Abstract
Purpose
The study’s aim was to address three fundamental questions related to pregnancy and adolescent idiopathic scoliosis (AIS), and provide clinically applicable answers to spine specialists and general practitioners alike.
Methods
The authors performed a systematic literature review using MEDLINE, EMBASE, Google Scholar, and Cochrane Database of Systematic Reviews to identify articles published between 1980 and 2015 that described pregnancy-related characteristics and outcomes in AIS patients. The search was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and evidence was classified according to the Oxford CEBM (Centre for Evidence-Based Medicine) appraisal tool.
Results
Twenty-two articles incorporating more than 3125 AIS patients were included. All studies concluded level 2b evidence or lower. Nulliparity rates were slightly higher among AIS patients, and more frequent infertility treatment was required. Pregnancy-related back pain was common, and while non-disabling, may have been more severe than in healthy women. Minor curve progression often occurred during pregnancy, though its permanence was questioned and significance unknown. Back pain and curve progression occurred independent of AIS treatment modality. With modern technology, anesthetic and obstetric complications in the perinatal period were not elevated in AIS mothers.
Conclusions
Women with AIS experience slightly elevated rates of nulliparity, infertility treatment, prepartum back pain, and peripartum curve progression. However, most women are able to have children and are not at increased risk of pregnancy-related complications. Higher quality evidence is needed to better define these relationships and allow more guided counseling and treatment.
Similar content being viewed by others
References
Negrini S, Aulisa AG, Aulisa L et al (2012) 2011 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis 7:3. doi:10.1186/1748-7161-7-3
Hresko MT (2013) Clinical practice. Idiopathic scoliosis in adolescents. N Engl J Med 368:834–841. doi:10.1056/NEJMcp1209063
Asher MA, Burton DC (2006) Asher_review. Scoliosis 1:2–10. doi:10.1186/1748-7161-1-2
Stirling AJ, Howel D, Millner PA et al (1996) Late-onset idiopathic scoliosis in children 6–14 years old. A cross-sectional prevalence study. J Bone Jt Surg Am 78:1330–1336
Dickson RA (1983) Scoliosis in the community. Br Med J (Clin Res Ed) 286:615–618
Gore DR, Passehl R, Sepic S, Dalton A (1981) Scoliosis screening: results of a community project. Pediatrics 67:196–200
Roach JW (1999) Adolescent idiopathic scoliosis. Orthop Clin N Am 30:353–365 (vii–viii)
Konieczny MR, Senyurt H, Krauspe R (2013) Epidemiology of adolescent idiopathic scoliosis. J Child Orthop 7:3–9. doi:10.1007/s11832-012-0457-4
Weinstein SL, Dolan LA, Cheng JCY et al (2008) Adolescent idiopathic scoliosis. Lancet 371:1527–1537. doi:10.1016/S0140-6736(08)60658-3
Raggio CL (2006) Sexual dimorphism in adolescent idiopathic scoliosis. Orthop Clin N Am 37:555–558. doi:10.1016/j.ocl.2006.09.010
Watanabe K, Michikawa T, Yonezawa I et al (2017) Physical activities and lifestyle factors related to adolescent idiopathic scoliosis. J Bone Jt Surg Am 99:284–294. doi:10.2106/JBJS.16.00459
Moher D, Shamseer L, Clarke M et al (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 4:1–9. doi:10.1186/2046-4053-4-1
Howick J, Chalmers I, Glasziou P et al (2011) The Oxford 2011 levels of evidence. Oxford Centre for Evidence-Based Medicine. http://www.cebm.net/index.aspx?o=5653. Accessed 27 June 2016
Atkins D, Best D, Briss PA et al (2004) Grading quality of evidence and strength of recommendations. BMJ 328:1490. doi:10.1136/bmj.328.7454.1490
Schünemann HJ, Jaeschke R, Cook DJ et al (2006) An official ATS statement: grading the quality of evidence and strength of recommendations in ATS guidelines and recommendations. Am J Respir Crit Care Med 174:605–614. doi:10.1164/rccm.200602-197ST
Bauchat JR, McCarthy RJ, Koski TR, Wong CA (2015) Labor analgesia consumption and time to neuraxial catheter placement in women with a history of surgical correction for scoliosis: a case-matched study. Anesth Analg 121:981–987. doi:10.1213/ANE.0000000000000690
Lebel DE, Sergienko R, Wiznitzer A et al (2012) Mode of delivery and other pregnancy outcomes of patients with documented scoliosis. J Matern Fetal Neonatal Med 25:639–641. doi:10.3109/14767058.2011.598587
Goldberg MS, Mayo NE, Poitras B et al (1994) The Ste-Justine adolescent idiopathic scoliosis cohort study. Part I: description of the study. Spine 19:1551–1561
Falick-Michaeli T, Schroeder JE, Barzilay Y et al (2015) Adolescent idiopathic scoliosis and pregnancy: an unsolved paradigm. Glob Spine J 5:179–184. doi:10.1055/s-0035-1552987
Cochran T, Nachemson A (1985) Long-term anatomic and functional changes in patients with adolescent idiopathic scoliosis treated with the Milwaukee brace. Spine 10:127
Lange JE, Steen H, Gunderson R, Brox JI (2011) Long-term results after Boston brace treatment in late-onset juvenile and adolescent idiopathic scoliosis. Scoliosis 6:18. doi:10.1186/1748-7161-6-18
Takayama K, Nakamura H, Matsuda H (2009) Quality of life in patients treated surgically for scoliosis: longer than 16-year follow-up. Spine 34:2179–2184. doi:10.1097/BRS.0b013e3181abf684
Smith PS, Wilson RC, Robinson APC, Lyons GR (2003) Regional blockade for delivery in women with scoliosis or previous spinal surgery. Int J Obstet Anesth 12:17–22
Betz RR, Bunnell WP, Lambrecht-Mulier E, MacEwen GD (1987) Scoliosis and pregnancy. J Bone Jt Surg Am 69:90–96
Ascani E, Bartolozzi P, Logroscino CA et al (1986) Natural history of untreated idiopathic scoliosis after skeletal maturity. Spine 11:784–789
Danielsson AJ, Nachemson AL (2001) Childbearing, curve progression, and sexual function in women 22 years after treatment for adolescent idiopathic scoliosis: a case–control study. Spine 26:1449–1456
Akazawa T, Minami S, Kotani T et al (2012) Health-related quality of life and low back pain of patients surgically treated for scoliosis after 21 years or more of follow-up. Spine 37:1899–1903. doi:10.1097/BRS.0b013e31825a22c2
Orvomaa E, Hiilesmaa V, Poussa M et al (1997) Pregnancy and delivery in patients operated by the Harrington method for idiopathic scoliosis. Eur Spine J 6:304–307. doi:10.1007/BF01142675
Kersten I, Lange AE, Haas JP et al (2014) Chronic diseases in pregnant women: prevalence and birth outcomes based on the SNiP-study. BMC Pregnancy Childbirth 2014:14:1–14:75. doi:10.1186/1471-2393-14-75
To WW, Wong MW (1996) Kyphoscoliosis complicating pregnancy. Int J Gynaecol Obstet 55:123–128
Goldberg MS, Mayo NE, Levy AR et al (1998) Adverse reproductive outcomes among women exposed to low levels of ionizing radiation from diagnostic radiography for adolescent idiopathic scoliosis. Epidemiology 9:271–278
Lange J, Steen H, Brox J (2009) Long-term results after Boston brace treatment in adolescent idiopathic scoliosis. Scoliosis 4:17. doi:10.1186/1748-7161-4-17
Bjerkreim I, Steen H, Brox JI (2007) Idiopathic scoliosis treated with Cotrel–Dubousset instrumentation: evaluation 10 years after surgery. Spine 32:2103–2110. doi:10.1097/BRS.0b013e318145a54a
Daley MD, Rolbin SH, Hew EM et al (1990) Epidural anesthesia for obstetrics after spinal surgery. Reg Anesth 15:280–284
Berman AT, Cohen DL, Schwentker EP (1982) The effects of pregnancy on idiopathic scoliosis. A preliminary report on eight cases and a review of the literature. Spine 7:76–77
Blount WP, Mellencamp D (1980) The effect of pregnancy on idiopathic scoliosis. J Bone Jt Surg Am 62:1083–1087
Hubbert CH (1985) Epidural anesthesia in patients with spinal fusion. Anesth Analg 64:843
Crosby ET, Halpern SH (1989) Obstetric epidural anaesthesia in patients with Harrington instrumentation. Can J Anaesth 36:693–696. doi:10.1007/BF03005423
Maruyama T (2008) Bracing adolescent idiopathic scoliosis: a systematic review of the literature of effective conservative treatment looking for end results 5 years after weaning. Disabil Rehabil 30:786–791. doi:10.1080/09638280801889782
Weinstein SL, Zavala DC, Ponseti IV (1981) Idiopathic scoliosis: long-term follow-up and prognosis in untreated patients. J Bone Jt Surg Am 63:702–712
Freidel K, Petermann F, Reichel D et al (2002) Quality of life in women with idiopathic scoliosis. Spine 27:E87–E91
Freidel K, Reichel D, Steiner A et al (2002) Idiopathic scoliosis and quality of life. Stud Health Technol Inform 88:24–29
Payne WK, Ogilvie JW, Resnick MD et al (1997) Does scoliosis have a psychological impact and does gender make a difference? Spine 22:1380–1384
Lim AS, Stewart K, Abramson MJ et al (2012) Asthma during pregnancy: the experiences, concerns and views of pregnant women with asthma. J Asthma 49:474–479. doi:10.3109/02770903.2012.678024
Weckesser A, Denny E (2013) Women living with epilepsy, experiences of pregnancy and reproductive health: a review of the literature. Seizure 22:91–98. doi:10.1016/j.seizure.2012.11.001
Hillier TA, Rizzo JH, Pedula KL et al (2003) Nulliparity and fracture risk in older women: the study of osteoporotic fractures. J Bone Miner Res 18:893–899. doi:10.1359/jbmr.2003.18.5.893
Opdahl S, Alsaker MDK, Janszky I et al (2011) Joint effects of nulliparity and other breast cancer risk factors. Br J Cancer 105:731–736. doi:10.1038/bjc.2011.286
Veldhuizen AG, Wever DJ, Webb PJ (2000) The aetiology of idiopathic scoliosis: biomechanical and neuromuscular factors. Eur Spine J 9:178–184. doi:10.1007/s005860000142
Schultz AB (1984) Biomechanical factors in the progression of idiopathic scoliosis. Ann Biomed Eng 12:621–630
Lombardi G, Akoume M-Y, Colombini A et al (2011) Biochemistry of adolescent idiopathic scoliosis. Adv Clin Chem 54:165–182
Wang WJ, Yeung HY, Chu WC-W et al (2011) Top theories for the etiopathogenesis of adolescent idiopathic scoliosis. J Pediatr Orthop 31:S14–S27. doi:10.1097/BPO.0b013e3181f73c12
Skaggs CD, Prather H, Gross G et al (2007) Back and pelvic pain in an underserved United States pregnant population: a preliminary descriptive survey. J Manip Physiol Ther 30:130–134. doi:10.1016/j.jmpt.2006.12.008
Mousavi SJ, Parnianpour M, Vleeming A (2007) Pregnancy related pelvic girdle pain and low back pain in an Iranian population. Spine 32:E100–E104. doi:10.1097/01.brs.0000254123.26649.6e
Bettany-Saltikov J, Weiss H-R, Chockalingam N et al (2015) Surgical versus non-surgical interventions in people with adolescent idiopathic scoliosis. Cochrane Database Syst Rev. doi:10.1002/14651858.CD010663.pub2
Anim-Somuah M, Smyth RM, Jones L (2011) Epidural versus non-epidural or no analgesia in labour. Cochrane Database Syst Rev. doi:10.1002/14651858.CD000331.pub3
Taffel SM, Placek PJ, Liss T (1987) Trends in the United States cesarean section rate and reasons for the 1980–85 rise. Am J Public Health 77:955–959
Hamilton BE, Martin JA, Osterman MJK, Curtain SC (2015) Births: preliminary Data for 2014. Natl Vital Stat Rep 64:1–19
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
No funding was received for this work.
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent
The study design consisted of a literature review of previously published data; no human participants were directly involved in any aspect of this study. Informed consent, therefore, was not applicable.
Rights and permissions
About this article
Cite this article
Dewan, M.C., Mummareddy, N. & Bonfield, C. The influence of pregnancy on women with adolescent idiopathic scoliosis. Eur Spine J 27, 253–263 (2018). https://doi.org/10.1007/s00586-017-5203-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-017-5203-7