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Development and Internal Validation of a Nomogram for Identifying Postpartum Fatigue in Postpartum Women: A
Zhidong Guo1, Min Xu1, Shouzhen Cheng2
1Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.
Aim:
To identify factors associated with postpartum fatigue in postpartum women and to develop and internally validate a clinical nomogram.
Design:
A cross-sectional study.
Methods:
This cross-sectional study recruited 780 postpartum women via convenience sampling at a tertiary hospital in Guangdong, China (January-May 2025). After excluding invalid questionnaires, 744 participants were randomly allocated (7:3) to derivation and internal validation sets. Data were collected using a general information questionnaire and validated scales for postpartum fatigue, depression and social support. Candidate factors were pre-specified based on clinical relevance and previous evidence. LASSO regression was used for variable selection. Model performance was assessed using the AUC, calibration plots, the Hosmer-Lemeshow test and decision curve analysis (DCA), with internal validation by randomly splitting the sample into derivation and internal validation sets.
Results:
Among the 744 postpartum women, the prevalence of postpartum fatigue was 69.0% (n = 513). Four independent factors were associated with postpartum fatigue: postpartum depression, maternal sleep quality, breastfeeding ability and intrapartum blood loss. The nomogram showed good discrimination in both the derivation (AUC = 0.821) and internal validation (AUC = 0.801) sets. At the optimal cut-off of 0.682, sensitivity and specificity were 75.2% and 76.8%, respectively. The Hosmer-Lemeshow test confirmed good calibration in both sets (derivation: χ2 = 8.949, p = 0.3466; internal validation: χ2 = 4.422, p = 0.8172). DCA indicated favourable clinical net benefit across a relevant range of thresholds.
Conclusions:
We developed and internally validated a practical nomogram for identifying postpartum fatigue using readily available clinical and psychosocial factors. The model showed good performance.
Implications For Nursing Practice:
This nomogram may assist nurses and midwives in early identification of postpartum women at increased likelihood of fatigue and facilitate individualized nursing interventions to improve postpartum recovery.
Patient Or Public Contribution:
No patient or public contribution was made to the design, conduct, analysis, interpretation or writing of this study.