The impact of hypertension, hemorrhage, and other maternal morbidities on functioning in the postpartum period as assessed by the WHODAS 2.0 36-item tool

Abstract

ObjectiveTo assess the scores of postpartum women using the WHO Disability Assessment Schedule 2.0 36‐item tool (WHODAS‐36), considering different morbidities.MethodsSecondary analysis of a retrospective cohort of women who delivered at a referral maternity in Brazil and were classified with and without severe maternal morbidity (SMM). WHODAS‐36 was used to assess functioning in postpartum women. Percentile distribution of total WHODAS score was compared across three groups: Percentile (P)<10, 10<P<90, and P>90. Cases of SMM were categorized and WHODAS‐36 score was assessed according to hypertension, hemorrhage, or other conditions.ResultsA total of 638 women were enrolled: 64 had mean scores below P<10 (1.09) and 66 were above P>90 (41.3). Of women scoring above P>90, those with morbidity had a higher mean score than those without (44.6% vs 36.8%, P=0.879). Women with higher WHODAS‐36 scores presented more complications during pregnancy, especially hypertension (47.0% vs 37.5%, P=0.09). Mean scores among women with any complication were higher than those with no morbidity (19.0 vs 14.2, P=0.01). WHODAS‐36 scores were higher among women with hypertensive complications (19.9 vs 16.0, P=0.004), but lower among those with hemorrhagic complications (13.8 vs 17.7, P=0.09).ConclusionsComplications during pregnancy, childbirth, and the puerperium increase long‐term WHODAS‐36 scores, demonstrating a persistent impact on functioning among women, up to 5 years postpartum.

Reference ranges of the WHO Disability Assessment Schedule (WHODAS 2.0) score and diagnostic validity of its 12-item version in identifying altered functioning in healthy postpartum women

“…Scores for five domains of WHODAS‐36 (all except domain 4) were significantly different, generally depicting a dose‐dependent effect according to the presence and severity of morbidity (except for domains 1 and 4). The mean WHODAS scores were higher for women with ongoing medical diseases in comparison with those without . Additionally, we examined the 31 perinatal deaths in the sample (29 in the group of maternal morbidity), and found no significant impact of perinatal death on general or domain scores.…”

“…The mean WHODAS scores were higher for women with ongoing medical diseases in comparison with those without. 20 Additionally, we examined the 31 perinatal deaths in the sample (29 in the group of maternal morbidity), and found no significant impact of perinatal death on general or domain scores.…”

A new conceptual framework for maternal morbidity

“…For example, life‐threatening postpartum hemorrhage and its associated impact on hemoglobin levels can lead to a loss of women's productivity; whereas the loss of a baby will affect the psychological well‐being of a mother, but can also bring a couple or a family closer together in facing adversity. Pregnancy, childbirth, and the lived experience of the postnatal period may also have an independent impact on health, social, and economic functioning and well‐being, whether a woman has recovered or not, but this framework assumes that the more severe the morbidity the higher the risk or probability of an adverse effect on functioning and well‐being …”

“…Pregnancy, childbirth, and the lived experience of the postnatal period may also have an independent impact on health, social, and economic functioning and well-being, whether a woman has recovered or not, but this framework assumes that the more severe the morbidity the higher the risk or probability of an adverse effect on functioning and well-being. 34 The reproductive health cycle (represented by an ellipse) is placed at the center of the framework, linking the different stages of pregnancy, labor, and childbirth to the puerperium, and pre-reproductive life to the postreproductive part of the life cycle. A maternal morbidity can start at any time during pregnancy, childbirth, or after pregnancy, and it may be self-limiting, or may continue.…”

Disability and functioning of women with low‐risk pregnancy: Assessment using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0)

“…In the area of maternity, there are only a small number of studies assessing functioning and disability in terms of the ICF. Furthermore, these studies have a focus on the postpartum period and severe maternal morbidity, therefore there is a lack of knowledge in the field of functioning and disability among women with low‐risk pregnancy, without severe complications, and the conditions that can lead to limitation in activity and restriction of participation.…”