Department of Social Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America.
Center for Methods in Implementation and Prevention Sciences, Yale University, New Haven, Connecticut, United States of America.
PLoS One. 2019 Nov 19;14(11):e0225163. doi: 10.1371/journal.pone.0225163. eCollection 2019.
Function is an important marker of health throughout the life course, however, in low-and-middle-income-countries, little is known about the burden of functional impairment as women transition from pregnancy to the first year post-partum. Leveraging longitudinal data from 960 women participating in the Share Child Cohort in Pakistan, this study sought to (1) characterize functional trajectories over time among women in their perinatal period and (2) assess predictors of chronic poor functioning following childbirth. We used a group-based trajectory modeling approach to examine maternal patterns of function from the third trimester of pregnancy through 12 months post-partum. Three trajectory groups were found: persistently well-functioning (51% of women), poor functioning with recovery (39% of women), and chronically poor functioning (10% of women). When compared to mothers in the highest functioning group, psychosocial characteristics (e.g., depression, stress, and serious life events) were significantly associated with sustained poor functioning one-year following child-birth. Mothers living in nuclear households were more likely to experience chronic poor functioning. Higher education independently predicted maternal function recovery, even when controlling for psychosocial characteristics. Education, above and beyond socio-economic assets, appears to play an important protective role in maternal functional trajectories following childbirth. Public health implications related to maternal function and perinatal mental health are discussed.
功能是整个生命过程中健康的重要标志，但在中低收入国家，对于女性从怀孕到产后第一年期间功能障碍的负担知之甚少。本研究利用来自巴基斯坦 Share 儿童队列的 960 名女性的纵向数据，旨在：(1) 描述围产期女性随时间推移的功能轨迹；(2) 评估产后慢性功能不良的预测因素。我们使用基于群组的轨迹建模方法，从妊娠第三个三个月到产后 12 个月来检查产妇的功能模式。发现了三种轨迹组：持续功能良好（51%的女性）、功能不良伴恢复（39%的女性）和慢性功能不良（10%的女性）。与功能最高的组相比，心理社会特征（如抑郁、压力和严重生活事件）与产后一年持续功能不良显著相关。居住在核心家庭中的母亲更有可能出现慢性功能不良。即使控制了心理社会特征，较高的教育水平也独立地预示着产妇功能恢复。教育除了社会经济资产外，似乎在产后产妇功能轨迹中起着重要的保护作用。讨论了与产妇功能和围产期心理健康相关的公共卫生意义。
