Effect of acupuncture on pregnancy related low back pain and pelvic pain: a systematic review and meta-analysis

Low back pain and pelvic pain during pregnancy are extremely common complaints that significantly affect the quality of life of pregnant and postpartum women. These conditions can manifest as early as the first trimester and tend to intensify as pregnancy progresses. Reported prevalence varies widely, from 24% to 90% of pregnant women, owing to the lack of standardized definitions for assessing these conditions. For many women, this pain interferes with daily activities, impairs sleep, and leads to more sick leave and the need for rest.

Low back pain typically localizes between the twelfth rib and the gluteal fold, while pelvic pain is concentrated between the posterior iliac crest and the gluteal folds, especially around the sacroiliac joints, and may radiate to the posterior thigh. Although the exact mechanisms are not yet fully understood, hormonal changes, mechanical postural alterations to accommodate the increasing weight of the uterus, and disturbances in neuromuscular control are thought to contribute to the development of this pain.

This study aimed to assess the efficacy of acupuncture in relieving low back and pelvic pain in pregnant and postpartum women through a systematic review with meta-analysis. The investigators conducted a comprehensive search of several medical databases, including PubMed, Cochrane Library, Embase, and others, through May 2015, looking for randomized controlled clinical trials investigating the use of acupuncture for these conditions. The inclusion criteria were rigorous, including only studies with pregnant or postpartum women with spontaneous symptoms, using acupuncture as the intervention. Studies with participants whose symptoms were caused by surgery, cancer, spinal injuries, or other pregnancy-related complications were excluded.

The methodological quality of the studies was assessed using criteria established by the Cochrane Handbook, analyzing aspects such as randomization, allocation concealment, blinding, and data integrity. For statistical analysis, the investigators used Review Manager software, calculating mean differences for continuous data and odds ratios for dichotomous data.

The analysis included ten studies with a total of 1,094 participants, all women with healthy singleton pregnancies or postpartum women with low back or pelvic pain. The results demonstrated significant benefits of acupuncture compared with the control groups, which received physical therapy, conventional therapy, or sham acupuncture. On the visual analog pain scale, acupuncture showed a mean reduction 22.4 points greater than the control group. When analyzing total treatment efficacy, acupuncture was 5.45 times more effective than conventional treatments.

Additional analyses suggested that acupuncture tended to be more effective for late-pregnancy pain and morning pain, although these data could not be adequately quantified. In terms of safety, the incidence of side effects was low in both groups and included preterm contractions, dizziness, discomfort at the insertion site, minor local bleeding, and bruising, but the data were insufficient for a robust quantitative analysis.

For patients and health care providers, these results offer important evidence on a non-pharmacologic therapeutic option for managing low back and pelvic pain during pregnancy and postpartum. Acupuncture emerges as a safe and effective alternative, especially considering the limitations on the use of analgesic medications during pregnancy. The results suggest that acupuncture can provide significant pain relief, improving the quality of life of pregnant women without the risks associated with conventional medications. For health care providers, the study provides a scientific basis for recommending acupuncture as part of an integrated treatment plan.

The technique showed good acceptance among patients and may be particularly valuable for women seeking natural alternatives or who cannot use conventional medications. The study also highlights the importance of a multidisciplinary approach in prenatal and postpartum care, integrating conventional medicine with evidence-based complementary practices.

The study has some important limitations that must be considered in interpreting the results. First, there was significant heterogeneity among studies, especially related to the acupuncture points used, with many studies using local tender points instead of standardized protocols. This variation in treatment points may explain part of the heterogeneity observed in the results. Second, the available data were limited for more specific analyses, such as efficacy at different weeks of gestation or effects of different needle insertion depths.

Third, although the studies reported a low incidence of side effects, the safety data were insufficient to provide definitive conclusions through quantitative analysis. In addition, the methodological quality of some of the included studies had limitations, with risks of bias related to blinding and allocation concealment. Despite these limitations, this study contributes significantly to the body of evidence on acupuncture for pregnancy-related pain, demonstrating quantifiable benefits that may encourage greater use of this therapy by providers and patients who previously may have had doubts about its efficacy. The authors suggest that needle insertion depth may be an interesting direction for future acupuncture research.