In the present study, 519 postpartum women were invited to participate, 2 declined and the 2 women provided only sociodemographic data, therefore 515 gave full consent (Fig 1). The mean age was 28 years, women mostly had a partner, more than 50% were multiparous, the illiteracy level was less than 2.4% and most participants had a secondary level of education and were employed. Over one third of the population took 30-60 minutes to arrive from their house to the health service (Table 1).
Clinical conditions were initially considered through the question: "Since childbirth, have you been informed that there is something wrong / some medical condition?" and 30.2% of the women had a health condition reported by the attending physician, although more than 80% reported good or very good health. Considering the gestational results, a quarter (26.2%) had preterm birth, and 58.3% delivered by cesarean section; however, predominantly with good perinatal outcomes, 95.7% reported “good baby health” in the postpartum evaluation, with 88.1% of exclusive breastfeeding (Table 2).
Looking into detail in cases of clinical conditions, based on the question: "any pre-existing condition", the majority (51.7%) reported having a condition before pregnancy and childbirth (Table 2). A list of conditions, classified them as direct and indirect, of which 13.8% had gestational diabetes, followed by gestational hypertension (13.4%), preeclampsia (10.7%), chronic hypertension (8.2%) and, operative wound infection (1.7%), as the most prevalent types of diseases (Table 2).
An important approach, besides evaluating pre-existing conditions, was to evaluate the amount of abnormal conditions diagnosed or identified by WOICE. We found that (53.1%) had at least one abnormal condition identified by WOICE, a quarter of women (26%) had two concomitant conditions identified by WOICE and only 4.0% had no abnormal condition (Table 2).
We identified, through the WOICE questionnaire in this group of women, the use of substances, asking participants whether they used (cigarettes, alcoholic beverages, marijuana, inhalants, sedatives or sleeping pills, hallucinogens, opioids and/or injectable drugs for non-medical use) and 10.0% of the participants used some type of substance during pregnancy (Table 3). In this group of questions, we also asked "during pregnancy, someone (friend, relative or anyone) expressed concern about the use of any substance" and 66.7% expressed such concern, followed by 50% of women that "tried to reduce or stop consumption of any substance ".
Around 1/3 of women had already resumed their sex life after giving birth and 89.2% felt they were satisfied with their sex lives, however 55.6% (n=10) reported pain during intercourse (Table 3). Around 39% of the women used contraception and 77.2% of them were prescribed with a method during their first postpartum care medical visit.
Using the WOICE tool, tool, we explored exposure to domestic and sexual violence by asking participants "whether or not they were afraid of the current partner / most recent spouse or any other person" if the spouse / or any other person who pushed, hit and kicked”. In our sample, 5.9% reported to have suffered violence (Table 3).
As part of the Mental Health assessment of our study, we used the validated scales (PHQ-9 and GAD-7). Abnormal conditions were considered if scores ≥ 10 (12, 13) and almost 20% of the women had anxiety symptoms, followed by 36.9% with depressive symptoms. For the evaluation of functionality or ability to perform daily tasks, used WHODAS-12 version 2.0 and verified that the mean score was 10.9 (±12.9), we found 4.4% of the women had functional alterations (score≥37.4) (16). (Table 4).
The questionnaire was always performed after the scheduled medical consultation and with no interference in the woman’s medical follow-up. However, since some of the questions could potentially lead to unpleasant memories and reveal exposure to violence and substance abuse, additional support was offered. Among the included women, 28.3% used such support, of those 97% psychological support and 6.6% social service support (Table 5).
In order to investigate factors associated with impaired functioning, mental health and clinical conditions, we performed three multiple regression analyzes. For the first model, that considered WHODAS≥37.4 as the outcome, the conditions independently associated with abnormal functioning were the presence of impaired clinical health and increased age. Nevertheless, less education and having a partner were protective conditions towards the report of impaired functioning (table 6). In model 2, considering as outcome abnormal anxiety and depression (scores ≥10), illiteracy and poor overall health rating were associated with increased anxiety/depression. However, parity was protective.
In model 3, the clinical conditions reported by the woman (defined when the woman reported having been informed of a clinical diagnosis after delivery) were considered as outcomes and we identified that having a partner reduces the perception of women on the presence of morbidities by 30% clinics (Table 6).
To understand if the same women suffer from combined conditions, or if there was a pattern in the combination of abnormal findings, we presented a figure that evaluates each parameter and its combinations. Almost a quarter of the participants presented depression and anxiety (38.6%), followed by clinical conditions associated to depression (14.6%), anxiety with clinical conditions (13.3%) (Figure 2).