However, few studies have examined the relations between postpartum Hb levels with different measures of maternal health status, such as impaired physical functioning or fatigue. Because postpartum anemia has been linked to a number of important postpartum morbidities, including depression, reduced cognition, and fatigue, the potential detrimental influence of postpartum anemia on maternal and newborn health has clinical and public health relevance. At 24 – 48 hours after delivery, postpartum anemia (defined as a hemoglobin (Hb) <11 g/dL) can affect 50% women.
Postpartum anemia is an underappreciated maternal morbidity with a high prevalence. Identifying determinants of poor maternal health status after delivery, therefore, provides an opportunity to intervene at multiple points on the causal pathway, with the goal of optimizing mothers’ HRQoL. These goals directly apply to postpartum women who may experience debilitating disorders of HRQoL, such as depression, fatigue, and pain. Furthermore, improving HRQoL and well-being is one of four initiatives and foundation measures proposed for Healthy People 2020, a US federal plan for building a healthier nation. Measurements of HRQoL provide important insight into patients’ experiences of medical care, and are useful supplements to more traditional physiological or biological indices of health status and recovery after surgery or childbirth. Health related quality of life (HRQoL) is recognized as an important outcome in clinical and comparative effectiveness studies, and in research studies evaluating quality of medical care. Future studies are needed to determine whether postpartum Hb influences HRQoL among women with moderate or severe postpartum anemia. However, our findings may only apply to women without predelivery anemia, severe blood loss or moderate-to-severe anemia after delivery. Our findings suggest that postpartum Hb levels may not influence HRQoL or fatigue.
Based on the EPDS, only one patient was depressed her postpartum Hb was 11.2 g/dl. In our unadjusted and adjusted regression analyses, we observed no statistically significant associations between postpartum Hb level with any SF-36 or MFI subscale (P>0.05). The mean predelivery and postpartum Hb levels were 12.3 (1.2) g/dl and 10.8 (1.4) g/dl, respectively.
We performed unadjusted and multivariate linear regression (adjusting for maternal age, parity, mode of delivery, and race) to assess the associations between post-delivery Hb with each subscale of the SF-36 and MFI. We also assessed patients for postpartum depression using the Edinburgh Postpartum Depression Scale (EPDS). Maternal Hb levels were measured on admission and on the first postpartum day. We collected data from sixty women intending vaginal delivery, and assessed HRQoL and maternal fatigue on admission and on the first postpartum day using the RAND 36-Item Short-Form Health Survey (SF-36) and the Multidimensional Fatigue Inventory (MFI), respectively. We performed a prospective study to examine the relations between postpartum Hb levels with postpartum HRQoL. However, it is unclear whether postpartum anemia is associated with reduced health-related quality of life. Postpartum anemia has been associated with postpartum morbidities, such as depression and poor cognition.
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