Biopsychosocial predictors of chronic pain after caesarean delivery: a prospective cohort evaluation of the SPACE (Sleep, Pain, Affect, Cognition, Energy)-Postpartum framework

Background: Chronic pain after caesarean delivery is associated with impaired maternal quality of life, yet validated risk assessment tools are lacking. We evaluated a novel symptom-based SPACE (Sleep, Pain, Affect, Cognition, Energy)-Postpartum framework, conceptualised as a multidomain symptom system through triangulation of qualitative interviews, prospective cohort observations, and prior literature, for predicting chronic pain at 3 months postpartum. Methods: In this prospective observational cohort study in participants undergoing caesarean delivery, psychosocial variables and the SPACE-Postpartum framework were evaluated via validated self-report questionnaires, including a single-item measure assessing perceived control, at 24-48 h, 2 weeks, and 3 months postpartum. Chronic pain was defined as pain persisting at 3 months. A five-item model, selecting one measure for each SPACE domain, was derived using ridge-regularised logistic regression. Latent class and mediation analyses explored clustering and pathways. Results: =0.024). Mediation analysis suggested acute pain had direct effects, while sleep disturbance was an independent risk marker for subsequent chronic pain. Conclusions: We report that chronic pain after caesarean delivery is common. Early multidomain assessment may enable risk stratification and facilitate targeted intervention. The SPACE-Postpartum framework provides early proof-of-concept for a structured system of interacting symptom domains to support risk stratification, warranting multicentre validation.