Abstract
OBJECTIVE: This study aimed to identify antenatal and pregnancy-related factors that affect recovery after childbirth, with the purpose of improving maternal health, return to work, and social participation. DATA SOURCES: We searched PubMed, Embase, and Web of Science up to October 2024 using predefined search terms. The review is registered in PROSPERO (#CRD42022361262). STUDY ELIGIBILITY CRITERIA: We included cohort studies, randomized controlled trials, and cross-sectional studies published in English or Dutch that evaluated antenatal and pregnancy-related factors associated with maternal morbidity beyond 6 weeks postpartum among women aged ≥18 years who delivered live-born singletons. A minimum follow-up of 6 weeks postpartum was required. METHODS: Two reviewers independently screened and assessed studies for quality. Data were synthesized narratively, organized by recovery domain. RESULTS: A total of 56 studies were included. Seven categories of influencing factors were identified: mental health in pregnancy (n=18), demographic and socioeconomic background (n=17), medical and psychological history (n=16), lifestyle in pregnancy (n=12), physical health in pregnancy (n=9), prepregnancy social and lifestyle factors (n=8), and psychosocial resources in pregnancy (n=5). Recovery outcomes included persistent pain, mental health problems, functional ability, and urinary incontinence. Although 47 studies focused on physical or mental health, only 9 studies assessed functional ability. No studies explicitly examined social participation. Previous pain, high body mass index, and antenatal mental health problems were consistently associated with poorer recovery outcomes. In contrast, physical activity, social support, and psychological resilience were generally protective factors. CONCLUSION: Postpartum recovery is influenced by multiple antenatal and pregnancy-related factors. A personalized, biopsychosocial approach to care may improve maternal health outcomes and social participation.