Does health-related quality of life change across pregnancy trimesters? A systematic review and meta-analysis

TL;DR

This study finds that health-related quality of life during pregnancy changes across trimesters, with mental health improving mid-pregnancy and physical health declining in the third trimester.

Contribution

The study provides the first systematic review and meta-analysis of HRQOL changes across all three pregnancy trimesters.

Findings

HRQOL scores in the third trimester were significantly lower than in the second trimester.

Mental health scores improved in mid-pregnancy and remained stable, while physical health scores declined after mid-pregnancy.

The choice of measurement instruments significantly influenced the detection of HRQOL changes.

Abstract

This study aimed to systematically review and synthesize existing evidence on health-related quality of life (HRQOL) across pregnancy trimesters, identifying consistent temporal patterns and domain-specific trajectories in maternal well-being.

Five databases (PubMed, EMBASE, CINAHL Complete, APA PsycArticles, and RISS) were searched to retrieve English and Korean articles published between January 2001 and May 2023. Two reviewers independently screened and appraised studies using the Joanna Briggs Institute critical appraisal tools. A meta-analysis was performed using STATA 17.0 (StataCorp LLC.), with pairwise comparisons of standardized mean differences used to evaluate trimester-specific variations. Subgroup analyses were performed based on measurement instruments and HRQOL domains (mental vs. physical health).

A total of 13 studies involving 4,809 pregnant participants were included. Overall HRQOL showed no significant differences between the first and second trimesters or between the first and third trimesters. However, HRQOL scores in the third trimester were significantly lower than those in the second trimester (Hedges’ g=–0.42; 95% confidence interval, –0.77 to –0.06). Subgroup analyses revealed that the choice of measurement instruments significantly influenced the detection of changes in HRQOL. Mental health scores improved in mid-pregnancy and remained relatively stable, whereas physical health scores declined after mid-pregnancy, reaching their lowest point in the third trimester.

HRQOL during pregnancy follows distinct temporal patterns, emphasizing the need for trimester-specific maternal care strategies. Early pregnancy may require greater emphasis on mental health support, while late pregnancy may benefit from interventions targeting physical discomfort and functional limitations.

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