A cohort study of functioning and disability among women after severe maternal morbidity

Abstract Objective To assess functioning and disability related to severe maternal morbidity (SMM) via the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0). Methods In a retrospective cohort study, women with or without a history of SMM who delivered at a tertiary public hospital in Brazil between July 2008 and June 2012, completed the WHODAS 2.0 questionnaire by individual interview between August 2012 and November 2013. General WHODAS scores were evaluated by maternal and neonatal characteristics, and specific domain scores according to SMM event. Results Overall, 638 women were enrolled (315 with SMM and 323 without SMM). The mean general WHODAS score was higher among women with SMM (19.04 ± 16.18) than among women without SMM (15.77 ± 14.46; P = 0.015). Domain scores were also higher in the SMM group for mobility (16.00 ± 20.22 vs 11.63 ± 17.51; P = 0.003), household activities (26.79 ± 30.16 vs 20.09 ± 26.08; P = 0.005), participation (23.55 ± 21.72 vs 17.27 ± 19.17; P < 0.001), and work/school activities for women currently studying or working (20.52 ± 26.64 vs 11.66 ± 19.67; P = 0.001). Excluding SMM, a parity of two or more was the only factor significantly associated with higher scores overall ( P = 0.013) and for domain 4 (getting along with people; P = 0.017). Conclusion By comparison with women without childbirth complications, SMM impaired self-reported functioning among women 1–5 years after delivery.