Study On The Influential Factors Of High-risk Pregnant Women’s Health-Related Quality Of Life-Based On The Transactional Model Of Stress

Objective:The purpose of this study is to investigate the health-related quality of life（HRQoL）of high-risk pregnant women in China,explore the influencing factors of HRQoL of the subjects,and deeply analyze the interaction mechanism of the factors influencing the HRQoL of the subjects from psychological level based on the transactional model of stress（TMS）,to provide evidence for developing interventions to ameliorate the HRQoL of the high-risk pregnant women,helping them go through the pregnancy safely and ensuring the safety of both mothers and fetus.Methods:Using the convenience sampling method,a questionnaire survey was performed among eligible high-risk pregnant women between June 2020 and October 2020 in maternity wards of two tertiary hospitals in Changchun and Wenzhou,respectively.The research tool consists of seven parts:（1）Socio-demographic characteristics and Obstetric information questionnaire;（2）Perceived Social Support Scale（PSSS）;（3）General Self-Efficacy Scale（GSES）;（4）Cognitive Appraisal of Health Scale（CAHS）;（5）Trait Coping Style Questionnaire（TCSQ）;（6）Pregnancy Stress Rating Scale（PSRS）;（7）Medical outcomes study 12-item short-form health survey（SF-12）.At the same period and the same places,normal pregnant women were selected as the comparative group,using the Socio-demographic characteristics and obstetric information questionnaire and SF-12 to collect their information.The Epidata 3.1 software was applied to set up the database,and IBM SPSS 25.0 were utilized for data analysis.The socio-demographic characteristics and obstetric information of the subjects were described by frequency and percentage;The scores of PSSS,GSES,CAHS,TCSQ,PSRS,and SF-12 of subjects were described by median and quartiles[M(P₂₅,P₇₅)]or mean and standard deviation（（?）±SD）;Mann-Whitney U test was used to compare the differences in the total score,as well as the scores of PCS,MCS and the eight dimensions,of SF-12 between high-risk pregnant women and normal pregnant women;The nonparametric tests were used to compare the differences of SF-12 based on the socio-demographic characteristics and obstetric information of high-risk pregnant women;Multiple stepwise regression was conducted to analyze the effect of the socio-demographic characteristics and obstetric information of high-risk pregnant women on their SF-12;Spearman correlation analysis was performed to explore the correlation between PSSS,GSES,CAHS,TCSQ,PSRS and SF-12 of high-risk pregnant women.AMOS 23.0 was used to establish and modify the structural equation model（SEM）of influencing factors of HRQoL among high-risk pregnant women based on the TMS.Results:1.The median score of SF-12 of the subjects（high-risk pregnant women）（N=405）was38.89（25.00,58.33）,PCS scored 35.71（25.00,57.14）,and MCS scored 40.91（22.73,63.64）.The total score,as well as the scores of PCS,MCS and the eight dimensions,of SF-12 of high-risk pregnant women were significantly lower than those of normal pregnant women（N=96）（P<0.05）.Moreover,the median score of PSRS of the subjects was 14.00（7.00,25.00）.The median score of GSES of the subjects was 2.50（2.10,2.90）.The median score of PSSS of the subjects was 64.00（56.00,71.00）.The median score of each dimension of CAHS was as follows:1)the dimension of challenge scored 3.67（3.50,4.00）;2)the dimension of benign/irrelevant scored 2.75（2.00,3.50）;3)the dimension of harm/loss scored 2.38（2.00,3.00）;4)the dimension of threat scored 2.40（1.90,2.80）.The mean score of positive coping style of the subjects was 29.88±6.12,and the median score of negative coping style of the subjects was 24.00（19.00,27.50）.2.The results of nonparametric test showed that the monthly income of family,gestational week,history of miscarriage,conceptional mode and the method of disease treatment of the subjects had statistically significant differences in their score of SF-12（P<0.05）.Furthermore,the results of multivariate stepwise regression analysis showed that the gestational age（≥37weeks）（β=0.456,P=0.002）,the history of miscarriage（≥3 times）（β=-0.132,P=0.007）and the method of disease treatment（non-drug method）（β=0.224,P=0.029）were predictive factors of SF-12 of high-risk pregnant women,which explained 8.1%of the variation of their SF-12（R²=0.081）.3.The results of Spearman correlation analysis showed that the correlations between all studied variables in TMS were significant.Specifically,GSES（r=0.191,P<0.01）,PSSS （r=0.165,P<0.01）,challenge（r=0.338,P<0.01）,benign/irrelevant（r=0.549,P<0.01）and positive coping style（r=0.259,P<0.01）were significantly positively correlated with SF-12, whereas PSRS（r=-0.337,P<0.01）,harm/loss（r=-0.562,P<0.01）,threat（r=-0.451,P<0.01）and negative coping style（r=-0.323,P<0.01）were significantly negatively correlated with SF-12.4.The fit indices of SEM of this study were as follows:X²/df=1.07,GFI=0.94,AGFI=0.92,CFI=1.00,TLI=0.99,RMSEA=0.01,NFI=0.94,IFI=1.00,CN=377.According to the results of the SEM,positive coping style（β=0.268）and negative coping style（β=-0.350）could directly predict the HRQoL of the subjects,while PSRS（β=-0.097）,PSSS（β=0.115）,GSES（β=0.211）,positive cognitive appraisal（β=0.094）and negative cognitive appraisal（β=-0.156）could indirectly predict the HRQoL of the subjects.The variance of HRQoL of high-risk pregnant women that could be explained by its external dependent variables was 24.3%.Conclusion:1.The level of HRQoL of high-risk pregnant women is poor and it’s significantly lower than that of the normal pregnant women,which need draw full attention from the health practitioners.2.The gestational age（≥37 weeks）,the history of miscarriage（≥3 times）and the method of disease treatment（non-drug method）are the main biological and social factors for the HRQoL among high-risk pregnant women.Consequently,high-risk pregnant women who are in the gestational age<37 weeks,have the history of miscarriage≥3 times and need to use drugs to control diseases during pregnancy deserves special attention during the implementation of perinatal care.3.The SEM of the influential factors of high-risk pregnant women’s HRQoL—based on the TMS had a good prediction about psychosocial factors in HRQoL of the subjects.Positive coping style and negative coping style can directly predict HRQoL of high-risk pregnant women,whereas the pregnancy stress,self-efficacy,perceived social support,cognitive appraisal of health have indirect prediction effects on HRQoL of the subjects.The findings of this study suggested that it is necessary for health practitioners to pay full attention to the above-mentioned psychological factors predicting on HRQoL of high-risk pregnant women,and committed to developing targeted intervention regimens to improve their HRQoL,thereby helping them go through the pregnancy smoothly and ensuring the health and safety of both mothers and their fetus.