Risks and Complications For Pregnancy With Scoliosis or Spinal Fusion
For those of us with scoliosis and spinal fusion who dream of starting a family, we frequently have loads of unanswered questions and worries surrounding the idea of getting pregnant and having a baby as it relates to our spines. Pregnancy, daunting at any time regardless of medical history, holds many unknowns and potential risks and complications for both the woman and the baby. As many of the experts in the medical pregnancy space say, pregnancy is not a health-neutral condition. Though it is natural and normal for a woman, there are many variables outside of anyone’s control that may affect the pregnancy, the baby or the mother.
Even in the age of Google, there are precious few resources on the unique needs we may have, carrying a pregnancy with a spinal condition like scoliosis or spinal fusion. Even fewer from those who’ve experienced it first hand.
If you’ve seen my blog posts before, you know I’ve already created several blogs specifically around pregnancy and postpartum with scoliosis or spinal fusion, including:
Why do I write so much about it? Well, as a woman with spinal fusion tackling pregnancies and postpartum without any helpful resources, I’ve made it my life’s mission to provide more evidence-based information for others coming behind me so that they have resources tailored for them and their spines.
Is this you? Or someone you work with? If so, keep reading…
So what’s different about this blog?
As I mentioned above, you can read any number of blogs dedicated to different topics on this phase of life. This particular blog will break down what the science says about risks and pregnancy-related complications for those of us with spinal conditions like scoliosis or spinal fusion.
More specifically, I’ll dive into:
How common are complications related to pregnancy and delivery for those of us with scoliosis and spinal fusion
The incidence of back pain associated with pregnancy for those of us with spinal conditions
How likely a scoliosis curve will progress during pregnancy
When we seek more specialized care during a pregnancy with scoliosis or spinal fusion
Practical takeaways from the current research
I am definitely a research nerd, but I don’t assume that you are, so I’ll summarize the main points in easy-to-understand language, but also add links for the studies themselves in case you’re wanting to dive a little deeper on your own.
Before I break this down, it’s important for me to remind you: we are not a monolith. Every single person living with scoliosis or spinal fusion has a different lived experience, different levels of pain (whether we have it or we don’t), and different severity of our curve or fusion.
And, as your friendly reminder: this blog is intended as general information, and cannot be considered medical advice. I am happy to work with you individually as your pregnancy or postpartum coach, or during a virtual consult to tailor the advice to you.
Now, let’s dive in…
What science says on risks and complications
Though there aren’t a lot of studies specific to long-term follow ups for pregnant women with scoliosis and spinal fusion, read below for the most up-to-date studies on risks and complications for women with scoliosis and spinal fusion:
A study from 2022 included in a Turkish gynecological journal investigated gestational outcomes (a.k.a. outcomes for mom and baby) in women with scoliosis. In this study investigating 23 pregnancies in a university birthing center, there did not appear to be any increased risk of complications to the baby or risk of pregnancy loss as compared to women without scoliosis - regardless of the scoliosis severity or spinal fusion. They did report a higher rate of c-section and need for general anesthesia as compared to controls. This study is limited to a small sample size and only includes women from one hospital system.
As it relates to spinal fusion, there is one excellent article from 2019 investigating the likelihood of back pain for women with fusion. They included 205 women, 97 of which who became pregnant after spinal fusion for scoliosis and followed them for 5 years after pregnancy to assess issues they faced as well as see longer-term effects of pregnancy. All told, there was no significant risk of pregnancy complication outside of having a higher likelihood of needing c-section than non-fused women and healthy controls. The risk of needing c-section was over 50% higher for women fused to L4 or below. There were otherwise no common complications to report for these women.
Pregnancy-related back pain with scoliosis or spinal fusion
In the same study on pregnancy with spinal fusion mentioned above: of that group, those fused to L3 or L4 were more likely to suffer low back pain during pregnancy.
In an open access article from 2023 on adolescent idiopathic scoliosis (or AIS) and pregnancy, information from one institution including 163 women with scoliosis (and 263 total pregnancies) retroactively looked at back pain, pregnancy outcomes and anesthesia. Of these, 62% of the subjects reported increased back pain during pregnancy.
That said, remember scoliosis-specific exercise can help to strengthen and stabilize the core as well as the muscles surrounding the spine! Also, seeing a scoliosis specialist or pelvic floor physical therapist can help to troubleshoot any painful movements or bothersome areas that are causing you difficulty.
Questions? Book a complementary 15-minute call where I can help direct you further if you need it.
Will pregnancy increase your scoliosis curve?
A systematic review from 2011 investigated the existing literature on the effects of pregnancy on scoliosis curves. It selected the 2 articles which best fit the criteria that followed 430 women across all categories -
Each study had control groups without scoliosis
In one study:
Women with scoliosis who had been braced
Who had become pregnant
Who had never been pregnant
In the other study:
Women with scoliosis who had NOT been braced
One group who had become pregnant
Who had never been pregnant
After analysis, the authors determined that overall, the risk of a curve progressing with pregnancy was low. There was a suggestion that women who had been braced and had multiple pregnancies had higher likelihood of curve progression, compared to women who had never been pregnant. The study also suggested that women with a larger scoliosis curve before pregnancy had higher risk of scoliosis progression.
In the same 2023 open access article on pregnancy with scoliosis, half of the women with x-rays before and following pregnancy experienced a curve increase greater than 3 degrees… but half did not. The authors reported the lack of available regular x-rays as a limitation, as most adults with scoliosis do not get regular imaging.
That said, it is widely accepted within the medical scoliosis community that a scoliosis curve will progress between 1 and 3 degrees each year throughout adulthood - regardless of pregnancies.
Concluding all of the above studies, universally I found the usual statement following any scientific research: more studies are needed. We are a small subset of the population, and it shows by the lack of scientific studies looking into this.
So… How do we interpret all of this?
Having scoliosis or a spinal fusion does seem to increase the likelihood that we may experience back pain during pregnancy, and may increase the risk of needing c-section as compared to women without. Though - that’s not guaranteed. Read on for tips to minimize your risk of back pain during pregnancy and improve your odds of a vaginal delivery…
What we are NOT more at risk of:
Being unable to become pregnant
Having higher risk of miscarriage or stillbirth
When to seek more specialized care
As I mentioned at the start of this blog, some of us may require more hands-on support during a pregnancy. You may want to pursue seeking more medical supports if you experience any of the following:
Chronic pain which limits your ability to participate in daily activities
More than 3 spinal revisions or operations
Spinal fusion that extends into the pelvis
Cobb angle of over 90 degrees
Breathing difficulties or heart problems, related or unrelated to your scoliosis or spinal fusion
A history of multiple pregnancy losses or difficulty becoming pregnant
Consult your medical team and discuss options that are available to you before pregnancy, if possible. Modern medicine includes plenty of support and interventions that may be able to help.
How you can prepare for pregnancy or delivery
If you’re reading this and feeling like suffering from back pain is inevitable - here are some tangible ways you can start preparing for pregnancy TODAY.
Find a scoliosis specialist and learn more about your individual scoliosis type and how to strengthen your postural muscles and optimize your body mechanics. This lowers the risk of movement-related back pain during pregnancy and increased wear and tear on the vulnerable segments of our spines.
You may have a hard time finding a local scoliosis specialist as it is still a small specialty area in most parts of the world. If that’s the case, schedule a virtual consult with me and I can help you as long as you have a computer or phone with a camera and microphone!
Work with a pelvic health physical or occupational therapist to check the state of your pelvic floor muscles and if they are “birth ready”. The pelvic floor muscles play a big role in our ability to vaginally birth a child - they have to “relax” and stretch twice their normal length to allow baby to exit the birth canal. If our muscles are overactive or tend to grip when they should be releasing, it will impact our ability to have an uncomplicated vaginal delivery.
If you don’t live in a place where you can easily see a pelvic specialist, or if you can’t afford one, I have created a very basic self-assessment you can look at here. Though it won’t give you the tools to change how the pelvic floor muscles are working, it gives a window into how they currently function.
Begin a general exercise routine with resistance training and core stabilization exercise. Studies suggest that weight training and prioritizing muscle strength produces brain and muscle changes that can protect against chronic pain. Read more about structuring your strength routine here.
If you aren’t already exercising and feeling daunted by where to begin, check out this blog on starting an exercise routine!
Consider working with a birth doula to give you more tools in the toolbox for labor and delivery, and optimize your odds of having a successful vaginal delivery. A doula can be an excellent advocate for you in the birthing room, to know what is “normal” and what is not, and to give you tools to decrease pain during birthing, knowing what positions to try and alternative treatments to move birth along. (I wish I had hired a doula before my first child was born and wonder if my outcome would have been different if I had…)
Other ways I can help
Remember I also have some pre-recorded masterclasses to help, based on where you are in your pre-baby journey.
The Scoliosis & Pregnancy Blueprint Masterclass is perfect for women and partners who are interested in pregnancy but need more information about scoliosis, spinal fusion, the pelvic floor and the basic details. This masterclass is also great for movement, birth and fitness professionals who are looking to provide more support to their patients and clients with scoliosis and spinal fusion.
This masterclass also features a special guest expert perspective of exercise during pregnancy by my close friend and colleague Dr. Beth Terranova of Strength & Spine.
The Curve Conscious Pregnancy Masterclass is tailored for women who are pregnant and interested in the specifics of birth prep, including positions to labor and early postpartum recovery. It includes important questions to ask your providers to create your best plan for a smooth, successful delivery and postpartum with scoliosis and spinal fusion.
All masterclass purchasers get access to my specially created Pregnancy + Birth Plan, which is a 6-page customizable document intended for expectant parents with scoliosis and spinal fusion to keep all pertinent medical information in one place, as well as their birth preferences. Having a well-organized plan helps to ensure you and your birth team are as prepared for birth and postpartum as you can be.
Well, here it is all in one place — all the science to date about risks and complications for pregnancy with scoliosis and spinal fusion. I hope you are finishing this blog feeling more informed and prepared to create your pregnancy and birth journey!
I would love to keep this conversation going! Remember I am here to help if you’re needing extra support. Feel free to comment below or reach out with any questions you have!
