Which hormone contributes to back pain by relaxing ligaments?

Back pain in pregnancyarises from relaxin-induced ligament laxity, lumbar lordosis, and increased mechanical strainfrom fetal growth. Normal lumbar curvature increases as the uterus enlarges, shifting the center of gravity anteriorly. Relaxin loosens sacroiliac and pubic ligaments, decreasing joint stability. Risk is worsened by prolonged standing, poor posture, and reduced abdominal muscle tone. Management focuses on non-pharmacologic interventions to support the spine, relieve muscle strain, and improve posture.

Rationale for correct answers

1.Using a maternity belt supports the abdomen, redistributes weight, and reduces strain on lumbar muscles, effectively relieving back pain.

3.Practicing prenatal yoga improves posture, flexibility, and core strength, helping stabilize the spine and decrease musculoskeletal discomfort.

4.Applying heat therapy relaxes paraspinal muscles, reduces muscle spasm, and improves circulation, providing symptomatic relief for back pain.

Rationale for incorrect answers

2.Performing high-impact exercise increases mechanical strain and joint instability, worsening back pain. Safer options are low-impact activities such as swimming, walking, and prenatal yoga.

5.Prolonged standing aggravates venous stasis and lumbar strain, worsening discomfort instead of relieving it. Regular rest and position changes are recommended.

Take home points

• Back pain in pregnancy is caused by ligament laxity, lumbar lordosis, and increased load.
• Effective relief measures include maternity belts, prenatal yoga, and heat therapy.
• High-impact activity and prolonged standing worsen symptoms.
• Differential diagnoses include urinary tract infection and preterm labor, which can also present with back pain.

Heartburn in pregnancy(pyrosis) results from progesterone-induced relaxationof the lower esophageal sphincter, delayed gastric emptying, and mechanical pressurefrom the enlarging uterus. Gastric acid normally has a pH of 1.5–3.5, and disruption of esophageal sphincter tone allows reflux of this acidic content into the esophagus, producing burning retrosternal pain. Risk factors include large meals, lying supine after eating, fatty/spicy foods, and abdominal compression. Management emphasizes lifestyle and positional modifications.

Rationale for correct answers

1.Eating small, frequent meals prevents gastric overdistension, lowering reflux risk.

2.Avoiding spicy and fatty foods reduces gastric acid stimulation and delays gastric emptying, helping relieve symptoms.

4.Elevating the head of the bed during sleep decreases nocturnal reflux by using gravity to limit acid regurgitation.

5.Avoiding tight clothing around the abdomen reduces intra-abdominal pressure, lowering the chance of reflux.

Rationale for incorrect answers

3.Lying down immediately after eating worsens reflux because gravity no longer prevents acid regurgitation. Patients should wait at least 2–3 hours before lying down.

Take home points

• Heartburn in pregnancy is due to progesterone relaxation of the LES and uterine pressure.
• Small, frequent meals and avoidance of spicy/fatty foods help reduce reflux.
• Elevating the head of the bed prevents nocturnal symptoms.
• Tight abdominal clothing increases reflux risk and should be avoided.