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Background Pregnancy-related anxiety has a negative impact on the physical and mental health of pregnant women and the normal growth and development of the fetus. Establishing prediction models for pregnancy-related anxiety to screen associated predictive factors may provide important opportunities for prenatal intervention. Objective To establish a prediction model of pregnancy-related anxiety risk of pregnant women. Methods From January to July 2021, a questionnaire survey on pregnancy-related anxiety and predictors was conducted among pregnant women having routine prenatal check-ups provided by an obstetrics clinic of a tertiary grade A hospital in Ningxia. The socio-demographic characteristics of the subjects were collected, and the pregnant women were evaluated by the Life Event Scale (LES), Perceived Social Support Scale (PSSS), Family APGAR Index (APGAR), and Pregnancy-related Anxiety Questionnaire (PAQ). R 4.2.0 software was used to fit all selected variables by least absolute shrinkage and selection operator (LASSO) regression to identify predictors of pregnancy-related anxiety in the second and third trimesters. On the basis of logistic regression analysis, prediction models of pregnancy-related anxiety in the second and third trimesters were constructed, and the model nomogram and receiver operating characteristic curve (ROC) were drawn. The prediction effect of the model was evaluated by area under the curve (AUC). A calibration chart was drawn to evaluate the calibration of the model. Results A total of 1500 questionnaires were distributed, and 1448 valid questionnaires were recovered, with an effective rate of 96.53%. Among the 1448 pregnant women, the overall positive rate of pregnancy-related anxiety was 28.80% (417/1448), and the positive rates in the second and third trimesters were 29.21% (276/935) and 27.49% (141/513), respectively. The predictors entering the the second trimester model were age of marriage, family care, social support, family expectations for the fetus, physical condition during pregnancy, and whether experiencing life stressful events during pregnancy. The predictors entering the the third trimester model were pregnancy intention, physical discomfort, and whether experiencing life stress during pregnancy. A risk prediction model of pregnancy-related anxiety for the second trimester was established: risk of pregnancy-related anxiety=−0.07× marriage age +0.12× family care −0.03× social support −0.65× family expectation of fetal sex +0.42× physical condition during pregnancy +0.47× whether experiencing life stressful events during pregnancy. A risk prediction model of pregnancy-related anxiety for the third trimester was established: risk of pregnancy-related anxiety=−5.69+0.82× pregnancy intention +1.06× physical discomfort +0.94× whether experiencing life stressful events during pregnancy. The ROC curves of the two models were drawn. The AUC of the second trimester model was 0.71, and the AUC of related validation model was 0.68. The AUC of the third trimester model was 0.72, and the AUC of related validation model was 0.66. Conclusion The risk prediction models of pregnancy-related anxiety constructed based on LASSO regression and logistic regression have good prediction ability, and they suggest that pregnant women in the second trimester with short marriage age, high family care, low social support, family expectations for fetal sex, average physical condition, and experiencing life stress during pregnancy, and pregnant women in the third trimester with spontaneous pregnant intention, unintended pregnancy, physical discomfort, and experiencing life stress during pregnancy are high-risk groups for pregnancy-related anxiety.
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Objective To develop anxiety scale suitable for Chinese pregnant women and evaluate its reliability and validity. Methods Based on existing research results and clinical experience,this study compiled pregnancy anxiety scale(PAS). A sample of 509 pregnant women were selected for investigation and 65 of them were randomly retested for test-retest reliability with 2 week interval. Item analysis was con-ducted to screen valid items. Then the construct validity of the scale was tested by exploratory factor analysis ( EFA) and confirmatory factor analysis(CFA). Finally the reliability and criterion validity of the scale were evaluated using Cronbach's α coefficient,retest reliability coefficient and Pearson correlation coefficient. Re-sults The PAS was composed of 27 items in four factors,including worry about delivery,worry about them-selves,worry about fetal health and general anxiety. The four factors were extracted by EFA which could ex-plain 62. 48% of the total variance. Besides,the result of CFA demonstrated that the model fitted the data with well construct validity (χ2/df=1. 89,RMR=0. 04,RMSEA=0. 06,IFI=0. 92,TLI=0. 91,CFI=0. 92, PGFI=0. 70,PNFI=0. 74,PCFI=0. 81). The score of the pregnancy-related anxiety scale and its factors scores were positively correlated with the scores of pregnancy-related anxiety questionnaire(PAQ) and child-birth attitudes questionnaire(CAQ). The correlation coefficients were 0. 60-0. 80 and 0. 50-0. 78 respectively (all P<0. 01). The Cronbach's α coefficient was 0. 93 for the total scale and that of the four factors ranged from 0. 82 to 0. 90. The test-retest reliability was 0. 68 for the total scale and ranged from 0. 54 to 0. 75 for the four factors. Conclusion The PAS has a good reliability and validity,and it can be used as a valid tool to measure the anxiety level of pregnant women.
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Objective To investigate the second or third trimester pregnancy-related anxiety on small-for-gestational-age infants.Methods This study was based on Ma'anshan Birth Cohort Study (MABC),with 3 040 maternal-singleton pairs finally selected for data analysis,from May 2013to September 2014.The psychological state of pregnancy was evaluated according to a self-developed ‘ anxiety scale for gestation'.Small-for-gestational-age was defined as ‘ having birth weight below the 10th percentile at a particular gestational week',while large-for-gestational-age infants was defined as ‘having birth weight above the 90th percentile'.Birth weight between the 10th and 90th percentile was classified as appropriate-for-gestational age infants.x2 test was used to compare the distribution of characteristics in pregnancy among three groups with different birth weights.Multivariate logistic regression models were conducted to evaluate the associations between third trimester pregnancy-related anxiety and birth weight.Results The incidence rates of small-and large-gestational-age infants were 9.6％ and 16.6％,respectively.Difference between women with only one of the second or third trimester pregnancy-related anxiety syndromes and small-for-gestational-age infants showed no statistical significance.Women with both second and third trimester pregnancy-related anxieties might increase the risk of small-for-gestational-age infants (OR=1.39,95％CI:1.04-1.87).However,there was no significant difference between pregnancy-related anxiety and large-for-gestational-age infants (OR=1.05,95％ CI:0.81-1.35) noticed.Conclusion Women with second and third trimesterpregnancy-related anxiety appeared a risk factor for small-for-gestational-age infants.
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Objective To investigate the relationship of pregnancy-related anxiety of pregnant women in second/third trimesters and autism-like behaviors in their offspring at 18 months of age.Methods Based on a prospective cohort study design,we evaluated the situation of pregnancy-related anxiety of women during second and third trimesters through a Pregnancy-Related Anxiety Questionnaire.Subjects under study were classified into three groups,1) those with pregnancy-related anxiety during both trimesters,2) those with pregnancy-related anxiety at one trimester and 3) those without pregnancy-related anxiety in either trimester.When their children were 18 months,autism-like behaviors (ALB) were evaluated,using the part A of Checklist for Autism in Toddlers-23,and then classified into three groups as non-ALB group,minor ALB group and major ALB group.Multi-nominal logistic Regression was used to analyze the relationship of pregnancy-related anxiety with autism-like behaviors.Results Compared with non-ALB group,children whose mother with pregnancy-related anxiety during both trimesters presented significant higher risk on ALB than children whose mother without pregnancy-related anxiety in these two periods (relative risk,RR=2.43,95％ CI:1.21-4.86,P=0.012),major factors as pregnant women's IQ and gestational diabetes mellitus,premature delivery and education levels of fosterers on these pregnant women were under control.Our results from the stratified analysis showed:when in the subgroup that mother was the main fosterer of the child,there was an significant increase of risk in children whose mothers with pregnancy-related anxiety during both trimesters (RR=4.22,95％ CI:1.73-10.32,P=0.002).Conclusion The association between pregnancy-related anxiety and autism-like behavior was not strong but influenced by the fosterer of the child.
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Objective To investigate the second or third trimester pregnancy-related anxiety on small-for-gestational-age infants.Methods This study was based on Ma'anshan Birth Cohort Study (MABC),with 3 040 maternal-singleton pairs finally selected for data analysis,from May 2013to September 2014.The psychological state of pregnancy was evaluated according to a self-developed ‘ anxiety scale for gestation'.Small-for-gestational-age was defined as ‘ having birth weight below the 10th percentile at a particular gestational week',while large-for-gestational-age infants was defined as ‘having birth weight above the 90th percentile'.Birth weight between the 10th and 90th percentile was classified as appropriate-for-gestational age infants.x2 test was used to compare the distribution of characteristics in pregnancy among three groups with different birth weights.Multivariate logistic regression models were conducted to evaluate the associations between third trimester pregnancy-related anxiety and birth weight.Results The incidence rates of small-and large-gestational-age infants were 9.6％ and 16.6％,respectively.Difference between women with only one of the second or third trimester pregnancy-related anxiety syndromes and small-for-gestational-age infants showed no statistical significance.Women with both second and third trimester pregnancy-related anxieties might increase the risk of small-for-gestational-age infants (OR=1.39,95％CI:1.04-1.87).However,there was no significant difference between pregnancy-related anxiety and large-for-gestational-age infants (OR=1.05,95％ CI:0.81-1.35) noticed.Conclusion Women with second and third trimesterpregnancy-related anxiety appeared a risk factor for small-for-gestational-age infants.
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Objective To investigate the relationship of pregnancy-related anxiety of pregnant women in second/third trimesters and autism-like behaviors in their offspring at 18 months of age.Methods Based on a prospective cohort study design,we evaluated the situation of pregnancy-related anxiety of women during second and third trimesters through a Pregnancy-Related Anxiety Questionnaire.Subjects under study were classified into three groups,1) those with pregnancy-related anxiety during both trimesters,2) those with pregnancy-related anxiety at one trimester and 3) those without pregnancy-related anxiety in either trimester.When their children were 18 months,autism-like behaviors (ALB) were evaluated,using the part A of Checklist for Autism in Toddlers-23,and then classified into three groups as non-ALB group,minor ALB group and major ALB group.Multi-nominal logistic Regression was used to analyze the relationship of pregnancy-related anxiety with autism-like behaviors.Results Compared with non-ALB group,children whose mother with pregnancy-related anxiety during both trimesters presented significant higher risk on ALB than children whose mother without pregnancy-related anxiety in these two periods (relative risk,RR=2.43,95％ CI:1.21-4.86,P=0.012),major factors as pregnant women's IQ and gestational diabetes mellitus,premature delivery and education levels of fosterers on these pregnant women were under control.Our results from the stratified analysis showed:when in the subgroup that mother was the main fosterer of the child,there was an significant increase of risk in children whose mothers with pregnancy-related anxiety during both trimesters (RR=4.22,95％ CI:1.73-10.32,P=0.002).Conclusion The association between pregnancy-related anxiety and autism-like behavior was not strong but influenced by the fosterer of the child.
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Objective To understand the association between pregnancy intention and pregnancy-related anxiety in the second and third trimester and its strength.Methods A prospective cohort study was conducted in Ma' anshan,Anhui province.A total of 3 474 eligible pregnant women within 14 weeks of gestation were recruited.The information about their demographic characteristics were collected in early pregnancy.The completed questionnaire of pregnancy-related anxiety were asked to return in the second and third trimester.Logistic regression analysis was conducted to evaluate the association between pregnancy intention and pregnancy-related anxiety in the second and third trimester.Results A total of 3 083 pregnant women were included in final analysis,The rate of unintentional pregnancy was 15.00％ (n=461).The detection rates of pregnancy-related anxiety in the second and third trimester were 29.13％ (n=898) and 30.36％ (n=936).After controlling potential confounding factors,unintentional pregnancy increased the risk of pregnancy-related anxiety in the second trimester compared with intentional pregnancy (OR=1.85,95％ CI:1.44-2.38);The risk of pregnancy-related anxiety also increased in the third trimester (OR=1.84,95％ CI:1.44-2.35).Intentional pregnancy did not increase the risk of pregnancy-related anxiety in the second and third trimester.Conclusion The study results suggests that unintentional pregnancy could increase the risk of pregnancy-related anxiety in the second and third trimester.
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Objective To understand the association between pregnancy intention and pregnancy-related anxiety in the second and third trimester and its strength.Methods A prospective cohort study was conducted in Ma' anshan,Anhui province.A total of 3 474 eligible pregnant women within 14 weeks of gestation were recruited.The information about their demographic characteristics were collected in early pregnancy.The completed questionnaire of pregnancy-related anxiety were asked to return in the second and third trimester.Logistic regression analysis was conducted to evaluate the association between pregnancy intention and pregnancy-related anxiety in the second and third trimester.Results A total of 3 083 pregnant women were included in final analysis,The rate of unintentional pregnancy was 15.00％ (n=461).The detection rates of pregnancy-related anxiety in the second and third trimester were 29.13％ (n=898) and 30.36％ (n=936).After controlling potential confounding factors,unintentional pregnancy increased the risk of pregnancy-related anxiety in the second trimester compared with intentional pregnancy (OR=1.85,95％ CI:1.44-2.38);The risk of pregnancy-related anxiety also increased in the third trimester (OR=1.84,95％ CI:1.44-2.35).Intentional pregnancy did not increase the risk of pregnancy-related anxiety in the second and third trimester.Conclusion The study results suggests that unintentional pregnancy could increase the risk of pregnancy-related anxiety in the second and third trimester.