Determinants of Maternal Health-Related Quality of Life after Childbirth: The Generation R Study

Trajectory and Determinants of Quality of Life Among Postpartum Women

BACKGROUND

The postpartum period is a critical phase in which postpartum women experience dynamic changes in their physiology, psychology, and family status.

OBJECTIVE

This study investigated the changes in women's quality of life (QoL) during the first, third, and sixth months of the postpartum period and their associated factors.

METHODS

A single-group repeated-measure design was used to collect data from 282 postpartum women recruited from a regional hospital in Taiwan. We used the brief World Health Organization Quality of Life scale, Social Support Scale, and Edinburgh Postnatal Depression Scale to assess postpartum women's quality of life, social support, and postpartum depressive symptoms, respectively. The data were analyzed using trajectory analysis and generalized estimating equations.

RESULTS

The trajectory analysis indicated that postpartum women could be categorized into low, medium, and high QoL groups. Although the medium and high QoL groups maintained stable QoL levels, the low QoL group experienced a linear decrease in QoL over time. Moreover, the determinants of postpartum women's QoL were immigrant status, employment status, family type, social support, and postpartum depression.

CONCLUSIONS

Health care providers should assess these determinants of postpartum QoL in perinatal women to identify those at risk of low postpartum quality of life. Early assessment and intervention by health care providers could significantly improve the health status of women after childbirth.

Identifying associated factors in relation to health-related quality of life among postpartum women in Jimma town: A community-based cross-sectional study

Background

The quality of life (QoL) of women during the postpartum period is affected by their living circumstances, reproductive history, exposure to and use of antenatal care, etc. The quality of life (QoL) issues associated to postpartum health among Ethiopian women have not been adequately examined in studies. Therefore, this study identified associated factors in relation to the health-related quality of life (QOL) among postpartum women in Jimma Town, Ethiopia.

Methods

A structured face-to-face interview and a self-administered questionnaire were utilized in a community-based cross-sectional study to obtain data from 397 postpartum women from May 15 to June 14, 2022, using a multistage sampling strategy. The data analysis utilized several descriptive statistics. Multiple logistic models were run on factors that were significant at the 25 % level in univariate analysis. Adjusted odds ratios and 95 % confidence intervals were computed to identify associated factors.

Results

The majority (51.2 %) of postpartum women had a low health-related quality of life, with a mean score of 50.58. Women poor health-related quality of life (QoL) was associated with age (AOR = 10.09; CI: 3.45-29.51), non-formal education of partners (AOR = 3.67; CI: 1.25-10.72), multiparousness (AOR = 2.21; CI: 1.14-4.29), unplanned pregnancy (AOR = 7.36; CI: 1.98-27.37), giving birth to a dead baby (AOR = 3.15; CI: 1.54-6.42), and not admitted to the hospital while pregnant (AOR = 5.50; CI: 3.86-26.30).

Conclusion

The finding revealed that the majority of postpartum women reported poorer health-related QoL. Thus, stakeholders should give attention to significant factors to set up measures to prevent and improve women's postpartum health-related QoL, and should be aware of women about the risk associated with poor health-related QoL.

Health-related quality of life of postpartum women and associated factors in Dendi district, West Shoa Zone, Oromia Region, Ethiopia: a community-based cross-sectional study

BACKGROUND

Promoting a favorable experience of postpartum care has become increasingly emphasized over recent years. Despite the fact that maternal health care services have improved over the years, postnatal care service utilization is generally low and the health-related quality of life of postpartum women remains overlooked. Furthermore, the health-related quality of life of postpartum women is not well studied. Therefore, this study aimed to assess the health-related quality of life of postpartum women and associated factors in Dendi district, West Shoa Zone, Oromia, Region, Ethiopia.

METHODS

A community-based cross-sectional study was conducted among 429 participants. A multistage stratified sampling procedure was used to select the sampling unit and simple random sampling technique was employed to select the study participants from 23 August 2022 to 16 November 2022. A pre-tested standard structured questionnaire was used to collect the data. Data were entered using Epi-Data 3.1 and then exported to Statistical package for social science version 26. Binary logistic regression analysis was computed at p-value < 0.25 were considered candidates for multivariable logistic regression. Adjusted Odds Ratios (AOR) with 95% confidence interval and statistical significance was declared at a p-value < 0.05.

RESULTS

The study revealed that 73.7% (95% CI: 69.4-77.7) had a low level of health-related quality-of-life with a mean of 44.02 (SD ± 10.4). Urban residing [AOR = 0.27, 95% CI: (0.10-0.74)], no education [AOR = 3.44, 95% CI (1.35-8.74)], received at least four antenatal contact [AOR = 0.56, 95% CI (0.33-0.95)], received at least one postnatal care [AOR = 0.30, 95% CI (0.14-0.62)], poor social support [AOR = 2.23, 95% CI: (1.025-4.893)], having postpartum depression [AOR = 2.99, 95% CI: (1.52-5.56)], cesarean delivery [AOR = 3.18, 95% CI: (1.09-9.26)], and lowest household assets [AOR = 5.68, 95% CI: (2.74-11.76)] were significant associations with low health-related quality of life of postpartum women.

CONCLUSIONS

The health-related quality of life among postpartum women was very low. Postpartum women with low socio-economic status and inadequate maternal health service utilization had a low health-related quality of life. Promoting women's education and postnatal care services is needed to improve the health-related quality of life of postpartum women.

Maternal health-related quality of life at 1 year after a preterm birth: role of socioeconomic status at birth

BACKGROUND

Maternal problems in the postpartum period may lead to suboptimal long-term health for women and could affect mother-child attachment. Social disadvantage is a risk factor for preterm birth, which carries its own burden of health issues and stress. The main aim of this study was to investigate the role for social factors in mothers' physical and emotional health-related quality of life (HRQoL) at 1 year after a preterm birth.

METHODS

EPIPAGE-2 is a French nationwide, prospective, population-based cohort of preterm children born before 35 weeks' gestation (N=3614 women). At birth, detailed data on the family's social status were collected. At 1 year after birth, mothers completed a mailed questionnaire to report information on their HRQoL, assessed by the Medical Outcomes Study 12-item Short Form. We used multivariate linear regression models to assess the association between social factors and maternal HRQoL.

RESULTS

At 1 year after childbirth, the emotional HRQoL of mothers of preterm children was worse than their physical HRQoL, even in women without any previous signs of psychological distress at the infant's discharge from hospital. Baseline social characteristics were the most important factors influencing the physical component of HRQoL. None of the studied social factors had any clear association with the mental component of HRQoL.

CONCLUSION

Our study underlines the importance of social disadvantage during pregnancy as risk factors for poor physical HRQoL at 1 year after a preterm birth.

Quality of life 1 year after hospital discharge in unvaccinated pregnant women with COVID-19 respiratory symptoms: a prospective observational study (ODISSEA-PINK study)

Introduction

Little is known about Quality of Life within the first court of unvaccinated COVID-19 pregnant women exposed to the pandemic stressor. Primary aim of this study was to evaluate 1 year after hospital discharge HRQoL in a cohort of COVID-19 unvaccinated pregnant patients with COVID-19.

Methods

in this prospective observational study, all COVID-19 positive pregnant women at any gestational age, admitted to the Obstetric Department at the University Hospital of Udine, Italy, from 1 March 2020 to 1 March 2021, requiring or not oxygen supplementation due to SARS-CoV2 pneumonia were evaluated. Patients with a history of neurological or psychiatric disease, those with a previous abortion, and those who refused to provide written informed consent were excluded from the study. We investigated pregnant positive COVID-19 women Health-related quality of life (HRQoL) with the Short-Form Health Survey-36 (SF-36) and Post-traumatic Stress-Disorder (PTSD) with the Impact of Event Scale-Revised (IES-R).

Results

62 pregnant women respected the inclusion criteria of the study, and data from 33 patients were analyzed. The mean age was 32 ± 6 years, with a median gestational age of 38 weeks [IQR 34-40]. 15.2% of patients required oxygen therapy through noninvasive respiratory support (with high flow nasal cannula) for a median of 9 days [IQR 6-12]. The median Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were 50.2 [IQR 46.7-53.7] and 56.0 [IQR 46.8-60.6] respectively. Ten patients out of 33 (30%) tested positive for PTSD. Maternal age, gestational age, and history of cardiac-pulmonary-kidney disease significantly affected HRQoL at multivariable analysis.

Discussion

In COVID-19 pregnant unvaccinated women some physical impairments reducing HRQoL are still present 1 year after hospital discharge. Previous medical history such as history of cardiac-pulmonary-kidney disease significantly affected HRQoL. Long and repeated follow-up should be pursued in this category of patients.Clinical trial registration:ClinicalTrials.gov, Identifier NCT04860687.

The impact of family social support on postpartum quality of life among Iranian women: structural equation modelling

OBJECTIVE

To assess the impact of family social support (FSS) on postpartum quality of life (PQOL).

METHODS

This analytical cross-sectional study enrolled postpartum women and asked them to complete the PQOL and FSS questionnaire (FSSQ) between October 2021 and February 2022 in three urban health centres in Shiraz, Iran. Pearson correlation coefficient analysis and multiple regression were used to determine the relationship between the FSS and PQOL variables. Structural equation modelling was used to determine the relationship pathways of the impact of FSS on PQOL.

RESULTS

A total of 240 women were enrolled in the study. The mean ± SD scores of PQOL and FSSQ were 61.63 ± 9.59 and 69.80 ± 11.19, respectively. Family support seeking (7.95) and emotional support seeking (-6.80) were two factors affecting PQOL.

CONCLUSION

Women should be empowered to seek support through education and actions from health workers, especially nurses and midwives, during routine regular prenatal care.

Women's quality of life and mental health in the first year after birth: Associated factors and effects of antenatal preventive measures among mothers in the ELFE cohort

BACKGROUND

During the perinatal period, women's perceived quality of life (QOL) may be altered due to physiological, psychological, and bodily changes, as well as changes in family functioning.

OBJECTIVES

to explore in a sample of women from the general population, the associations between physical and mental QOL at 1 year post-partum and i) pregnancy social support, demographic, socioeconomic, medical and child health-related factors, paternal and maternal psychological characteristics at 2 months and 1 year post-partum, ii) antenatal preventive measures (early prenatal interview/antenatal classes).

METHODS

We used data from the "French Longitudinal Study since Childhood" (ELFE), a representative cohort of children and their parents followed from birth to adulthood. Data were collected from mothers in the maternity ward, at 2 months and 1-year post-partum. QOL was assessed using the SF12 physical (PCS-12) and mental (MCS-12) subscales.

RESULTS

Women with both low PCS-12 and MCS-12 scores were more likely to have high maternal age and to experience psychological difficulties during pregnancy. They also had more frequent PNDS, quarrels with insults within the couple, low sleep time at 2 months postpartum, and more frequently received psychological, social and child caregiver support, and were more often housewives or students at 1-year post-partum. Others factors are specific for low PCS-12 or MCS-12. There was no association with antenatal preventive measure and QOL at 1-year post-partum.

CONCLUSION

Factors influencing maternal QOL are multiple and multidimensional and can mostly be identified during the ante or early postnatal period. A graduated and coordinated preventive and curative pathway would improve women's health. An ecosystemic approach to pregnancy and the perinatal period could help preventing the negative effects of environment on mothers and thus infants during the "1000-day period".

The Association Between Pregnancy-Related Factors and Health Status Before and After Childbirth With Satisfaction With Skilled Delivery in Multiple Dimensions Among Postpartum Mothers in the Akatsi South District, Ghana

Background

Skilled delivery has been a pronounced concern and has been investigated over the years in developing countries. An inclusive understanding of the satisfaction of postpartum mothers is vital in improving the quality of skilled delivery, which is beneath the standard in some parts of developing countries. This study assessed the association between pregnancy-related factors and health status before and after childbirth with satisfaction with skilled delivery in multiple dimensions among postpartum mothers in the Akatsi South District, Ghana.

Methods

A community-based, cross-sectional study was conducted among 538 postpartum mothers who participated through the systematic sampling method. Data collection was performed through a pretested and structured questionnaire developed from the WHO responsiveness concept and other prior studies. Questions on satisfaction were categorized into six dimensions. The associations were determined using bivariable and multivariable logistic regression analyses.

Results

The overall satisfaction of postpartum mothers with skilled delivery was 80.7%. The highest (89.6%) and the lowest (12.8%) satisfaction with skilled delivery were found in technical quality and financial dimensions. Analysis revealed that autonomously age and delivery procedure were significantly associated with the dimensions of communication and responsiveness. Postpartum mothers who delivered at private healthcare facilities [crude odds ratio (COR) = 1.70; (95% CI 1.00–2.90); p = 0.049] had preterm pregnancy before delivery [COR = 2.08; (95% CI 1.02–4.21); p = 0.043], had cesarean section [COR = 2.73; (95% CI 1.05–7.12); p = 0.040], and presented with complications after childbirth [COR = 2.63; (95% CI 1.09–6.35); p = 0.032] were more likely to be satisfied in the dimension of communication only compared to their counterparts. Regarding responsiveness, multiparous mothers [COR = 1.63; (95% CI 1.06–2.51); p = 0.007] were more likely to be satisfied than primiparous mothers. Overall satisfaction was significantly and positively correlated with the various dimensions of skilled delivery.

Conclusions

The majority were satisfied with five dimensions of satisfaction with skilled delivery except for the financial dimension. The District Health Directorate of Akatsi South should take into consideration these findings in their policy development for forward-looking skilled delivery.

Impact of maternal morbidities on the longitudinal health-related quality of life trajectories among women who gave childbirth in four hospitals of Northwest Ethiopia: a group-based trajectory modelling study

OBJECTIVES

To identify distinct trajectories of health-related quality of life and its predictors among postpartum women in Northwest Ethiopia.

DESIGN

Health facility-linked community-based prospective follow-up study.

SETTING

South Gondar zone, Northwest Ethiopia.

PARTICIPANTS

We recruited 775 mothers (252 exposed and 523 non-exposed) after childbirth and before discharge. Exposed and non-exposed mothers were identified based on the criteria published by the WHO Maternal Morbidity Working Group.

OUTCOME MEASURES

The primary outcome measure of this study was trajectories of health-related quality of life. The Stata Traj package was used to determine the trajectories using a group-based trajectory modelling. Multinomial logistic regression model was used to identify predictors of trajectory membership.

RESULTS

Four distinct trajectories for physical and psychological and five trajectories for the social relationships and environmental health-related quality of life were identified. Direct and indirect maternal morbidities, lower educational status, poor social support, being government employed and merchant/student in occupation, vaginal delivery, lower monthly expenditure, stress, fear of childbirth and anxiety were found to be predictors of lower health-related quality of life trajectory group membership.

CONCLUSIONS

Health professionals should target maternal morbidities and mental health problems when developing health intervention strategies to improve maternal health-related quality of life in the postpartum period. Developing encouraging strategies for social support and providing health education or counselling for women with less or no education are essential to avert the decrease in health-related quality of life trajectories of postpartum women.

Management of external cephalic version in France: A national practice survey

INTRODUCTION

The breech presentation represents 4,7% of deliveries at term. There is a method of external cephalic version (ECV) performed from 36 weeks of gestation. French guidelines for the clinical practice of ECV were published in 2020.

OBJECTIVE

To evaluate the national practices of ECV in French maternity units, especially on the use of tocolysis, 1 year after publication of the French clinical recommendations guidelines by the French national college of obstetricians and gynecologists (CNGOF).

METHODS

Data self-reported for this national descriptive study were collected from March to May 2021 by an online questionnaire distributed to all French maternities. The 25 items of the questionnaire collected information of maternity units, the general practice of ECV, use or not of tocolysis for ECV attempt and the relevance of a prospective study.

RESULTS

Of the 517 French maternity units, 150 (29%) responded to the online survey.  95,3% systematically performed ECV. A Kleihauer test was routinely performed in 71 units (49.7%). A tocolysis was associated with ECV attempt in 52.4% of cases. The drugs used were intravenous atosiban (30,7%), mainly in levels 2b and 3 maternity units, intravenous salbutamol (24%), other mode of administration of salbutamol (14,7%) and oral nifedipine (22,6%) mainly in levels 1 and 2a maternity units. Adverse effects were described in 20%, mainly with the use of salbutamol (73,3%).

CONCLUSIONS

52.4% of the French maternity units surveyed used tocolysis for the ECV attempt, although it is systematically recommended. The choice of tocolytic drug differed according to the maternity units.

Patient perceptions of the benefits and barriers of virtual postnatal care: a qualitative study

Objective

The objective of this study is to understand the perceptions of new mothers using virtual care via video conferencing to gain insight into the benefits and barriers of virtual care for obstetric patients.

Methods

Semi-structured interviews were conducted with 15 patients attending the Kingston Health Sciences Centre. The interviews were 20–25 min in length and recorded through an audio recorder. Thematic analysis was conducted in order to derive the major themes explored in this study.

Results

New mothers must often adopt new routines to balance their needs and their child’s needs. These routines could impact compliance and motivation to attend follow-up care. In our study, participants expressed high satisfaction with virtual care, emphasizing benefits related to comfort, convenience, communication, socioeconomic factors, and the ease of technology use. Participants also perceived that they could receive emotional support and build trust with their health care providers despite the remote nature of their care. Due to its ease of use and increased accessibility, we argue that virtual care shows promise to facilitate long-term compliance to care in obstetric patients.

Conclusions

Virtual care is a useful modality that could improve compliance to obstetric care. Further research and clinical endeavours should examine how social factors and determinants intersect to determine how they underpin patient perceptions of virtual and in-person care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03999-9.

When birth is not as expected: a systematic review of the impact of a mismatch between expectations and experiences

Background

Pregnancy and childbirth are significant events in women’s lives and most women have expectations or plans for how they hope their labour and birth will go. It is possible that strong expectations about labour and birth lead to dissatisfaction or other negative outcomes if these expectations are not met, but it is not clear if this is the case. The aim was therefore to synthesise prospective studies in order to understand whether unmet birth expectations are associated with adverse outcomes for women, their partners and their infants.

Method

Searches were carried out in Academic Search Complete; CINAHL; Medline; PsycINFO, PsychArticles, PubMed, SCOPUS and Web of Science. Forward and backward searches were also completed. Studies were included if they reported prospective empirical research that examined the association between a mismatch in birth expectations/experience and postnatal outcomes in women, their children and/or their partners. Data were synthesised qualitatively using a narrative approach where study characteristics, context and methodological quality were extracted and summarised and then the differences and similarities among studies were used to draw conclusions.

Results

Eleven quantitative studies were identified for inclusion from nine countries. A mismatch between birth expectations and experiences was associated with reduced birth satisfaction. Three studies found a link between a mismatch and the development of postnatal post-traumatic stress disorder (PTSD). The evidence was inconsistent for postnatal depression, and fear of childbirth. Only one study looked at physical outcomes in the form of health-related quality of life.

Conclusions

A mismatch between birth expectations and experiences is associated with birth satisfaction and it may increase the risk of developing postnatal PTSD. However, it is not clear whether a mismatch is associated with other postnatal mental health conditions. Further prospective research is needed to examine gaps in knowledge and provide standardised methods of measuring childbirth expectations-experiences mismatch. To ensure women’s expectations are met, and therefore experience a satisfying birth experience, maternity providers should provide sensitive care, which acknowledges women’s needs and preferences, is based on open and clear communication, is delivered as early in pregnancy as possible, and enables women to make their own decisions about care.

Trial registration

Protocol registration: PROSPERO CRD42020191081.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03898-z.

Health-Related Quality-of-Life and Associated Factors Among Post-Partum Women in Arba Minch Town

Background

It is generally accepted that pregnancy and childbirth are natural physiological processes. However, these significantly affect the quality of mothers’ lives. Little is known about the level of quality-of-life and associated factors among postpartum women in Ethiopia, particularly in the study area.

Methods

A community-based cross-sectional study was conducted among 409 randomly selected post-partum women who were living in Arba Minch town. Systematic random sampling was employed to select the study participants. The standard quality-of-life assessment tool which is known as the short-form SF 36 tool was used to assess health-related quality-of-life. The logistic regression model was used to identify associated factors. Statistically significant variables at a p-value<0.25 in the bi-variable analysis were candidate variables for multi-variable analysis and statistical significance which was declared at a p-value<0.05.

Results

Among the study participants, 255 (62.3%) had lower level health-related quality-of-life (HRQoL). About 46.2% of the study participants had lower physical HRQoL and about 79% of the study participants had lower mental HRQoL. The overall mean score of HRQoL was 45.15 (±8.13). Factors associated with lower overall HRQoL were age group 17–24 years (AOR=2.73, 95% CI=1.22–6.10), no formal education [AOR 2.02, 95% CI (1.05–3.89)], and cesarean delivery (AOR=0.49, 95% CI=0.24–0.97). A factor associated with lower physical HRQoL was cesarean delivery (AOR=0.34, 95% CI=0.13–0.88). Factors associated with lower mental HRQoL were age group 17–24 (AOR=3.37, 95% CI=1.60–7.04), not receiving antenatal care (AOR=3.65, 95% CI=1.45–9.16), and having postpartum depression (AOR=2.27, 95% CI=1.30–3.93).

Conclusion

The results suggest that the majority of post-partum women had a lower HRQoL, particularly women’s mental health was compromised. In this study, a suggestion is made that the respective bodies need to give particular attention to mothers during the post-partum period to prevent poor quality-of-life.

Potential Risks and Factors of Women's Health Promotion

In addition to diseases shared by both sexes, there are a number of illnesses and injuries that are primarily associated with women [...].

Health Related Quality of Life Post Labour Induction with Misoprostol Versus Dinoprostone At Muhimbili National Hospital in Dar Es Salaam, Tanzania: A cross Sectional Study

BACKGROUND

Labour induction using Misoprostol or Dinoprostone results to similar maternal and foetal clinical outcomes. However, the clinical outcome measures have rarely been combined with effects of interventions on patients' health related quality of life. This study aimed to assess postpartum health related quality of life of parturient after labour induction with vaginal administration of misoprostol versus dinoprostone.

METHODS

This was a comparative cross sectional study in which pregnant women who underwent labour induction with misoprostol and dinoprostone during the study period were included. Data were collected within 24 hours post-delivery using the 36 item short form health survey questionnaire which consists of 24 attributes distributed in five domains including bodily pains and physical performance three attributes each, mental health seven attributes, general health two attributes, social functioning six attributes and three attributes for labour induction satisfaction. We first estimated scores of all attributes in each domain using Likert scales and then the domain scores were converted into a 0 to 100 scales to express in percentage of total scores. Quality of life was compared in the two study groups using the independent samples T Test. Multivariate regression analysis was performed to control for marital status, gravidity, parity, baseline cervical status, time interval from induction to delivery and mode of delivery.

RESULTS

Women who received misoprostol reported better health related quality of life compared to those who received dinoprostone (mean score 92.89 vs. 87.25;P<.00). Misoprostol group had significantly higher scores in all domains of health related quality of life; reduced bodily pain (93.76 vs. 84.19;P<.00), physical performance (83.64 vs. 73.58;P<.00), mental health (96.40 vs. 93.55; P<.00), general health (93.78 vs. 90.23;P=.01), social functioning (94.81 vs. 91.25;P<.00) and satisfaction perceptions (94.96 vs. 90.71;P<.00).

CONCLUSION

Health related quality of life information is of particular value in routine care of natal and postnatal mothers. Current and updated guidelines should address the impacts of labour induction interventions on maternal health related quality of life, and encourage the use of quality of life information in provision of holistic natal and postnatal care services. Clinical trials are recommended to determine the effectiveness of labour induction with either of the two methods and address the historical adverse outcomes associated to the use of misoprostol.