Postpartum symptom clusters in birthing individuals: A systematic review

Abstract

Background: Birthing individuals experience various postpartum symptoms which have been associated with adverse health outcomes. Previous systematic reviews have focused on the examination of individual symptoms and their impact on health, which have limited our understanding of postpartum symptom clusters. Objective: To examine the compositions of symptom clusters, analytic methodologies and predictors of symptom clusters in birthing individuals up to 1 year postpartum. Design: Systematic review. Methods: This systematic review was reported following the PRISMA. Five databases were searched: PubMed, Embase, CINAHL Complete, PsycINFO and Scopus. Two reviewers performed title and abstract and full-text screening independently. StandardQuality Assessment Criteria were used to assess the articles' qualities. Key information was extracted into evidence table, which was checked for accuracy and completeness. A narrative synthesis was conducted.Results: A total of 30 articles were included. Studies were conducted in 16 countries, mostly in Europe (n = 9) and North America (n = 7). The majority were quantitative (n = 27) and cross-sectional (n = 27). Factor analysis was the most frequently used analytic methodology (n = 21). All three qualitative studies used grounded theory.Taking into consideration the variations among the studies, stress (n = 15, infant or partner-related and from other sources), depression (n = 12), somatic (n = 12) and anxiety clusters (n = 10) were most frequently identified. Symptom cluster predictors were examined in less than half of the included studies (n = 13). Among these, most were focused on how individual postpartum symptoms influence symptom clusters. Conclusions: Stress, depression, somatic and anxiety clusters are the most frequently identified postpartum symptom clusters. Future studies should examine the consistency, stability and clinical meaningfulness of these four symptom clusters. Relevance to clinical practice: The identification and management of the four symptom clusters should be of particular interest to clinicians and researchers.No patient or public contribution: This systematic review did not directly involve patient or public contribution to the manuscript.

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

“…At 6 months, one out of three postpartum women experiences sleep disturbance and perceived stress while up to 17% and 10% experience postpartum depression and posttraumatic stress respectively (Declercq et al, 2013; Dørheim et al, 2009; Sorenson & Tschetter, 2010). Stress, depression, and anxiety clusters are also three of the most frequently identified postpartum symptom clusters (Scroggins et al, 2022). These studies collectively support examining the included symptoms.…”

“…Both approaches are important in understanding symptom cluster experiences (Miaskowski et al, 2017). Yet, limited studies have used a priori approach, such as LCA, in postpartum women despite similar conceptual and statistical approaches being widely used in other health populations including those with chronic illness (Miaskowski et al, 2017; Scroggins et al, 2022). This is a critical gap because LCA allows the identification of (1) patient subgroups who are at a greater risk for worse symptom experiences and (2) subgroup characteristics to inform personalized symptom management, which is lacking in current practice (Hickey et al, 2019; Miaskowski et al, 2017).…”

Maternal Psychological Symptom Trajectories from 2 to 24 Months Postpartum: A Latent Class Growth Analysis

“…However, previous research has focused on individual symptom trajectories rather than multiple trajectories of co-occurring symptoms. This is a critical limitation considering postpartum women experience multiple, interrelated psychological symptoms concurrently (Scroggins et al, 2023). As such, it also remains unknown how SDOH influence multiple co-occurring symptom trajectories.…”