To identify antenatal and pregnancy related factors that affect recovery after childbirth, with the purpose of improving maternal health, return to work, and social participation. We searched PubMed, Embase and Web of Science up to October 2024 using predefined search terms. The review is registered in PROSPERO (#CRD42022361262). We included cohort studies, randomized controlled trials, and cross-sectional studies published in English or Dutch, evaluating antenatal and pregnancy related factors on maternal morbidity beyond six weeks postpartum, among women aged ≥ 18 years, who delivered live-born singletons. A minimum follow-up of six weeks postpartum was required. Two reviewers independently screened and assessed studies for quality. Data were synthesized narratively, organized by recovery domain. Fifty-six studies were included. Seven categories of influencing factors were identified: mental health in pregnancy (n=18), demographic and socioeconomic background (n=17), medical and psychological history (n=16), lifestyle in pregnancy (n=12), physical health in pregnancy (n=9), pre-pregnancy social and lifestyle factors (n=8) and psychosocial resources in pregnancy (n=5). Recovery outcomes included persistent pain, mental health problems, functional ability and urine incontinence. Although 47 studies focused on physical or mental health, only nine studies assessed functional ability. No studies explicitly examined social participation. Previous pain, high BMI, and antenatal mental health problems were consistently associated with poorer recovery outcomes. In contrast, physical activity, social support and psychological resilience were generally protective factors. Postpartum recovery is influenced by multiple antenatal and pregnancy related factors. A personalized, biopsychosocial approach to care may improve maternal health outcomes and societal participation.
Frijmersum et al. (Tue,) studied this question.