| Objective To assess the state of social demographic, physical, psychosocial factor of pregnant women during pregnancy, and to explore whether maternal factors have influence on pregnancy outcome, and then, to comprehend deeply the reasons for pregnant women choosing cesarean section with social factors, and their perceptions of mode of delivery after a previous caesarean section.Method The objectives were the pregnant women who had regularly visited the Hospital-based outpatient gynecology clinic of Anhui Province Hospital with plan to delivery in this hospital between Sept, 2007 and Oct, 2008, and set up the prospective observation cohort. These women were not with organic or mental diseases, neither diet during pregnancy. At last completed data of 512 subjects were collected. The basic information and first trimester prenatal diagnostic profiles of the pregnant women who were in the cohort were gathered. Subsequently, regular follow-up and measurements about physical indexes and hematologic parameters which aiming at members of the cohort were carried out under the obstetricians, the follow-up were ended until the delivery and the information about the parturition condition and the newborn were collected from the obstetric records. A number of measuring scales, such as BAI (Beck Anxiety Inventory), CES-D (Center for Epidemiological Survey,Depression Scale), and LES (Life Event Scale) were used to evaluate the mental condition of the pregnant during terminal pregnancy , also BAI and CES-D were used to evaluate the mental condition of the pregnant again during terminal pregnancy. And a semi-structured interviews were applied to 68 cases who selected cesarean section because of social factors., and their perceptions of delivery modes after delivery. The collected data were analyzed by using SPSS (statistical package for social science). ANOVA (Analysis of Variance), two-independent-samples t test and Pearson correlation analysis were used to analyzed measurement data and chi-square test were used to count data of maternal factors and the physical index of neonate. Student's t-test was used to analyzed the comparison between anxiety, depression during pregnancy and the mode of delivery, complication of delivery and chi-square test were used to other factors. Multiple linear regression analyses was used to analyzed maternal factors and neonatal birth weight. Data of qualitative research analyzed with generic analysis.Results Physical, psychosocial factor and other maternal factors of pregnant women during pregnancy impact the pregnancy outcome on different levels:(1) Progestational height, weight and BMI of the pregnant women and the weight gain during pregnancy have positive correlation with the physical index of the newborn, pregnant women with different progestational BMI. The amount and speed of weight gain during pregnancy have opposite correlation with progestational BMI, the birth weight of the newborn and the incidence rate of macrosomia was increasing with the amount and speed of weight gain increasing.(2) Anxiety, depression, and life event have opposite correlated with weight,length of the newborn and gestational age, the degree of depression and anxiety were higher in the last trimester than at the middle, and the higher the degree, the bigger risk of occurring complication of delivery. There was a significant correlation among the life event and the degree of anxiety and depression, also among the weight,length of the newborn and gestational age, especially the negative events, but there was no correlation among positive events and others without anxiety at the middle of trimester.(3) Birth weight of the newborn whose mother with anemia were lower than the baby without this appearance, and hemoglobin levels of the pregnant at the middle of trimester were correlated oppositly with birth weight,birth length of the newborn and gestational age.(4) The older of the pregnant women, the bigger possibility of choosing cesarean section and younger of fetal age. The other health factors of the pregnant were not related to the mode of delivery.(5) Progestational height, weight gain during pregnancy and anxiety during terminal pregnancy are the independent influencing factor on the birth weight of the newborn.(6) Five subjects were generalized from the results of the semi-structural interviews, i.e., the fear of natural childbirth,the reliance on cesarean section, the affect of the source of the information, the desire to independent choice, and others. Most of the pregnant women are satisfied with their respective mode of deliver, but most of them would prefer vaginal birth if they have the chance to choose the delivery mode again, the main benefit is that the feelings of mother-to-child communication.Conclusions Maternal pre-pregnancy BMI, weight gain, anemia during pregnancy and psychosocial factor are significance influential factor on birth weight of newborn. The higher the degree of anxiety and depression, the bigger risk of occurring complication of delivery. And the need of relieving the pain, not understanding the importance of the labor modes, not-scientific-enough information source, and the three factors determined the pregnant to select cesarean section.
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