Postpartum quality of life and mental health in women with heart disease: Integrated clinical communication and treatment

Table 1 Demographic characteristics and postpartum quality of life (mean ± SD)

Variables	n (%)		P value
Gestational age, yr	31.00 ± 5.0 (19.0-49.0)1		0.064
Gestational age, yr			0.266
< 25	8 (7.62)	97.78 ± 9.00
25-34	80 (76.19)	90.51 ± 13.81
≥ 35	17 (16.19)	88.21 ± 15.29
Education			0.915
No more than junior middle school	8 (7.62)	93.14 ± 10.87
Senior high school	13 (12.38)	87.84 ± 15.43
Junior college	24 (22.86)	91.86 ± 12.98
Bachelor degree	49 (46.67)	90.57 ± 15.17
Master’s degree or above	11 (10.48)	90.27 ± 10.35
Annual household income, RMB			0.559
< 30k	14 (13.33)	94.56 ± 13.24
30k-80k	23 (21.90)	91.70 ± 12.21
80k-120k	25 (23.81)	88.66 ± 16.69
120k-200k	22 (20.95)	89.66 ± 14.55
200k-300k	15 (14.29)	93.00 ± 9.55
≥ 300k	6 (5.71)	92.58 ± 15.15
Work conditions during pregnancy			0.337
Did not work	43 (40.95)	90.78 ± 13.53
Reduced workload	34 (32.38)	88.27 ± 15.47
No change and increase in workload	28 (26.67)	93.49 ± 11.96

¹Median ± interquartile range (range).

Table 2 Clinical characteristics and postpartum quality of life (mean ± SD)

Variables	n (%)		P value
Prepregnant BMI (kg/m2)			0.408
< 18.5 (leaner)	12 (11.43)	90.64 ± 13.90
18.5-24.9 (normal)	69 (65.71)	91.84 ± 14.57
≥ 25 (overweight and obesity)	24 (22.86)	87.43 ± 11.36
BMI increment (kg/m2)	4.92 ± 1.89 (-0.37 to 9.86)1		0.319
Pregnancy diagnosis			0.206
Yes	55 (52.38)	89.06 ± 12.55
No	50 (47.62)	92.49 ± 15.02
Prepregnant cardiac surgery			0.007b
Yes	32 (30.48)	96.14 ± 12.62
No	73 (69.52)	88.30 ± 13.73
Type of heart disease			0.075
Structural	74 (70.48)	92.25 ± 13.93
Functional	31 (29.52)	86.98 ± 13.03
mWHO classification			0.026a
Ⅰ	25 (23.81)	96.05 ± 13.48
Ⅱ	44 (41.90)	89.71 ± 13.42
Ⅱ-Ⅲ	9 (8.57)	80.42 ± 14.64
Ⅲ	10 (9.52)	95.47 ± 12.85
Ⅳ	17 (16.19)	87.97 ± 12.50
NYHA classification			< 0.001b
Ⅰ	64 (60.95)	94.58 ± 13.22
Ⅱ	33 (31.43)	87.01 ± 12.13
Ⅲ, Ⅳ	8 (7.62)	74.78 ± 10.11

¹Mean ± SD (range).

^aP < 0.05.

^bP < 0.01.

BMI: Body mass index; mWHO classification: modified World Health Organization pregnancy risk classification.

Table 3 Pregnancy characteristics and postpartum quality of life (mean ± SD)

Variables	n (%)		P value
Gravidity			0.524
1	64 (60.95)	90.26 ± 13.25
2	27 (25.71)	89.69 ± 15.53
≥ 3	14 (13.33)	94.58 ± 13.28
Parity			0.026a
Primiparas	91 (86.67)	91.86 ± 13.60
Multiparas	14 (13.33)	83.09 ± 13.29
Pregnancy complications			0.052
Yes	34 (32.38)	94.47 ± 12.90
No	71 (67.62)	88.88 ± 13.97
Planned pregnancy			0.085
Yes	69 (65.71)	92.37 ± 13.18
No	36 (34.29)	84.48 ± 14.62
Delivery method			0.529
Vaginal delivery	11 (10.48)	90.51 ± 14.77
Cesarean section	80 (76.19)	92.18 ± 13.73
Emergency cesarean section	14 (13.33)	87.40 ± 12.69
Gestational weeks, d	264.00 ± 19.0 (225.0-285.0)1		0.040a
Neonatal gender			0.079
Male	54 (51.43)	93.82 ± 13.66
Female	51 (48.57)	88.78 ± 13.31
Neonatal weight	2977.91 ± 591.63 (1640.0-4650.0)2		0.097
Neonatal hospitalization			0.037a
Yes	37 (35.24)	87.34 ± 14.57
No	68 (64.76)	93.58 ± 12.72
Milk-feeding way			0.965
Exclusive breastfeeding	40 (38.0)	91.02 ± 13.45
Mixed feeding	43 (41.0)	91.38 ± 13.11
Artificial feeding	22 (21.0)	92.07 ± 15.69

¹Median ± interquartile range (range).

²Mean ± SD (range).

^aP < 0.05.

Table 4 Descriptive statistics for the scales at 6 wk postpartum (mean ± SD)

Variables	Value
EPDS	≤ 9	52 (49.52)1
	10-12	18 (17.14)1
	≥ 13	35 (33.33)1
	Total	10.08 ± 5.08
CAQ	≥ 2	39 (37.14)1
	Avoidance	1.59 ± 0.82
	Fear	1.52 ± 0.73
	Heart-focused attention	2.40 ± 1.34
	Total	1.79 ± 0.79
EHFScBS	Total	35.38 ± 10.51
SF-12	PCS	41.09 ± 9.91
	MCS	49.60 ± 14.872
	Total	90.69 ± 13.82

¹n (%).

²Median ± interquartile range.

EPDS: Edinburgh Postnatal Depression Scale; CAQ: Cardiac Anxiety Questionnaire; EHFScBS: European Heart Failure Self-Care Behavior Scale; SF-12: 12-Item Short-Form Health Survey; PCS: Physical components summary; MCS: Mental components summary.

Table 5 Design-specific cardiac-related problems and quality of life at 6 wk postpartum (mean ± SD)

Variables	N (%)		P value
Compliance
Hospital review after ending the pregnancy			0.360
Yes	65 (61.90)	91.67 ± 12.85
No	40 (38.10)	89.11 ± 15.31
Understanding of the disease
Advised to avoid having children			0.125
Yes	41 (39.05)	88.10 ± 16.11
No	64 (60.95)	92.35 ± 11.98
Full consultation and understanding of the diagnosis			0.947
Yes	83 (79.05)	90.64 ± 14.36
No	22 (20.95)	90.87 ± 11.84
Medical concerns
Seek psychological counselling			0.907
Yes	3 (2.86)	89.77 ± 15.92
No	102 (97.14)	90.72 ± 13.85
Fear of a bad pregnancy			< 0.001c
Yes	60 (57.14)	86.38 ± 13.35
No	45 (42.86)	96.44 ± 12.39
Worried about child’s heart			0.016a
Yes	60 (57.14)	87.89 ± 13.76
No	45 (42.86)	94.42 ± 13.14
Worried about reduced longevity			0.007b
Yes	51 (48.57)	86.96 ± 14.16
No	54 (51.43)	94.22 ± 12.63

^aP < 0.05.

^bP < 0.01.

^cP < 0.001.

Table 6 Linear regression model results for the 12-Item Short-Form Health Survey

Predictors	β	Standard error	t	P value	95% confidence interval for β
Constant	127.304	6.431	19.795	< 0.001	114.543 to 140.065
Without prepregnant cardiac surgery	-7.532	2.040	-3.692	< 0.001	-11.580 to -3.484
CAQ	-5.264	1.242	-4.237	< 0.001	-0.429 to -0.155
EPDS	-0.189	0.197	-6.041	< 0.001	-1.580 to -0.799
No fear of a bad pregnancy	4.193	2.035	2.060	0.042	0.155 to 8.230
Multiparas	-7.457	2.781	-2.682	0.009	-12.974 to -1.939

EPDS: Edinburgh Postnatal Depression Scale; CAQ: Cardiac Anxiety Questionnaire. F(5,99) = 23.989; P < 0.001; R² = 0.548; adjusted R² = 0.525; D-W = 1.934.