Health-related quality of life during three trimesters of pregnancy in Morocco: cross-sectional pilot study.

Background: Pregnancy is universally considered a normal physiological process. However, it has a considerable impact on the quality of mothers' lives. This study piloted the use of the generic EuroQoL-5 Dimensions-5 Levels (EQ-5D-5L) descriptive system and the EuroQol Visual Analogue Scale (EQ-VAS) questionnaire, to assess the health-related quality of life (HRQoL) during pregnancy and its associated factors.

Methods: In this cross-sectional pilot study carried out from August to December 2019 we assessed the HRQoL and its associated factors among Moroccan pregnant women who received prenatal care at Settat's health centers. The collected data from 270 pregnant women were compared to a dataset of 289 non-pregnant women using the EQ-5D-5L instrument and socioeconomic and obstetrical questionnaires. A multiple linear regression model was used to identify associated factors. The HRQoL comparison was made using the improved RIDIT approach, which allows estimating the Absolute Risk Increase (ARI) of problems related to mobility, usual activities, and self-care and the ARI of pain/discomfort and anxiety/depression (i.e. an ARI = 10% in mobility means that pregnancy increases problems in this health dimension by 10%).

Findings: A total of 559 women were included in our study. Our results showed that the HRQoL in pregnant women was significantly lower than in non-pregnant women (EQ-5D index score = 0.71 ± 0.24 vs 0.79 ± 0.29; p < 0.0001). Similarly, the pregnancy reduced the EQ-VAS score (mean difference = -7.8 ± 17.21; p < 0.0001). The pregnancy increased the problems in mobility (ARI = 9.7% [1.7-17.6], p = 0.02), in self-care (ARI = 8% [2-14], p = 0.01), and in usual activities (ARI = 27.3% [18.9-35.7], p < 0.0001). Also, the pregnancy increased pain/discomfort (ARI = 26.5% [18-35.1], p < 0.0001) and anxiety/depression (ARI = 12% [3.2-20.9], p = 0.0112). The rural pregnant women had the worst HRQoL (EQ-5D index score = 0.57) compared to their urban peers (EQ-5D index score = 0.77). Likewise, women in the third trimester and nulliparous had the worst HRQoL (EQ-5D index score = 0.64 and 0.84 respectively).

Interpretation: The results highlighted that place of residence, parity, and gestational age are strongly associated with pregnant's HRQoL. The five EQ-5D-5L dimensions were affected during pregnancy. Consequently, there is a need to develop specific programs to monitor the HRQoL during pregnancy in order to ensure better maternal health care.

Funding: This study was funded by University Hassan First's own fund [grant number FP/01/2018].