Postpartum stress in the first 6 months after delivery: a longitudinal study in Nantong, China

Abstract

ObjectivesThe objective is to to explore the longitudinal change trajectories of postpartum stress and its related factors.DesignA longitudinal study with follow-ups from 42 days to 6 months after delivery.Settings and participantsA total of 406 postpartum women were recruited at baseline (42 days after delivery) from 6 hospitals in Nantong, Jiangsu Province, China, and followed up at 3 and 6 months. After the follow-ups, 358 postpartum women were retained for further analysis.MethodsPostpartum stress was evaluated using the Maternal Postpartum Stress Scale (MPSS) at baseline (42 days) and 3 and 6 months after delivery. MPSS has three dimensions, such as: personal needs and fatigue, infant nurturing and body changes and sexuality. Postpartum depression and anxiety were measured using the Edinburgh Postnatal Depression Scale and the short-form Depression, Anxiety and Stress Scale, respectively. The MPSS scores were normalised using a rank-based inverse normal transformation.ResultsPostpartum stress decreased significantly after 3 months, and postpartum stress reduced further after 6 months. Additionally, the scores for all three dimensions reduced after 6 months, while infant nurturing reduced after both 3 and 6 months. Older age (β=0.028, p=0.049), higher education level (β=0.153, p=0.005) and higher body mass index (BMI) (β=0.027, p=0.008) of the postpartum women were significantly associated with higher postpartum stress levels in corresponding dimensions at 42 days. Older age was also associated with higher postpartum stress at 3 (β=0.030, p=0.033) and 6 months (β=0.050, p<0.001) in the dimension of personal needs and fatigue. Postpartum stress levels were significantly higher in women with depression or anxiety symptoms.ConclusionsPostpartum stress continuously declined from 42 days to 6 months after delivery. Postpartum women with older age, higher education levels, higher BMI and anxiety or depression symptoms should be the target population for early intervention.

Assessment of Postpartum Stress Using the Maternal Postpartum Stress Scale (MPSS) in Spanish Women

“…The correlations were found to be nonstatistically significant, ranging from −0.15 to −0.02. Conversely to our findings, Wang et al [3] found associations between age, education levels (including paternal) and high BMI with all the dimensions of the MPSS. This may be due to sample size differences (167 vs. 406) or the specificity of the population of the study (Spanish-speaking women).…”

“…As this shows, those three items were most likely not working well and even hindering the reliability of the subscale they were part of. This may be taken into consideration when using the scale looking for an association between variables associated with postpartum stress [3]. Thus, as this is caused by low communality on these items, recommendations made by other authors were followed [29].…”

“…Moreover, these authors found that the associations vary during the postpartum phase depending on the month and the dimension, considering a higher BMI a determining factor 6 months after delivery affecting body changes and sexuality dimension [3]. Lewis et al [31] found in a randomized trial that exercise can help to reduce maternal perceived stress at 6 months postpartum.…”

“…Postpartum is a critical period for both the mother and child, and it can have negative effects on maternal health [1][2][3]. Postpartum stress is a common psychological response to the responsibilities of raising a child, and it often leads to recurrent and sometimes unrealistic concerns and fears about several aspects of motherhood and personal health [1].…”

“…Experiencing trauma during the existential experience of birth requires a distinctly different approach than other traumas [21]. Self-report measures may be more efficient in field studies and accessible for screening and early detection of postpartum stress [3].…”