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Association of inpatient postpartum recovery with patient-reported outcome measures following hospital discharge: a prospective cohort study

BMC Pregnancy and Childbirth volume 24, Article number: 618 (2024) Cite this article

Abstract

Background

The relationship between the quality of inpatient versus outpatient obstetric postpartum recovery is under-explored. We examined the association between inpatient reported quality of recovery with outpatient global recovery, pain severity, pain interference, anxiety, and depression screening scores postpartum.

Methods

We conducted a multicenter observational cohort study of women in labor who underwent vaginal, operative vaginal, or intrapartum cesarean birth. Subjects completed baseline assessments of pain, social support, anxiety, and depression in early labor. We assessed the Obstetric Quality of Recovery-10 (ObsQoR-10) on the day of discharge and the ObsQoR-10, Global Health Scale (GHVAS; 0–100), Brief Pain Inventory (BPI), and the Edinburgh Postnatal Depression Scale (EPDS) on postpartum day seven. We hypothesized that the ObsQoR-10 scores at discharge would be useful in predicting postpartum day seven measures of recovery and postpartum depression screening scores.

Results

We consented 558 subjects, 551/558(98%) completed baseline assessments, 400/551(72%) completed the ObsQoR-10 tool, and 344/551(62%) completed an EPDS assessment. Median (1st, 3rd quartile) ObsQoR-10 scores were 78 (63, 90) at discharge and 85 (68,93) on postpartum day seven, (difference of 7 [99% CI 2 to 13], P < 0.001). GHVAS on postpartum day seven identified 204/344 (59%) of subjects with good recovery. An ObsQoR-10 score of > 86 at discharge had a RR of 1.5 [95% CI 1.2 to 1.8], P < 0.001 for good recovery at postpartum day seven, the EPDS identified 20/344 (5.8%) respondents with a score ≥ 13 on postpartum day seven. The area under the curve between the ObsQoR-10 at discharge with an EPDS ≥ 13 was 0.74 (99% CI 0.61 to 0.86, P < 0.001). The RR for an EPDS ≥ 13 on postpartum day seven with an ObsQoR-10 < 77 on the day of discharge was 7.8 (95% CI 1.8 to 33.8; P = 0.001).

Conclusions

ObsQoR-10 scores at discharge and postpartum day seven demonstrated increased obstetric recovery in the post-discharge period. The observed association between the ObsQoR-10 and the EPDS, suggests that the ObsQoR-10 might facilitate identification of women at increased risk of postpartum anxiety or depression. Identification of high-risk women at discharge may allow early interventions to reduce morbidity secondary to postpartum depression.

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Introduction

Pregnancy and postpartum recovery are important life events for women [1]. Unfortunately, the postpartum period is a complex construct consisting of multiple domains which can be difficult to assess [2]. While patient-reported outcome measures (PROMs) are considered to be the gold standard for evaluating postpartum recovery, [3,4,5,6] few studies have explored the relationship between inpatient and outpatient quality of recovery metrics.

Postpartum recovery studies in obstetrics have mostly focused on homogenous cohorts after spontaneous, induced, or operative (forceps or vacuum-assisted) vaginal births, as well as after emergency/urgent cesarean births, and have been restricted to the inpatient setting [7,8,9,10,11]. The majority of maternal deaths in the US, however, occur in the outpatient setting [12]. The association between inpatient postpartum recovery and meaningful outpatient metrics such as global health, pain severity, pain interference, and depression screening in the early outpatient postpartum period is not well described. Studies have shown that pain during labor and the postpartum period appear to be independently linked to depression scores at six weeks postpartum [13, 14]. The use of an extensively validated quality of inpatient recovery metric such as the Obstetric Quality of Recovery-10 item tool (ObsQoR-10) [15, 16], could help identify patients with good recovery or those at greatest risk of undesirable outpatient outcomes.

We conducted a study of women in labor and planning a vaginal birth, examining associations between inpatient and postpartum day seven quality of recovery metrics. We hypothesized that the quality of recovery measures on the day of discharge would be predictive of postpartum day seven outcomes (global recovery, pain severity, pain interference, and postpartum depression). Secondary outcomes included the impact of variables around birth on quality of recovery in the postpartum period.

Methods

This prospective multicenter observational study of women in labor and planning a vaginal birth was approved by the Institutional Review Boards (IRB) of Both large academic institutions provide were enrolled between March 2020 and January 2022. This manuscript adheres to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

Inclusion criteria were age > 18 years, English-speaking, with a planned vaginal birth of a full-term viable singleton (≥ 37 weeks gestation). Exclusion criteria included planned cesarean birth, inability to communicate with the research staff, and multiple gestation pregnancies. Eligible women consented shortly after admission to the Labor and Delivery Unit in early labor, cervical dilation < 4 cm, via an IRB-approved electronic consent process.

Subjects were asked to complete three sets of electronic PROMs during this study, collected using the research electronic data capture (REDCap™) system. The first was completed by subjects prior to birth. Sociodemographic data collected included age, weight, race, ethnicity, household income, marital status, education level, employment status, medical insurance). Social support was assessed using the Perceived Social Support Index (F-SozU-K6) 0 to 30 scale, [17] with higher values indicating greater perceived support. The F-SozU-K6 has demonstrated high internal consistency Cronbach’s α = 0.90 and high perceived social support is associated with lower depression (PHQ-2 ρ = -0.26, P < 0.01) and lower generalized anxiety (GAD-2, ρ = 0.21 P < 0.01) [18]. Anxiety and depression screening was performed using the Patient Health Questionnaire-4 (PHQ-4) [19]. Factor analysis demonstrated that two discrete factors (Depression and Anxiety) explained 84% of the total variance of the PHQ-4. Increasing PHQ-4 scores were strongly associated with functional impairment, disability days, and healthcare use. Intercorrelation between the PHQ-4 and the longer PHQ-9 was r = 0.76 demonstrating good construct validity [20]. The Brief Pain Inventory short form (BPI) was used to assess pain severity (3 items, 0, no pain, to 10, pain as bad as you can imagine) and pain interference (three items rated from 0, does not interfere, to 10, completely interferes) [21]. The BPI has demonstrated excellent internal consistency and convergent validity in chronic pain conditions [22].

On the day of discharge, subjects completed the ten questions that comprise the ObsQoR-10 tool (Fig. 1) [11]. The ObsQoR-10 has demonstrated good construct validity with both the GHVAS r = 0.511 and with EuroQol 5-dimension 3L scores (r = -0.509) in women after birth [7].

Fig. 1
figure 1

ObsQoR-10 questions and scoring. Total score 0 to 100, with increasing scores representing greater recovery

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On postpartum day seven, subjects again completed the ObsQoR-10 tool and the Global Health Visual Analog Scale (GHVAS, 0 to 100 scale, where 0 is poor and 100 represents excellent global health). A cut-off value of 70 on the GHVAS scale has been used to represent a good overall global health status and in women after birth as a measure of good recovery [9, 23]. Subjects also completed the BPI and the Edinburgh Postpartum Depression Scale (EPDS, 0 to 30 with scores 13 or more indicative of a high possibility of major depression in postpartum English-speaking women, and 10 or more indicative of all types of depression including minor depression) [24, 25]. Performance of the EPDS assessed in a systematic review of 58 studies that included 22,788 women after birth demonstrated sensitivity and specificity of 0.85 (95% CI 0.79 to 0.90) and 0.84 (0.79 to 0.88) for a cut-off value of 10 or higher, and 0.66 (0.58 to 0.74) and 0.95 (0.92 to 0.96) for a cut-off value of 13 or higher, respectively [26].

Obstetric and anesthetic data were extracted from the medical records, including the subject’s gravidity and parity status, history of prior cesarean birth, history of hypertensive disorders of pregnancy, and labor analgesia utilization. Anesthesia and obstetric outcomes included the occurrence of an unintentional dural puncture, mode of birth, the presence and degree of perineal laceration, need for a maternal blood transfusion, and maternal intensive care unit admission. Neonatal outcomes included Apgar (0 to 10) scores at 1 and 5 min and neonatal intensive care admission.

Statistical analysis

The primary outcome of this study was the utility of day of discharge ObsQoR-10 to predict postpartum day seven GHVAS > 70, EPDS ≥ 10, and EPDS ≥ 13. Missing data for the primary analysis were handled using listwise deletion. Secondary outcomes were the differences in ObsQoR-10 scores between discharge and postpartum day seven. Exploratory analyses included evaluating pre-birth and birthing variables that impacted ObsQoR-10 scores on the day of hospital discharge and postpartum day seven; differences in ObsQor-10 scores at the day of discharge between clinically relevant stratified values for postpartum day seven GHVAS, BPI pain severity, BPI pain interference, and EPDS.

The distribution of the ObsQoR-10 was evaluated using the one-sample Kolmogorov–Smirnov test and examined graphically using q-q plots. The primary outcome was determined by constructing receiver operating characteristic (ROC) curves between ObsQoR-10 at discharge, the postpartum day seven GHVAS at a cut-off value of 70, and the EPDS at cut-off values of 10 and 13.22 Aggregate classification performance was calculated as the area under the curve. ObsQoR-10 cut-off values were determined at Youden’s index. The risk ratio (RR) for the day of discharge ObsQoR-10 at the cut-off value for predicting good global health (GHVAS > 70) or a positive EPDS (EPDS ≥ 10 and EPDS ≥ 13) screen at postpartum day seven were determined using logistic regression.

Differences in ObsQoR-10 scores between day of discharge and postpartum day seven were evaluated using the Wilcoxon signed rank test and the difference in the medians and 99% confidence interval by percentile bootstrapping. Bland–Altman analysis was applied to evaluate the limits of agreement confidence limits between day of discharge and postpartum day seven. The correlation between discharge and postpartum day seven ObsQoR-10 values was assessed using Spearman’s rho (ρ). Correlations were stratified as weak (< 0.4), moderate (0.4 – 0.6), and strong (> 0.6) [27].

ObsQoR-10 discriminant validity was assessed by determining the effect size of the association of the sociodemographic, medical history and PROM data, and obstetric labor and birth variables with the ObsQoR-10. Pearson’s correlation was used to assess the effect size of continuous variables and Kendall’s Tau-b for nominal and ordinal variables. Effect size differences of > 0.1 were evaluated for their effect on ObsQoR-10 values. Differences in location and 99% confidence intervals were estimated using the Hodges-Lehmann estimator.

Discharge ObsQoR-10 values at the cut-off values for the GHVAS and EPDS, and at discrete levels of pain severity and interference on postpartum day seven were determined. The BPI pain severity score was classified into none to mild (0 to < 3), moderate (≥ 3 to < 6), and severe (≥ 6) pain. BPI pain interference was classified into none to mild (0 and < 3), moderate (≥ 3 to < 6), and severe (≥ 6) interference [28]. Unadjusted ObsQoR-10 values were compared between groups using the Wilcoxon test and among multiple groups using Dunn’s test with Bonferroni correction. Adjusted values were determined using generalized estimating equations adjusted for history of anxiety, history of depression, mode of birth, neonatal intensive care unit admission, and length of stay. Estimated mean differences were corrected for multiple comparisons using the Bonferroni method.

The sample for this study was determined as a number sufficient to provide approximately 400 analyzable subjects. This sample should provide approximately 15% of subjects that screen positive for possible postnatal depression (EPDS ≥ 10) [29], and achieve 80% power at an alpha of 0.05 to detect a change in probability from 2 to 10% (odd ratio 3.97) for an ObsQoR-10 below the cut-off compared to above the cut-off value.

A P < 0.01 was required to reject the null hypothesis. Statistical tests were two-sided. Sample size analysis was calculated using PASS15, Power Analysis and Sample Size Software, version 15.0.13, NCSS, LLC. Kaysville, Utah, USA, http://ncss.com/software/pass. Data was analyzed using RStudio version 2024.04.3 Build 764 (Posit Software, PBC, Boston, MA; URL: http://www.posit.co/) and R version 4.4.1, release date June 14, 2024 (The R Foundation for Statistical Computing, Vienna, Austria).

Results

Eight hundred fifty-eight women were approached, 558/858 (65%) consented, and 551/558(99%) completed the baseline assessments (Fig. 2). A single ObsQoR-10 was completed by 400/551(71%) patients, and 292/551(53%) completed both at discharge and postpartum day seven. The mean ± SD interval between discharge and day seven evaluations was 5 ± 1 days. No study subject was an inpatient on postpartum day seven.

Fig. 2
figure 2

Study flow diagram. The median difference in the ObsQoR-10 scores between the study sites was -3 (-11 to 3, P = 0.200) at discharge and -4 (-8 to 0, P = 0.080) on postpartum day seven

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ObsQoR-10 on the day of discharge moderately correlated with ObsQoR-10 on postpartum day seven (ρ = 0.45 [99% CI 0.31 to 0.56], P < 0.001) (Fig. 3). Median (1st,3rd quartile) ObsQoR-10 scores on the day of discharge were 78 (63, 90) and 85 (68, 93) on postpartum day seven (unadjusted difference 7 [99% CI 2 to 13], P < 0.001). Bland–Altman analysis demonstrated a positive bias in the difference in ObsQor-10 scores of 6.3 with 95% upper and lower limits of agreement of -28 to 40 (Fig. 3). There was a negligible association between the difference in days between the ObsQoR-10 scores and days discharged from the hospital (ρ  = -0.05 [99% CI -0.17 to 0.07], P = 0.36).

Fig. 3
figure 3

Panel A Scatter plot of the day of discharge with postpartum day seven ObsQoR-10 scores. Spearman’s rank correlation ρ = 0.45 [99% CI 0.31 to 0.56], P < 0.001. The solid line is the least squares slope, and the dashed lines are the 95% confidence intervals. The slope (SEM) is 0.38 ± 0.04 and the y intercept 53 ± 3.5. The slope is different from a zero slope, F = 68.2, P < 0.001. Panel B Bland–Altman differences plot. Mean difference (bias) 6.3 (95% CI 4.2 to 8.2), upper level of agreement 40.9 (95% CI 37.4 to 44.4) and lower level of agreement -28.2 (95% CI -31.8 to -24.8). Between day of discharge and postpartum day seven there were 185 positive differences, 91 negative differences, and 16 ties (Z = -6.373, P < 0.001)

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Median (1st, 3rd quartile) GHVAS scores were 73 (50,84) at postpartum day seven and high overall health status (GHVAS > 70) was reported by 204/344(59%) subjects. The AUC of the ROC curve between ObsQoR-10 at discharge and GHVAS on postpartum day seven was 0.61 [99% CI 0.52 to 0.70], P = 0.002. The cut-point analysis identified an ObsQoR-10 score of > 86 at discharge with a RR of 1.5 [95% CI 1.2 to 1.8], P < 0.001 for a GHVAS > 70 at postpartum day seven.

The EPDS identified 36/344 (10.5%) respondents with a score ≥ 10 and 20/344 (5.8%) with a score ≥ 13 at postpartum day seven. EPDS scores were not correlated with the mode of birth (Kendall’s tau b 0.06 [99% CI -0.03 to 0.15], P = 0.20). ROC curves between ObsQoR-10 scores on the day of discharge with EPDS scores ≥ 10 and ≥ 13 are shown in Fig. 4. The cut-point analysis identified an ObsQoR-10 on the day of discharge of 77 for EPDS ≥ 13 and 88 for EPDS ≥ 10. The RR for an EPDS ≥ 13 with an ObsQoR-10 < 77 on the day of discharge was 7.8 [95% CI 1.8 to 33.8], P- = 0.001, and the RR for an EPDS ≥ 10 with an ObsQoR-10 < 88 at discharge was 3.4 [95% CI 1.2 to 9.7], P = 0.01.

Fig. 4
figure 4

Receiver operating characteristics plots of ObsQoR-10 scores obtained on the day of discharge and Edinburgh postnatal depression scale scores obtained on postpartum day seven at the cut points of ≥ 10 and ≥ 13. The area under the curve between the ObsQoR-10 at discharge with an EDPS ≥ 10 and ≥ 13 were 0.71 (99% CI 0.60 to 0.82, P < 0.001) and 0.74 (99% CI 0.61 to 0.86, P < 0.001), respectively

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No baseline sociodemographic variables significantly affected ObsQoR-10 scores on the day of discharge or at postpartum day seven (Table 1). At discharge, ObsQoR-10 scores were lower in women reporting a history of anxiety 70 ± 19 compared to no history of anxiety 77 ± 17, unadjusted difference -7 [99% CI -13 to -2], P < 0.001. ObsQoR-10 values at discharge in women reporting a history of depression were 69 ± 20 compared with 76 ± 17 in those without a history of depression, unadjuWomen whose infants were admitted to the neonatal intensive care unit admission reported lowested difference -7 [99% CI -14 to 0], P = 0.008 (Table 2).

Table 1 Association of sociodemographic characteristics with ObQoR-10 scores
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Table 2 Association of medical history and baseline PROMs with ObQoR-10 scores
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The effect of obstetric data and labor and birth outcomes on the ObsQoR-10 scores are shown in Table 3. Women whose infants were admitted to the neonatal intensive care unit admission reported lower ObsQoR-10 scores on the day of discharge 67 ± 17 compared with non-NICU admission women 76 ± 18, unadjusted difference -9 [99% CI -17 to -1], P = 0.005. Cesarean birth and longer length of hospitalization (> 2 days) were associated with lower ObsQoR-10 scores on the day of discharge and at postpartum day seven. Unadjusted differences in ObsQoR-10 scores for cesarean birth 64 ± 19 versus vaginal birth 77 ± 17 were -13 [99% CI -21 to -5], P < 0.001 at discharge, and on postpartum day seven were 72 ± 18 after cesarean birth compared to 82 ± 15 after vaginal birth, difference -9 [99% CI -15 to -4], P < 0.001). Length of hospitalization > 2 days was associated with lower ObsQoR-10 69 ± 20 compared to 77 ± 17, difference -7 [99% CI -14 to -1]; P = 0.001) at discharge and 75 ± 17 compared to 82 ± 15 difference -7 [99% CI -12 to -3], P < 0.001, on postpartum day seven.

Table 3 Association of obstetric data and labor and birth outcomes with ObQoR-10 scores
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ObsQoR-10 scores at day of discharge at clinically important cut-off values of GHVAS, EPDS, BPI pain severity, and BPI pain interference are shown in Table 4. Differences in unadjusted ObsQoR-10 were observed between levels of GHVAS, EPDS, BPI pain severity, and BPI pain interference. Adjusted ObsQoR-10 scores were significant for EPDS, but not for GHVAS, BPI pain severity and BPI pain interference.

Table 4 Differences in discharge ObQoR-10 scores between categories of GHVAS, pain intensity, pain interference and EPDS
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Discussion

In this study of a cohort of women planning vaginal birth, we found a moderate correlation between discharge ObsQoR-10 scores and ObsQoR-10 values at day seven, with a positive bias in the responses suggesting increased maternal recovery into the post discharge period. Subjects with an ObsQoR-10 values > 86 at discharge had an increased likelihood to demonstrate high global recovery at day seven supporting the value of the association of the ObsQoR-10 with recovery beyond the hospitalization period. Additionally, there was an inverse relationship between ObsQoR-10 scores and EPDS screening score, suggesting that the ObsQoR-10 may represent an early identifier of women at risk for poor postpartum mental health outcomes.

The ObsQoR-10 tool has recently been identified as one of the 15 core outcome measures that should be used to evaluate the impact of enhanced recovery implementation in the obstetric setting [30]. Interestingly it was the only composite measure that was included in the core outcome set, which is consistent with the appreciation that postpartum recovery is a complex multidimensional construct, that requires evaluation with PROMs which assess multiple health domains [2, 4]. Our findings suggest that the ObsQoR-10 value extends beyond the assessment of recovery in the immediate postpartum period.

We observed a lack of impact of sociodemographic characteristics on the ObsQoR-10 scores demonstrating high discriminant validity of the tool in our cohort. Although intrapartum cesarean birth had a negative effect on ObsQoR-10 scores, it did not affect the EPDS scores, and therefore we believe that the association demonstrated between ObsQoR-10 and EPDS remains valid.

Prior studies have reported that prenatal, labor, and postpartum pain are linked to depression scores at six weeks postpartum [13, 31]. The American College of Obstetricians and Gynecologists recommends screening patients at least once perinatally for depression and anxiety using a standardized, validated tool [32]. The International Consortium for Health Outcomes Measurement (ICHOM) recommends using PHQ-2 for screening antenatal depression, and if positive, then it recommends following up with EPDS [33]. The EPDS is considered one of the most widely used PROM tools for assessing maternal postpartum depression [34]. In many clinical practices, this screening assessment is done six weeks postpartum; however, studies evaluating the EPDS scores administered as early as the first week postpartum showed robustness with the EPDS scores administered at four and eight weeks postpartum [35, 36].

The correlation between our study's ObsQoR-10 and GHVAS scores is lower than previously reported [7, 11]. This could reflect greater heterogeneity in our sample, as well as the timing and methods of data collection. To our knowledge, no prior study has examined the association between inpatient quality of recovery and recovery one week postpartum.

The strengths of this study are the assessment of a large cohort, data collection beyond hospital discharge, and the method of data collection applicable to routine clinical practice. Nevertheless, the results of this study should only be interpreted in the context of its limitations, which include low participation of underrepresented women of race, ethnicity, income, and educational attainment when compared to the geographical location. We also did not obtain information on breastfeeding, which is an important contributor to postpartum pain, anxiety, and depression [37]. We present findings from two centers within a single Illinois region; therefore, the generalizability of these findings should be evaluated in other healthcare settings. Because we used a screening questionnaire (PHQ-4) for the baseline assessments of anxiety and depression, we may have underestimated the effect of these behavioral factors on ObsQoR-10 scores. Our cohort reported high social support, education levels, and household income, which could have limited our ability to assess the impact of these factors on the ObsQoR-10 scores. We administered the EPDS seven days postpartum, which could be considered a limitation of the study as depression can only be diagnosed after symptoms for ≥ 2 weeks as per DSM-V diagnostic criteria, and symptoms of postpartum blues are frequently present up to 10 days postpartum. Nevertheless, we feel that our approach was justified and potentially clinically important since, in a study evaluating the EPDS at one, four, and eight weeks postpartum, Dennis et al. found that the administration of this tool at one week was predictive of maternal mood at four and eight weeks postpartum [29]. In addition, the study period (March 2020 and January 2022) occurred during the COVID-19 pandemic period, which may have impacted participants' responses, in particular regarding anxiety and depression-related questions. Finally, the EPDS positive screen rate in our study was lower than we had anticipated a priori which reduces the certainty around our estimates of effect sizes for the associations between the ObsQoR-10 values and positive EPDS screening.

Conclusions

Our study corroborated the utility of the ObsQoR-10 for recovery assessment of postpartum patients during hospitalization and extended the findings to the first seven postpartum days. We found associations between discharge ObsQoR-10 scores and postpartum day seven global health and depression screening scores. These findings suggest that ObsQoR-10 could facilitate early identification of women at increased risk of postpartum depression and worse recovery that may benefit from early targeted interventions. Future studies of larger and more diverse groups of women are warranted to address the limitations and confirm the findings of this study.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

ACOG:

American College of Obstetricians and Gynecologists

AUC:

Area under the curve

BPI:

Brief Pain Inventory

CI:

Confidence interval

EPDS:

Edinburgh Postpartum Depression Scale

F-SozU-K6:

Perceived Social Support Index

GHVAS:

Global Health Visual Analog Scale

IRB:

Institutional Review Board

ICHOM:

International Consortium for Health Outcomes Measurement

ObsQoR-10:

Obstetric Quality of Recovery-10 item scale

PHQ-4:

Patient Health Questionnaire-4 item scale

PROMs:

Patient Reported Outcome Measures

REDCap:

Research Electronic Data Capture

ROC:

Receiver Operating Characteristics

RR:

Risk ratio

STROBE:

Strengthening the Reporting of Observational Studies in Epidemiology

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Prior Presentations

This study was presented at the Anesthesiology 2022 Annual Meeting, October 23, 2022. Abstract number A1079.

Funding

The study was supported by the Departments of Anesthesiology of Northwestern University Feinberg School of Medicine and Rush University.

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Prentice Women’s Hospital of Northwestern University, 251 E. Huron St. F5-704, Chicago, IL, 60611, USA

    Carrie M. Stump & Feyce M. Peralta

  2. Department of Anesthesiology, Stanford University, Stanford, CA, 94304, USA

    Pervez Sultan

  3. Department of Anesthesiology, Rush University, Chicago, IL, 60612, USA

    Michael E. Holland, Lelesse C. Shepard & Robert J. McCarthy

  4. Department of Obstetrics, Prentice Women’s Hospital of Northwestern University, Chicago, IL, 60611, USA

    Nevert Badreldin

Authors
  1. Carrie M. Stump
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  2. Feyce M. Peralta
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  3. Pervez Sultan
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  4. Michael E. Holland
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  6. Lelesse C. Shepard
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  7. Robert J. McCarthy
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Contributions

C.M.S.: This author made substantial contributions to the conception and design of the study; the acquisition of data; drafting the manuscript and approved the submitted version. F.M.P.: This author made substantial contributions to the conception and design of the study, drafting the manuscript and approved the submitted version. As the guarantor, this author accepts full responsibility for the finished work and/or the conduct of the study, had access to the data, and controlled the decision to publish. She has agreed to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which he was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature. P.S.: This author made substantial contributions to the interpretation of data; drafting the manuscript and approved the submitted version. M.E.H.: This author made substantial contributions to the conception and design of the study; the acquisition of data; drafting the manuscript and approving the submitted version. Nevert Badreldin: This author made substantial contributions to the interpretation of data; drafting the manuscript and approving the submitted version. L.C.S.: This author made substantial contributions to the conception and design of the study; the acquisition of data; drafting the manuscript and approving the submitted version. R.J.M.: This author made substantial contributions to the conception and design of the study; performed the analysis and interpretation of data; drafting the manuscript and approving the submitted version.

Corresponding author

Correspondence to Feyce M. Peralta.

Ethics declarations

Ethics approval and consent to participate

This study was approved by the Institutional Review Boards (IRB) of Participants were enrolled between March 2020 and January 2022. All patient provided written informed consent to participate.

Competing interests

The authors declare no competing interests.

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Stump, C.M., Peralta, F.M., Sultan, P. et al. Association of inpatient postpartum recovery with patient-reported outcome measures following hospital discharge: a prospective cohort study. BMC Pregnancy Childbirth 24, 618 (2024). https://doi.org/10.1186/s12884-024-06805-4

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Keywords

BMC Pregnancy and Childbirth

ISSN: 1471-2393

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