Efficacy and safety of acupuncture in treating low back and pelvic girdle pain during pregnancy: a systematic review and meta-analysis of randomized controlled trials

Back and pelvic pain during pregnancy is one of the most common forms of discomfort experienced by expectant mothers, affecting approximately half of all pregnant women worldwide. This condition, known as pregnancy-related lumbopelvic pain, typically appears around the 18th week of gestation and tends to intensify progressively, peaking between the 24th and 36th weeks. The natural anatomical and physiological changes of pregnancy significantly alter the musculoskeletal system, creating conditions that predispose patients to this pain. The impact extends well beyond simple physical discomfort, substantially interfering with self-care capacity and compromising quality of life during a period already filled with changes and adaptations.

The researchers conducted a systematic review and meta-analysis to rigorously evaluate the efficacy and safety of acupuncture in treating lumbopelvic pain during pregnancy. The methodology was extremely rigorous, involving searches across six major medical databases between January 2000 and August 2023. Inclusion criteria were specific, selecting only randomized controlled trials involving pregnant women between 16 and 34 weeks of gestation with a confirmed diagnosis of lumbopelvic pain. At the end of the selection process, 12 high-quality studies were included in the analysis, encompassing 1,641 participants.

Most studies compared acupuncture combined with standard care versus standard care alone, while some used non-penetrating sham acupuncture as a control.

The results obtained were notably positive and clinically significant. The analysis demonstrated that acupuncture, when combined with standard care, produced a substantial reduction in pain intensity as measured by the visual analog scale, with a mean difference of 2.83 points favoring the acupuncture-treated group. In addition to pain relief, important improvements were observed in several other domains. The Oswestry Disability Index, which assesses functional limitations resulting from low back pain, showed a significant 9.14-point reduction.

Quality of life among participants also benefited, with documented improvement in the physical component of the SF-12 health questionnaire. Particularly relevant were the findings related to obstetric outcomes: significant reductions in cesarean section rates, decreased incidence of preterm births, and shorter labor duration.

The clinical implications of these findings are considerable for both patients and healthcare professionals. For pregnant women facing lumbopelvic pain, acupuncture emerges as a promising and safe therapeutic alternative, especially important given the limitations on analgesic medication use during pregnancy. Prolonged medication use may pose risks to both mother and fetus, including maternal nausea, drowsiness, fetal growth restriction, and potential risk of malformations. Acupuncture offers a non-pharmacological approach that has demonstrated efficacy without compromising maternal-fetal safety.

For healthcare professionals, these results provide robust scientific evidence that can guide clinical decisions. The acupuncture points most frequently used in the studies included Baihui, Kunlun, and Ashi points — located on the skull, foot, and pain sites, respectively. The research suggests that these points may serve as a first-line choice for acupuncturists, with additional condition-specific points selected according to each patient's individual presentation.

Regarding safety, the meta-analysis revealed a favorable profile for acupuncture during pregnancy. Reported adverse events were predominantly minor and procedure-related, such as pain at the needle insertion site and minor bleeding, but none were considered clinically significant or persistent. Importantly, there was no increase in the incidence of adverse effects such as drowsiness, dizziness, headache, or hypotension. The results also indicated that acupuncture did not negatively influence newborn weight or other neonatal health measures, providing additional reassurance about its safety during pregnancy.

Despite these encouraging results, the researchers acknowledged several important limitations of their study. A significant limitation was that half of the included studies did not use adequate blinding, which may introduce bias into the results. Although other measures were taken to minimize this issue, such as rigorous treatment protocols, adequate blinding remains a challenge in acupuncture research because of the nature of the procedure. In addition, some meta-analysis results still showed heterogeneity across studies, even when appropriate statistical models were applied to address this variability.

Differences in skill among acupuncturists may also have contributed to variations in analgesic effects, representing a source of heterogeneity that is difficult to fully control.

In conclusion, this systematic review and meta-analysis provides compelling scientific evidence that acupuncture can be considered a promising and safe therapy for treating lumbopelvic pain during pregnancy. The results demonstrate not only efficacy in pain relief and functional improvement, but also benefits in important obstetric outcomes such as reductions in cesarean sections and preterm births. For pregnant women suffering from this common and debilitating condition, acupuncture offers a valuable therapeutic option that can significantly improve quality of life during pregnancy. However, the researchers emphasize that, although the results are promising, additional rigorously designed clinical trials with adequate blinding and larger sample sizes are needed to definitively confirm these findings and establish standardized treatment protocols.

This research represents an important step in the scientific validation of a millennia-old practice from traditional Chinese medicine for a specific and clinically relevant application in modern obstetrics.