Musculoskeletal pain during pregnancy and its impact on quality of life: A cross-sectional study

Abstract

Objective(s)

Musculoskeletal (MSK) pain is a common condition during pregnancy, yet its broader functional, psychological, and social impacts remain underexplored, particularly in Middle Eastern populations. This study aimed to assess the prevalence and distribution of MSK pain during pregnancy, evaluate its impact on health-related quality of life (HRQoL), and identify associated sociodemographic, obstetric, and lifestyle factors.

Study Design

A cross-sectional study was conducted among 300 pregnant women attending a tertiary university hospital in Riyadh, Saudi Arabia. Data were collected using the validated Short Form-12 (SF-12) Health Survey. Statistical analyses included chi-square tests, independent t-tests, and multivariate logistic regression.

Results

The mean age of participants was 32.5 ± 5.5 years, and 54.3% were in their third trimester. MSK pain was highly prevalent, with lower back pain being the most commonly reported site (64.3%). The mean overall HRQoL score was 51.9 ± 18.5, with 47.3% of participants classified as having poor quality of life. MSK pain was significantly associated with lower scores in physical functioning, mental health, social functioning, and overall quality of life. Multivariate analysis identified multiparity (AOR = 3.12) and physical inactivity (AOR = 2.34) as independent predictors of MSK pain.

Conclusion(s)

Musculoskeletal pain—particularly lower back pain—is highly prevalent during pregnancy and is significantly associated with reduced quality of life. Multiparity and physical inactivity are important associated factors. Promoting antenatal physical activity and targeted patient education may help reduce the burden of MSK pain.

Introduction

Musculoskeletal (MSK) pain encompasses a broad group of conditions affecting the muscles, bones, joints, ligaments, tendons, and associated soft tissues, and is commonly characterized by pain, reduced mobility, and functional limitations [1]. According to the World Health Organization, musculoskeletal disorders are a leading contributor to disability worldwide, significantly affecting individuals’ physical function and quality of life [1].

During pregnancy, MSK pain is highly prevalent, affecting approximately 50–70% of pregnant women globally, with reported variation depending on population characteristics and assessment methods [2], [3], [4]. The most frequently affected anatomical regions include the lower back, pelvic girdle, hips, and, less commonly, the neck, shoulders, wrists, and lower extremities. Low back and pelvic girdle pain are particularly common, with prevalence estimates ranging from 34% to 72% [3], [5].

The etiology of pregnancy-related MSK pain is multifactorial. Hormonal changes—particularly increased levels of relaxin and progesterone—result in ligamentous laxity and joint instability. In addition, gestational weight gain and an anterior shift in the center of gravity lead to altered biomechanics and increased mechanical stress, especially in the lumbopelvic region [6], [7]. These physiological adaptations collectively increase susceptibility to pain and functional impairment.

Importantly, MSK pain during pregnancy is not merely a benign or expected symptom. Evidence indicates that it is associated with significant reductions in health-related quality of life (HRQoL), affecting physical functioning, mental health, sleep quality, and social participation [8], [9]. Previous studies have also demonstrated associations between MSK pain and adverse pregnancy experiences, including reduced physical activity and impaired daily functioning [10], [11].

Several risk factors for MSK pain during pregnancy have been identified, including multiparity, low levels of physical activity, higher body mass index, and previous history of musculoskeletal disorders [5], [12], [13]. In particular, physical inactivity has been consistently reported as a modifiable risk factor, highlighting the potential for preventive interventions [10], [14].

While existing research has primarily focused on low back and pelvic girdle pain, the broader distribution of MSK pain across multiple body regions and its multidimensional impact on quality of life remain insufficiently explored. Furthermore, there is limited evidence from Middle Eastern populations, where sociocultural, lifestyle, and healthcare factors may differ and influence both the prevalence and impact of MSK pain [15], [16].

Therefore, this study aimed to assess the prevalence and distribution of musculoskeletal pain during pregnancy, evaluate its impact on health-related quality of life using the SF−12 Health Survey [17], and identify associated sociodemographic, obstetric, and lifestyle factors among pregnant women.

Methods

Study Design and Population

A cross-sectional study was conducted among pregnant women attending antenatal clinics at King Khalid University Hospital in Riyadh, Saudi Arabia, between February 2026 and April 2026. A convenience sampling approach was used.

Eligibility Criteria

Inclusion criteria were pregnant women aged ≥ 18 years at any gestational stage who provided informed consent. Women with known pre-existing musculoskeletal or rheumatological disorders, high-risk pregnancies, or multiple gestations were excluded.

Data Collection

Data were collected using a structured questionnaire including sociodemographic, obstetric, and lifestyle variables.

Quality of Life Assessment

HRQoL was assessed using the validated SF−12 Health Survey [17], which measures eight domains: physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotional, and mental health.

Scores were transformed to a 0–100 scale, where higher scores indicate better health. Overall QoL was calculated as the mean score.

Categorization of Quality of Life

For descriptive purposes, overall QoL was categorized as:

• •Poor: 0–49
• •Moderate: 50–74
• •Good: 75–100

This categorization was applied for descriptive purposes to facilitate interpretation of HRQoL scores.

Statistical Analysis

Data were analyzed using SPSS version 28. Associations were tested using chi-square and t-tests.

Variables included in the multivariate logistic regression model were selected based on clinical relevance and univariate significance (p < 0.20). Multicollinearity was assessed and found to be non-significant. A p-value < 0.05 was considered statistically significant.

Results

Participant Characteristics

A total of 300 pregnant women were included in the study. The mean age of participants was 32.5 ± 5.5 years, with the majority aged between 30 and 39 years. More than half of the participants (54.3%) were in their third trimester, followed by 27.7% in the second trimester and 18.0% in the first trimester.

With regard to obstetric history, most women had 1–2 previous pregnancies (41.3%), while smaller proportions reported no previous pregnancies or higher parity. The majority of participants (75.3%) reported no engagement in regular physical exercise during pregnancy. Additional sociodemographic and obstetric details are presented in Table 1.

Table 1.

Sociodemographic and obstetric characteristics of pregnant women and related lifestyle factors in the King Khalid University (n = 300).

Variable	No. (%)
Age in years
< 30	91 (30.3%)
30–39	180 (60.0%)
40 +	29 (9.7%)
Mean ± SD	32.5 ± 5.5
Pregnancy duration
First trimester	54 (18.0%)
Second trimester	83 (27.7%)
Third trimester	163 (54.3%)
Mean ± SD	23.9 ± 10.0
Number of Previous Pregnancies
None	49 (16.3%)
1–2	124 (41.3%)
3–4	89 (29.7%)
5 +	38 (12.7%)
Mean ± SD	2.3 ± 1.8
Do you exercise?
Yes	74 (24.7%)
No	226 (75.3%)
Pre-pregnancy Weight (kg)
Mean ± SD	67.5 ± 16.1

Prevalence and Distribution of Musculoskeletal Pain

Musculoskeletal (MSK) pain was highly prevalent among the study population. The lower back was the most commonly affected site, followed by the shoulders and hips/thighs. Other regions, including the neck, upper back, ankles/feet, and wrists/hands, were less frequently reported.

A similar pattern was observed for pain experienced within the preceding 7 days, with lower back pain remaining the most frequent complaint. While a substantial proportion of women reported no recent pain, a notable subset experienced pain severe enough to affect daily functioning, most commonly due to lower back involvement.

The detailed distribution of pain sites during pregnancy, in the last 7 days, and their impact on daily activities are summarized in Table 2.

Table 2.

Prevalence, distribution, and functional impact of musculoskeletal pain sites during pregnancy among study participants (n = 300).

Variable	No. (%)
Pain site during this pregnancy
Lower Back	193 (64.3%)
Shoulders	75 (25.0%)
Hips/Thighs	60 (20.0%)
Neck	57 (19.0%)
Ankles/Feet	55 (18.3%)
Upper Back	48 (16.0%)
Wrists/Hands	28 (9.3%)
None	65 (21.7%)
Pain site in the last 7 days
Lower Back	146 (48.7%)
Hips/Thighs	47 (15.7%)
Upper Back	47 (15.7%)
Neck	44 (14.7%)
Shoulders	43 (14.3%)
Ankles/Feet	37 (12.3%)
Wrists/Hands	18 (6.0%)
None	88 (29.3%)
Which pain affected / limited daily work
No effect	200 (66.7%)
Lower Back	61 (20.3%)
Upper Back	20 (6.7%)
Ankles/Feet	19 (6.3%)
Neck	17 (5.7%)
Shoulders	16 (5.3%)
Hips/Thighs	12 (4.0%)
Wrists/Hands	8 (2.7%)

Health-Related Quality of Life

Overall, participants demonstrated moderate health-related quality of life (HRQoL), with a mean overall score of 51.9 ± 18.5.

Among the assessed domains, physical functioning showed relatively lower scores, indicating notable limitations in performing daily activities, particularly more strenuous tasks. Mental health and social functioning scores were also moderate, while vitality demonstrated comparatively lower levels, suggesting reduced energy and increased fatigue among participants.

The distribution of HRQoL domain scores is presented in Table 3, and the categorized levels of quality of life are illustrated in Fig. 1, where nearly half of the participants were classified as having poor overall quality of life.

Table 3.

Domain-wise health-related quality of life scores among pregnant women based on the SF−12 scale (0–100 transformed scores).

Domain / Item	Min–Max	Mean ± SD
General Health	0.0–100.0	67.2 ± 22.8
Physical functioning
• Strenuous activities (running, lifting)	0.0–100.0	41.8 ± 29.9
• Climbing stairs	0.0–100.0	53.8 ± 34.1
Physical functioning (overall)	0.0–100.0	47.8 ± 26.5
Role physical
• Accomplished less due to physical health	0.0–100.0	51.0 ± 50.1
• Limited the work/activities	0.0–100.0	55.0 ± 49.8
Role physical (overall)	0.0–100.0	53.0 ± 42.4
Role emotional
• Accomplished less due to emotional problems	0.0–100.0	38.0 ± 48.6
• Worked less carefully due to emotional problems	0.0–100.0	44.0 ± 49.7
Role emotional (overall)	0.0–100.0	41.0 ± 39.3
Pain interferes with normal work	20.0–100.0	68.9 ± 18.6
Mental health
• Felt calm and peaceful	0.0–100.0	53.0 ± 26.6
• Felt downhearted and depressed	0.0–100.0	55.8 ± 28.6
Mental health (overall)	0.0–100.0	54.4 ± 21.6
Vitality	0.0–100.0	45.7 ± 26.0
Interference with social activities	0.0–100.0	48.3 ± 24.1
Overall quality of life	10.0–96.7	51.9 ± 18.5

Fig. 1.

Health-related quality of life domains and overall quality of life among pregnant women based on SF−12 scores (n = 300).

Factors Associated with Musculoskeletal Pain

Musculoskeletal pain was prevalent across most participant groups, with no statistically significant association observed with age, gestational age, or pre-pregnancy weight.

However, parity and physical activity demonstrated significant associations. Women with higher parity, particularly those with 3–4 previous pregnancies, were more likely to report MSK pain compared to nulliparous women. Additionally, women who did not engage in regular physical activity had a higher prevalence of MSK pain compared to those who exercised.

These associations are detailed in Table 4.

Table 4.

Association between sociodemographic and obstetric factors and musculoskeletal pain during pregnancy among study participants (n = 300).

Factor	MSK pain during pregnancy		p-value
	Yes: No. (%)	No: No. (%)
Age in years			.374^
< 30	78 (85.7%)	13 (14.3%)
30–39	163 (90.6%)	17 (9.4%)
40 +	27 (93.1%)	2 (6.9%)
Pregnancy duration			.611
First trimester	49 (90.7%)	5 (9.3%)
Second trimester	76 (91.6%)	7 (8.4%)
Third trimester	143 (87.7%)	20 (12.3%)
Number of Previous Pregnancies			.006*
None	38 (77.6%)	11 (22.4%)
1–2	111 (89.5%)	13 (10.5%)
3–4	86 (96.6%)	3 (3.4%)
5 +	33 (86.8%)	5 (13.2%)
Do you exercise?			.048*
Yes	62 (83.8%)	12 (16.2%)
No	206 (91.2%)	20 (8.8%)
Pre-pregnancy Weight (kg)			.714#
Mean ± SD	67.7 ± 15.2	66.0 ± 22.5

P: Pearson X² test.

^: Exact Probability test.

#: Independent t-test.

* P < 0.05 (significant).

Association Between Musculoskeletal Pain and Quality of Life

The presence of MSK pain was significantly associated with poorer health-related quality of life. Women without MSK pain were more likely to report better outcomes in several domains, including physical functioning, mental health, social functioning, and pain-related quality of life.

Similarly, overall quality of life was significantly higher among women without MSK pain. In contrast, no statistically significant differences were observed in role limitations (physical or emotional) or vitality.

These findings are summarized in Table 5.

Table 5.

Association between musculoskeletal pain during pregnancy and health-related quality of life domains and overall quality of life among study participants (n = 300).

QoL	MSK pain during pregnancy				p-value
	Yes		No
	No	%	No	%
Physical functioning					.011*
Poor	94	35.1%	5	15.6%
Moderate	104	38.8%	11	34.4%
Good	70	26.1%	16	50.0%
Role physical					.133
Poor	93	34.7%	6	18.8%
Moderate	75	28.0%	9	28.1%
Good	100	37.3%	17	53.1%
Role emotional					.180
Poor	115	42.9%	9	28.1%
Moderate	94	35.1%	12	37.5%
Good	59	22.0%	11	34.4%
Mental health					.033*
Poor	80	29.9%	3	9.4%
Moderate	137	51.1%	19	59.4%
Good	51	19.0%	10	31.3%
Pain					.035*^
Poor	39	14.6%	1	3.1%
Moderate	105	39.2%	9	28.1%
Good	124	46.3%	22	68.8%
Vitality ((Energy/Fatigue)					.305^
Poor	191	71.3%	20	62.5%
Moderate	0	0.0%	0	0.0%
Good	77	28.7%	12	37.5%
Social Functioning					.001*
Poor	91	34.0%	5	15.6%
Moderate	110	41.0%	9	28.1%
Good	67	25.0%	18	56.3%
Overall quality of life					.001*
Poor	135	50.4%	7	21.9%
Moderate	101	37.7%	15	46.9%
Good	32	11.9%	10	31.3%

P: Pearson X² test.

^: Exact Probability test.

* P < 0.05 (significant).

Multivariate Analysis

Multivariate logistic regression analysis identified significant independent predictors of musculoskeletal pain during pregnancy.

Women with 3–4 previous pregnancies had higher odds of experiencing MSK pain compared to those with no prior pregnancies. In addition, lack of physical activity was independently associated with increased likelihood of MSK pain.

Other variables, including age, gestational trimester, and pre-pregnancy weight, were not statistically significant after adjustment. The full regression model is presented in Table 6.

Table 6.

Multivariate logistic regression analysis of predictors of musculoskeletal pain during pregnancy among study participants.

Predictor	Adjusted OR (AOR)	95% CI	p-value
Age in years
< 30	Reference	-	-
30–39	1.42	0.62–3.25	0.402
40 +	1.88	0.38–9.31	0.438
Pregnancy duration
First trimester	Reference	-	-
Second trimester	1.15	0.42–3.15	0.785
Third trimester	0.84	0.35–2.01	0.702
Number of previous pregnancies
None	Reference	-	-
1–2	2.05	0.89–4.74	0.091
3–4	3.12	1.01–9.62	0.048*
5 +	1.67	0.52–5.39	0.389
Exercise during pregnancy
Yes	Reference	-	-
No	2.34	1.11–4.91	0.025*
Pre-pregnancy weight (kg)	1.01	0.99–1.03	0.214

OR = Odds Ratio; CI = Confidence Interval.

^*Significant at p < 0.05

Discussion

This study found a high prevalence of musculoskeletal (MSK) pain among pregnant women, with lower back pain being the most commonly affected region. Moreover, MSK pain was significantly associated with poorer health-related quality of life (HRQoL), particularly in the domains of physical functioning, mental health, and social functioning. In addition, multiparity and lack of physical activity were identified as independent predictors of MSK pain.

The high prevalence of MSK pain observed in this study is consistent with previous literature reporting that more than half of pregnant women experience some form of musculoskeletal discomfort [2], [15]. In particular, the predominance of lower back pain aligns with prior systematic reviews and cohort studies, which have identified the lumbopelvic region as the most vulnerable area during pregnancy due to biomechanical and hormonal changes [3], [6].

Beyond prevalence, the present study highlights the multidimensional impact of MSK pain on quality of life. Women experiencing MSK pain reported significantly poorer outcomes in physical functioning, which is consistent with previous studies demonstrating reduced mobility and limitations in performing daily activities [8]. Similarly, the observed association between MSK pain and poorer mental health is in line with existing evidence suggesting that chronic or persistent pain during pregnancy may contribute to psychological distress, including anxiety, irritability, and sleep disturbances [9].

Interestingly, not all domains of HRQoL showed statistically significant differences, suggesting that the impact of MSK pain may be domain-specific. For example, vitality and role limitations were not significantly associated with pain in this study, which may reflect the multifactorial nature of fatigue and emotional role limitations during pregnancy.

The identification of multiparity as an independent predictor of MSK pain is consistent with prior research [13]. Repeated pregnancies may result in cumulative biomechanical strain, reduced core stability, and progressive weakening of musculoskeletal support structures. Similarly, the association between physical inactivity and increased odds of MSK pain reinforces existing evidence highlighting the protective role of regular physical activity during pregnancy [10], [14].

From a clinical perspective, these findings underscore the importance of early identification and management of MSK pain during pregnancy. Given that physical inactivity emerged as a modifiable risk factor, promoting safe and structured antenatal exercise programs could represent an effective strategy for reducing pain and improving quality of life.

The findings of this study contribute to the limited body of evidence available from Middle Eastern populations [15], [16]. Sociocultural factors, lifestyle patterns, and levels of physical activity may differ from those in Western settings, potentially influencing both the prevalence and impact of MSK pain.

However, the results should be interpreted in light of the study design. Due to the cross-sectional nature of the study, causal relationships cannot be established, and the observed associations between MSK pain and quality of life should be interpreted cautiously. It is possible that reduced quality of life may also influence the perception or reporting of pain, indicating a potentially bidirectional relationship. Future longitudinal studies are recommended to further explore temporal relationships between musculoskeletal pain and quality-of-life outcomes during pregnancy.

Strengths and Limitations

This study has several strengths. It included a relatively large sample size and used a validated instrument (SF−12) to assess multiple domains of quality of life. Additionally, the evaluation of multiple anatomical pain sites provides a comprehensive perspective on MSK pain during pregnancy.

However, the cross-sectional design limits causal inference. The study was conducted at a single center, which may limit generalizability. Furthermore, reliance on self-reported data introduces potential recall bias.

Conclusion

Musculoskeletal pain is highly prevalent among pregnant women and is significantly associated with reduced quality of life across multiple domains. Multiparity and physical inactivity were identified as important associated factors. These findings highlight the importance of integrating preventive strategies, particularly promoting safe physical activity during pregnancy, to improve maternal well-being.

Ethical Approval

Approved by the Institutional Review Board of King Khalid University Hospital.

Funding

This research received no specific grant from any funding agency.

CRediT authorship contribution statement

Mashael Alshebly: Writing – review & editing, Supervision, Project administration. Almutairi Raseil: Writing – review & editing, Writing – original draft, Formal analysis, Data curation. Raghad Alqahtani: Writing – review & editing, Writing – original draft, Formal analysis, Data curation. Alfarhan Laila Abdullah: Writing – review & editing, Writing – original draft, Formal analysis, Data curation. Renad AlAtawi: Writing – review & editing, Writing – original draft, Formal analysis, Data curation. Retal AlShohail: Writing – review & editing, Writing – original draft, Formal analysis, Data curation. Shoug Alkhalifa: Writing – review & editing, Writing – original draft, Formal analysis, Data curation.

Informed Consent

Obtained from all participants.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Data Availability

Data are available from the corresponding author upon request.