Pregnancy-related Anxiety In Early Pregnancy And Eating Behaviors In Preschoolers: Mediating Emotional And Behavioral Problems

ObjectiveBased on the birth cohort,this study analyzed the influence of pregnancy-related anxiety（PrA）in the 1^sttrimester of pregnancy on eating behaviors of children aged 3-7years,and explored the role of emotional and behavioral problems in the relationship between PrA and eating behaviors in children aged 3 to 7 years.MethodsFrom October 2008 to October 2010,in Maanshan Maternal and Child Health Hospital of Anhui Province,pregnant women who had filed early pregnancy and agreed to join the birth cohort in Anhui,China were recruited.The self-compiled Maternal and Child Health Record I was used to collect the demographic characteristics and pregnancy information of the pregnant woman and her husband in the 1^sttrimester of pregnancy,and Pregnancy-related Anxiety Questionnaire（PRAQ）was used to assess PrA in the 1^sttrimester of pregnancy.Clinical delivery information and delivery information were extracted from the electronic medical system of the hospital.The self-compiled"Health and Behavior Record of Preschool Children"was used to collect the demographic characteristics and eating behaviors informations of preschool children,and the parental version of"Strength and Difficulty Questionnaire"was used to assess the emotional and behavioral problems of preschool children.Excluding spontaneous abortion,induced labor,stillbirth,twin and lost follow-up,a total of 4,669 single live births were included in the pediatric follow-up cohort.A total of 1,705 mother-child pairs were included in this study after 78 preschoolers without information on emotional and behavioral problems and/or dietary behavior were excluded from the maternal serum BPA database（1,783）.χ~2test and Fisher test were used to analyze the influencing factors of abnormal emotional and behavioral problems and unhealthy eating behaviors in preschool children.After controlling for confounding factors,a multifactor binomial logistic regression model was used to analyze the associations between PrA in the 1^sttrimester of pregnancy,preschool children’s emotional and behavioral problems,preschool children’s eating behaviors.Structural equation models were used to examine the mediating effects of preschoolers’emotional and behavioral problems on the association between PrA in the 1^sttrimester of pregnancy and preschoolers’eating behaviors.ResultsThe prevalence of PrA in the 1^sttrimester of pregnancy was 25.6%.The detection rates of abnormal emotional symptom,abnormal conduct problem,abnormal hyperactivity problem,abnormal prosocial behavior and abnormal overall difficulty in preschool children were 6.3%,8.1%,8.4%,11.4%and 8.0%,respectively.The detection rates of always unable to eat independently,always unable to eat happily,always picky eating and long eating time in preschool children were 11.4%,4.9%,29.9%and 11.7%,respectively.PrA in the 1^sttrimester of pregnancy was positively correlated with preschoolers’abnormal emotional symptom,abnormal conduct problem,abnormal hyperactivity problem,abnormal prosocial behavior and general difficulty,and adjusted OR（95%CI）were 2.17（1.44-3.28）,1.99（1.38-2.89）,1.98（1.37-2.86）,1.42（1.01-1.99）and 2.18（1.50-3.16）,respectively.After adjusting for PrA in the 1^sttrimester of pregnancy and other confounding factors,preschoolers’abnormal emotional symptom,abnormal conduct problem,abnormal prosocial behavior,and abnormal overall difficulty were positively correlated with preschoolers’inability to complete meals independently,OR（95%CI）were 2.81（1.74-4.55）,2.35（1.50-3.69）,1.76（1.17-2.63）and 2.01（1.27-3.20）,respectively;Preschoolers’abnormal emotional symptom and abnormal conduct problem were positively correlated with preschoolers’inability to eat happily,and OR（95%CI）were2.34（1.19-4.59）and 1.99（1.04-3.80）,respectively;Preschoolers’abnormal emotional symptom,abnormal conduct problem,abnormal hyperactivity problem,abnormal prosocial behavior,and abnormal overall difficulty are positively correlated with their picky eating,OR（95%CI）were 1.65（1.10-2.48）,1.56（1.08-2.26）,1.50（1.05-2.16）,1.47（1.07-2.03）and 1.54（1.07-2.23）,respectively;Preschoolers’abnormal hyperactivity problem was positively correlated with long meal time in preschool children,OR（95%CI）was 1.71（1.05-2.78）.PrA in the 1^sttrimester of pregnancy was positively correlated with preschoolers’inability to eat independently,inability to eat happily,picky eating and long meal time.After adjustment,OR（95%CI）were 1.49（1.07-2.08）,1.79（1.12-2.86）,1.34（1.05-1.70）and 1.57（1.13-2.19）,respectively.The mediating roles of abnormal emotional symptom,abnormal conduct problem,abnormal prosocial behavior and abnormal overall difficulty in the relationship between PrA in the 1^sttrimester of pregnancy and always unable to complete meals independently were 18.6%,15.6%,6.3%and 16.7%,respectively;The mediating roles of abnormal emotional symptom,abnormal conduct problem in the relationship between PrA in the 1^sttrimester of pregnancy and always unable to eat happily was 11.0%and8.7%,respectively.The mediating roles of abnormal emotional symptom,abnormal conduct problem,abnormal hyperactivity problem,abnormal prosocial behavior and abnormal overall difficulty in the relationship between PrA in the 1^sttrimester of pregnancy and picky eating were 9.6%,8.1%,10.3%,4.6%and 10.1%,respectively.ConclusionBased on a large birth cohort,this study found that PrA in the 1^sttrimester of pregnancy was significantly associated with poor dietary behavior in preschool children.PrA in the 1^sttrimester of pregnancy is significantly associated with emotional and behavioral problems in preschoolers.PrA in the 1^sttrimester of pregnancy can increase the risk of poor eating behaviors in preschoolers through emotional and behavioral problems in preschoolers.