Is Dry Needling Safe During Pregnancy?

Pregnancy is a remarkable journey filled with profound changes, both physical and emotional. From the moment of conception to the miraculous arrival of a newborn, each stage of pregnancy brings its own set of challenges and joys. Challenges during pregnancy include things like morning sickness, fatigue and musculoskeletal dysfunction/pain.

Dry needling is an intramuscular manual therapy technique using monofilament needles to improve pain, function and tissue health.

Common Myths Around Dry Needling During Pregnancy:

  1. Dry needling with electrical stimulation will induce preterm labor.
  2. Dry needling during the first trimester will cause a miscarriage.
  3. You can needle any body region safely during pregnancy.

Myth Busting #1:

“Dry needling with electrical stimulation will induce preterm labor.”

Reality: It is very difficult to determine a causal effect of dry needling inducing labor. A 2017 retrospective case report was done by an DAOM private practice to attempt to induce labor with electro stim acupuncture. While this is slightly different from how we use dry needling to treat musculoskeletal pain, it can give insight into the likelihood of inducing labor with dry needling. This study concluded that electrostim acupuncture was effective in inducing labor. However, if we read the fine print, 5 of the 8 participants were past their due dates and the remaining 3 took multiple treatment sessions that
pushed their labor into >37 weeks gestation. The results from this study were perhaps due to the normal process of labor and delivery or to electrostim acupuncture.

Recommendation: Avoid dry needling at the thoracolumbar junction during pregnancy, as the sympathetic nerve that innervates the uterus is the inferior hypogastric nerve, which arises from sacral splanchnic nerves from the sympathetic trunk and preganglionic fibers at vertebral levels T10-L2. There is extensive literature to support safety of electrical stimulation during pregnancy, which stems primarily from transcutaneous electrical stimulation data. Due to the precision of a needle, we can target specific musculature rather than utilizing transcutaneous electrical stimulation, which has the potential to cross talk to more tissues than an indwelling needle.

 

Myth Busting #2:

“Dry needling during the first trimester will cause a miscarriage.”

Reality: There is no research to indicate that dry needling during the first trimester will cause miscarriage. The rate of miscarriage during the first trimester is close to 20%. 1 in 5 women during the first trimester will experience a miscarriage. After 14 weeks gestation, miscarriage rate drops to .5% (1 in 200). Because the rate of miscarriage is so high during the first trimester, the recommendation is to avoid dry needling during the first trimester (0–14 weeks of gestation). If a patient has had recurrent miscarriages, it is recommended to wait until the anatomy scan at 20 weeks gestation to ensure appropriate fetal
development.

 

Myth Busting #3:

“You can needle any body region safely during pregnancy.”

Reality: There are 3 regions of the body we recommend avoiding during pregnancy.

  1. Thoracolumbar junction due to its innervation to the uterus.
  2. Abdominal wall. This region seems fairly obvious, but as the fetus grows, the uterus begins to extend above the pelvic bowl around 8–12 weeks of gestation; therefore, it is recommended not to needle abdominal musculature during pregnancy.
  3. Pelvic floor. Similar to the abdominal wall, but as the fetus grows, organs in the pelvic bowl tend to shift and because of this it is recommended to not needle the pelvic floor musculature as to avoid interacting with the uterine wall.

Dry needling with electrical stimulation can be a very effective and safe way to reduce musculoskeletal pain during pregnancy, improve neuromuscular recruitment, and decrease post treatment soreness, which allows patients to return to activities of daily living and exercise with less pain.

Ultimately, we would be doing our patients a disservice if we did not utilize this tool in our clinical practice during pregnancy.

References:

Cole E. Avoiding Medical Induction With Electrostimulation Acupuncture: A Private Practice Case Series of 8 Pregnant Women. Integr Med (Encinitas). 2017 Dec;16(6):32-34. PMID: 30936814; PMCID:
PMC6438083.

Szymański JK, Słabuszewska-Jóźwiak A, Jakiel G. Sacral Neuromodulation in Pregnant Women-A Case Report and Literature Review. Int J Environ Res Public Health. 2022 Jul 8;19(14):8340. doi:
10.3390/ijerph19148340. PMID: 35886191; PMCID: PMC9318487.

Houdeau E, Rousseau A, Meusnier C, Prud’Homme MJ, Rousseau JP. Sympathetic innervation of the upper and lower regions of the uterus and cervix in the rat have different origins and routes. J Comp
Neurol. 1998 Sep 28;399(3):403-12. PMID: 9733086.

Ammon Avalos L, Galindo C, Li DK. A systematic review to calculate background miscarriage rates using life table analysis. Birth Defects Res A Clin Mol Teratol. 2012 Jun;94(6):417-23. doi: 10.1002/bdra.23014. Epub 2012 Apr 18. PMID: 22511535.