Abstract
The aim of this study is to evaluate the evolution of pain through pregnancy until after delivery, as well as to explore the mediating role of pregnancy worries in this evolution of pain. We conducted a longitudinal cohort study. The convenience sample was evaluated on four separate occasions: in the first trimester of pregnancy (pain), during the third trimester (pain and worry), during labor (pain), and after birth (< 24 h; pain). The final sample included 120 pregnant women with a mean age of 31.29 years (SD = 4.9; range = [22, 42 years]). The results evidenced changes in pain over time (F = 13.31, p < .001). Pain severity increased in the third trimester compared to the first trimester (t = − 4.60; 95% CI = [− 1.31, − 0.52]; p < .001), while pain during the third trimester and pain after delivery were comparable (t = − 0.94; 95% CI = [− 1.02, 0.36]; p = .35). Pain during labor was uncorrelated with all other pain measures, so it was not included in the model. The results of the mediation analyses indicated a total effect of pain during pregnancy (first and third trimester) and worry on pain severity after delivery (B = 0.35; SE = 0.14; t = 2.43; 95% CI = [0.06, 0.65]; p = .017). Pregnancy worries (B = 0.14; SE = 0.07; 95% CI = [0.06, 0.29]), but not pain during the third trimester (B = 0.03; SE = 0.12; 95% CI = [− 0.17, 0.31]) mediated the relationship between pain during the first trimester and pain after delivery. These results support the need to reduce worry in pregnant mothers, especially when pain during the first trimester is high, to reduce the risk of pain after delivery.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Abdallah R, Steyn PP, Kamel I (2019) Factors Influencing the Perception of Pain in Pregnancy. Springer
Aziato L, Acheampong AK, Umoar KL (2017) Labour pain experiences and perceptions: a qualitative study among post-partum women in Ghana. BMC Pregnancy Childbirth 17(1):73. https://doi.org/10.1186/s12884-017-1248-1
Baron R, Kenny D (1986) The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol 51(6):1173–1182
Bateman BT, Hernandez-Diaz S, Rathmell JP, Seeger JD, Doherty M, Fischer MA, Huybrechts KF (2014) Patterns of Opioid Utilization in Pregnancy in a Large Cohort of Commercial Insurance Beneficiaries in the United States. Anesthesiology 120(5):1216–1224. https://doi.org/10.1097/ALN.0000000000000172
Blackmore ER, Gustafsson H, Gilchrist M, Wyman C, O’Connor GT (2016) Pregnancy-related anxiety: Evidence of distinct clinical significance from a prospective longitudinal study. J Affect Disord 197:251–258. https://doi.org/10.1016/j.jad.2016.03.008
Borrelli SE, Walsh D, Spiby H (2018) First-time mothers’ expectations of the unknown territory of childbirth: Uncertainties, coping strategies and ‘going with the flow.’ Midwifery 63:39–45. https://doi.org/10.1016/j.midw.2018.04.022
Brosschot JF, Gerin W, Thayer JF (2006) The perseverative cognition hypothesis: A review of worry, prolonged stress-related physiological activation, and health. J Psychosom Res 60(2):113–124. https://doi.org/10.1016/j.jpsychores.2005.06.074
Callister LC, Khalaf I, Semenic S, Kartchner R, Vehvilainen-Julkunen K (2003) The pain of childbirth: perceptions of culturally diverse women. Pain Manag Nurs 4(4):145–154. https://doi.org/10.1016/S1524-9042(03)00028-6
Carmona Monge FJ, Peñacoba-Puente C, Marín Morales D, Carretero Abellán I (2012) Factor structure, validity and reliability of the Spanish version of the Cambridge Worry Scale. Midwifery 28(1):112–119. https://doi.org/10.1016/j.midw.2010.11.006
Christopher S, McCullough J, Snodgrass SJ, Cook C (2019) Predictive Risk Factors for First-Onset Lumbopelvic Pain in Postpartum Women: A Systematic Review. J Womens Health Phys Ther 43(3):127–135. https://doi.org/10.1097/JWH.0000000000000133
Cleeland CS, Ryan KM (1994) Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore 23(3):129–213
Cooklin AR, Amir LH, Nguyen CD, Buck ML, Cullinane M, Fisher JRW, Donath SM, Team CS (2018) Physical health, breastfeeding problems and maternal mood in the early postpartum: a prospective cohort study. Arch Womens Ment Health 21(3):365–374
Desai RJ, Hernandez-Diaz S, Bateman BT, Huybrechts KF (2014) Increase in prescription opioid use during pregnancy among medicaid-enrolled women. Obstet Gynecol 123(5):997–1002
Doğru HY, Özsoy F, Doğru S, Karaman T, Şahin A, Özsoy AZ, Çakmak B, Süren M (2018) Catastrophizing, Depression and Anxiety During Pregnancy: Relation Between Lumbopelvic Pain and Physical/Social Functioning. J Rational-Emot Cognitive-Behav Ther 36(2):119–136
Dworkin RH, Turk DC, Farrar JT, Haythornthwaite JA, Jensen MP, Katz NP, Kerns RD, Stucki G, Allen RR, Bellamy N, Carr DB, Chandler J, Cowan P, Dionne R, Galer BS, Hertz S, Jadad AR, Kramer LD, Manning DC, …, Witter J (2005) Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain 113(1): 9–19. https://doi.org/10.1016/j.pain.2004.09.012
Elden H, Gutke A, Kjellby-Wendt G, Fagevik-Olsen M, Ostgaard H-C (2016) Predictors and consequences of long-term pregnancy-related pelvic girdle pain: a longitudinal follow-up study. BMC Musculoskelet Disord 17(1):276. https://doi.org/10.1186/s12891-016-1154-0
Escott D, Slade P, Spiby H (2009) Preparation for pain management during childbirth: The psychological aspects of coping strategy development in antenatal education. Clin Psychol Rev 29(7):617–622. https://doi.org/10.1016/j.cpr.2009.07.002
Fredriksen EH, Moland KM, Sundby J (2008) “Listen to your body”: A qualitative text analysis of internet discussions related to pregnancy health and pelvic girdle pain in pregnancy. Patient Educ Couns 73(2):294–299. https://doi.org/10.1016/j.pec.2008.02.002
Gaudet C, Wen SW, Walker MC (2013) Chronic perinatal pain as a risk factor for postpartum depression symptoms in Canadian women. Can J Public Health 104(5):375–387
Gayeski ME, Brüggemann OM, Monticelli M, dos Santos EKA (2015) Application of Nonpharmacologic Methods to Relieve Pain during Labor: The Point of View of Primiparous Women. Pain Manag Nurs 16(3):273–284. https://doi.org/10.1016/j.pmn.2014.08.006
Gelaye B, Zhong Q-Y, Basu A, Levey EJ, Rondon MB, Sanchez S, Koenen KC, Henderson DC, Williams MA (2017) Trauma and traumatic stress in a sample of pregnant women. Psychiatry Res 257:506–513. https://doi.org/10.1016/j.psychres.2017.08.016
Glowacka M, Rosen N, Chorney J, Snelgrove−Clarke E, George RB (2014) Prevalence and Predictors of Genito-Pelvic Pain in Pregnancy and Postpartum: The Prospective Impact of Fear Avoidance. J Sex Med 11(12):3021–3034. https://doi.org/10.1111/jsm.12675
Graham CD, Gouick J, Krahé C, Gillanders D (2016) A systematic review of the use of Acceptance and Commitment Therapy (ACT) in chronic disease and long-term conditions. Clin Psychol Rev 46:46–58. https://doi.org/10.1016/j.cpr.2016.04.009
Hayes AF (2017) Introduction to Mediation, Moderation, and Conditional Process Analysis Second Edition A Regression-Based Approach
IBM Corp & IBM Corp (2017) IBM SPSS Statistics for Windows, Version 22.0. (No. 22). IBM Corp
Karlsdottir SI, Sveinsdottir H, Kristjansdottir H, Aspelund T, Olafsdottir OA (2018) Predictors of women’s positive childbirth pain experience: Findings from an Icelandic national study. Women Birth 31(3):e178–e184. https://doi.org/10.1016/j.wombi.2017.09.007
Koutsospyros D, & Epstein L (2019) Pain in Pregnancy and Labor. In Academic Pain Medicine. Springer
Lim G, LaSorda KR, Farrell LM, McCarthy AM, Facco F, Wasan AD (2020) Obstetric pain correlates with postpartum depression symptoms: a pilot prospective observational study. BMC pregnancy and childbirth. BMC Pregnancy Childbirth 20(1):1–14
Longinus N, Omiepirisa Y, & Subhamay G (2012) Physical and Psychological Aspects of Pain in Obstetrics. In Pain in Perspective. InTech. https://doi.org/10.5772/53923
Lutterodt MC, Kähler P, Kragstrup J, Nicolaisdottir DR, Siersma V, & Ertmann RK (2019) Examining to what extent pregnancy-related physical symptoms worry women in the first trimester of pregnancy: a cross-sectional study in general practice. BJGP Open, bjgpopen19X101674. https://doi.org/10.3399/bjgpopen19X101674
MacKinnon AL, Yang L, Feeley N, Gold I, Hayton B, Zelkowitz P (2017) Birth setting, labour experience, and postpartum psychological distress. Midwifery 50:110–116. https://doi.org/10.1016/j.midw.2017.03.023
Melzack MR (2005) Evolution of the Neuromatrix Theory of Pain. The Prithvi Raj Lecture: Presented at the Third World Congress of World Institute of Pain, Barcelona 2004. Pain Pract 5(2):85–94. https://doi.org/10.1111/j.1533-2500.2005.05203.x
Melzack R, Katz J (2013) Pain. WIREs CognSci 4:1–15
Melzack R, Kinch R, Dobkin P, Lebrun M, Taenzer P (1984) Severity of labour pain: influence of physical as well as psychologic variables. Can Med Assoc J 130(5):579
Michaelides A, Zis P (2019) Depression, anxiety and acute pain: links and management challenges. Postgrad Med 131(7):438–444. https://doi.org/10.1080/00325481.2019.1663705
Mindell JA, Cook RA, Nikolovski J (2015) Sleep patterns and sleep disturbances across pregnancy. Sleep Med 16(4):483–488. https://doi.org/10.1016/j.sleep.2014.12.006
Munro A, George RB, Chorney J, Snelgrove-Clarke E, Rosen NO (2017) Prevalence and Predictors of Chronic Pain in Pregnancy and Postpartum. J Obstet Gynaecol Can 39(9):734–741. https://doi.org/10.1016/j.jogc.2017.01.026
Peñacoba C, Monge FJC, Morales DM (2011) Pregnancy worries: a longitudinal study of Spanish women. Acta Obstet Gynecol Scand 90(9):1030–1035. https://doi.org/10.1111/j.1600-0412.2011.01208.x
Rivera Díaz R, Lopera Rivera A (2012) Management of non-obstetric pain during pregnancy. Colomb J Anestesiol 40(3):213–223
Rubertsson C, Hellström J, Cross M, Sydsjö G (2014) Anxiety in early pregnancy: prevalence and contributing factors. Arch Womens Ment Health 17(3):221–228. https://doi.org/10.1007/s00737-013-0409-0
Salari P, Firoozi M, Shebi A (2005) Study of the stressors associated with pregnancy. J Sabzevar Univ Med Sci 12(3):34–40
Sansone RA, Sansone LA (2012) Rumination: Relationships with physical health. Innov Clin Neurosci 9(2):29–34
Shackman AJ, Salomons TV, Slagter HA, Fox AS, Winter JJ, Davidson RJ (2011) The integration of negative affect, pain and cognitive control in the cingulate cortex. Nat Rev Neurosci 12(3):154–167
Shi Q, Mendoza TR, Dueck AC, Ma H, Zhang J, Qian Y, Bhowmik D, Cleeland CS (2017) Determination of mild, moderate, and severe pain interference in patients with cancer. Pain 158(6):1108–1112. https://doi.org/10.1097/j.pain.0000000000000890
Sinesi A, Maxwell M, O’Carroll R, Cheyne H (2019) Anxiety scales used in pregnancy: systematic review. BJ Psych Open 5(1):e5. https://doi.org/10.1192/bjo.2018.75
Turner DP, Smitherman TA, Eisenach JC, Penzien DB, Houle TT (2012) Predictors of Headache Before, During, and After Pregnancy: A Cohort Study. Headache 52(3):348–362. https://doi.org/10.1111/j.1526-4610.2011.02066.x
Williams A, Eccleston C, & Morley S (2013) Psychological therapies for the management of chronic pain (excluding headache) in adults (Review). In Cochrane Database of Systematic Reviews 2012 (Issue 2)
Verkuil B, Brosschot JF, Gebhardt WA, Thayer JF (2010) When Worries Make you Sick: A Review of Perseverative Cognition, the Default Stress Response and Somatic Health. J Exp Psychopathol 1(1):jep.009110. https://doi.org/10.5127/jep.009110
Funding
This work was funded by the Health Research Fund (Fondo de Investigaciones Sanitarias, FIS), grant number PI07/0571 from the Instituto de Salud Carlos III (Spain). Suso-Ribera, Carlos also received support from the Jaume I University to conduct the present work (Reference E-2019–06).
Author information
Authors and Affiliations
Contributions
Catala, Patricia: conception and design of the work; analysis and interpretation of data; drafted the work; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Suso-Ribera, Carlos: interpretation of data; revised the word critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Marin, Dolores: interpretation of data; revised the word critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Bedmar, Dolores: analysis and interpretation of data; revised the word critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Peñacoba, Cecilia: conception and design of the work, acquisition of data; drafted the work; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Corresponding author
Ethics declarations
Ethics approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Bioethics Committee of the Hospital Universitario de Fuenlabrada (Reference PI07/0571).
Consent to participate
Informed consent was obtained from all individual participants included in the study.
Consent to publish
Not applicable.
Conflict of interest
The authors declare no competing interests.
Additional information
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Catala, P., Suso-Ribera, C., Marin, D. et al. A longitudinal study exploring the evolution of pain during pregnancy and after delivery: does worry matter?. Arch Womens Ment Health 24, 759–766 (2021). https://doi.org/10.1007/s00737-021-01127-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00737-021-01127-2