Maternal Health Status in the Year After Delivery Among Low-Income Women

Abstract

Objective: To describe the health status and factors influencing health status of mothers following delivery in low-income, minority women; and to delineate opportunities for interpregnancy interventions to improve women's health and subsequent pregnancy outcome. Design: Prospective cohort. Setting: Four satellite primary care clinics and the obstetric clinic of Harlem Hospital Medical Center. Participants: 367 black, Englishspeaking women enrolled in a program designed to provide enriched services during pregnancy and first year of infancy. Methods: Home interview when child was 12–18 months of age. Measures: Maternal health status included morbidity causing hospitalisation, self-rating of health, and mental health measured by the General Health Questionnaire. Other factors included measures of sociodemographic status, maternal health behaviors, environmental stress, social support, and infant health. Results: Although less than 15% of the women were in poor health on any single measure, over one-quarter (28%) were in poor health when measures were considered in combination. Half the hospital episodes were due to reproductive events including subsequent pregnancy. Poor maternal health was associated with unemployment, being separated/divorced, cigarette and alcohol use, high stress and low social support, and low birth weight and poor infant health and development. Conclusions: A multidimensional approach to health status provides a better description of the substantial burden of morbidity. The linkage between the low birth weight in the preceding pregnancy and poor maternal health provides insight into modifiable factors leading to the continuity of risk across pregnancies. Potential interventions include increased continuity of women's reproductive health care with special attention to modifiable health behaviors.