Measuring perinatal and postpartum quality of life of women and associated factors in semi-urban Bangladesh
The objective of this study was to measure the health-related quality of life (HRQoL) among pregnant women in the perinatal and postpartum periods and determine influencing factors that predict their HRQoL.
The study was conducted among pregnant women who live in a semi-urban area of Chandpur, Bangladesh. A total of 465 women were recruited. The EuroQoL 5-Dimension 3-Level (EQ-5D-3L) and EuroQoL visual analog scale (EQ-VAS) instruments were used to measure the HRQoL of participants. Two-sample mean test (t test) was performed to examine the changes in HRQoL between the perinatal and postnatal periods of the same individuals. Multivariate linear regression was employed to identify the factors influencing HRQoL during the two periods.
Overall, the HRQoL scores improved significantly from the perinatal (0.49) to postpartum (0.86) period. Approximately 58% of women experienced moderate or extreme levels of health problems during the perinatal period regardless of their health status. However, most women had significantly improved health status in the postpartum period. Gestational weight gain and recommended postnatal care were significantly associated with improved HRQoL. Factors that negatively influenced changes in HRQoL included adolescent motherhood, caesarean delivery, inadequate antenatal care consultations and living in a poor household, during both the perinatal and postpartum periods.
Overall health status is found to be poor among women during the perinatal period compared with the postpartum period. The study indicates that interventions to address the influencing factors are needed to ensure better quality of life for women both pre- and post-birth. Community-based initiatives, such as awareness building, might address negative factors and subsequently improve health status and reduce adverse health outcomes related to pregnancy and postnatal care.
KeywordsEQ-5D-3L EQ-VAS Health-related quality of life Pregnancy Bangladesh
We would like to thank the funding body “Grand Challenges Explorations of the Bill & Melinda Gates Foundation”. We would like to thank the women who participated in this study. Finally, we would like to gratefully acknowledge that study participant recruitment was facilitated and supported by the Maternal and Child Welfare Centre (MCWC), Chandpur, Bangladesh.
Conceptualised the study: RAM, ARS and MS. Contributed data extraction and analyses: RAM, under the guidance of ARS, KA and JG. Result interpretation: RAM, under the guidance of ARS, KA, JG and MS. Prepared the first draft: RAM. Contributed during the conceptualisation and interpretation of results and substantial revision: RAM, NA, NS, RA, ARS, MS, KA and JG. Revised and finalised the final draft manuscript: RAM, NA, NS, RA, ARS, MS, KA and JG. All authors read and approved the final version of the manuscript.
The present study was funded by Grand Challenges Explorations of the Bill and Melinda Gates Foundation and Grant Number was OPP1118550.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 3.Hwang, S. S., Smith, V. C., McCormick, M. C., & Barfield, W. D. (2012). The association between maternal oral health experiences and risk of preterm birth in 10 states, Pregnancy Risk Assessment Monitoring System, 2004–2006. Maternal and Child Health Journal, 16(8), 1688–1695.PubMedPubMedCentralGoogle Scholar
- 5.Semasaka, J. P. S., Krantz, G., Nzayirambaho, M., Munyanshongore, C., Edvardsson, K., & Mogren, I. (2016). Self-reported pregnancy-related health problems and self-rated health status in Rwandan women postpartum: A population-based cross-sectional study. BMC Pregnancy and Childbirth, 16(1), 1–17.Google Scholar
- 6.Sam, K., & Leung, W. K. (2017). Oral health-related quality of life and periodontal status. Maternal and Child Health Journal, 34(2), 114–122.Google Scholar
- 7.Schytt, E., Lindmark, G., & Waldenstro, U. (2005). Physical symptoms after childbirth: Prevalence and associations with self-rated health. BJOG: An International Journal of Obstetrics and Gynaecology, 112(2), 210–217.Google Scholar
- 8.Symon, A. (2003). A review of mothers’ prenatal and postnatal quality of life. Health and Quality of Life Outcomes, 1(38), 1–8.Google Scholar
- 9.Jomeen, J. (2004). The importance of assessing psychological status during pregnancy, childbirth and the postnatal period as a multidimensional construct: A literature review. Clinical Effectiveness in Nursing, 8(3–4), 143–155.Google Scholar
- 11.Castro, R. T. A., Anderman, C. P., Glover, V., Connor, T. G. O., Ehlert, U., & Kammerer, M. (2017). Associated symptoms of depression: Patterns of change during pregnancy. Archives of Women’s Mental Health, 20(1), 123–128.Google Scholar
- 15.Ministry of Health and Family Welfare, MoHFW. (2014). Health Bulletin: Chadpur (Sadar) Upazalia Health Office. Dhaka: Directorate General of Health Services (DGHS).Google Scholar
- 16.Sultana, M., Mahumud, R. A., Ali, N., Ahmed, S., Islam, Z., Khan, J. A. M., et al. (2017). The effectiveness of introducing Group Prenatal Care (GPC) in selected health facilities in a district of Bangladesh: Study protocol. BMC Pregnancy and Childbirth, 17(48), 1–7.Google Scholar
- 19.National Institute of Population Research and Training (NIPORT), Mitra and Associates, and ICF International. (2013). Bangladesh demographic and health survey 2011. Dhaka and Calverton, MD: NIPORT, Mitra and Associates, and ICF International.Google Scholar
- 22.The EuroQoL Group. (1990). EuroQoL—A new facility for the measurement of health-related quality of life. Health Policy, 16(3), 199–208.Google Scholar
- 23.Szende, A., Janssen, B., & Cabases, J. (Eds.). (2014). Self-reported population health: An international perspective based on EQ-5D. Dordrecht: Springer.Google Scholar
- 25.Sultana, M., Sarker, A. R., Mahumud, R. A., Ahmed, S., Ahmed, W., Chakrovorty, S., et al. (2016). Inequalities in health status from EQ-5D findings: A cross-sectional study in low-income communities of Bangladesh. International Journal Health Policy and Management, 5(5), 301–308.Google Scholar
- 26.Safita, N., Islam, S. M. S., Chow, C. K., Niessen, L., Lechner, A., Holle, R., et al. (2016). The impact of type 2 diabetes on health related quality of life in Bangladesh: Results from a matched study comparing treated cases with non-diabetic controls. Health and Quality of Life Outcomes, 14(129), 1–9.Google Scholar
- 29.Oviedo-Caro, M. A., Bueno-Antequera, J., & Munguía-Izquierdo, D. (2018). Explanatory factors and levels of health-related quality of life among healthy pregnant women at mid pregnancy: A cross sectional study of The PregnActive Project. Journal of Advance Nursing, 74, 2766–2776.Google Scholar
- 30.Lagadec, N., Steinecker, M., Kapassi, A., Magnier, A. M., Chastang, J., Robert, S., et al. (2018). Factors influencing the quality of life of pregnant women: A systematic review. BMC Pregnancy and Childbirth, 18(455), 1–14.Google Scholar
- 31.Moafi, F., Kazemi, F., Siboni, F. S., & Alimoradi, Z. (2018). The relationship between food security and quality of life among pregnant women. BMC Pregnancy and Childbirth, 18(319), 1–9.Google Scholar
- 32.Calou, C. G. P., de Oliveira, M. F., Carvalho, F. H. C., Soares, P. R. A. L., Bezerra, R. A., de Lima, S. K. M., et al. (2018). Maternal predictors related to quality of life in pregnant women in the Northeast of Brazil. Health and Quality of Life Outcomes, 16(109), 1–10.Google Scholar
- 34.Rutstein, S. O. (2015). Steps to constructing the new DHS Wealth Index. Rockville, MD: ICF International.Google Scholar
- 35.Streiner, D. L., & Norman, G. R. (2008). Health measurement scales: A practical guide to their development and use (4th ed.). Oxford: Oxford University Press.Google Scholar
- 36.Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: L. Erlbaum Associates.Google Scholar
- 38.Bonferroni, C. E. (1936). Teoria statistica delle classi e calcolo delle probabilità. Pubblicazioni del R Istituto Superiore di Scienze Economiche e Commerciali di Firenze, 8, 3–62.Google Scholar
- 39.Haas, J. S., Jackso, R. A., Fuentes-Afflick, E., Stewart, A. L., Dean, M. L., Brawarsky, P., et al. (2004). Changes in the health status of women during and after pregnancy. Journal of General Internal Medicine, 20(1), 45–51.Google Scholar
- 40.Sakthong, P., Charoenvisuthiwongs, R., & Shabunthom, R. (2008). A comparison of EQ-5D index scores using the UK, US, and Japan preference weights in a Thai sample with type 2 diabetes. Health and Quality of Life Outcomes, 6(71), 1–9.Google Scholar
- 41.Madjdian, D. S., & Bras, H. A. J. (2016). Family, gender, and women’s nutritional status: A comparison between two Himalayan communities in Nepal. Economic History of Developing Regions, 31(1), 1–30.Google Scholar
- 43.Carson, A., Chabot, C., Greyson, D., Shannon, K., Duff, P., & Shoveller, J. (2016). A narrative analysis of the birth stories of early-age mothers. Sociology of Health and Illness, 39(6), 1–16.Google Scholar
- 44.Pearsa, K. C., Fishera, P. A., Kima, H. K., Brucea, J., Healey, C. V., & Yoerger, K. (2013). Immediate effects of a school readiness intervention for children in foster care. Early Education and Development, 24(6), 771–791. https://doi.org/10.1080/10409289.2013.736037.immediate.CrossRefGoogle Scholar
- 46.Hitimana, R., Lindholm, L., Krantz, G., Nzayirambaho, M., Condo, J., Semasaka, J. P. S., et al. (2018). Health-related quality of life determinants among Rwandan women after delivery: Does antenatal care utilization matter? A cross-sectional study. Journal of Health, Population and Nutrition, 37(1), 1–10.Google Scholar
- 47.Hitimana, R., Lindholm, L., Krantz, G., Nzayirambaho, M., Sengoma, J. S., Condo, J., et al. (2017). Health related quality of life determinants for Rwandan women after delivery: Regis Hitimana. European Journal of Public Health, 27(3), ckx186.101.Google Scholar
- 50.Oyerinde, K. (2013). Community medicine and health education can antenatal care result in significant maternal mortality reduction in developing countries? Journal of Community Medicine and Health Education, 3, 2–3.Google Scholar
- 57.Villar, J., Carroli, G., Zavaleta, N., Donner, A., Wojdyla, D., Faundes, A., et al. (2007). Maternal and neonatal individual risks and benefits associated with caesarean delivery: Multicentre prospective study. British Medical Journal, 335, 1–11.Google Scholar
- 59.Petroul, S., & Khan, K. (2013). An overview of the health economic implications of elective caesarean section. Applied Health Economics and Health Policy, 11, 561–576.Google Scholar
- 61.Kusuma, Y. S., Kumari, R., & Kaushal, S. (2013). Migration and access to maternal healthcare: Determinants of adequate antenatal care and institutional delivery among socio-economically disadvantaged migrants in Delhi, India. Tropical Medicine and International Health, 18, 1202–1210.PubMedGoogle Scholar
- 64.Mahumud, R. A., Alamgir, N. I., Hossain, M. T., Baruwa, E., Sultana, M., Gow, J., et al. (2019). Women’s preferences for maternal healthcare services in Bangladesh: Evidence from a discrete choice experiment. Journal of Clinical Medicine, 8(2), 1–21.Google Scholar