Effect of Body Acupuncture on Pregnancy-Related Low Back Pain and Pelvic Pain: A Systematic Review

Low back pain and pelvic pain during pregnancy are some of the most common and challenging discomforts that pregnant women face. Approximately 34% to 76% of pregnant women experience low back pain, pelvic girdle pain, or both during pregnancy. These painful conditions can begin around the 18th week of pregnancy and reach their peak between weeks 24 and 36, causing significant impacts on quality of life and women's daily activities. Although the exact causes are not fully understood, it is believed that this pain results from hormonal, mechanical, circulatory, and psychosocial changes inherent to the gestational period.

Factors such as age, parity, physical activity, body mass index, strenuous working conditions, and a previous history of low back pain may increase the risk of developing these symptoms.

The objective of this research was to investigate the efficacy of body acupuncture in relieving symptoms of pregnancy-related low back pain and pelvic pain. To this end, the researchers conducted a rigorous systematic review, examining 8 international databases (Cinahl, PubMed, Web of Science, Google Scholar, Science Direct, Scopus, Ebsco Host, and Cochrane Library) for the period between January 2000 and March 2020. The methodology followed the PRISMA guidelines for systematic reviews, ensuring transparency and quality in the analysis of the studies. Initially, 30,160 studies were identified, but after applying inclusion and exclusion criteria, only 6 randomized controlled trials were selected for final analysis.

The quality of these studies was assessed using the Jadad scale and the PRISMA guidelines. Criteria included studies in English or Turkish, randomized controlled clinical trials, and research focused specifically on body acupuncture for low back pain and pelvic pain during pregnancy.

The results of the analysis of the 6 studies, which included a total of 838 pregnant women from 3 different countries, consistently demonstrated that body acupuncture was effective in reducing pregnancy-related low back pain and pelvic pain complaints. Studies varied in size, from 47 to 321 participants, and included pregnant women between 18 and 30 years of age. Study quality was considered satisfactory, with Jadad scale scores >=3 points, with two studies receiving the maximum score of 5 points. Acupuncture interventions varied in duration and frequency, from weekly to twice-weekly applications, with sessions lasting 20 to 30 minutes.

The acupuncture points used included traditional locations from Chinese medicine, such as points on the back, abdomen, legs, and specific tender points. Importantly, no study reported significant side effects associated with acupuncture treatment.

For patients and healthcare professionals, these findings offer encouraging perspectives for the nonpharmacologic management of pain during pregnancy. Body acupuncture emerges as a safe and effective alternative to conventional treatments, which are often limited to analgesic medications (which can be limited during pregnancy), physical therapy, and exercise. This complementary method can be especially valuable considering that many pregnant women prefer to avoid medications during pregnancy due to concerns about possible effects on fetal development. Acupuncture works through well-established pain control mechanisms, including the 'gate control' theory in the spinal cord and the release of the body's natural endorphins.

For healthcare professionals, integrating acupuncture as an adjuvant treatment alongside standard care can offer a valuable additional tool in the therapeutic arsenal for pregnant women with low back pain and pelvic pain.

Despite the promising results, it is important to recognize the limitations of this study. Only articles published in English and Turkish were included, which may have excluded relevant research published in other languages, particularly in Chinese, where acupuncture has a millennia-long tradition. In addition, the review focused exclusively on body acupuncture, excluding other modalities such as ear acupuncture, which limited the total number of studies available for analysis. Some included studies presented methodological limitations, such as the lack of adequate comparison groups or insufficient follow-up periods to assess long-term effects.

The authors suggest that future studies with longer follow-up periods and larger samples would be valuable to confirm and expand these findings. Despite these limitations, the available evidence suggests that body acupuncture represents a promising and safe therapeutic option for pregnant women suffering from low back pain and pelvic pain, offering a holistic approach that can effectively complement conventional obstetric care.