Pelvic Girdle Pain (Pregnancy-Associated)



  • Persistent musculoskeletal pain localized from the level of the posterior iliac crest and gluteal fold over the anterior and posterior elements of the bony pelvis
  • May radiate across hip joint and thigh bones
  • Usually starts around the 18th week of pregnancy; can start in 1st trimester or present as late as 3 weeks postpartum
  • Pelvic girdle pain (PGP) is a separate entity from pregnancy-related lower back pain.
  • Synonyms: pelvic arthropathy; osteitis pubis; pelvic insufficiency; pelvic instability; pelvic relaxation pain; pelvic girdle relaxation; posterior pelvic pain; pregnancy-related PGP (PPGP); symphysis pubis dysfunction; lumbopelvic pain; peripartum pelvic pain; pelvic girdle syndrome


45% of all pregnant women; 25% of all postpartum women suffer from PGP, although likely underreported.

4–76%; wide range may be based on varying criteria and designs of studies.

Etiology and Pathophysiology

Generally agreed up pathophysiology hypothesis involves both hormonal and biomechanical factors.

  • Increased amounts of relaxin produced by the corpus luteum and uterine decidua during pregnancy
  • Relaxin acts on connective tissue, leading to greater ligament laxity especially in joints of the pelvis that normally serve to provide pelvic stability.
  • Increased laxity causes widening and separation of the symphysis pubis as well as sacroiliac joints.
  • Increased motion in pelvic joints decreases efficiency of load bearing and increases shearing forces across the joints.

Risk Factors

  • Risk factors with consistent findings
    • History of low back pain
    • Previous PGP
    • Previous trauma to the pelvis
    • Progesterone intrauterine device (1)
  • Probable risk factors with inconsistent findings
    • Increased workload
    • Physically demanding job
    • Pluripara
    • Parity
    • Increased BMI
    • Stress (1)
    • Operative delivery (2)
  • Not a risk factor with consistent findings
    • Smoking
    • Oral contraceptive pills
    • Age
    • Interval between pregnancies (1)

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