A Longitudinal Study Of Postpartum Fatigue And Its Influencing Factors In Advanced Maternal Age

ObjectivesA longitudinal survey is carry out on postpartum fatigue in advanced maternal age at second day,first month and third month（T₁～T₃）after delivery:（1）Cross-sectional analysis of postpartum fatigue and its influencing factors from T₁to T₃after delivery.（2）To explore the overall trajectory of postpartum fatigue within 3months after delivery.（3）To identify the population heterogeneity and influencing factors of the trajectory of postpartum fatigue in advanced maternal age.MethodsFrom April to October 2020,advanced maternal age who delivered in the Second Affiliated Hospital of Zhengzhou University were research objects.The longitudinal survey was carried out on them with general maternal data questionnaire（maternal social demographic information,obstetric data,parenting data）,the Fatigue Self-assessment Scale-1（FSAS-1）,Edinburgh Postnatal Depression Scale（EPDS）,Perceived Social Support Scale（PSSS）,and Pittsburgh Sleep Quality Index（PSQI）.Statistical software SPSS 21.0 and Mplus 8.3 were used for management and analysis data.Statistical methods were mainly descriptive statistics,multiple stepwise linear regression analysis,repeated measure analysis of variance,LGCM,LCGM and logistic regression analysis,α=0.05.Results1.In our study,175 cases of advanced maternal age were recruited,and 13 cases were lost,with a loss rate of 7.43%.In the end,162 cases of advanced maternal age completed 3 follow-up surveys.The general data of lost-women and participating-women were balanced（P>0.05）.2.Scores of postpartum fatigue at T₁～T₃were（53.26±11.41）,（48.97±10.66）and（45.83±10.46）respectively.Repeated measurement analysis of variance showed that postpartum fatigue showed a downward trend at the three time points（F=166.145,P<0.001）.The incidence of moderate or above fatigue at T₁～T₃was 87.7%,77.8%and 67.3%,respectively.3.Results of multiple linear regression showed that postpartum hemorrhage,mode of delivery,working status during pregnancy,feeding pattern,maternal and infant skin-to-skin and depression,sleep quality,and social support were the influencing factors of postpartum fatigue at second day（T₁）after delivery,explaining68.0%of the total variation.Postpartum hemorrhage,working status during pregnancy and depression,sleep quality and social support were the influencing factors of postpartum fatigue at first month（T₂）after delivery,which explained69.2%of the total variation.Postpartum hemorrhage,working status during pregnancy,feeding pattern and depression,sleep quality,and social support were the influencing factors for postpartum fatigue at third month（T₃）after delivery,explaining 63.4%of the total variation.4.Longitudinal trajectory exploration of postpartum fatigue:A linear unconditional growth model was built to verify the linear model of postpartum fatigue.The results showed that the three dimensions of postpartum fatigue and physical fatigue,mental fatigue,fatigue consequences showed a linear downward trend（P<0.05）,with an average decrease of 2.431,3.456,4.144 and 2.068 units per time.The variation of the intercept was significant（P<0.001）,and the variation of the slope of mental fatigue and fatigue consequences was significant（P<0.05）,indicating that there were individual differences in the initial value of postpartum fatigue,and there were individual differences in the change speed of mental fatigue and fatigue consequences.5.Explorations of population heterogeneity in the trajectory of postpartum fatigue:In our study,two distinct trajectories of postpartum fatigue were identified:the“high fatigue decline group”（57.3%）and the“low fatigue decline group”（42.7%）.Working status during pregnancy,feeding pattern,depressive symptoms,and sleep quality during pregnancy were influencing factors of the trajectory of postpartum fatigue.Conclusions1.Postpartum fatigue in advanced maternal age is relatively common and high in degree.It has a linear trend of decline with the postpartum time,but the decline rate is slow and still at a high level.2.Postpartum fatigue is a condition that involves physical and mental states.Long working hours during pregnancy,natural childbirth,large amount of postpartum haemorrhage,not involved in maternal and infant skin-to-skin after delivery,exclusive breastfeeding from maternal,postpartum fatigue is more serious.We need to identify the high risk factors at different stages after delivery to guide intervention studies.We suggest that by improving maternal psychological state,the environment of sleep and social support to reduce postpartum fatigue damage.3.There is group heterogeneity in the trajectory of postpartum fatigue in advanced maternal age.Exclusive breastfeeding,long working hours during pregnancy,depression tendency and poor sleep quality are the risk factors of high fatigue state,and proper working during pregnancy is the protective factor of high fatigue state.For women with high fatigue tendency,the focus of work is to promote the decline of postpartum fatigue level by means of psychology,exercise,sleep and other methods.And for women with low fatigue,the focus is on comprehensive monitoring of postpartum fatigue,and deal with high levels in a time.