Abstract
OBJECTIVES: To explore the levels of health-related functioning during pregnancy and postpartum and its association with non-severe maternal morbidities. DESIGN: An observational longitudinal study. SETTING: A tertiary women's hospital in urban China. PARTICIPANTS: Pregnant women in late pregnancy were recruited via consecutive sampling. The Chinese version of the Women's Outcome Instrument for maternal healthCarE instrument was applied to measure health-related functioning and maternal morbidities at 28-41.6 weeks of gestation and at 6 weeks postpartum. Main outcome measures included health-related functioning, physical symptoms, anxiety and depression. RESULTS: Among the 624 participants, health-related functioning scores were significantly higher during late pregnancy than at 6 weeks postpartum (16.33±4.78 vs 14.40±3.65, p<0.001), reflected by a marked reduction in the prevalence of severe functional impairment (from 20.5% to 11.2%). Multivariate analyses revealed that antenatal impairment was significantly associated with moderately high physical symptoms (aOR=3.618, 95% CI 1.061 to 12.354, p<0.05), mild to moderate anxiety (mild: aOR=2.986, 95% CI 1.318 to 6.767, p<0.01; moderate: aOR=7.250, 95% CI 1.076 to 48.813, p<0.05) and mild depression (aOR=3.808, 95% CI 1.652 to 8.776, p<0.01). Postnatal impairment was linked to forceps delivery (aOR=1.874, 95% CI 1.007 to 3.483, p<0.05), moderately high to high physical symptoms (moderately high: aOR=4.591, 95% CI 1.960 to 10.751, p<0.01; high: aOR=13.277, 95% CI 5.501 to 32.073, p<0.01), moderate anxiety (aOR=3.059, 95% CI 1.015 to 9.217, p<0.05) and moderate to moderately severe depression (moderate: aOR=10.538, 95% CI 3.327 to 33.415, p<0.01; moderately severe: aOR=23.453, 95% CI 1.383 to 398.218, p<0.05). A dose-response relationship was observed between the severity of antenatal impairment and postpartum morbidities (all p<0.001 for moderate and severe impairment). CONCLUSION: Functional impairment is prevalent perinatally and associated interactively with maternal morbidities. Assessment of health-related functioning and the provision of targeted interventions are recommended to improve maternal health outcomes in the perinatal period and beyond.