Petrou Stavros, Kim Sung Wook, McParland Penny, Boyle Elaine M
University of Warwick, Coventry, UK.
University Hospitals, Leicester NHS Trust, Leicester, UK.
Birth. 2017 Jun;44(2):110-119. doi: 10.1111/birt.12268. Epub 2016 Nov 14.
Relatively little is known about the effects of mode of delivery on long-term health-related quality-of-life outcomes. Furthermore, no previous study has expressed these outcomes in preference-based (utility) metrics.
The study population comprised 2,161 mothers recruited from a prospective population-based study in the East Midlands of England encompassing live births and stillbirths between 32 and 36 weeks' gestation and a sample of term-born controls. Perinatal data were extracted from the mothers' maternity records. Health-related quality-of-life outcomes were assessed at 12 months postpartum, using the EuroQol Five Dimensions (EQ-5D) measure with responses to the EQ-5D descriptive system converted into health utility scores. Descriptive statistics and multivariable analyses were used to estimate the relationship between the mode of delivery and health-related quality-of-life outcomes.
The overall health-related quality-of-life profile of the women in the study cohort mirrored that of the English adult population as revealed by national health surveys. A significantly higher proportion of women delivering by cesarean delivery reported some, moderate, severe, or extreme pain or discomfort at 12 months postpartum than women undergoing spontaneous vaginal delivery. Multivariable analyses, using the Ordinary Least Squares estimator revealed that, after controlling for maternal sociodemographic characteristics, cesarean delivery without maternal or fetal compromise was associated with a significant EQ-5D utility decrement in comparison to spontaneous vaginal delivery among all women (-0.026; p = 0.038) and among mothers of term-born infants (-0.062; p < 0.001). Among mothers of term-born infants, this result was replicated in models that controlled for all maternal and infant characteristics (utility decrement of -0.061; p < 0.001). The results were confirmed by sensitivity analyses that varied the categorization of the main exposure variable (mode of delivery) and the econometric strategy.
Among mothers of term-born infants, cesarean delivery without maternal or fetal compromise is associated with poorer long-term health-related quality of life in comparison to spontaneous vaginal delivery. Further longitudinal studies are needed to understand the magnitude, trajectory, and underpinning mechanisms of health-related quality-of-life outcomes following different modes of delivery.
关于分娩方式对长期健康相关生活质量结局的影响，人们了解相对较少。此外，此前尚无研究使用基于偏好（效用）的指标来表述这些结局。
研究人群包括从英格兰东米德兰兹地区一项基于人群的前瞻性研究中招募的2161名母亲，该研究涵盖妊娠32至36周的活产和死产情况，并选取了足月出生的对照样本。围产期数据从母亲的产科记录中提取。产后12个月时，使用欧洲五维度健康量表（EQ-5D）对健康相关生活质量结局进行评估，将对EQ-5D描述系统的回答转换为健康效用得分。采用描述性统计和多变量分析来估计分娩方式与健康相关生活质量结局之间的关系。
研究队列中女性的总体健康相关生活质量状况与全国健康调查所揭示的英国成年人群体的状况相似。与自然阴道分娩的女性相比，剖宫产分娩的女性在产后12个月时报告有一些、中度、重度或极度疼痛或不适的比例显著更高。使用普通最小二乘法估计器的多变量分析显示，在控制了母亲的社会人口学特征后，与自然阴道分娩相比，无母体或胎儿并发症的剖宫产分娩在所有女性中（-0.026；p = 0.038）以及足月产婴儿的母亲中（-0.062；p < 0.001）均与EQ-5D效用显著降低相关。在足月产婴儿的母亲中，这一结果在控制了所有母体和婴儿特征的模型中得到了重复（效用降低0.061；p < 0.001）。敏感性分析改变了主要暴露变量（分娩方式）的分类和计量经济学策略，证实了该结果。
对于足月产婴儿的母亲，与自然阴道分娩相比，无母体或胎儿并发症的剖宫产分娩与较差的长期健康相关生活质量相关。需要进一步开展纵向研究，以了解不同分娩方式后健康相关生活质量结局的程度、轨迹及潜在机制。
