Postpartum Symptom Clusters in Birthing Individuals

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Problem: Many birthing individuals experience postpartum symptoms which are associated with adverse health conditions including long-term weight gain and depression. Postpartum symptoms often occur in clusters (i.e., three or more co-occurring symptoms that are related to each other) which makes it more difficult to manage. To date, research has been focused on individual symptoms which limits our understanding of how postpartum symptom clusters manifest and impact health. Therefore, the purpose of this dissertation was to develop knowledge on postpartum symptom clusters among birthing individuals. One systematic review (Chapter 2) and three quantitative studies (Chapters 3 to 5) were conducted to achieve this purpose.Methods: For the systematic review, five databases were searched to locate articles. Two reviewers performed title/abstract and full-text screening. Article qualities were examined using Standard Quality Assessment Criteria. Key information was extracted and synthesized using a narrative synthesis. For three quantitative studies, secondary data from the Community and Child Health Network study was used. First, latent profile analysis was performed in Chapter 3 to identify subgroups of postpartum women with different postpartum symptom profiles at 6 months postpartum using observed variables (i.e., general stress, posttraumatic stress, postpartum depression, and sleep disturbance-quality and -quantity). Next, in Chapters 3 to 5, associations between the identified symptom profiles and (a) clinical and social determinants of health (SDOH) characteristics and/or (b) maternal health outcomes (i.e., long-term depression, well-being, and allostatic load) were examined using bivariate and multivariate analysis. Findings: A total of 30 articles were included in the systematic review (Chapter 2). The majority were quantitative and cross-sectional. Factor analysis was the most frequently used. Stress, depression, somatic, and anxiety clusters were the most frequently identified. In Chapter 3, five distinct postpartum symptom profiles were identified which were labeled as Profile 1: Minimum, Profile 2: Highly disturbed sleep quantity, Profile 3: Mild-moderate, Profile 4: High, and Profile 5: High psychological symptoms. Postpartum women in high symptom severity profiles (Profiles 4 and 5) had significantly more early postpartum complications and a history of depression (Chapter 3). Experiences of different social-economic hardships (e.g., discrimination in healthcare settings or food insecurity) also had a significant impact on postpartum symptom profiles (Chapter 4). Furthermore, postpartum women in high symptom severity profiles had significantly higher depression at 18 and 24 months, lower well-being at 24 months, and higher overall allostatic load at 12 months (Chapters 3 and 5). Conclusion: This dissertation study found that birthing individuals do have complex and unique postpartum symptom cluster experiences and such experiences have a significant impact on their long-term health. Future research and practice should consider providing targeted interventions to optimally manage postpartum symptom clusters and prevent the development of adverse health outcomes. In doing so, it is critical to consider and address comprehensive SDOH from multiple layers of society.






Scroggins, Jihye Kim (2023). Postpartum Symptom Clusters in Birthing Individuals. Dissertation, Duke University. Retrieved from


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