title: "The Burden of Pregnancy"; heavier for the heaviest? The changes in Health Related Quality of Life (HRQoL) assessed by the 15D instrument during pregnancy and postpartum in different body mass index groups: a longitudinal survey.
abstract: BACKGROUND
  Only little information is available on health-related quality of life (HRQoL) and its changes during the course of a normal pregnancy. We studied changes in HRQoL in a pregnant population during pregnancy and until 1 year postpartum in different body mass index (BMI) groups.
  
  
  METHODS
  Seven hundred and fifty pregnant women attending the first ultrasound examination before gestational week 14 were invited to participate in a longitudinal, communal-based survey. The participants were divided into three groups according to their BMI; <25, 25-29.9, and ≥30 kg/m2. The women were asked to fill in questionnaires assessing HRQoL (15D), depressive symptoms (Edinburgh Depression Scale, EPDS), medical, obstetric and socioeconomic status at baseline. HRQoL and EPDS were re-assessed at 30 weeks of gestation, and 6 weeks, 3 and 12 months postpartum.
  
  
  RESULTS
  Of the invited 750 mothers, 325 (43%) returned the questionnaires and at least one follow-up questionnaire. At baseline, mean 15D scores decreased with increasing BMI but the difference was not statistically significant when adjusted for age, educational attainment, parity or EPDS-scores (0.929, 0.921 and 0.916, p = 0.16). During the course of pregnancy, the HRQoL of all women decreased but this decrease was significantly greater in the obese group (-0.088; 95% CI -0.110 to -0.065) than in the other groups [-0.054 (95% CI -0.062 to -0.045) and -0.051 (95% CI -0.068 to -0.033), p = 0.019]. Within 3 months postpartum the mean HRQoL recovered in all BMI groups to baseline levels, irrespective of the mode of delivery or pregnancy-related complications.
  
  
  CONCLUSIONS
  The burden of pregnancy is heavier for the heaviest.
authors.affiliation: Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Niina
authors.initials: N
authors.lastname: Sahrakorpi
authors.affiliation: Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland.|Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland.
authors.forename: Saila B
authors.initials: SB
authors.lastname: Koivusalo
authors.affiliation: Department of Obstetrics and Gynecology, South-Karelia Central Hospital, Lappeenranta, Finland.
authors.forename: Beata
authors.initials: B
authors.lastname: Stach-Lempinen
authors.affiliation: Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.|Folkhälsan Research Center, Helsinki, University of Helsinki, Helsinki, Finland.
authors.forename: Johan G
authors.initials: JG
authors.lastname: Eriksson
authors.affiliation: Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.|Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland.
authors.forename: Hannu
authors.initials: H
authors.lastname: Kautiainen
authors.affiliation: Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland.|Group Administration, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Risto P
authors.initials: RP
authors.lastname: Roine
mesh_terms: D000328:Adult; D015992:Body Mass Index; D019052:Depression, Postpartum / Q000523:psychology*; D005260:Female; D005387:Finland; D006801:Humans; D008137:Longitudinal Studies; D008427:Maternal Health Services; D009765:Obesity / Q000523:psychology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D011795:Surveys and Questionnaires
keywords: Body mass index; HRQoL; obesity; postpartum; pregnancy