title: Exercise level before pregnancy and engaging in high-impact sports reduce the risk of pelvic girdle pain: a population-based cohort study of 39 184 women.
abstract: OBJECTIVE
  To examine whether an association exists between exercise levels pre-pregnancy and pelvic girdle pain in pregnancy. Pelvic girdle pain in pregnancy has been associated with physical inactivity, a risk factor for adverse pregnancy outcomes.
  
  
  METHODS
  We used data from a population-based cohort study including 39 184 nulliparous women with a singleton pregnancy enrolled in the Norwegian Mother and Child Cohort study. Pre-pregnancy exercise frequency and types were assessed by questionnaire in pregnancy week 17. Pelvic girdle pain, defined as combined pain in the anterior pelvis and in the posterior pelvis bilaterally, was self-reported in pregnancy week 30. Multivariable Poisson regression estimated risks of pelvic girdle pain associated with pre-pregnancy exercise. We examined a dose-response association of prepregnancy exercise frequency using restricted cubic splines. A test for non-linearity was also conducted. Final models were adjusted for pre-pregnancy BMI, age, education, history of low back pain and history of depression.
  
  
  RESULTS
  4069 women (10.4%) reported pelvic girdle pain in pregnancy and the prevalence among women who were non-exercisers prepregnancy was 12.5%. There was a non-linear association for pre-pregnancy exercise and risk of pelvic girdle pain (test for non-linearity, p=0.003). Compared to non-exercisers, women exercising 3-5 times weekly pre-pregnancy had a 14% lower risk of developing pelvic girdle pain in pregnancy (aRR 0.86, 95% CI 0.77 to 0.96). Taking part in high-impact exercises such as running, jogging, orienteering, ballgames, netball games and high-impact aerobics were associated with less risk of pelvic girdle pain.
  
  
  CONCLUSIONS
  Women who exercise regularly and engage in high-impact exercises before the first pregnancy may have a reduced risk of pelvic girdle pain in pregnancy.
authors.affiliation: Department of Psychosomatics and Health Behaviour, Norwegian Institute of Public Health, Oslo, Norway Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors.forename: Katrine Mari
authors.initials: KM
authors.lastname: Owe
authors.affiliation: Department of Psychosomatics and Health Behaviour, Norwegian Institute of Public Health, Oslo, Norway Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.
authors.forename: Elisabeth K
authors.initials: EK
authors.lastname: Bjelland
authors.affiliation: Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.
authors.forename: Britt
authors.initials: B
authors.lastname: Stuge
authors.affiliation: Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
authors.forename: Nicola
authors.initials: N
authors.lastname: Orsini
authors.affiliation: Department of Psychosomatics and Health Behaviour, Norwegian Institute of Public Health, Oslo, Norway Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway.
authors.forename: Malin
authors.initials: M
authors.lastname: Eberhard-Gran
authors.affiliation: Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Rikshospitalet, Oslo, Norway Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Siri
authors.initials: S
authors.lastname: Vangen
mesh_terms: D000328:Adult; D015331:Cohort Studies; D015444:Exercise; D005260:Female; D006801:Humans; D009664:Norway / Q000453:epidemiology; D059388:Pelvic Girdle Pain / Q000453:epidemiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D013177:Sports; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Exercise; Pelvis; Pregnancy; Prospective; Sports & exercise medicine