A Survey Of The Demand Of Women With Advanced Maternal Age During Their Second Pregnancy Based On The Background Of "Universal Two-child" Policy

Background:Pregnancy is woman's natural physiological process which has an important effect on their physical and mental development.Since the fifth plenary session of the 18th cpc central committee put forward a "Universal two-child" policy,the number of the second pregnancy women with advanced ages has increased significantly.The physiological function of older pregnant woman is in a downward trend,and so the second pregnancy will increase the risk for both of mother and child.In majority of cases,older women during their second pregnancies have to raise their children,take care of their parents and confront their high intensity work.Such numerous unfavorable factors simultaneously affect the physical and mental health of pregnant women.Therefore,paying close attention to the changes of physical and mental needs of pregnant women,taking individualized guidance and providing individualized service according to different needs are important measure to improve the quality of life during the period of pregnancy and to guarantee the health of mother and child.With the progress of the society and the improvement of the educational level,the needs of pregnant women are increasing.At present,the research on the demands of gestation mainly focus on the pregnant women at the right age and multipara,but there are few reports on the needs of the elderly women with their second pregnancies.Objectives:1.The main objective of this research is to develop and evaluate the validity and reliability of the Demands Scale of Women with Advanced Maternal Age during Their Second Pregnancy.2.The secondary objective is to provide scientific basis for health care guidance for pregnant women with advanced maternal age during their second pregnancy by analyzing the demand status and the influencing factors.Methods:1.Based on the relevant literature and pregnant women's interview,combined with the theoretical framework of the Maslow's hierarchy of needs,we formulated the dimensions and items of the Demands Scale of Women with Advanced Maternal Age during Their Second Pregnancy.Then through Delphi expert consultation,the items of the scale were added,deleted,modified and merged,then formed the predicted demand scale of pregnant women with advanced age during their second pregnancy.2.From July to October 2016,convenience sampling method was employed to recruit 280 women with advanced maternal age during their second pregnancy who underwent antenatal examination at the outpatient department of a tertiary grade A hospital in Yancheng.Critical ratio value and correlation coefficient were adopted to screen scale items.Internal consistency test,content validity and exploratory factor analysis were used to evaluate the reliability and validity of questionnaire.3.From November 2016 to March 2017,the convenience sampling were employed to recruit 382 women with advanced maternal age during their second pregnancy who underwent antenatal examination at the outpatient department of a tertiary grade A hospital in Yancheng.Then Demands Scale of Women with Advanced Maternal Age during Their Second Pregnancy and Society Support Rating Scale(SSRS)were used to the study.Data were collected and analyzed by descriptive statistics,t-test,variance analysis,and multiple stepwise regression analysis to describe the status of pregnant women's needs and explore the influencing factors.Results:1.The consensus was formed through two rounds of expert enquiries.The qualified rates of the two rounds of expert questionnaires were 100%.The expert authority coefficients in the two rounds were 0.790 and 0.800 respectively.The two rounds of Kendall's coefficient of concordance in the expert opinion were 0.280 and 0.290 separately(P<0.05).The initial scale consisted of forty-eight items in seven fields.2.Statistical method was used to select the items of the scale.We used the critical ratio(CR)to test the scores of high and low groups through Independent-Sample t-test.The data in the two groups had statistical significant difference(P<0.05).It indicated that the discrimination of the scale was good.Pearson correlation analysis was used to analyze the correlation between every item and its dimension score.The correlation coefficient between the 13th item and the total score of physiological demand dimension was 0.103.The 27th and 30th item had 0.328 and 0.369 correlation coefficients with the total score of respect demand dimension respectively.These 3 items were excluded because their item-to-dimension correlation coefficients were less than 0.400.Correlation coefficients in the other items were from 0.697 to 0.863,and these values had statistical significant differences(P<0.05).The Demands Scale of Women with Advanced Maternal Age during Their Second Pregnancy scale was consisted of 7 dimensions with 45 items.3.The analyses of the validity and reliability of the Demands Scale of Women with Advanced Maternal Age during Their Second Pregnancy were as follows:?Internal consistency reliability:The Cronbach's a coefficient of the total scale was 0.880,and the internal consistency coefficient of each subscale is from 0.800 to 0.940.?Content validity:The Delphi result showed that the content validity index was 0.866 for the total scale.?Structure validity:7 factors were extracted by principal components analysis,and the cumulative contribution rate was 64.082%.The factor load values of the items were all over 0.400 after the maximum orthogonal rotation of variance.The data analysis showed that the theoretical structure and hypothesis were basically consistent.4.The current situation of the demand of women with advanced maternal age during their second pregnancy.382 questionnaires were distributed and 350 valid questionnaires were retrieved,and the effective response rate was 91.6%.The results showed that the scores of pregnancy needs in the second pregnancy from high to low were safety needs,cognitive needs,love and belonging needs,self-actualization needs,respect needs,physiological needs and aesthetic needs.Among them,control of sweet food demand score was the highest;secondly,pregnancy complications related knowledge needs had a second higher score,while sexual needs had the lowest score.5.The main influence factors of woman with advanced maternal age during their second pregnancy were as follows:The single-factor analysis showed that the pregnant demand scores had significant statistical differences in different ages,domiciles,levels of education,profession,family income monthly,history of pregnancy and childbirth,pregnant week,ages of their first child and suspended form of work(P<0.05).The results of Pearson correlation analysis showed that the total scores of social support,subjective support score,objective support score and the utilization dimension for support score were all negatively correlated with pregnancy demand(r were-0.841?-0.855?-0.137?-0.716,respectively).The multivariate regression analysis showed that different ages,levels of education,history of pregnancy and childbirth,ages of the first child,subjective support,utilization of support were the predictors of the demand of women with advanced maternal age during their second pregnancy(B value respectively were 0.280?0.122?0.075?0.070?-0.378?-0.277).Conclusions:1.The Demands Scale of Women with Advanced Maternal Age during Their Second Pregnancy has high reliability and acceptable validity,and which can reflect the demand of women with advanced maternal age during their second pregnancy comprehensively and accurately.2.The demand of women with advanced maternal age during their second pregnancy is situated at the middle level.The ages of pregnant women,levels of education,ages of the first child,histories of abnormal pregnancy and subjective support,utilization of support are the main factors that influence the demand of women with advanced maternal age during their second pregnancy.