title: Determinants of health-related quality of life in the postpartum period after obstetric complications.
abstract: OBJECTIVE
  To determine the influence of socio-demographic, clinical parameters and obstetric complications on postpartum health-related quality of life (HRQoL).
  
  
  METHODS
  We used data of three randomized controlled trials to investigate HRQoL determinants in women after an obstetric complication. The DIGITAT and HYPITAT trials compared induction of labor and expectant management in women with intra-uterine growth restriction (IUGR) and hypertensive disorders. The WOMB trial randomized anemic women after postpartum hemorrhage to red blood cell transfusion or expectant management. The HRQoL-measure Short-Form36 was completed at six weeks postpartum. Multivariable analyses were used to identify which parameters affected the Short-Form36 physical component score (PCS) and mental component score (MCS).
  
  
  RESULTS
  HRQoL analyses included 1391 women (60%) of the 2310 trial participants. HYPITAT and DIGITAT participants had significantly lower MCS than WOMB participants. In multivariable analysis, PCS after elective and emergency cesarean section was 5-6 points lower than after vaginal delivery. Gestational hypertension, neonatal admission and delivery in an academic hospital had a small negative effect on PCS. No effect was found for randomization status, maternal age, BMI, country of birth, education, parity, induction of labor, analgesics, birth weight, perineal laceration, delivery of placenta, postpartum hemorrhage, congenital anomaly, urinary tract infection, thromboembolic event or endometritis. MCS was influenced only mildly by these parameters.
  
  
  CONCLUSIONS
  IUGR and hypertensive disorders lead to lower HRQoL scores postpartum than PPH. In a heterogeneous obstetric population, only mode of delivery by cesarean section has a profound, negative impact, on physical HRQoL (PCS). No profound impacts on MCS were detected.
authors.affiliation: Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands; Department of Obstetrics and Gynecology, Maasstad Hospital, Rotterdam, The Netherlands.
authors.forename: Babette W
authors.initials: BW
authors.lastname: Prick
authors.affiliation: Department of Public Health, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Denise
authors.initials: D
authors.lastname: Bijlenga
authors.affiliation: Sanquin Blood Supply Foundation, Rotterdam, The Netherlands.
authors.forename: A J Gerard
authors.initials: AJ
authors.lastname: Jansen
authors.affiliation: Department of Obstetrics and Gynecology, Bronovo Hospital, Den Haag, The Netherlands.
authors.forename: Kim E
authors.initials: KE
authors.lastname: Boers
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: Sicco A
authors.initials: SA
authors.lastname: Scherjon
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: Corine M
authors.initials: CM
authors.lastname: Koopmans
authors.affiliation: Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors.forename: Marielle G
authors.initials: MG
authors.lastname: van Pampus
authors.affiliation: Department of Public Health, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Essink-Bot
authors.affiliation: Sanquin Blood Supply Foundation, Rotterdam, The Netherlands.
authors.forename: Dick J
authors.initials: DJ
authors.lastname: van Rhenen
authors.affiliation: School of Pediatrics and Reproductive Health, University of Adelaide, Adelaide 5000 SA, Australia.
authors.forename: Ben W
authors.initials: BW
authors.lastname: Mol
authors.affiliation: Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands. Electronic address: j.j.duvekot@erasmusmc.nl.
authors.forename: Johannes J
authors.initials: JJ
authors.lastname: Duvekot
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D006801:Humans; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications; D011788:Quality of Life; D012044:Regression Analysis; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Health-related quality of life; Obstetric labor complications; Postpartum period; Pregnancy complications