Pregnancy variables that impact postpartum quality of life: a multicenter prospective study

Postpartum quality of life is a multidimensional variable regarding a woman's own assessment of her health, which frequently deteriorates after childbirth. To identify the physical, cognitive, emotional, cultural and/or social factors present during pregnancy that are most related to postpartum Quality of Life (QoL). A team of experts identified some factors that could influence the experience of pregnancy, childbirth and postpartum. A longitudinal study was carried out in the public health service of the Basque Country. Participants were recruited consecutively and through peer snowball sampling. During pregnancy, were evaluated anxiety (STAI), depression (EPDS), coping style (NuPCI), self-efficacy (CBSEI), fear of childbirth (WEQ-A), partner support (PSEQ) and substance use (EMAeHealth); along with sociodemographic variables. In the postpartum period, information about type of delivery and quality of life (SF-12) was collected online. A multivariate analysis was carried out. 92 women answered the questionnaires during pregnancy (M = 28 weeks, SD = 7.03) and in the postpartum (M = 37 days, SD = 30.13). Multigroup structural equation models revealed that fear of childbirth and emotional state during pregnancy were significantly associated with postpartum quality of life (QoL), with patterns differing by educational level. Although no statistically significant interactions were found, standardized path coefficients indicated clinically meaningful differences. Most effect sizes ranged from moderate to large (β ≥ 0.30), and explained variance exceeded thresholds for substantial predictive power (R² = 0.30-0.74), reinforcing the practical significance of the findings despite sample size limitations. Some variables in pregnancy, especially emotional state and fear of childbirth, have a negative impact on postpartum QoL. Early intervention on these variables can increase women's well-being in the medium and long term.