Prenatal and early postpartum factors associated with multidimensional childbirth memory among Chinese women: a prospective cohort study

Childbirth memories may remain psychologically salient for years, but prospective evidence on factors associated with their distinct dimensions is limited. We examined antenatal, obstetric, delivery-related, and early postpartum factors associated with six dimensions of childbirth memory, and explored factors measured concurrently at 6–12 weeks postpartum. In this prospective cohort, 1,123 women completed antenatal assessment (T0); 1,110 formed the valid T0 cohort, 984 completed assessment within 72 h postpartum (T1), and 747 completed the Birth Memories and Recall Questionnaire (BirthMARQ) at 6–12 weeks postpartum (T2). Six BirthMARQ domains were analyzed as parallel outcomes. Missing data were handled by multiple imputation (m = 20). For each domain, stacked least absolute shrinkage and selection operator (LASSO) with participant-grouped 10-fold cross-validation selected variables from 36 pre-T2 candidate factors. Post-LASSO linear models were fitted in each imputed dataset and pooled using Rubin’s rules. Benjamini-Hochberg false-discovery-rate (FDR) adjustment addressed multiplicity. Completers and non-completers differed mainly in education and parity, whereas prenatal psychological measures showed little imbalance. After FDR correction, higher prenatal childbirth-fear scores were associated with higher emotional-memory scores ( B = 0.180, 95% confidence interval (CI) 0.120–0.240), whereas higher birth satisfaction was associated with lower emotional-memory scores ( B =-0.310, 95% CI -0.398 to -0.221). Infant complications were associated with higher sensory-memory ( B = 2.434, 95% CI 1.003–3.866) and recall scores ( B = 1.275, 95% CI 0.568–1.981), and higher prenatal depressive-symptom scores were associated with higher recall scores ( B = 0.098, 95% CI 0.040–0.157). All remained significant after FDR correction. No factor was selected for coherence. Concurrent birth-trauma rating was associated with several domains, but temporal direction could not be established. This study adds prospective evidence from Chinese women that antecedent factors relate differently to childbirth-memory dimensions, extending research focused on global birth appraisals and trauma-related outcomes. The findings identify domain-specific hypotheses for longitudinal replication and evaluation of antenatal support and maternity care; they do not establish intervention effects or justify immediate changes in practice. Not applicable.