Guannan Bai

Health-related quality of life (HRQOL) is an essential issue for maternal and child health. This thesis aims to extend the understanding of maternal HRQOL during pregnancy and after childbirth, as well as HRQOL of children. The following specific research questions were formulated:
1. To what extent are nausea, vomiting, and fatigue in early pregnancy independently associated with maternal HRQOL?
2. What are trajectories of HRQOL during pregnancy and what are predictors of these trajectories?
3. What are the determinants of maternal HRQOL after childbirth?
4. To what extent is maternal HRQOL during pregnancy associated with birth outcomes?
5. What are the determinants of HRQOL among school-aged children?
6. To what extent do prevalent chronic conditions in childhood impact HRQOL of school-aged children in the Netherlands?
7. What are the feasibility and validity of the Health Status Classification System-Preschool (HSCS-PS) in a large community-dwelling sample of preschool children?

The studies presented in this thesis were embedded in the Generation R Study and the Dutch Health Interview Survey in the Netherlands. The Generation R Study is a prospective population-based mother- and child cohort study. It has been designed for identifying the early environmental and genetic factors for normal and abnormal growth, development and health from fetal life onwards until the adulthood. The Dutch Health Interview Survey, conducted by Statistics Netherlands, is a cross-sectional national health survey among the population living in private households in the Netherlands. The purpose of the Dutch Health Interview Survey is to give an overview of the developments in health, medical contacts, lifestyle and preventive behavior of the Dutch population.

Chapter 2 shows that nausea, vomiting and fatigue are very common in early pregnancy. Compared with women who never reported nausea, vomiting and fatigue in early pregnancy, women with daily presence of at least one of these symptoms had significantly worse physical and mental HRQOL.

Chapter 3 describes the distinct trajectories of physical and mental HRQOL during pregnancy, identified by Latent Class Mixture Modeling. Healthy physical and mental HRQOL trajectories during pregnancy were most common. Predictors indicative of suboptimal HRQOL trajectories included pregnancy-related physical symptoms and pregnancy-specific anxiety.

Chapter 4 presents the multiple determinants of maternal HRQOL assessed at two months after delivery. Worse physical HRQOL was associated with older maternal age, shorter time after delivery, cesarean delivery, loss of energy, maternal psychopathology, and the hospital admission of the baby; worse mental HRQOL was associated with older maternal age, non-western background, low household income, loss of energy and maternal psychopathology. In particular, maternal psychopathology is a profound determinant of worse mental HRQOL after delivery.

In Chapter 5, our findings did not confirm the hypotheses that worse maternal physical and mental HRQOL in early, mid- and late pregnancy are associated with more preterm birth, shorter pregnancy duration, and lower birth weight in the total study population. In contrast, in late pregnancy, we saw that a relatively better physical HRQOL is associated