Heterogeneity of "Zuo Yuezi" practices among Chinese postpartum women and its association with postpartum depression

Practice related to the traditional postpartum confinement custom "Zuo Yuezi" vary among individuals, and its relationship with postpartum depression (PPD) remains unclear. This study aims to explore the current practice and heterogeneity of "Zuo Yuezi" among Chinese women and to analyze its association with PPD.

A cross-sectional study was conducted among 542 women from 3 hospitals between January and February 2016. Data were collected on whether participants practiced "Zuo Yuezi", their willingness and attitudes toward "Zuo Yuezi", demographic characteristics, adherence to specific "Zuo Yuezi" practices, emotional experiences during the "Zuo Yuezi" period, and PPD symptoms. Latent profile analysis (LPA) was used to identify heterogeneity in "Zuo Yuezi" practices, and multivariate logistic regression was used to analyze the association between practice patterns and PPD.

A total of 542 postpartum women completed the survey. About 98% (531/542) of participants reported practicing "Zuo Yuezi", among whom 41.2% followed traditional customs and 29.5% followed parental advice. Approximately 95% of women practiced "Zuo Yuezi" for ≥30 days, and nearly half strictly followed a 30-day "Zuo Yuezi" period. Significant heterogeneity was observed in practice components and adherence levels, with the greatest heterogeneity in dietary practices and the lowest in hygiene practices. Latent profile analysis identified 4 levels of adherence to "Zuo Yuezi" practices: low, medium-low, medium, and high. Higher adherence was associated with belief in disease prevention, home-based "Zuo Yuezi" practices, and longer "Zuo Yuezi" duration. Lower adherence was associated with an increased risk of PPD (χ²=16.103, P<0.05).

The practice of "Zuo Yuezi" is widespread but heterogeneous. Lower adherence to "Zuo Yuezi" practices may increase the risk of postpartum depression, highlighting the need for culturally sensitive and individualized perinatal care.