Developmental Trajectories And Associated Factors Of Health-promoting Behaviors Among Pregnant Women

Objectives1.Through the investigation of health-promoting behaviors during first pregnancy trimester,we aimed to analyze the level of health-promoting behaviors and to explore associated factors.2.Through the follow-up of health-promoting behaviors during second and third pregnancy trimester,we aimed to identify distinct patterns of health-promoting behavior trajectories and explore the predictors of these trajectory group memberships.Methods1.The investigation of health-promoting behaviors during first pregnancy trimester:the study was carried out in the obstetric clinic of one Class 3 first level general hospital between August 1,2020 to May 1,2021 in Qingdao,China.Pregnant women who met the standards of inclusions and exclusions were recruited during first pregnancy trimester(T1=12±2 weeks).The General Data Questionnaire,The Family Adaptability,Partnership,Growth,Affection,Resolution(APGAR)index,The Sense of Coherence Scale(SOC-13),The Chinese version of General self-efficacy scale(GSES)and The Health-Promoting Lifestyle Profile was distributed at baseline.We used SPSS 25.0 software to analyze.The independent sample t test and one-way ANOVA were used to compare the healthpromoting behaviors of pregnant women with different characteristics in first pregnancy trimester.The Pearson correlation analysis and mediating effect analysis were used to identify path influence of associated factors on health-promoting behaviors.2.The follow-up of health-promoting behaviors during second and third pregnancy trimester: Pregnant women in their first pregnancy trimester were followed up every 12 weeks using the Health-Promoting Lifestyle Profile.We used SPSS 25.0 and SAS 9.4software to analyze.The method of repetitive measure analysis of variance analysis was used to assess the level of health-promoting behaviors during pregnancy.The group-based trajectory model was applied to identify health-promoting behavior trajectories,the value of AIC,BIC,аBIC,Ave PP and group membership probabilities were used to evaluate the model.The multinomial logistic regression was adopted to determine the predictors of trajectory group memberships.Results1.The results of health-promoting behaviors during first pregnancy trimester(1)The total score of health promotion behaviors in first pregnancy trimester was(138.94±19.11),which was in the moderate level.The influencing factors such as prepregnancy exercise habits(t=6.35,P<0.01),monthly family income(F=3.48,P<0.05)and payment methods(F=3.92,P<0.05)had statistical significance in the effects of healthpromoting behaviors.(2)Family function,self-efficacy,the sense of coherence and the health-promoting behaviors in first pregnancy trimester were related respectively.We found self-efficacy and the sense of coherence both had the mediating effect on the association between family function and health-promoting behaviors.Multiple mediating effect analysis was used to identify the mechanisms of these factors.In the model of family function-selfefficacy-the sense of coherence-health-promoting behaviors.The total effect was 2.97,the direct effect was 1.52.the indirect effect was 1.45.The mediating effect of selfefficacy was 0.60,the mediating effect of the sense of coherence was 0.68,the mediating effect of self-efficacy-the sense of coherence was 0.18.2.The results of health-promoting behaviors during pregnancy(1)The entire sample of pregnant women experienced a significant increase in health-promoting behaviors throughout the pregnancy trimesters.Three trajectories were identified by using group-based trajectory model.According to the intercept and slope,the three types of health-promoting behaviors were named as “low-increase behavior trajectory”,“moderate-increase behavior trajectory” and “stable then increased behavior trajectory”,which account for 20.10%,58.00%,21.90%,respectively.(2)Considering the stable then increased behavior trajectory as the comparison group,low self-efficacy(OR=0.14,0.03～0.80),low maternal sense of coherence(OR=0.88,0.82～0.94),lack of pre-pregnancy exercise habit(OR=0.03,0.01～0.23)and unplanned pregnancy(OR=0.15,0.03～0.79)were significantly associated with the lowincrease behavior trajectory.Low self-efficacy(OR=0.13,0.03～0.52)and lack of prepregnancy exercise habit(OR=0.11,0.02～0.64)were significantly associated with the moderate-increase behavior trajectory.Conclusions1.The total score of health promotion behaviors in first pregnancy trimester was in the moderate level,increase efforts should be taken to improve the health-promoting behaviors.Meanwhile,pre-pregnancy exercise habits,monthly family income and payment methods were significantly associated with health-promoting behaviors in first pregnancy trimester.2.Family function can directly predict health-promoting behaviors.Meanwhile,family function can indirectly predict health-promoting behaviors through self-efficacy or the sense of coherence.Furthermore,family function can also affect self-efficacy indirectly enhance the sense of coherence,leading to the improved health-promoting behaviors.3.The entire sample reported health-promoting behaviors experienced a stable increase during pregnancy.Meanwhile,substantial individual variability among pregnant women were found in current study.We identified three trajectories among pregnant women: a “low-increase behavior trajectory(20.11% of sample)”,a “moderate-increase behavior trajectory(58.02% of sample)” and a “stable then increased behavior trajectory(21.87% of sample)”.4.As compared to the stable then increased behavior trajectory.The predictive factors of low-increase behavior trajectory were the sense of coherence,self-efficacy,pregnancy intention and pre-pregnancy exercise habit.The predictive factors of lowincrease behavior trajectory were the sense of coherence and self-efficacy.