Is Sciatica Common in Pregnancy?
True sciatica (nerve root compression causing radiating leg pain below the knee) is uncommon in pregnancy, but sciatica-like symptoms and lower extremity pain are frequently reported, affecting approximately 22% of pregnant women. 1
Distinguishing True Sciatica from Pregnancy-Related Musculoskeletal Pain
The term "sciatica" is often misapplied in pregnancy. True sciatica involves nerve root dysfunction with pain radiating below the knee in the sciatic nerve distribution, typically from mechanical pressure or inflammation. 2 However, most leg pain in pregnancy stems from musculoskeletal causes rather than true nerve root compression:
Musculoskeletal pain is extremely common, with low back pain occurring in up to two-thirds of pregnancies and pelvic girdle pain in nearly 20% of pregnant women, peaking in months 6-7 of gestation. 3
Reported "sciatica" prevalence of 22.1% in pregnant women likely includes both true sciatica and referred pain from pelvic girdle dysfunction or lumbar spine strain. 1
Pelvic girdle pain causes more disability than lumbar pain and can produce radiating symptoms that mimic sciatica but originate from sacroiliac joint or symphysis pubis dysfunction rather than nerve root compression. 4
Mechanisms of True Sciatica in Pregnancy
When genuine sciatica occurs during pregnancy, several unique mechanisms are responsible:
Lumbosacral trunk compression from enlarged pelvic organs (uterus, ovarian masses) can compress nerve roots near the sacroiliac joint, causing true sciatic symptoms. 5
Lumbar disc herniation manifesting as severe sciatica or foot drop requires emergency surgical intervention in rare cases, with 6 of 9 pregnant women in one surgical series presenting with lumbar disc herniations. 6
Pregnancy-related ligamentous laxity from hormones (relaxin, progesterone, estrogen) reduces ligament rigidity and weakens joint stability, potentially contributing to nerve compression. 3
Clinical Pitfalls and Red Flags
A critical pitfall is assuming all leg pain in pregnancy is benign musculoskeletal discomfort. 5 Failure to recognize true sciatica can lead to unnecessary morbidity:
Perform thorough gynecological examination even when neurological findings suggest herniated disc, as pelvic masses can compress the lumbosacral trunk. 5
Ask about cyclic pain patterns related to menses in early pregnancy or pre-existing conditions, as this suggests gynecological rather than spinal etiology. 5
True neurological deficits (foot drop, sensory loss, reflex changes) warrant urgent evaluation with MRI, as these indicate genuine nerve root compromise requiring potential surgical intervention. 6
Cauda equina symptoms (urinary retention, saddle anesthesia, bilateral leg weakness) represent surgical emergencies even during pregnancy. 2, 6
Healthcare Utilization Patterns
Of pregnant women experiencing sciatica-like symptoms, 79.3% seek medical help, indicating significant impact on quality of life. 1 This high healthcare utilization rate reflects the severity of symptoms and their interference with daily activities, though many cases represent musculoskeletal pain rather than true nerve root compression.
Management Approach
For most pregnancy-related leg pain labeled as "sciatica":
Conservative management is appropriate for musculoskeletal causes, including activity modification, avoiding heavy lifting (>10-20 kg more than 20 times weekly), physical therapy, pelvic belts, and analgesics. 3, 4
Symptoms typically resolve spontaneously after delivery in the majority of cases. 3
Surgical intervention is reserved for true sciatica with progressive neurological deficits, cauda equina syndrome, or intractable pain unresponsive to conservative measures, and can be performed safely with interdisciplinary planning. 6