Psychosocial determinants of sustained maternal functional impairment: Longitudinal findings from a pregnancy-birth cohort study in rural Pakistan

Abstract

Function is an important marker of health throughout the life course, however, in low-and-middle-income-countries, little is known about the burden of functional impairment as women transition from pregnancy to the first year post-partum. Leveraging longitudinal data from 960 women participating in the Share Child Cohort in Pakistan, this study sought to (1) characterize functional trajectories over time among women in their perinatal period and (2) assess predictors of chronic poor functioning following childbirth. We used a group-based trajectory modeling approach to examine maternal patterns of function from the third trimester of pregnancy through 12 months post-partum. Three trajectory groups were found: persistently well-functioning (51% of women), poor functioning with recovery (39% of women), and chronically poor functioning (10% of women). When compared to mothers in the highest functioning group, psychosocial characteristics (e.g., depression, stress, and serious life events) were significantly associated with sustained poor functioning one-year following child-birth. Mothers living in nuclear households were more likely to experience chronic poor functioning. Higher education independently predicted maternal function recovery, even when controlling for psychosocial characteristics. Education, above and beyond socio-economic assets, appears to play an important protective role in maternal functional trajectories following childbirth. Public health implications related to maternal function and perinatal mental health are discussed.

Longitudinal functional status trajectories and its predictors among postpartum women with and without maternal morbidities in Northwest Ethiopia: a group based multi-trajectory modelling

“…In our study, relative to the well-functioning trajectory, women with lower education level were more likely to belong to the very poor functional trajectory group as compared with women with higher education status. This is in line with the results of previous studies, which reported that high level of education was associated with greater functional status 16 49 55. This might be due to the fact that higher education may enhance resilience and significantly increase likelihood of recovery.…”

“…Additionally, we required at least 10% of the sample to be present in a particular group and all trajectories were distinct from one another by visual assessment of trajectory figures looking for non-overlapping confidence intervals 46. The labelling of each trajectory was based on a previous research work 49…”

“…46 The labelling of each trajectory was based on a previous research work. 49 Finally, we have used multinomial logistic regression model to identify factors that were associated with probability of group (trajectory) membership. First, unadjusted bivariable associations between each predictor and trajectory membership were tested in order to identify predictors having a p value of ≤0.2 to enter into the multivariable multinomial logistic regression.…”

Adverse Childhood Experiences and Implications of Perceived Stress, Anxiety, and Cortisol Among Women in Pakistan

“…In LMIC, home violence in the form of interpersonal violence is particularly common, which is also re ected in our sample (51,52). Home violence was the only domain that signi cantly predicted cortisol, possibly because it is linked to consequences that are emotional in nature: isolation, fear, guilt, low self-esteem (53).…”

Longitudinal mediation analysis of the factors associated with trajectories of posttraumatic stress disorder symptoms among postpartum women in Northwest Ethiopia: Application of the Karlson-Holm-Breen (KHB) method

“…High values of entropy (> .80) indicate that individuals are classified with confidence (i.e., the model is generally pretty sure that persons belong to a particular class) and there is adequate separation between the latent classes [ 66 ]. Additionally, we required at least 5% of the sample to be present in a particular group and all trajectories were distinct from one another by visual assessment of trajectory figures looking for nonoverlapping confidence intervals [ 65 , 67 , 68 ]. The labeling of each trajectory was based on a previous research work [ 1 ].…”