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Mode of delivery and long-term health-related quality-of-life outcomes : a prospective population-based study

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Petrou, Stavros, Kim, Sung Wook, McParland, Penny and Boyle, Elaine M. (2016) Mode of delivery and long-term health-related quality-of-life outcomes : a prospective population-based study. Birth, 44 (2). pp. 110-119. doi:10.1111/birt.12268

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Official URL: http://dx.doi.org/10.1111/birt.12268

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Abstract

Background

Relatively little is known about the effects of mode of delivery on long-term health-related quality-of-life outcomes. Furthermore, no previous study has expressed these outcomes in preference-based (utility) metrics.
Methods

The study population comprised 2,161 mothers recruited from a prospective population-based study in the East Midlands of England encompassing live births and stillbirths between 32+0 and 36+6 weeks’ gestation and a sample of term-born controls. Perinatal data were extracted from the mothers’ maternity records. Health-related quality-of-life outcomes were assessed at 12 months postpartum, using the EuroQol Five Dimensions (EQ-5D) measure with responses to the EQ-5D descriptive system converted into health utility scores. Descriptive statistics and multivariable analyses were used to estimate the relationship between the mode of delivery and health-related quality-of-life outcomes.
Results

The overall health-related quality-of-life profile of the women in the study cohort mirrored that of the English adult population as revealed by national health surveys. A significantly higher proportion of women delivering by cesarean delivery reported some, moderate, severe, or extreme pain or discomfort at 12 months postpartum than women undergoing spontaneous vaginal delivery. Multivariable analyses, using the Ordinary Least Squares estimator revealed that, after controlling for maternal sociodemographic characteristics, cesarean delivery without maternal or fetal compromise was associated with a significant EQ-5D utility decrement in comparison to spontaneous vaginal delivery among all women (−0.026; p = 0.038) and among mothers of term-born infants (−0.062; p < 0.001). Among mothers of term-born infants, this result was replicated in models that controlled for all maternal and infant characteristics (utility decrement of −0.061; p < 0.001). The results were confirmed by sensitivity analyses that varied the categorization of the main exposure variable (mode of delivery) and the econometric strategy.
Conclusions

Among mothers of term-born infants, cesarean delivery without maternal or fetal compromise is associated with poorer long-term health-related quality of life in comparison to spontaneous vaginal delivery. Further longitudinal studies are needed to understand the magnitude, trajectory, and underpinning mechanisms of health-related quality-of-life outcomes following different modes of delivery.

Item Type: Journal Article
Subjects: H Social Sciences > HN Social history and conditions. Social problems. Social reform
H Social Sciences > HQ The family. Marriage. Woman
R Medicine > RA Public aspects of medicine
R Medicine > RG Gynecology and obstetrics
Divisions: Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Mental Health and Wellbeing
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Quality of life , Health status indicators, Childbirth
Journal or Publication Title: Birth
Publisher: Wiley-Blackwell Publishing, Inc.
ISSN: 0730-7659
Official Date: 14 November 2016
Dates:
DateEvent
14 November 2016Available
30 September 2016Accepted
Volume: 44
Number: 2
Page Range: pp. 110-119
DOI: 10.1111/birt.12268
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Restricted or Subscription Access
Funder: Great Britain. Department of Health (DoH), National Institute for Health Research (Great Britain) (NIHR), Birmingham Science City Translational Medicine Clinical Research and Infrastructure Trials Platform (Great Britain), Advantage West Midlands (AWM)
Grant number: RP-PG-0407-10029 (NIHR),
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