Association Between High-risk Pregnancy Factors And Prenatal Psychological Symptoms And The Protection Effect Of Mindfulness

Objective:This study aimed to evaluate the prevalence of high-risk pregnancy and to assess the prenatal psychological symptoms among high-risk pregnant women.A further objective is to clarify associations between advanced age,history of abnormal pregnancy,pregnancy complications and psychological symptoms.In addition,risk and protection factors of psychological symptoms were also studied so that some suggestions could be made to improve pregnant women's mental health.Methods:This was a cross-sectional study.Pregnant women in a Grade 3A hospital in Shandong Province were recruited according to the inclusion and exclusion standards.The measurements include self-reported Patient Health Questionnaire(PHQ-9),State-Trait Anxiety Scale(STAI),Fatigue Severity Scale(FSS),Pittsburgh Sleep Quality Index(PSQI),Mindful Attention Awareness Scale(MAAS)and socio-demographics.A total of 2377 pregnant women were recruited with a mean gestational age 38±2.702 weeks.IBM SPSS 23.0 was used in this study.The basic data were described using means ±standard deviations and frequent(percent).Independent sample t test was used to compare the psychological symptoms among pregnant women with different high-risk factors?logistic regression models and interaction test were used to find the risk and protection factors of psychological symptoms.Results:(1)More than half pregnant women were in high-risk pregnancy:the high-risk pregnancy rate is 67.7%,the older pregnancy rate is 23.2%,the prevalence of history of abnormal pregnancy is 33.2%,and the prevalence of pregnancy complications is 35.7%.(2)High-risk pregnant women showed severer psychological symptoms:compared with pregnant women without high-risk factors,high-risk pregnant women had poorer fatigue and sleep symptoms;those with history of abnormal pregnancy or pregnancy complications showed poorer depressive,anxiety,fatigue and sleep symptoms.(3)Age is a complicated factor of psychological symptoms:advanced age could predict less depression and anxiety(OR=0.577;95%CI:0.361-0.921;OR=0.690,95%CI:0.484-0.982);pregnant women in 26-29 years old would experience severer depression,fatigue and sleep problems if she had history of abnormal pregnancy,and severer depression,anxiety,fatigue and sleep problems if she had pregnancy complications.(4)History of abnormal pregnancy is a risk factor of sleep symptom(OR=1.341,95%CI:1.093-1.644).(5)Pregnancy complications is a risk factor of fatigue and sleep symptoms(ORF=1.340,95%CI:1.068-1.680;OR=1.220,95%CI:1.003-1.485).(6)Mindfulness is a protection factor of depressive,anxiety,fatigue and sleep symptoms(OR=0.936,95%CI:0.921-0.952;OR=0.941,95%CI:0.928-0.954;OR=0.973,95%CI:0.963-0.984;OR=0.972,95%CI:0.962-0.981).Higher level of mindfulness could predict less depressive,anxiety,fatigue and sleep problems.(7)There's an interaction effect between mindfulness and history of abnormal pregnancy on fatigue:mindfulness could improve fatigue more easily in pregnant women with history of abnormal pregnancy than those without.Conclusions:(1)Prevalence of high-risk pregnancy is high.It is important to identify high-risk factors as soon as possible and focus on the psychological symptoms in high-risk pregnant women.(2)Pregnant women with history of abnormal pregnancy and complications experienced severer psychological symptoms while pregnant women with advanced age experienced less anxiety and depressive symptoms.(3)To enhance mindfulness could improve pregnant women's psychological symptoms,and especially could improve fatigue in women with history of abnormal pregnancy.