A cohort study of functioning and disability among women after severe maternal morbidity.
OBJECTIVE
To assess functioning and disability related to severe maternal morbidity (SMM) via the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0).


METHODS
In a retrospective cohort study, women with or without a history of SMM who delivered at a tertiary public hospital in Brazil between July 2008 and June 2012, completed the WHODAS 2.0 questionnaire by individual interview between August 2012 and November 2013. General WHODAS scores were evaluated by maternal and neonatal characteristics, and specific domain scores according to SMM event.


RESULTS
Overall, 638 women were enrolled (315 with SMM and 323 without SMM). The mean general WHODAS score was higher among women with SMM (19.04±16.18) than among women without SMM (15.77±14.46; P=0.015). Domain scores were also higher in the SMM group for mobility (16.00±20.22 vs 11.63±17.51; P=0.003), household activities (26.79±30.16 vs 20.09±26.08; P=0.005), participation (23.55±21.72 vs 17.27±19.17; P<0.001), and work/school activities for women currently studying or working (20.52±26.64 vs 11.66±19.67; P=0.001). Excluding SMM, a parity of two or more was the only factor significantly associated with higher scores overall (P=0.013) and for domain 4 (getting along with people; P=0.017).


CONCLUSIONS
By comparison with women without childbirth complications, SMM impaired self-reported functioning among women 1-5years after delivery.
Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medical Sciences, Campinas, São Paulo, Brazil.
Carla
C
Silveira
Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medical Sciences, Campinas, São Paulo, Brazil. Electronic address: parpinelli@caism.unicamp.br.
Mary A
MA
Parpinelli
Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medical Sciences, Campinas, São Paulo, Brazil.
Rodolfo C
RC
Pacagnella
Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medical Sciences, Campinas, São Paulo, Brazil; Federal University of Sao Carlos (UFSCAR), School of Medicine, Sao Carlos, São Paulo, Brazil.
Carla B
CB
Andreucci
Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medical Sciences, Campinas, São Paulo, Brazil.
Elton C
EC
Ferreira
Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medical Sciences, Campinas, São Paulo, Brazil.
Carina R
CR
Angelini
Federal University of Sao Carlos (UFSCAR), School of Medicine, Sao Carlos, São Paulo, Brazil.
Jamile C
JC
Bussadori
Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medical Sciences, Campinas, São Paulo, Brazil.
Juliana P
JP
Santos
Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medical Sciences, Campinas, São Paulo, Brazil.
Dulce M
DM
Zanardi
Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medical Sciences, Campinas, São Paulo, Brazil.
Gustavo N
GN
Cecchino
Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medical Sciences, Campinas, São Paulo, Brazil.
Renato T
RT
Souza
Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medical Sciences, Campinas, São Paulo, Brazil.
Maria L
ML
Costa
Department of Obstetrics and Gynecology, Medical School of Jundiaí, Jundiaí, São Paulo, Brazil.
Rodrigo S
RS
Camargo
Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medical Sciences, Campinas, São Paulo, Brazil.
Jose G
JG
Cecatti
D000203:Activities of Daily Living; D000328:Adult; D001938:Brazil; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D009017:Morbidity; D010298:Parity; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D012044:Regression Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers; D014944:World Health Organization; D055815:Young Adult
Daily activities; Disability; Functioning; Postpartum period; Severe maternal morbidity