Abstract
OBJECTIVE: To characterize the changes in health status experienced by a multi-ethnic cohort of women during and after pregnancy.
DESIGN: Observational cohort.
SETTING/PARTICIPANTS: Pregnant women from 1 of 6 sites in the San Francisco area (N=1,809).
MEASUREMENTS AND MAIN RESULTS: Women who agreed to participate were asked to complete a series of telephone surveys that ascertained health status as well as demographic and medical factors. Substantial changes in health status occurred over the course of pregnancy. For example, physical function declined, from a mean score of 95.2 prior to pregnancy to 58.1 during the third trimester (0–100 scale, where 100 represents better health), and improved during the postpartum period (mean score, 90.7). The prevalence of depressive symptoms rose from 11.7% prior to pregnancy to 25.2% during the third trimester, and then declined to 14.2% during the postpartum period. Insufficient money for food or housing and lack of exercise were associated with poor health status before, during, and after pregnancy.
CONCLUSIONS: Women experience substantial changes in health status during and after pregnancy. These data should guide the expectations of women, their health care providers, and public policy.
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Hueston WJ, Kasik-Miller S. Changes in functional health status during normal pregnancy. J Fam Pract. 1998;47:209–12.
Otchet F, Carey MS, Adam L. General health and psychological symptom status in pregnancy and the puerperium: what is normal? Obstet Gynecol. 1999;94:935–41.
McKee MD, Cunningham M, Jankowski KR, Zayas L. Health-related functional status in pregnancy: relationship to depression and social support in a multi-ethnic population. Obstet Gynecol. 2001;97:988–93.
Smith K, Downs B, O'Connell M. Maternity Leave and Employment Patterns: 1961–1955, Vol. P70–79. Washington, DC: U.S. Census Bureau; 2001. Current Population Reports.
Starfield B. Primary Care: Balancing Health Needs, Services, and Technology. New York, NY: Oxford University Press; 1998.
Grumbach K, Bodenheimer T. A primary care home for Americans: putting the house in order. JAMA. 2002;288:889–93.
Haas JS, Meneses V, McCormick MC. Outcomes and health status of socially disadvantaged women during pregnancy. J Womens Health Gend Based Med. 1999;8:547–53.
Ware JE Jr. SF-36 Health Survey: Manual and Interpretation Guide. Boston, MA: The Health Institute; 1993.
Gonzalez VM, Stewart A, Ritter PL, Lorig K. Translation and validation of arthritis outcome measures into Spanish. Arthritis Rheum. 1995;38:1429–46.
Ren XS, Amick B III, Zhou L, Gandek B. Translation and psychometric evaluation of a Chinese version of the SF-36 Health Survey in the United States. J Clin Epidemiol. 1998;51:1129–38.
Lam CL, Gandek B, Ren XS, Chan MS. Tests of scaling assumptions and construct validity of the Chinese (HK) version of the SF-36 Health Survey. J Clin Epidemiol. 1998;51:1139–47.
Andresen EM, Malmgren JA, Carter WB, Patrick DL. Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). Am J Prev Med. 1994;10:77–84.
Perez-Stable EJ, Marin G, Marin BV, Katz MH. Depressive symptoms and cigarette smoking among Latinos in San Francisco. Am J Public Health. 1990;80:1500–2.
Bush B, Shaw S, Cleary P, Delbanco TL, Aronson MD. Screening for alcohol abuse using the CAGE questionnaire. Am J Med. 1987;82:231–5.
McHorney CA, Ware JE Jr, Lu JF, Sherbourne CD. The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care. 1994;32:40–66.
Haas JS, McCormick MC. Hospital use and health status of women during the 5 years following the birth of a premature, low-birthweight infant. Am J Public Health. 1997;87:1151–5.
Goldenberg RL, Rouse DJ. Prevention of premature birth. N Engl J Med. 1998;339:313–20.
Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics. 3rd ed. New York, NY: Churchill Linvingstone; 1996.
Rosenfield A, Maine D. Maternal mortality—a neglected tragedy. Where is the M in MCH? Lancet. 1985;2:83–5.
Koonin LM, MacKay AP, Berg CJ, Atrash HK, Smith JC. Pregnancy-related mortality surveillance—United States, 1987–1990. MMWR CDC Surveill Summ. 1997;46:17–36.
Sachs BP, Brown DA, Driscoll SG, et al. Maternal mortality in Massachusetts. Trends and prevention. N Engl J Med. 1987;316:667–72.
Tarlov AR, Ware JE Jr, Greenfield S, Nelson EC, Perrin E, Zubkoff M. The Medical Outcomes Study. An application of methods for monitoring the results of medical care. JAMA. 1989;262:925–30.
Calkins DR, Rubenstein LV, Cleary PD, et al. Failure of physicians to recognize functional disability in ambulatory patients. Ann Intern Med. 1991;114:451–4.
Ganz PA, Moinpour CM, Pauler DK, et al. Health status and quality of life in patients with early-stage Hodgkin’s disease treated on Southwest Oncology Group Study 9133. J Clin Oncol. 2003;21:3512–9.
Ruo B, Rumsfeld JS, Hlatky MA, Liu H, Browner WS, Whooley MA. Depressive symptoms and health-related quality of life: the Heart and Soul Study. JAMA. 2003;290:215–21.
Rumsfeld JS, MaWhinney S, McCarthy M Jr, et al. Health-related quality of life as a predictor of mortality following coronary artery bypass graft surgery. Participants of the Department of Veterans Affairs Cooperative Study Group on Processes, Structures, and Outcomes of Care in Cardiac Surgery. JAMA. 1999;281:1298–303.
Eisenman DP, Gelberg L, Liu H, Shapiro MF. Mental health and health-related quality of life among adult Latino primary care patients living in the United States with previous exposure to political violence. JAMA. 2003;290:627–34.
Permanyer G, Alonso J, Alijarde-Guimera M, Soler-Soler J. Comparison of perceived health status and conventional functional evaluation in stable patients with coronary artery disease. J Clin Epidemiol. 1991;44:779–86.
Lee TH, Shammash JB, Ribeiro JP, Hartley LH, Sherwood J, Goldman L. Estimation of maximum oxygen uptake from clinical data: performance of the Specific Activity Scale. Am Heart J. 1988;115(pt 1):203–4.
McCallum J, Shadbolt B, Wang D. Self-related health and survival: a 7-year follow-up study of Australian elderly. Am J Public Health. 1994;84:1100–5.
Lowrie EG, Curtin RB, Lepain N, Schatell D. Medical outcomes study short form-36: a consistent and powerful predictor of morbidity and mortality in dialysis patients. Am J Kidney Dis. 2003;41:1286–92.
O’Hara MW, Zekoski EM, Philipps LH, Wright EJ. Controlled prospective study of postpartum mood disorders: comparison of childbearing and nonchildbearing women. J Abnorm Psychol. 1990;99:3–15.
Evans J, Heron J, Francomb H, Oke S, Golding J. Cohort study of depressed mood during pregnancy and after childbirth. BMJ. 2001;323:257–60.
Georgiopoulos AM, Bryan TL, Yawn BP, Houston MS, Rummans TA, Therneau TM. Population-based screening for postpartum depression. Obstet Gynecol. 1999;93(pt 1):653–7.
Pajulo M, Savonlahti E, Sourander A, Helenius H, Piha J. Antenatal depression, substance dependency and social support. J Affect Disord. 2001;65:9–17.
Marcus SM, Flynn HA, Blow FC, Barry KL. Depressive symptoms among pregnant women screened in obstetrics settings. J Womens Health (Larchmt). 2003;12:373–80.
Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994;51:8–19.
Dayan J, Creveuil C, Herlicoviez M, et al. Role of anxiety and depression in the onset of spontaneous preterm labor. Am J Epidemiol. 2002;155:293–301.
ACOG committee opinion. Exercise during pregnancy and the postpartum period. Number 267, January 2002. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet. 2002;77:79–81.
Kramer MS. Aerobic exercise for women during pregnancy. Cochrane Database Syst Rev. 2002;(2):CD000180. Review.
McGovern P, Dowd B, Gjerdingen D, Moscovice I, Kochevar L, Murphy S. The determinants of time off work after childbirth. J Health Polit Policy Law. 2000;25:527–64.
Sydsjo G, Sydsjo A. Newly delivered women’s evaluation of personal health status and attitudes towards sickness absence and social benefits. Acta Obstet Gynecol Scand. 2002;81:104–11.
Perneger TV, Etter JF, Rougemont A. Prospective versus retrospective measurement of change in health status: a community based study in Geneva, Switzerland. J Epidemiol Community Health. 1997;51:320–5.
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None of the authors has a conflict of interest.
This work was supported by the National Institute of Child Health and Human Development (R01 HD37389).
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Haas, J.S., Jackson, R.A., Fuentes-Afflick, E. et al. Changes in the health status of women during and after pregnancy. J GEN INTERN MED 20, 45–51 (2005). https://doi.org/10.1111/j.1525-1497.2004.40097.x
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DOI: https://doi.org/10.1111/j.1525-1497.2004.40097.x