2007;18(3):459-476. doi:10.1016/j.pmr.2007.05.005
  11. Ritchie JR. Orthopedic considerations during pregnancy. Clin Obstet Gynecol. 2003;46(2):456-466. doi:10.1097/00003081-200306000-00024
  12. Plows JF, Stanley JL, Baker PN, Reynolds CM, Vickers MH. The Pathophysiology of Gestational Diabetes Mellitus. Int J Mol Sci. 2018;19(11):3342. doi:10.3390/ijms19113342
  13. James AH. Pregnancy-associated thrombosis. Hematol Am Soc Hematol Educ Program. Published online 2009:277-285. doi:10.1182/asheducation-2009.1.277
  14. American College of Obstetrics & Gynecology. Your guide to women’s health direct from the experts. Accessed March 2, 2025. https://www.acog.org/womens-health
  15. Aldabe D, Ribeiro DC, Milosavljevic S, Dawn Bussey M. Pregnancy-related pelvic girdle pain and its relationship with relaxin levels during pregnancy: a systematic review. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc. 2012;21(9):1769-1776. doi:10.1007/s00586-012-2162-x
  16. Dehghan F, Haerian BS, Muniandy S, Yusof A, Dragoo JL, Salleh N. The effect of relaxin on the musculoskeletal system. Scand J Med Sci Sports. 2014;24(4). doi:10.1111/sms.12149
  17. Bani D, Masini E, Bello MG, Bigazzi M, Sacchi TB. Relaxin protects against myocardial injury caused by ischemia and reperfusion in rat heart. Am J Pathol. 1998;152(5):1367-1376.
  18. Figueiredo KA, Mui AL, Nelson CC, Cox ME. Relaxin stimulates leukocyte adhesion and migration through a relaxin receptor LGR7-dependent mechanism. J Biol Chem. 2006;281(6):3030-3039. doi:10.1074/jbc.M506665200
  19. To WWK, Wong MWN. Factors associated with back pain symptoms in pregnancy and the persistence of pain 2 years after pregnancy. Acta Obstet Gynecol Scand. 2003;82(12):1086-1091. doi:10.1046/j.1600-0412.2003.00235.x
  20. Saitoh Y, Oku Y, Izumoto S, Go J. Rapid growth of a meningioma during pregnancy: relationship with estrogen and progesterone receptors–case report. Neurol Med Chir (Tokyo). 1989;29(5):440-443. doi:10.2176/nmc.29.440
  21. Suelmann BBM, van Dooijeweert C, van der Wall E, Linn S, van Diest PJ. Pregnancy-associated breast cancer: nationwide Dutch study confirms a discriminatory aggressive histopathologic profile. Breast Cancer Res Treat. 2021;186(3):699-704. doi:10.1007/s10549-021-06130-w
  22. Lv X, Liu P, Li Y. The clinical characteristics and treatment of cerebral AVM in pregnancy. Neuroradiol J. 2015;28(3):234-237. doi:10.1177/1971400915589692
  23. Laslett M. Evidence-based diagnosis and treatment of the painful sacroiliac joint. J Man Manip Ther. 2008;16(3):142-152. doi:10.1179/jmt.2008.16.3.142
  24. Gupta A, Ceprnja D, Crosbie J. Does therapist-assisted exercise improve pregnancy related pelvic girdle pain? A randomised, cross-over, blinded, sham-controlled trial. Physiotherapy. 2015;101:e497. doi:10.1016/j.physio.2015.03.3295
  25. Syed H, Slayman T, DuChene Thoma K. ACOG Committee Opinion No. 804: Physical Activity and Exercise During Pregnancy and the Postpartum Period. Obstet Gynecol. 2021;137(2):375-376. doi:10.1097/AOG.0000000000004266
  26. Dahle LO, Berg G, Hammar M, Hurtig M, Larsson L. The effect of oral magnesium substitution on pregnancy-induced leg cramps. Am J Obstet Gynecol. 1995;173(1):175-180. doi:10.1016/0002-9378(95)90186-8

Original Version of the Topic

Saloni Sharma, MD. Pregnancy related complications. 12/2/2013

Previous Revision(s) of the Topic

Saloni Sharma, MD. Pregnancy related complications. 3/13/2018

Reina Nakamura, DO, Sara Dykowski, MD. Pregnancy Related Complications. 6/1/2022

Author Disclosure

Sara Dykowski, MD
Nothing to Disclose

Reina Nakamura, DO
Nothing to Disclose