Pelvic girdle pain (PGP) is a common yet underdiagnosed musculoskeletal disorder that affects women during pregnancy and postpartum. While symptoms often resolve, a considerable proportion of women experience persistent pain for years, leading to functional limitations and reduced quality of life [1]. Despite European clinical guidelines (2008) and postpartum updates (2022), PGP remains inconsistently recognised, variably diagnosed, and inadequately managed in routine antenatal and postnatal care [2,3]. This comprehensive systematic review aimed to: (1) estimate the pooled prevalence of PGP in pregnancy and postpartum, (2) identify key obstetric, biomechanical, and psychosocial risk factors associated with persistent postpartum PGP, and (3) synthesise evidence on clinically utilised diagnostic methods to inform standardised practice.

Following PRISMA 2020 guidelines, six databases (Ovid MEDLINE, Embase, CINAHL, Emcare, Scopus, PEDro) were searched from inception. Observational studies reporting PGP in pregnancy or postpartum were eligible for inclusion. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal tools. A random-effects meta-analysis was performed to estimate pooled proportions and effect sizes for associated risk factors. Where quantitative synthesis was not feasible, findings were summarised narratively. Heterogeneity (I²), publication bias (Egger’s and Begg’s tests), and subgroup analyses were conducted based on study design, trimester, diagnostic test, and follow-up period. Certainty of evidence was evaluated using the GRADE approach.

Thirty studies comprising a total of 142,447 participants were included. Prevalence estimates of PGP during pregnancy varied widely, with a pooled estimate of up to 61% (95% CI: 51–71, I2 = 97%, p < 0.001) derived from seven studies, most of which reported data from the third trimester.  Postpartum prevalence was similarly variable, with a pooled estimate of up to 28% (95% CI: 17–38, I2 = 99.9%, p < 0.001) based on fourteen studies. Emotional distress measured at one and two time points during pregnancy was significantly associated with persistent postpartum PGP (OR = 1.35, 95% CI: 1.15-1.59; OR = 1.73, 95% CI: 1.40-2.13, respectively). Positive bilateral posterior pelvic pain provocation (P4) test (OR = 1.72, 95% CI: 1.30-2.27) and prior low back pain (OR = 1.89, 95% CI: 1.43-2.50) were also significantly associated with postpartum PGP. Diagnostic practices varied widely across studies; the P4 test was the most frequently reported clinical examination, followed by the active straight leg raise (ASLR) test. No diagnostic gold standard was identified.

These findings indicate that PGP represents a significant maternal health morbidity. The association between antenatal emotional distress and persistent postpartum PGP highlights the importance of psychosocial factors in symptom chronicity. In addition, clinical indicators such as a positive P4 test and prior low back pain suggest potential for early identification of women at risk. However, the substantial heterogeneity and lack of diagnostic gold standards limit consistency in diagnosis and may contribute to underdiagnosis. These findings support the need for a multidimensional approach integrating clinical and psychosocial assessment.

Pelvic girdle pain affects over half of pregnant women and persists postpartum in nearly one‑third. Early recognition of key risk factors, standardisation of diagnostic methods, and integration of psychosocial screening into routine antenatal care are essential to improve detection and mitigate the long‑term impact on maternal well‑being.

Bergström C, Persson M, Nergård KA, Mogren I. Prevalence and predictors of persistent pelvic girdle pain 12 years postpartum. BMC musculoskeletal disorders. 2017 Sep 16;18(1):399.
Vleeming A, Albert HB, Östgaard HC, Sturesson B, Stuge B. European guidelines for the diagnosis and treatment of pelvic girdle pain. European Spine Journal. 2008 Jun;17(6):794-819.
Simonds AH, Abraham K, Spitznagle T. Clinical practice guidelines for pelvic girdle pain in the postpartum population. The Journal of Women's & Pelvic Health Physical Therapy. 2022 Jan 1;46(1):E1-38.