Pain during pregnancy: associations with pelvic girdle–related symptoms, central sensitization, sleep quality, kinesiophobia, and physical activity

Abstract Background Pregnancy-related pain may occur across multiple anatomical regions and may be influenced by biomechanical, psychological, and central pain-processing mechanisms. However, the relationships between overall pain severity, pain distribution, pelvic-girdle-specific symptoms, central sensitization, sleep quality, physical activity, and kinesiophobia during pregnancy remain incompletely understood. This study investigated the associations of these factors with overall pain severity and pelvic-girdle-specific symptom burden during pregnancy. Methods In this cross-sectional analytical study, 128 pregnant women were assessed. Overall pain intensity and anatomical distribution were evaluated using the Visual Analog Scale (VAS) and a 26-region body diagram. Pelvic-girdle-specific symptoms and functional limitations, central sensitization, physical activity, sleep quality, and kinesiophobia were assessed using the Pelvic Girdle Questionnaire (PGQ), Central Sensitization Inventory (CSI), Pregnancy Physical Activity Questionnaire (PPAQ), Pittsburgh Sleep Quality Index (PSQI), and Tampa Scale for Kinesiophobia (TSK-17), respectively. Results Mean VAS pain intensity was 4.5 ± 2.1. The lower back was the most frequently reported pain site (60.9%), and 82.0% of participants reported pain in at least one lumbopelvic region. Poor sleep quality (66.4%), CSI scores ≥ 40 (39.8%), and high kinesiophobia (40.6%) were common. Pain intensity correlated with PGQ (ρ = 0.420), CSI (ρ = 0.378), and PSQI (ρ = 0.284) scores (all p ≤ 0.001) but not with PPAQ or TSK-17 scores. In hierarchical regression, sociodemographic and obstetric variables explained 10.9% of the variance and the scale scores an additional 19.2% (final R² =0.302). Higher PGQ scores were independently associated with greater pain intensity (β = 0.315, p = 0.009), whereas employment (β=−0.235, p = 0.009) and multiparity (β= −0.216, p = 0.012) were associated with lower pain intensity. CSI scores showed a positive association that did not reach significance once PGQ was included (β = 0.216, p = 0.064); PSQI, PPAQ, and TSK-17 scores were not independently associated with pain intensity. Conclusions Pain intensity during pregnancy was associated with pelvic girdle–related symptoms and functional limitations and with symptoms suggestive of central sensitization. These findings support a multidimensional approach to pain assessment during pregnancy, although causal relationships cannot be inferred from this cross-sectional study.