OBJECTIVES: To evaluate the ability of the EQ-5D-5L instrument to detect variations in HRQoL across different stages of pregnancy and the postpartum period.

METHODS: In a national cross-sectional study, we collected EQ-5D-5L and EQ-VAS measures from 1,181 pregnant and 741 postpartum individuals (EQ Fast Track Funding #260-2020RA). We derived gestational age at the time of survey and months since delivery (for postpartum participants), using information on last menstrual period, anticipated date of delivery, and observed date of delivery. We assessed median EQ-5D-5L utilities and EQ-VAS scores, as well as individual EQ-5D-5L item responses, by stage of pregnancy/postpartum at survey. Segmented regression was used to estimate changes in HRQoL measures.

RESULTS: We observed declines in median EQ-5D-5L utility scores from 0.68 (IQR 0.38, 0.70) at 3 months of pregnancy to 0.38 (IQR 0.13, 0.68) at 4 months of pregnancy. Median EQ-5D-5L utility values remained at 0.38 until month 8, when they declined to 0.21 (IQR -0.03, 0.59), then increased immediately postpartum, returning to 0.69 (IQR 0.38, 1.00) during the 1st month postpartum. Segmented regression results indicated that after adjustment for covariates, on average, there was a 4% decline (β=-0.04) in EQ-5D-5L utility values each month of pregnancy, followed by a 31% improvement at 1 month postpartum (β=0.31). We observed no such variations in EQ-VAS scores. When we examined each EQ-5D-5L item, we found that issues with pain/discomfort, usual activities, mobility, and self-care peaked at month 9 of pregnancy and declined through the postpartum period. The proportion of respondents reporting problems with anxiety/depression remained >50% throughout pregnancy and the postpartum period.

CONCLUSIONS: HRQoL as measured by the EQ-5D-5L utilities varies across pregnancy, with progressive declines beginning early in 2nd trimester followed by immediate recovery during the first two months postpartum. Measures of HRQoL for pregnant persons should consider the gestational age at the time of measurement.