Pre- and postpartum fear of childbirth and its predictors among rural women in China.

BACKGROUND: Fear of childbirth (FOC) can influence both maternal and child health. Research on FOC in China is scarce, especially on rural women. This study aimed to assess pre- and postpartum FOC and its predictors among Chinese rural women. METHODS: This was a prospective correlation study. A total of 569 women completed the prenatal questionnaire in the third trimester, and 477 of them completed the postpartum questionnaire within three days after childbirth. Maternal socio-demographic information, clinical information, childbirth self-efficacy and prenatal and postpartum FOC were investigated. FOC was evaluated using the Wijma Childbirth Expectancy/ Experience Questionnaire (WDEQ). Descriptive, bivariate, multivariate linear regression analysis, univariate and multivariate logistic regression analyses were performed. RESULTS: The mean pre- and postpartum FOC scores were 64.5 (standard deviation: 25.1) and 64.3 (standard deviation: 23.9), respectively, with 20.8% of women reporting severe fear before childbirth and 18.2% after childbirth. Multivariate linear regression analysis revealed predictors for higher levels of prenatal FOC including higher education level, nullipara, higher monthly household income, lower family support, and lower childbirth self-efficacy (p < 0.05) and the predictors for higher levels of postpartum FOC included unemployed status, lower childbirth self-efficacy, and higher prenatal FOC (p < 0.05). Multivariate logistic regression showed that higher childbirth self-efficacy reduced the likelihood of severe prenatal FOC (OR: 0.99, p < 0.001), while severe prenatal FOC increased the likelihood of severe postpartum FOC (OR: 3.57, p < 0.001). CONCLUSION: The rural women have high levels of FOC before and after childbirth, with approximately 20% experiencing severe FOC during both periods. Higher education level, nullipara, higher monthly household income, lower family support, and lower childbirth self-efficacy are predictors of heightened prenatal FOC. Unemployed status, lower childbirth self-efficacy, and higher prenatal FOC are predictors of heightened postpartum FOC. Notably, enhancing childbirth self-efficacy emerges as crucial in mitigating severe prenatal FOC, while severe prenatal FOC significantly increases the likelihood of severe postpartum FOC. The development of targeted intervention strategies for the above factors can help reduce women's FOC level and improve their overall pregnancy and childbirth experience.

Current status of electronic health literacy among pregnant women with gestational diabetes mellitus and their perceptions of online health information: a mixed-methods study.

BACKGROUND: Women diagnosed with gestational diabetes mellitus often rely on internet-based health information for managing their condition. This study aims to investigate the present state of electronic health literacy among women with gestational diabetes mellitus, analyze the influencing factors, and explore their experiences regarding accessing, comprehending, evaluating, and applying online health information pertinent to gestational diabetes mellitus. METHODS: A sequential explanatory mixed methods research design was adopted in this study. Initially, 235 women with gestational diabetes mellitus participated in a cross-sectional survey. The research tools included general information and the Chinese version of the electronic Health Literacy Scale (eHEALS). Descriptive analyses were conducted to describe the characteristics of the sample, and multiple linear regression analyses were used to explore the factors influencing electronic health literacy among women with gestational diabetes mellitus. Secondly, 11 women with gestational diabetes mellitus joined semi-structured in-depth interviews to obtain their perceptions about online health information. The data were analyzed using inductive content analysis to develop themes. RESULTS: The median score of eHEALS in the Chinese version among 235 women diagnosed with gestational diabetes mellitus was 29 (interquartile range [IQR], 26 to 32). Factors influencing electronic health literacy among these women included accessing health information from medical professionals (ß = 0.137, p = 0.029) and utilizing health information from applications (ß = 0.159, p = 0.013). From the qualitative phase of the study, four thematic categories emerged: reasons and basis for accessing health information from the Internet; address barriers to accessing and applying online health information; desires for a higher level of online health information services; outcomes of accessing and applying online health information. CONCLUSION: The electronic health literacy of women diagnosed with gestational diabetes mellitus remains suboptimal and warrants improvement. The sources of access to health information affect electronic health literacy in women with gestational diabetes mellitus. Moreover, women facing gestational diabetes encounter numerous impediments when attempting to access health-related information online, underscoring the necessity for enhanced online health information services to meet their needs.

Effect of Bright Light Therapy on Perinatal Depression: A Systematic Review and Meta-Analysis: Effet de la luminothérapie sur la dépression périnatale: une revue systématique et une méta-analyse.

OBJECTIVE: This study represents the inaugural attempt to systematically review and analyse the efficacy of bright light therapy on depression among women experiencing major depressive disorder or depressive symptoms during the perinatal period, encompassing its efficacy on depression scores, remission rates, and response rates. METHODS: We searched 10 databases for randomized controlled trials examining bright light therapy's efficacy on perinatal depression up to January 2024. Data extraction was performed independently by 2 investigators. The Cochrane Handbook guidelines appraised the study quality, and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach assessed evidence certainty. RESULTS: We incorporated 6 studies, encompassing 151 participants. When contrasted with dim light therapy, bright light therapy did not significantly alter depression scores (standard mean difference = -0.29, 95% confidence interval [CI], -0.62 to 0.04, P = 0.08, I² = 34%) or response rates (risk ratio [RR] = 1.56, 95% CI, 0.98 to 2.49, P = 0.06, I² = 0%) in women experiencing perinatal depression. Conversely, bright light therapy was associated with a substantial increase in remission rates (RR = 2.63, 95% CI, 1.29 to 5.38, P = 0.008, I² = 2%). CONCLUSION: Bright light therapy did not show efficacy in treating perinatal depression in terms of depression scores and response rates. However, regarding the remission rate, bright light did show efficacy compared to control conditions. Due to the limited sample size in the included studies, type II err or may occur. To obtain more conclusive evidence, future studies must employ larger sample sizes.

Development, validation and reliability testing of the hospice care environment scale.

BACKGROUND: WHO stated the environment is an important factor affecting the development of hospice care. The environment is the sum of factors affecting behavior besides the individual factors. Currently, a scale to comprehensively assess the hospice environment of nurse is still lacking. This study aimed to develop an instrument to investigate the environmental factors affecting hospice care of nurses. METHODS: Literature review and a semi-structured interview were conducted to form the items pool of the Hospice Care Environment Scale. Two rounds of Delphi expert consultation were conducted by 16 experts to revise the scale dimensions and entries to form the Hospice Care Environment Scale. A psychometric evaluation was then performed among 530 oncology nurses in a large tertiary oncology hospital in Hubei Province. The 500 valid questionnaires were randomly divided into two groups in a 1:1 ratio, sample 1 (n1 = 250) for item screening and sample 2 (n2 = 250) for quality evaluation of the resulting scale. Item analysis, reliability analysis, validity analysis and acceptability analysis were performed. RESULT: The Hospice Care Environment Scale consists of two dimensions and 13 entries. The Cronbach's α coefficient of the Hospice Care Environment Scale was 0.970, and the Cronbach's α coefficient of the two dimensions were 0.952 and 0.969, respectively, with the Item-content validity index and average Scale- content validity index of the scale was both 1.000. The validation factor analysis showed the standardized path coefficients of each item were basically above 0.5, and the factor structure model was stable and suitable. The average completion time of the scale was about 3 min, which had good feasibility. CONCLUSION: The Hospice Care Environment Scale to assess the environment of hospice care services, has good content and construct validity and reliability. This scale can provide guidance to evaluate the hospice care environment.

Behaviors and influencing factors of Chinese oncology nurses towards hospice care: a cross-sectional study based on social cognitive theory in 2022.

BACKGROUND: Although there is growing demand for hospice care in China due to its aging population and increasing cancer rates, the sector remains slow to expand. Oncology nurses are the primary providers of hospice care, but little is known about their behaviors towards hospice care and related factors. METHODS: This cross-sectional study conveniently sampled 933 oncology nurses from six grade A tertiary hospitals in Hubei Province between January to March 2022. The questionnaire was composed of seven parts: general information (including sociodemographic and work-related information), hospice care behaviors, hospice care knowledge, hospice care attitudes, hospice care self-efficacy, hospice care outcome expectancy, and hospice care environment. Data were analyzed using descriptive analysis, independent sample t-tests, one-way ANOVA, Pearson's correlation, multiple linear regression, random forest regression, and BP neural network model analysis. RESULTS: A total of 852 questionnaires were valid. The mean score of hospice care behaviors was 50.47 ± 10.56, with a mean item score of 3.61 ± 0.75. The three highest scoring behaviors were "pain assessment of patients (4.21 ± 0.91)", "satisfying the physical and mental needs of dying patients (4.04 ± 0.92)", and "creating good relationships between the medical staff and family members (4.02 ± 0.87)". The two lowest-scoring behaviors were "proactively recommending medical institutions for hospice care to terminally ill patients and their families (2.55 ± 1.10)" and "proactively talking to patients and families about death-related topics for patients who are critically ill and cannot be reversed (2.87 ± 1.03)." Multiple linear regression, random forest regression, and BP neural network models all showed that the frequency of sharing hospice care experiences with colleagues, hospice care attitudes, hospice care self-efficacy, and hospice care environments were positively associated with hospice care behaviors. CONCLUSIONS: The frequency of hospice care behaviors among Chinese oncology nurses is generally at a moderate to high level. The results provide a basis for promoting hospice care behaviors among oncology nurses in order to improve the quality of life for terminally ill cancer patients.

Relationship between illness perception and self-management behaviors among women with gestational diabetes mellitus in China during the COVID-19 pandemic: A mediating role of depression.

OBJECTIVE: Describe the current status of illness perception, depression, and self-management behaviors among women with gestational diabetes mellitus (GDM) during the COVID-19 pandemic, and explore the role of depression in the relationship between illness perception and self-management behaviors among women with GDM. METHODS: Pregnant women diagnosed with GDM were recruited at the obstetrics clinic of a Grade-A tertiary hospital in Wuhan, through convenience sampling. Self-reported questionnaires including basic information, illness perception, depression, and self-management behaviors were used to collect data from April 2021 to February 2022. Mediation analysis was performed by SPSS Process macro. RESULTS: Among GDM pregnant women, the mean self-management behaviors score was 73.89 (SD = 12.21), the mean illness perception score was 31.80 (SD = 8.77), and 44.3% had depression scores of 10 or higher. The indirect effect of illness perception on self-management behaviors mediated by depression was significant (path a * b, ß = -0.045), accounting for 26.6% of the total effect. CONCLUSION: GDM pregnant women have a certain negative illness perception of GDM, and the detection rate of depression symptoms is relatively high. The level of self-management behaviors among GDM pregnant women is notably suboptimal and warrants improvement. Depression partially mediates the relationship between illness perception and self-management behaviors. Improving positive illness perception and decreasing depression are important strategies to improve self-management behaviors in women with GDM.

Longitudinal study of multidimensional factors influencing maternal and offspring health outcomes: a study protocol.

BACKGROUND: Reducing preventable adverse maternal and offspring outcomes is a global priority. The causes of adverse maternal and fetal outcomes are complex with multidimensional influencing factors. In addition, the Covid-19 epidemic has had a significant psychological and physical impact on people. China is now stepping into the post-epidemic era. We are curious about the psychological and physical situation of maternity in China at this stage. Therefore, we plan to initiate a prospective longitudinal study to investigate the multidimensional influences and mechanisms that affect maternal and offspring health. METHOD: We will recruit eligible pregnant women at Renmin Hospital of Hubei Province, China. The expected sample size is 1490. We will assess socio-demographics, Covid-19 related information, social capital, sleep, mental health and medical records, including clinical examination and biochemical tests. Eligible pregnant women will be enrolled in the study with less than 14 weeks of gestation. Participants will receive a total of nine follow-up visits between mid-pregnancy and one year postpartum. The offspring will be followed up at birth, 6 weeks, 3 months, 6 months and one year. In addition, a qualitative study will be conducted to understand the underlying causes that affect maternal and offspring health outcomes. DISCUSSION: This is the first longitudinal study of maternity in Wuhan, Hubei Province which integrates physical, psychological and social capital dimensions. Wuhan is the first city to be affected by Covid-19 in China. As China moves into the post-epidemic era, this study will provide us with a better understanding of the long-term impact of the epidemic on maternal and offspring health outcomes. We will implement a range of rigorous measures to enhance participants' retention rate and ensure the quality of data. The study will provide empirical results for maternal health in the post-epidemic era.

Optimal gestational weight gain in Chinese pregnant women with gestational diabetes mellitus: A large retrospective cohort study.

AIM: To examine the optimal gestational weight gain (GWG) for Chinese pregnant women with gestational diabetes mellitus (GDM) based on the Chinese-specific body mass index (BMI) classification. METHODS: A retrospective cohort study was conducted using the 2017-2020 data from pregnant women with GDM in a tertiary hospital. A quadratic function model and the total predicted probability of adverse pregnancy outcomes were developed to obtain the optimal GWG. Differences in the incidence of adverse pregnancy outcomes between our optimal GWG recommendations and the Institute of Medicine (IOM) 2009 GWG guidelines were also analyzed. RESULTS: A total of 8103 pregnant women with GDM were analyzed. Based on the Chinese-specific BMI classification, the optimal GWG range was 11.0-17.5 kg for underweight women, 3.7-9.7 kg for normal-weight women, -0.6 to 4.8 kg for overweight women, and - 9.8 to 4.2 kg for obese women. Excessive GWG had a higher risk of large for gestational age (LGA) (OR: 2.99, 95% CI: 2.42-3.70), macrosomia (OR: 2.35, 95% CI: 1.77-3.12), pre-eclampsia (OR: 1.91, 95% CI: 1.37-2.65), gestational hypertension (OR: 1.65, 95% CI: 1.24-2.19), cesarean section (OR: 1.29, 95% CI: 1.15-1.44), postpartum hemorrhage (OR: 1.29, 95% CI: 1.02-1.64); insufficient GWG had a higher risk of small for gestational age (OR: 1.82, 95% CI: 1.20-2.75). Compared to the IOM 2009 GWG guidelines, the prevalence of macrosomia, LGA, and postpartum hemorrhage were significantly lower in pregnant women following the implementation of our recommended GWG range (p < 0.05). CONCLUSIONS: Compared to the IOM 2009 GWG recommendations, our optimal GWG recommendations for Chinese pregnant women were more sensitive.

Validating the use of the Wijma Delivery Expectancy/Experience Questionnaire in Mainland China: a descriptive, cross-sectional study.

BACKGROUND: Fear of childbirth (FOC) is a common psychological problem in Chinese pregnant women. FOC can influence both maternal health and infants' wellness. Special assessment tools for FOC in Mandarin Chinese are currently lacking. The aim of this study was to evaluate the psychometric properties of the Mandarin Chinese of the Wijma Delivery Expectancy/Experience Questionnaire Version A (W-DEQ-A). METHODS: We recruited 364 Chinese pregnant women from April 2021 to July 2021. Translation and cultural adaptation, as well as reliability and validity testing were conducted. Analyses included the content validity, structural validity, criterion-related validity, convergent validity and reliability. The content validity indices were used to assess the content validity of the tool. The structural validity was tested through exploratory factor analysis and confirmatory factor analysis. The Cronbach's alpha coefficient was used to evaluate the reliability of the W-DEQ-A Chinese version. RESULTS: The Chinese translation showed excellent similarities and equivalence to the original version, with the satisfactory content validity. Factor analysis indicated 5 factors, accounting for 57% of the total variance. Both criterion-related validity and convergent validity proved to be acceptable. The reliability was tested with a Cronbach's alpha coefficient of 0.911 for the total scale. CONCLUSION: The W-DEQ-A Chinese version is a reliable and valid tool to identify FOC in Mandarin Chinese-speaking populations.

Is the Gestational Weight Gain Recommended by the National Academy of Medicine Guidelines Suitable for Chinese Twin-Pregnant Women with Gestational Diabetes Mellitus?

OBJECTIVES: This study aimed to assess the applicability of the National Academy of Medicine (NAM) interim guidelines for twin pregnancies to the specific population of gestational diabetes mellitus by exploring the relationship between gestational weight gain and adverse pregnancy outcomes in Chinese twin-pregnant women with gestational diabetes mellitus. STUDY DESIGN: This was a retrospective cohort study of women diagnosed with diabetes in pregnancy between July 2017 and December 2020 at the Maternal and Child Health Hospital in Chongqing, China. The primary variable of interest was maternal total gestational weight gain. The primary outcomes were perinatal outcomes, which included: preeclampsia, small for gestational age, large for gestational age, low birth weight, neonatal pneumonia, neonatal respiratory distress syndrome, and neonatal intensive unit admission, etc. The association between inappropriate gestational weight gain and adverse pregnancy outcomes was estimated using multiple logistic regression analysis. RESULTS: A total of 455 twin-pregnant women who had gestational diabetes mellitus were analyzed. Women with low gestational weight gain had reduced risk of preeclampsia (adjusted odds ratio [aOR], 0.32; 95% CI or confidence interval, 0.17-0.63; p = 0.001) and their infants had higher risks of small for gestational age (aOR, 1.93; 95% CI, 1.04-3.58; p = 0.037), low birth weight (aOR, 2.27; 95% CI, 1.32-3.90; p = 0.003), neonatal intensive unit admission (aOR, 3.29; 95% CI, 1.10-5.78; p = 0.038), pneumonia (aOR, 2.41; 95% CI, 1.08-5.33; p = 0.031), and neonatal respiratory distress syndrome (aOR, 2.29; 95% CI, 1.10-4.78; p = 0.027); the infants of women with excessive gestational weight gain had a higher risk of large for gestational age (aOR, 3.76; 95% CI, 1.42-9.96; p = 0.008). CONCLUSION: Gestational weight gain controlled within the range recommended by the NAM could reduce the risk of perinatal adverse outcomes. The 2009 NAM gestational weight gain recommendations can be used for Chinese twin-pregnant women with gestational diabetes mellitus. KEY POINTS: · Inappropriate gestational weight gain can lead to adverse perinatal outcomes in twin pregnancies.. · Gestational weight gain controlled within recommended range could reduce the risk of poor perinatal outcomes.. · The National Academy of Medicine recommendations are suitable for Chinese twin-pregnant women with GDM..