Heterogeneity And Growth Trajectory Of Maternal Health-related Behaviors During Pregnancy And Their Correlation With Pregnancy Outcomes

AimTo understand the practice of health-related behaviors(diet,exercise,sleep,weight management,emotional management)of pregnant women at different stages of pregnancy(first,second,and third trimester),to explore the relationship between health-related behaviors and pregnancy outcomes,to identify health-related behaviors that play an important role in preventing adverse pregnancy outcomes,and interveneable health-related behaviors,and determine the best intervention time points for the above health behavior-related risk factors.Finally,according to the research results,some suggestions for perinatal health care services are provided from the perspective of nursing disciplines and the perspective of optimizing clinical nursing practice.MethodThis research is divided into three parts:(1)Heterogeneity and growth trajectory of health-related behaviors during pregnancy A prospective cohort study was conducted to explore the practice of healthrelated behaviors of pregnant women at different stages of pregnancy under real clinical scenarios;In dietary behavior,dietary quality index and dietary pattern were used to analyze species richness and structure,respectively;In weight management,two pregnancy weight gain standards,IOM and Chinese Nutrition Society were used in comparison;In emotion management,the developmental trajectories of depression,anxiety,and social support were analyzed using a latent developmental model based on quantitative data from longitudinal measures.(2)Correlation analysis between health-related behaviors during pregnancy and pregnancy outcomes The pregnancy outcomes of the participants were further longitudinally tracked(main pregnancy outcomes:live birth,gestational age of delivery,mode of delivery,postpartum hemorrhage,neonatal birth weight,neonatal Apgar score,neonatal emergency care;secondary pregnancy outcomes:maternal complications/comorbidities during pregnancy).Logistic regression analysis was used to explore the effect of different health-related behaviors(diet,exercise,sleep,weight,and mood management),health behavior patterns(dietary patterns),and health behavior growth trajectories(anxiety,depression,social support development trajectories)on pregnancy outcomes after controlling for confounding factors.(3)Heterogeneity and growth trajectory of postpartum health-related behaviors The postpartum health behaviors of the participants were further tracked longitudinally.The status and influencing factors of health-related behaviors(breastfeeding,postpartum weight retention,and emotional management)at different postpartum stages(postpartum 6 weeks and postpartum 6 months)were explored.A latent growth model was used to analyze the growth trajectories of maternal perinatal depression,anxiety,and social support based on longitudinal tracking data in five time periods:first trimester,second trimester,third trimester,6 weeks postpartum,and 6 months postpartum.Results(1)Exploring the heterogeneity and growth trajectory of health-related behaviors during pregnancy A total of 1368 eligible participants with informed consent were recruited at the time of pregnancy registration and 1016(first trimester),910(second trimester),and 779(third trimester)questionnaires were effectively collected during follow-up.In diet:two,two,and two(factor analysis)and two,three,and three(latent profile analysis)different dietary patterns were recognized in the first,second,and third trimester,respectively;Significant differences in the use of folic acid,calcium,iron,zinc,vitamin and DHA supplements,tea and coffee intake,and meal times were noticed at different stages of pregnancy.In exercise and sleep,significant differences in exercise time,outdoor activity time,sleep time,and sleep quality were noticed at different stages of pregnancy.Slow walking was the most common exercise adopted by women during pregnancy(>90%).The proportions of insufficient and excessive gestational weight gain(GWG)were 22.2%and 36.1%(IOM standard),7.3%,and 49.0%(Chinese Nutrition Society standard),respectively.In emotional management,the incidence of depressive symptoms was 37.4%,30.9%,and 31.8%,and the incidence of anxiety symptoms was 16.2%,13.5%,and 15.5%,in the first,second,and third trimesters,respectively.Growth trajectory modeling identified two types of LCGM anxiety growth trajectory models and named as "persistently low anxiety group"(1105,86.0%)and "persistently high anxiety group"(180,14.0%)according to the characteristics of their anxiety scores.(2)Correlation analysis results of health-related behaviors during pregnancy and pregnancy outcomes Of the 1368 participants initially included,1332 were followed up with definite pregnancy outcomes(1278 live birth and 52 pregnancy loss),and 36 were lost.The multivariate regression model revealed that:Taking a nap almost every day was a protective factor for pregnancy loss(OR:0.355,95%CI:0.1340.940);Iodine supplementation in the first trimester(OR:10.715,95%CI:1.353-84.878)was associated with preterm birth;Excessive GWG(IOM criteria)(OR:1.782,95%CI:1.119-2.837),depression in the first trimester(OR:1.782,95%CI:1.119-2.837),poor sleep quality in the second trimester(OR:4.334,95%CI:1.459-12.870)associated with cesarean delivery;The use of DHA(OR:1.712,95%CI:1.006-2.914),and brisk walking exercise in the third trimester(OR:0.194,95%CI:0.045-0.835)were associated with episiotomy;Adopting other exercise methods in the third trimester(OR:10.611,95%CI:2.068-54.449)was associated with postpartum hemorrhage;Excessive GWG(IOM criteria)(OR:3.016,95%CI:1.438-6.326)was associated with macrosomia;Coffee intake(OR:4.496,95%CI:1.140-17.736)and moderate(OR:0.030,95%CI:0.002-0.382),high(OR:0.038,95%CI:0.002-0.588)social support in the first trimester were associated with hypertensive disorders of pregnancy;The first trimester-PCA-grains,vegetables and fruits dietary pattern(OR:2.249,95%CI:1.1864.263),the overall food intake remain stable(OR:0.302,95%CI:0.149-0.612)and decreased sleep time after pregnancy(OR:2.125,95%CI:1.036-4.358)were associated with gestational diabetes;The use of dietary supplements(OR:0.219,95%CI:0.058-0.826)and the use of vitamin supplements(OR:0.589,95%CI:0.3690.941)in the first trimester were protective factors for anemia during pregnancy.(3)Exploring the heterogeneity and growth trajectory of postpartum healthrelated behaviors Among 1278 participants with live birth,765 and 616 completed the postpartum questionnaire after 6 weeks and 6 months postpartum.In postpartum weight management,the postpartum weight retention(PPWR)was 4.27±4.23kg and 2.26±4.43kg after 6 weeks postpartum and 6 months postpartum respectively,and the PPWR ratio was 45.1%and 27.4%,respectively.Pre-pregnancy BMI and GWG were associated with PPWR.In breastfeeding(BF),the exclusive BF rate was 50.8%after 6 weeks postpartum,and the BF rates were 92.5%and 74.4%after 6 weeks postpartum and 6 months postpartum,respectively;Educational level,pregnancy risk rating,cesarean section,parity,occupational status were associated with BF;In emotional management,the incidence rates of depressive symptoms after 6 weeks and 6 months after delivery were 22.0%and 19.2%,and were 14.6%and 14.9%in anxiety symptoms.Growth trajectory modeling of perinatal anxiety,depression,and social support identified three different traj ectories,which were named "low/moderate/high depression group","low/moderate/high anxiety group" and " low/moderate/high social support group";Non-city household registration,low education level,low education level of the spouse,lack of medical insurance,non-working/housewives occupational status and multiparous were associated with high depression,high anxiety,and low social support.Conclusion(1)Differences in health-related behaviors during different stages of pregnancy certain existed.Modifications of health-related behaviors during pregnancy may prevent adverse pregnancy outcomes to a certain extent,including but not limited to Appropriate use of dietary supplements,vitamin supplements,restriction of coffee intake;adequate rest;adequate social support;improving mental health care services to reduce depression symptoms in the first trimester;Improving the sleep quality of pregnant women in the second trimester;Appropriate use of dietary supplements and brisk walking exercise in the third trimester;Maintaining a reasonable GWG.(2)Excessive GWG and PPWR are issues worthy of attention in perinatal health management.The rate of excessive GWG is above 1/3(IOM standard),and close to 1/2(Chinese Nutrition Society standard).The rates of PPWR are 45.1%and 27.4%after 6 weeks and 6 months postpartum.Maintaining a reasonable GWG may help reduce PPWR.(3)Perinatal depression and perinatal anxiety are also issues worthy of attention.During the entire perinatal period(from early pregnancy up to one year postpartum),the incidence of depressive and anxiety symptoms is 19.2%～37.4%and 13.5%～16.2%.Low socioeconomic status is related to low social support,high anxiety,and high depression symptoms.It is necessary to focus on the mental health of women with noncity household registration,low education level,low education level of the spouse,no medical insurance,non-working/housewives,and multiparous.