Multifactorial Determinants of Carpal Tunnel Syndrome Severity in Pregnancy: A Cross-Sectional Analysis

Background Carpal Tunnel Syndrome (CTS) is a prevalent yet often overlooked condition in pregnancy, with reported incidence rates of 31–62%. This study investigates the prevalence, severity, and multifactorial determinants of CTS among pregnant women, focusing on demographic, anatomical, and occupational risk factors. Methods A cross-sectional study of 158 pregnant women (mean age: 28.5 ± 5.2 years; gestational age: 30.2 ± 6.1 weeks) was conducted at Imam Khomeini Hospital, Iran. Participants were assessed using the Boston Carpal Tunnel Questionnaire (BCTQ) to evaluate symptom severity (SSS) and functional status (FSS). Anthropometric measurements (including wrist circumference), parity, and occupational data were collected. Statistical analyses included univariate comparisons and multivariate regression to identify predictors of CTS severity. Results Moderate CTS burden was observed (SSS: 2.8 ± 1.1; FSS: 2.5 ± 1.0). Severity significantly increased with age (> 30 years: SSS 3.2 ± 1.2, FSS 2.8 ± 1.1; p < 0.05), third-trimester pregnancy (SSS 3.0 ± 1.1, FSS 2.7 ± 1.0; p < 0.03), and occupational demands (p < 0.05). Larger wrist circumference (≥ 15.5 cm) and multiparity independently predicted higher severity (β = 0.12 and 0.14, respectively; p < 0.05). The final regression model (adjusted R² = 0.42) confirmed age, trimester, occupation, wrist size, and parity as key determinants. Conclusion CTS severity in pregnancy is driven by interconnected physiological, anatomical, and occupational factors. Targeted screening and ergonomic interventions are recommended, particularly for older, multiparous, or employed women with larger wrist morphologies.