The effects of mode of delivery and time since birth on chronic pelvic pain and health-related quality of life

Association of infants' feeding pattern up to 2 years postpartum with mothers' mental and physical health: the Japan Environment and Children's Study

BACKGROUND

Exclusive breastfeeding, a longer breastfeeding duration, and interaction with the baby during lactation improve mothers' mental health. However, few studies have targeted women around 2.5 years after childbirth, when women are still considered to have been in a period of mental and physical health vulnerability. This study examined this aspect in a large cohort of mother-child pairs.

METHODS

Data were obtained from 85,735 mothers in an ongoing nationwide birth cohort study in Japan. Exposures were exclusive breastfeeding (yes/no), continued breastfeeding up to 2 years (yes/no), and interaction with the baby during feeding (yes/no). Outcomes were mothers' mental and physical health 2.5 years after childbirth measured using Mental and Physical Component Summary scores (MCS and PCS scores, respectively) from the 8-item Short-Form Health Survey. Generalized additive mixed model analysis was used to derive each estimate for the three exposures and their interactions, with each "no" answer as reference.

RESULTS

Exclusive breastfeeding and interaction with the baby during feeding were associated with MCS score increases of 0.28 (95%CI: 0.10-0.47) and 0.41 (95%CI: 0.29-0.54), respectively. However, no associations were found for continued breastfeeding up to 2 years and no interactions were identified. No significant differences were observed for PCS scores.

LIMITATIONS

All variables were measured using a self-administered questionnaire.

CONCLUSIONS

Continued exclusive breastfeeding until 6 months and interaction with the baby during feeding may help to promote mother's mental health 2.5 years after childbirth. These findings further strengthen the rationale for the World Health Organization's recommended lactation practices.

Cesarean section and parenting stress: Results from the Japan Environment and Children's Study

BACKGROUND

Accumulating evidence suggests a long-term health risk of cesarean section for the mother and child, but few studies have examined the link between cesarean section and parenting stress. Here, we examined this association by exploiting a large dataset.

METHODS

Participants were 65,235 mothers participating in the Japan Environment and Children's Study, an ongoing nationwide birth cohort. Outcome variables were parenting stress assessed as total score and subscale scores (representing the difficult child, parental distress, and spouse factors) on the Japanese 19-item version of the Parenting Stress Index Short Form (J-PSI-SF). Exposures were the mode of delivery, the timing of the J-PSI-SF assessment (1.5, 2.5, and 3.5 years postpartum), and the interaction between them. Multivariate regression analysis was used to calculate adjusted β coefficients and standard error of the means (SEMs).

RESULTS

The J-PSI-SF total score was higher in the cesarean section group than in the vaginal delivery group (adjusted β = 0.24, SEM = 0.09). This increase was primarily due to higher scores for the difficult child factor (adjusted β = 0.18, SEM = 0.05) and not to higher scores for the parental distress or spouse factor.

CONCLUSIONS

Cesarean section was associated with higher parenting stress, especially in relation to the difficult child factor. Our results highlight the importance of paying particular attention to the mental health of both mother and child in the case of cesarean section.

Parity and mode of birth and their relationships with quality of life: A longitudinal study

Objective

To examine how (a) parity and (b) mode of birth were associated with later Quality of Life (QOL) in young adult women, with a mean follow-up of 11.0 years.

Design

Prospective cohort study

Setting

Australia

r sample

A total of 7770 women participating in the 1973–1978 cohort of the Longitudinal Study of Women’s Health.

Methods

Linear regression models were used to estimate (1) prospective associations between parity and mode of birth with eight subscale and two summary scores of the SF36, assessed after a mean follow-up of 11 years., and (2) differences between SF36 scores at follow up for women in different parity and mode of birth categories.

Main outcome measure

Quality of Life as measured by the SF36

Results

Women experiencing no births (parity 0) and one birth (parity 1) had lower scores on all the physical health measures, and on some mental health measures, than women who had 2 births (parity 2) (all p<0.05).

Conclusions

Parity and mode of birth may have long-term implications for women’s physical and mental health. Both childless and women with only one child had poorer physical and mental health than their peers with two children. Women with only caesarean section(s) also had poorer health than women who had vaginal birth/s.

The effect of mode of delivery on health-related quality-of-life in mothers: a systematic review and meta-analysis

BACKGROUND

Previous research is inconclusive on the effects of mode of delivery on maternal health-related quality-of-life (HRQoL). We conducted a systematic review and meta-analysis to assess the current evidence for associations between mode of delivery and postpartum health-related quality-of-life.

METHODS

Electronic databases MEDLINE ALL (OVID), Web of Science, The Cochrane Library, CINAHL and EMBASE (OVID) were searched for English written articles investigating the relationship between mode of delivery and quality-of-life published form inception to 15th October 2020. Two reviewers independently screened titles and abstracts, assessed full texts, and extracted data. Meta-analysis was conducted where possible.

RESULTS

Twenty-one studies, including 19,879 women, met the inclusion criteria. A meta-analysis of 18 studies found HRQoL scores were significantly higher for women after vaginal delivery in comparison to caesarean (emergency and elective combined) (Effect Size (ES) 0.17, 95% CI 0.01-0.25, n = 7665) with highest scores after assisted vaginal delivery (ES 0.21, 95% CI 0.13-0.30, n = 2547). Physical functioning (ES 11.18, 95% CI = 2.29-20.06, n = 1746), physical role (ES 13.10, 95% CI = 1.16-25.05, n = 1471), vitality (ES 6.31, 95% CI = 1.14-10.29, n = 1746) and social functioning (ES 5.69, 95% CI = 1.26-10.11, n = 1746) were significantly higher after vaginal delivery compared to caesarean.

CONCLUSIONS

Health-related quality-of-life scores were higher for women after vaginal delivery in comparison to caesarean section. Consequently, women should be encouraged to deliver vaginally where possible. The findings of this research should be available to the relevant population to help support informed choice.

Effect estimate of time-varying social support and trust on the physical and mental health of mothers at 2.5 years postpartum: The Japan Environment and Children's Study (JECS)

BACKGROUND

Many epidemiological studies have reported the association between various social factors and health status in mothers during and after pregnancy. However, little is known about their joint and longitudinal impact. We therefore examined the association of lack of social support and trust during pregnancy and at 2.5 years postpartum with health status in mothers.

METHODS

To adequately address time-varying exposure, marginal structural models were fitted to a pseudopopulation constructed by inverse probability weighting. The model included records of 90,071 mothers participating in the Japan Environment and Children's Study. Social support and trust were measured using a 9-item questionnaire (Q1-9). Mental and physical health were measured using Mental and Physical Component Summary scores from the 8-item Short-Form Health Survey.

RESULTS

For the Mental Component Summary, the magnitude of the effect estimate was largest when participants lacked close friends/neighbors (Q4) at only 2.5 years postpartum (= -6.23), followed by a lack in emotional support (Q2) at the same time point (= -4.94). For the Physical Component Summary, effect estimates were negligible. The magnitude of the effect estimates of lack of social support and trust tended to be larger when there was a lack at only 2.5 years postpartum than at both time points.

CONCLUSIONS

These findings suggest that, after childbirth, a loss in social support, particularly in a concrete or instrumental aspect, carries high risk, especially for mental health. Our results highlight the importance of supporting mothers for more than a few years after pregnancy.

Neuropathic component of postoperative pain for predicting post-caesarean chronic pain at three months. A prospective observational study

BACKGROUND

Recent investigations have showed that caesarean section (CS) might be a cause of chronic pain, with a consequent decrease in quality of life.

METHODS

Prospective observational study in a Spanish tertiary hospital. Main Outcome measure was to assess early neuropathic characteristics of pain (DN2 score ≥ 3) one week after CS as a potential risk factor for post-caesarean section chronic pain (PCSCP) at three months. Secondary outcome was to identify other risk factors. 610 consecutive consenting patients undergoing CS were interviewed preoperatively, at discharge from recovery room and 24h postoperatively. Telephone follow-up interviews were conducted one week, three months and twelve months following surgery.

RESULTS

We analysed 597 consecutive patients. The incidence of PCSCP at three and twelve postoperative months were 6.2% and 1% respectively. Subjects with NRS score superior to five on movement one week after CS presented higher incidence of PCSCP (NRS superior to five: 19 (52,2%); NRS equal or lower to five: 172 (30,9%); p=0,009). On multivariate analysis neuropathic pain one week after CS was associated with a higher risk of PCSCP (AOR: 1.63 (95% CI: 1.26-2.11; p<0.001). Other identified risk factors for PCSCP were: uterine exteriorization during CS (AOR: 3.89 (95% CI 1.25-12.10; p=0.019) and a lower gestational age (AOR: 0.87 (95% CI: 0.78-0.96; p=0.008).

CONCLUSIONS

Incidence of PCSCP at three and twelve postoperative months was low, 6.2% and 1% respectively. Early neuropathic characteristics of pain after one week measured by neuropathic pain questionnaire, consisting of two questions (DN2) ≥ 3/7 could be used to identify patients at risk for chronic post-surgical pain and develop preventive strategies.

Post-caesarean delivery analgesia in resource-limited settings: a narrative review

Post-caesarean pain is an important and often neglected outcome. It causes suffering, affects breastfeeding and is associated with postpartum depression and the development of chronic pain syndromes. Pain control is often difficult even in resource-rich environments; it is likely far worse in resource-limited settings, where emphasis is on reducing the high maternal mortality rate. Lack of adequate staffing, education, and postoperative monitoring severely limit the options in resource-limited settings. Resource-limited settings are further compromised by limited access to essential analgesic drugs and equipment for their administration. Solutions using affordable and accessible medications as part of a multimodal analgesic strategy are possible, supplemented by education and training programmes. More research is required, both to establish current practice and to test methods for improving maternal pain control. While government involvement is necessary to improve infrastructure and resources in individual countries, other solutions should also be sought, empowering local institutions and harnessing individual cultural characteristics.

Systematic review of quality of life measures in patients with endometriosis

OBJECTIVES

Endometriosis and quality of life has been the subject of much research, however, there is little consensus on how best to evaluate quality of life in endometriosis, resulting in many and diverse scales being used. In our study, we aim to identify quality of life scales used in endometriosis, to review their strengths and weaknesses and to establish what would define an ideal scale in the evaluation of endometriosis-related quality of life.

MATERIALS AND METHODS

A search of the MEDLINE and EMBASE databases was carried out for publications in English and French for the period from 1980 to February 2017, using the words 'endometriosis' and 'quality of life'. Publications were selected if they reported on quality of life in patients with endometriosis and specified use of a quality of life scale. A quantitative and a qualitative analysis of each scale was performed in order to establish the strengths and weaknesses for each scale (systematic registration number: PROSPERO 2014: CRD42014014210).

RESULTS

A total of 1538 articles publications were initially identified. After exclusion of duplicates and application of inclusion criteria, 201 studies were selected for analysis. The SF-36, a generic HRQoL measure, was found to be the most frequently used scale, followed by the EHP-30, a measure specific to endometriosis. Both perform well, when compared with other scales, with scale weaknesses offset by strengths. EHP-5 and EQ-5D also showed to be of good quality. All four were the only scales to report on MCID studied in endometriosis patients.

CONCLUSION

For clinical practice, routine evaluation of HRQOL in women with endometriosis is essential both for health-care providers and patients. Both SF-36 and EHP-30 perform better overall with regard to their strengths and weaknesses when compared to other scales.

Postpartum chronic pain

Postpartum chronic pain is a clinical reality which affects 6.1% to 11.5% of women after delivery and affects their recovery. The large range of incidence observed in the literature relies on criteria used to define chronic postpartum pain. The features depend on the type of delivery. Cesarean delivery which rate is increasing worldwide seems currently associated with lower risk of chronic postpartum pain, specifically chronic pelvic pain. Further chronic scar pain which often involves a neuropathic component is often of mild intensity. In opposite, after vaginal delivery, chronic pelvic pain and perineal pain have an important negative impact on women's mood and quality of life. As for any chronic pain, individual risk factors account more than degree of tissue trauma. From actual reports in the field, better pain education of both women and health care providers might help to reduce the problem.

Incidence and severity of chronic pain after caesarean section: A systematic review with meta-analysis

BACKGROUND

The frequency of caesarean section has increased dramatically in recent decades. Despite this, robust data regarding the consequences of caesarean section in terms of developing chronic postsurgical pain (CPSP) are still lacking.

OBJECTIVE

This systematic review analysed the incidence and severity of CPSP in women 3 to less than 6, 6 to less than 12, and at least 12 months after caesarean section.

DESIGN

Systematic review of prospective and retrospective observational studies and randomised controlled trials with meta-analysis.

DATA SOURCE

We searched MEDLINE to May 2015.

ELIGIBILITY CRITERIA

We included all studies investigating the incidence and/or severity of CPSP at least 3 months after caesarean section. The primary outcome was chronic postsurgical wound pain (CPSP 'wound'). Secondary outcomes were persistent pain in the back area, pelvic region or reported as residual pain, and severity of 'birth-related' chronic pain.

RESULTS

Meta-analysis using the random-effects model based on 15 studies (n = 4475) reporting CPSP 'wound' at 3 to less than 6 months after caesarean section revealed an incidence of 15.4% [95% confidence interval (CI): 9.9 to 20.9%]. For 6 to less than 12 and at least 12 months after caesarean section, the incidence of CPSP 'wound' was estimated at 11.5% (95% CI: 8.1 to 15.0%, n = 3345) and 11.2% (95% CI: 7.4 to 15.0%, n = 3451), respectively. Meta-regression analysis using the publication year as predictor revealed stable CPSP 'wound' incidences at each postoperative time slot from 2002 to the present. Of those patients who reported chronic pain, 9.6% (95% CI: 0.0 to 21.0%) had severe pain, 23.5% (95% CI: 10.0 to 37.0%) had moderate pain and 49.2% (95% CI: 18.9 to 79.4%) had mild pain at 6 months.

LIMITATIONS

Major limitations are high statistical heterogeneity of the meta-analyses and inconsistencies in reporting severity of chronic 'birth-related' pain.

CONCLUSION

This meta-analysis finds a clinically relevant incidence of CPSP 'wound' after caesarean section ranging from 15% at 3 months to 11% at 12 months or longer that has been largely stable in recent years.

The relationships between timing of first childbirth, parity, and health-related quality of life

PURPOSE

A few studies have investigated the relationship between age at first childbirth and health-related quality of life (HRQoL). This study examined the relationship between age at first childbirth and HRQoL and whether parity mediates this timing of the first childbirth-HRQoL relationship in women aged 50 years or above.

METHODS

The study population included 5146 parous women ≥ 50 years in the cross-sectional survey, the Korea National Health and Nutrition Examination Survey 2010-2012. HRQoL was evaluated by the EuroQol five-dimensional descriptive system. Participants were grouped according to quartiles of age at first childbirth (ranges: 13-21, 22-23, 24-25, and 26-44 years). This study used linear regression analysis to examine the relationship between age at first childbirth and HRQoL and on each dimension. Mediation analysis was used to examine the contribution of age at first childbirth to HRQoL and to each dimension.

RESULTS

This study found the increasing pattern of HRQoL across quartiles of age at first childbirth (P for trend = 0.030). Odds of problems in self-care and anxiety/depression dimensions significantly increased across the quartiles. Women with later age at first childbirth tended to have better HRQoL (B = 0.352, P = 0.003); parity significantly contributed to this relationship. Decreasing parity accounted for 33.5% of the relationship between late first childbirth and increased HRQoL. Early age at first childbirth significantly increased odds of the mobility problem through increasing parity.

CONCLUSIONS

Women of an early age at first childbirth tended to have lower HRQoL through giving more deliveries. Our findings suggest that more attention needs to be given to women with early pregnancy and more delivery to prevent impaired HRQoL.

Maternal Health-Related Quality of Life and Its Predicting Factors in the Postpartum Period in Iran

Background/Purpose. Postpartum period is accompanied by many physical, emotional, and social changes in women's health. The aim of this study was to examine the mothers' quality of life in postpartum period. In addition, it also sought to recognize the variables that predict their quality of life. Methods. This cross-sectional, descriptive study was undertaken among 380 women in 10 urban health centers in Ilam province in west of Iran. They were selected using proportional random sampling method. The SF-36 questionnaire was used to identify women's health-related quality of life (HRQoL). Data were analyzed using SPSS version 15. Results. Women who were employed, aged less than 30 years, had college degree, have no history of disease in pregnancy, and had given birth more than 3 months ago had higher quality of life scores. Independent predictors for lower physical HRQoL were being with history of disease in pregnancy; being with high school diploma or lower education; and giving birth less than 3 months ago. Also, independent predictor for lower mental HRQoL was being housewife. Conclusion. According to study findings, greater attention must be paid to providing postpartum healthcare for housewife and less educated women as well as those with history of disease in pregnancy.

Comparing the Prevalence, Risk Factors, and Repercussions of Postpartum Genito-Pelvic Pain and Dyspareunia

INTRODUCTION

Childbirth is a risk factor for developing genito-pelvic pain and/or dyspareunia during the postpartum period and potentially in the longer term. These two types of pain can occur simultaneously or sequentially and could be affected by different risk factors and have a range of repercussions to women's lives, including their sexual functioning.

AIM

This study reviewed the available evidence to compare and contrast the prevalence, risk factors, and repercussions of postpartum genito-pelvic pain vs dyspareunia.

METHODS

All available data related to postpartum genito-pelvic pain and dyspareunia were reviewed.

MAIN OUTCOME MEASURES

A description of the prevalence, risk factors, and sexual and psychological consequences of postpartum genito-pelvic pain and dyspareunia and the methodologic limitations of previous studies.

RESULTS

The prevalence of postpartum genito-pelvic pain is much lower than that of postpartum dyspareunia. There is evidence of converging and differential risk factors for acute and persistent experiences of these two types of pain. Postpartum genito-pelvic pain and dyspareunia are associated with impaired sexual functioning. Rarely are these pain experiences examined together to make direct comparisons.

CONCLUSION

There has been a critical lack of studies examining postpartum genito-pelvic pain and dyspareunia together and integrating biomedical and psychosocial risk factors. This approach should be spearheaded by a multidisciplinary group of researchers of diverse and relevant expertise, including obstetricians, gynecologists, anesthesiologists, and psychologists.

Chronic pelvic pain in women: an epidemiological perspective

Chronic pelvic pain (CPP) is common in women of reproductive age and has a significant impact on quality of life, work efficiency and healthcare utilization. CPP can be a manifestation of many different, often multifactorial conditions, and in the absence of an identified cause, the management can be particularly challenging. High quality epidemiological studies would improve the understanding of CPP and identify risk factors which may be targeted for the development of appropriate management strategies. This review focuses on what is known about the prevalence, risk factors, individual and societal burden of CPP and outlines important management strategies.