Maternal health, antenatal and at 8 weeks after delivery, in home versus in-hospital fetal monitoring in high-risk pregnancies

Abstract

Objective: To assess maternal health outcome, comparing high-risk pregnant women to either domiciliary monitoring or in-hospital monitoring, and a low risk pregnant group. Design: Paper and pencil questionnaire, distributed antenatal and 8 weeks after the delivery. Setting: A university hospital. Subjects: Three groups: 130 high-risk pregnant women, who entered a randomized clinical trial and were allocated to either home ( n=69) or in-hospital monitoring ( n=61), and a reference cohort of low risk pregnant women ( n=55). Main outcome measures: Antenatal physical and mental health (RAND36) and social experiences; mode of delivery; complications postpartum; physical health, mental health, and social experiences at 8 weeks postpartum. Results: In all groups, antenatal physical health was considerably lower compared to the physical health of US women aged 18–44 years. Antenatal mental health was lower in high-risk women than in low-risk women ( P<0.05). Antenatal maternal health, the mode of delivery, and maternal complications postpartum did not differ significantly between in-hospital and domiciliary monitored women. Eight weeks after delivery, physical health improved considerably in all groups; mental health was significantly lower in high-risks as compared to low-risk women ( P<0.01). The allocated monitoring strategy showed a significant effect on mental health at 8 weeks after delivery; the mental health score being lower in the domiciliary monitored group ( P<0.05). Conclusions: At 8 weeks after the delivery, physical health improves substantially in all groups. Mental health is higher in low-risks than in high-risks. Within the high-risk group domiciliary and in-hospital monitored women have the same physical maternal outcome at 8 weeks after delivery. However, mental maternal health in in-hospital monitored women at 8 weeks was probably biased by a medicalization effect.