Impact of maternal morbidities on the longitudinal health-related quality of life trajectories among women who gave childbirth in four hospitals of Northwest Ethiopia: a group-based trajectory modelling study

OBJECTIVES: To identify distinct trajectories of health-related quality of life and its predictors among postpartum women in Northwest Ethiopia. DESIGN: Health facility-linked community-based prospective follow-up study. SETTING: South Gondar zone, Northwest Ethiopia. PARTICIPANTS: We recruited 775 mothers (252 exposed and 523 non-exposed) after childbirth and before discharge. Exposed and non-exposed mothers were identified based on the criteria published by the WHO Maternal Morbidity Working Group. OUTCOME MEASURES: The primary outcome measure of this study was trajectories of health-related quality of life. The Stata Traj package was used to determine the trajectories using a group-based trajectory modelling. Multinomial logistic regression model was used to identify predictors of trajectory membership. RESULTS: Four distinct trajectories for physical and psychological and five trajectories for the social relationships and environmental health-related quality of life were identified. Direct and indirect maternal morbidities, lower educational status, poor social support, being government employed and merchant/student in occupation, vaginal delivery, lower monthly expenditure, stress, fear of childbirth and anxiety were found to be predictors of lower health-related quality of life trajectory group membership. CONCLUSIONS: Health professionals should target maternal morbidities and mental health problems when developing health intervention strategies to improve maternal health-related quality of life in the postpartum period. Developing encouraging strategies for social support and providing health education or counselling for women with less or no education are essential to avert the decrease in health-related quality of life trajectories of postpartum women.