基于潜类别增长模型宫颈机能不全孕妇妊娠压力发展轨迹刻画及影响因素

Research on the development trajectory and influencing factors of pregnancy stress in women with cervical incompetence based on the latent class growth model

目的探讨宫颈机能不全孕妇从接受宫颈环扎术前1 d到妊娠28周妊娠压力的变化轨迹,分析其影响因素对轨迹类别的预测作用。方法采用前瞻性研究设计,选取2022年4月至2023年3月在南京医科大学附属妇产医院接受宫颈环扎术治疗的宫颈机能不全孕妇149例,分别在宫颈环扎术前1 d、术后1个月、妊娠28周对孕妇发放调查量表、收集数据资料。使用潜变量增长模型刻画孕妇妊娠压力变化轨迹,建立多元logistic回归模型,分析不同类型妊娠压力变化趋势的影响因素。结果本研究识别出3条不同特点的妊娠压力轨迹,分别命名为中水平—下降组(49.0%)、中水平—稳定组(24.8%)、低水平—下降组(26.2%)。Logistic回归显示妊娠相关焦虑、睡眠质量指数水平越高,个体越可能被归类为中水平—稳定组,而家庭关怀指数水平越高,个体越不可能被归类为中水平—稳定组。结论宫颈机能不全孕妇间妊娠压力存在差异,且识别出妊娠相关焦虑、睡眠质量、家庭关怀指数为影响妊娠压力的主要因素,为后续心理干预提供参考依据。

Objective To explore the trajectory of pregnancy stress changes in pregnant women with cervical incompetence from 1 day before cervical cerclage surgery to 28 weeks of pregnancy,and analyze the predictive role of influencing factors on trajectory categories.Methods A prospective study design was used to select 149 pregnant women with cervical incompetence who underwent cervical cerclage surgery at the Women's Hospital of Nanjing Medical University from April 2022 to March 2023.Survey scales and data were distributed to pregnant women 1 day before cervical cerclage surgery,1 month after surgery,and 28 weeks of pregnancy,respectively.Latent variable growth model was used to depict the trajectory of pregnancy stress changes in pregnant women,and a multiple logistic regression model was established to analyze the influencing factors of different types of pregnancy stress changes.Results There were three pregnancy pressure trajectories with different characteristics identified,named as the moderate-decreasing group(49.0%),moderate-stable group(24.8%),and low-decreasing group(26.2%).Logistic regression showed that the higher the levels of pregnancy related anxiety and sleep quality index,the more likely an individual was to be classified as moderate-stable group,while the higher the level of family care index,the less likely an individual was to be classified as moderate-stable group.Conclusion There are differences in pregnancy stress among pregnant women with cervical insufficiency,and pregnancy related anxiety,sleep quality,and family care index have been identified as the main factors affecting pregnancy stress,providing a reference basis for subsequent psychological intervention.