Health-Related Quality of Life of Mothers and Children

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 studies presented in this thesis were embedded in the Generation R Study and the Dutch Health Interview Survey in the Netherlands. Seven studies have been included in this thesis. The main findings are: (1) 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; (2) Physical and mental trajectories of health-related quality of life during pregnancy differ, with the most common being healthy trajectories. Predictors indicative of suboptimal HRQOL trajectories included pregnancy-related physical symptoms and pregnancy-specific anxiety. (3) Multiple determinants are associated with worse maternal HRQOL at two months after delivery. Particularly, maternal psychopathology is a profound determinant of worse mental HRQOL after delivery. (4) We 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. (5) There are multiple determinants of worse HRQOL in childhood. Having a non-western immigrant background, parents who did not work, more health conditions/disorders and using more healthcare were associated with poorer physical HRQOL. Boys, single-parent family, obesity and having more health conditions/disorders were associated with poorer psychosocial HRQOL. (6) Children with a prevalent chronic condition (asthma, eczema, dyslexia, attention deficit hyperactive disorder, or migraine/severe headache) have a low physical /psychosocial HRQOL compared with children without any chronic conditions. The pattern of impaired HRQOL is specific across these conditions. (7) Our results support the feasibility, concurrent validity, and discriminant validity of the Health Status Classification System-Preschool (HSCS-PS) in the general population, which is a preference-based measure of HRQOL among preschool-aged children.

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