Our study indicated that the diet pattern of women during 42 days postpartum in Guangzhou, China, had characteristics of adherence to eating yang food (such as chickens, red meat and eggs) and a restricted intake of yin food (like vegetables, fruits and milk), especially in suburban area. Traditional practices of “zuoyuezi”, such as reduced physical activities and regular intake of ginger vinegar soup are used universally. Besides, our study found that health problems in women during postpartum period were highly prevalent, and the dietary and behavioral factors were related to health.
Our study revealed that nearly 80% of the women reported at least one problem during postpartum period. Reported health problems included backache (43.0%), constipation (23.6%), breast swelling (18.5%) and hemorrhoids (13.8%), postpartum weight retention (3.5 kg). Other studies have found a similar result. In a India study, nearly three-fourths of women had reported illness during early postpartum period, the common morbidities were anaemia (53.4%) fever (4%), breast conditions (4.9%), and perineal conditions (4.5%) . In a cohort study in Bangladesh, nearly half (42%) of all women suffered from at least one morbidity, at 6–9 weeks after delivery, included genital infection (19%) and of urinary tract infections (12.3%) . The high incidence of health problems, will not only affect physical health of both women and infants, but also cause social consequences, such as decline in the life quality during postpartum period. And the logistic regression analysis in this study showed that certain postpartum dietary and behavioral practices were thought to be associated with health status.
In traditional Chineses belief, postpartum women are believed to need special dietary and behavioral approaches in the first month after childbirth to help physical recovery, which is known as “zuòyuèzi”. Those customs are associated with food taboo and confinement of practice, and vary considerably around cultures, but all focus on avoidance of yin food (raw or cold food, such as vegetable and fruits) and placement of restrictions on movement after giving birth . In this study, Regular intake of ginger vinegar during puerperium was popular in Guangzhou. Previous studies supported that ginger vinegar consumption is beneficial to recovery after childbirth and stimulating milk secretion, which is also popular in Hong Kong, China . But, the present study demonstrated that regular intake of ginger vinegar is a risk factor for insufficient milk secretion and prolonged uterine bleeding. Ginger was reported to improve breast milk volume in early postpartum period . While another study found that cows fed with high level of vinegar yielded less milk . Excessive intake of ginger will lead to hypertension, which may be contributed to increasing the risk of prolonged uterine bleeding . Hence, those reported differences may be ascribed to the different consumption and proportions of ginger and vinegar.
It was found that the intakes of animal food (250–350 g/d) and vegetables (> 500 g/d) were associated with less prolonged uterine bleeding. Additionally, no negative effects of fruit and vegetable intake were found, which showed that these traditional food taboos are not reasonable. Animal food contain a lot of high-quality proteins, which is beneficial for rehabilitation. Thus, appropriate intake of animal food and vegetables during postpartum period is encouraged. Besides, our survey found that too much consumption of cereals (> 450 g/d) is a risk factor for breast swelling and leg cramps, but the modest intake of cereals (250–450 g/d) is a protective factor for dizziness. Appropriate amounts of carbohydrate can promote physical recovery, and help maintain blood glucose, but it is not advised to be taken excessively.
In the present study, it was found that a range of behavioral practices are associated with health status. For instance, logistic regression revealed that breastfeeding likely to reduced the risk of backache and constipation. Breastfeeding have several health benefits for mother and baby. A follow-up study found that breastfeeding had beneficial effect on the recovery process of pelvic girdle pain after childbirth. Basking is associated with less hemorrhoids, breast swelling, lactation insufficiency and backache. Outdoor sunlight and the accompanying outdoor activities during postpartum period may be good to health. And sunlight spurs the body to produce vitamin D in skin, giving them important protection from a range of diseases and enhancing skeletal health. Studies supported moderate physical exercise or gymnastics after childbirth to accelerate reproductive recovery, help weight management, and enhance psychological well-being and physical fitness[34, 35]. According to the logistic regression analysis, it was found that doing postpartum exercise was related to less prolonged uterine bleeding and postpartum weight retention. Yet, resting in bed for 12 ~ 18 h/day was positively associated with backache and breast swelling, but bed rest time for greater than 18 h/d or less than 12 h/d is the risk factor for prolonged uterine bleeding, and lactation insufficiency, respectively. In addition, getting out of bed within two days after delivery was associated with less dizziness and leg cramps. And doing housework regularly during postpartum period will result in high incidence of backache and breast swelling. That is to say, regular exercise and adequate rest are equally important. A survey in the United States showed that career women were in poorer health status during postpartum period than other women, thus it is recommended to rest properly . Above all, it is advisable to stay in bed for 12–18 hours a day, get out of bed within 2 days after delivery and do postnatal exercises regularly on the basis of adequate rest. However, this survey did not find any adverse effects on bathing, shampooing, brushing teeth, basking; on the contrary, basking is still promoting factors for women's puerperal health, which showed that these traditional behavior taboos are not reasonable. In summary, the above results suggested that women should pay attention to regular outdoor sunbath, postpartum excise, good hygiene status and breastfeeding during postpartum period to promote physical recovery and stay away health problems.
Strengths and limitations
The first strength of this study was to recruit women from urban and suburban areas with a large sample size as well, allowing a comparison between those with their various degrees of adherence to traditional Chinese belief and practices during the postpartum period. The second strength was that trained interviewers conducted the face-to-face surveys and used the validated food frequency questionnaire to get quantitatively and comprehensive assessment of dietary and behavioral practices.
Two limitations of this study warrant mention. First, the health problems and body weight from pre-pregnancy to postpartum were self-reported. For health problems like backaches, breast swelling, constipation, cramp, haemorrhoids, etc, reportability is probably fairly reliable, since all of the interviewers were health professionals from maternal and child health clinic, and had trained uniformly before investigation, but self-reported maternal weight is error-prone, and the context of investigation may impact error distributions. Although the measured weight is preferable, self-report is a cost-effective and practical measurement approach for calculating pre-pregnancy BMI, and self-reported weight during pregnancy is generally considered more accurate than weight reported during other life stages. Furthermore, our study converted postpartum weight retention into binary variable, and reduced the possibility of making mistakes. Secondly, the cross sectional study cannot support causality between related factors and health problems. Therefore, a prospective study is required for further research.