Measurements
All details of maternal and neonatal
conditions during pregnancy and delivery were obtained
from the hospital information
systems. After applying the inclusion and exclusion criteria, we invited
mothers for a clinical visit within 6 weeks after delivery and
encouraged them to participate in our questionnaires, including EPDS,
Leakage Index Questionnaire, and Pain Scale (Numerical rating scales).
EPDS is the most commonly-used PPD
scale worldwide and is one of the most authoritative self-evaluation
scales to screen for
PPD.20 Each of its 10
items is divided into 4 grades and scored from 0 to 3. The total score
ranges from 0 to 30, with higher scores signifying more serious
PPD21. Compared to
other questionnaires, it has a satisfactory diagnostic efficiency and is
more concise to
subjects.22 The
sensitivity of EPDS has been proven to range from 0.67 to 1.00, and the
specificity is consistently 0.87 or higher when the cut-off value is
13.23 Therefore, a
score of EPDS ≥13 was determined to be positive for PPD screening in our
study.
The Leakage Index Questionnaire
(involving 3 items with multiple choices) and Pain Scale were used to
evaluate the recovery of muscles in the pelvic floor and the degree of
postpartum pain in mothers respectively. The scores of the former range
from 0 to 6 and from 0 to 10 in the latter. The higher scores on the
Leakage Index Questionnaire predict poorer recovery of pelvic floor
muscles. Moreover, educational background, annual family income, and
milk feeding methods were also investigated in our questionnaire
(details are shown in Figure S1).