Identification of postpartum symptom subgroups and associated long‐term maternal depressive symptoms and well‐being

Abstract

Many postpartum women experience postpartum symptoms which often occur in clusters (i.e., three or more co‐occurring symptoms that are related to each other). To date, research has focused on individual symptoms, which limits our understanding of how postpartum symptom clusters manifest and influence health. This secondary analysis used the Community and Child Health Network study data (N = 1784). No patient or public directly participated or contributed to the current analysis. Guided by the Symptom Management Theory, latent class analysis was performed to identify subgroups of postpartum women with different symptom experiences using observed variables at 6 months postpartum: anxiety (MINI‐anxiety), general stress (PSS‐10), posttraumatic stress (PCL‐C), postpartum depression (EPDS), sleep disturbance (PSQI‐sleep disturbance), and sleep duration (PSQI‐sleep duration). Bivariate and multiple regression analyses were conducted to examine the association between subgroups and (a) individual characteristics and (b) long‐term depressive symptoms (CES‐D‐9) and well‐being at 18 and/or 24 months postpartum. Five subgroups were selected that had better‐fit indices, entropy, and interpretability. Subgroups were labeled as (1) Minimum overall, (2) Mild‐moderate overall, (3) Moderate‐high sleep symptoms, (4) High psychological symptoms, and (5) High overall. After adjusting for covariates, postpartum women in Subgroups 4 and 5 had higher CES‐D‐9 scores at 18 and 24 months and lower well‐being scores at 24 months. More postpartum women in Subgroups 4 and 5 experienced a history of depression or unemployment. Clinicians should provide targeted interventions for postpartum women in high‐symptom subgroups.

Examination of Maternal Allostatic Load Among Postpartum Women With Distinct Postpartum Symptom Typologies

“…Five different postpartum symptom typologies identified in our previous study were used as categorical independent variables (Figure 1). The details regarding the identification of symptom typologies can be found elsewhere (Scroggins et al, 2023). Briefly, LCA was conducted to identify subgroups of postpartum women with different symptom typologies at 6 months postpartum using six symptom indicator variables (anxiety, general stress, posttraumatic stress, postpartum depression, sleep disturbance, sleep duration).…”

“…Although there are few existing studies examining overall allostatic load and individual biomarkers in postpartum women, no studies have examined allostatic load for primary and secondary mediators representing different body systems in postpartum women and how they are associated with different postpartum symptom typologies. In our previous study (Scroggins et al, 2023), we conducted latent class analysis (LCA) and identified subgroups of postpartum women with distinct postpartum symptom typologies using observed symptom variables (anxiety, general stress, posttraumatic stress, postpartum depression, sleep disturbance, and sleep duration), available in the existing Community Child Health Network (CCHN) study data. While our previous study was important to advance our understanding of complex postpartum symptom experiences, we still have limited knowledge as to how the symptom typologies influence maternal allostatic load.…”