The Influence of Psychological Resilience on Perceived Stress in High-Risk Pregnant Women: The Mediating Role of Positive Coping

The Influence of Psychological Resilience on Perceived Stress in High-Risk Pregnant Women: The Mediating Role of Positive Coping | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Influence of Psychological Resilience on Perceived Stress in High-Risk Pregnant Women: The Mediating Role of Positive Coping Ying Liu, XinYan Zhao, ZhongYan Cao, JinZhu Yin, Bing Liu, DeFeng Chen, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7519801/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background: High-risk pregnant women face more challenges during pregnancy and postpartum than low-risk pregnant women. This study aims to explore whether different coping strategies among high-risk pregnant women affect their perceived stress levels. Objective: To understand the status of perceived stress in high-risk pregnancy (HRP) women and explore the mediating role of coping styles between psychological resilience and perceived stress. Methods: A convenience sample of 331 high-risk pregnant women from a Grade A tertiary hospital in Guangzhou was surveyed using the Connor-Davidson Resilience Scale (CD-RISC-25), the Simple Coping Style Questionnaire (SCSQ), and the Perceived Stress Scale (PSS-10). Results: The median total perceived stress score for high-risk pregnant women was 26.03 (23.0, 30.0); the median total psychological resilience score was 63.02 (55.0, 71.0). For coping styles, the positive coping score was 2.07 (1.75, 2.42), and the negative coping score was 1.28 (0.88, 1.63). Psychological resilience was negatively correlated with perceived stress (P < 0.05) and positively correlated with positive coping (P < 0.05); positive coping was negatively correlated with perceived stress (P < 0.05). Positive coping was a mediator between psychological resilience and perceived stress (effect value: -0.025), accounting for 14.22% of the total effect. Conclusion: Psychological resilience in high-risk pregnant women can influence perceived stress through positive coping. Healthcare workers should pay more attention to high-risk pregnant women with low psychological resilience in their daily work and guide patients to adopt positive coping styles to reduce their perceived stress. High-Risk Pregnancy Psychological Resilience Coping Style Perceived Stress Mediating Effect Figures Figure 1 Introduction High-risk pregnancy (HRP) generally refers to pregnancies where the patient has certain medical or surgical conditions, past or current obstetric problems, or social or demographic factors that increase the risk of adverse maternal, fetal, or neonatal outcomes, or increase the risk of delivery complications. Consequently women with high-risk pregnancies require careful symptom observation, coping, and corresponding management at various stages of pregnancy. Completing these tasks places greater stress on these women, An increase in stressful events may heighten the risk of adverse pregnancy outcomes for women with high-risk pregnancies [ 2 ]. Scholar Lazarus proposed the Stress and Coping Theory proposed by American scholar Lazarus in the 1960s, which posits that stress arises from an imbalance between internal/external demands and the body's coping resources, disrupting the individual's homeostasis. The theory suggests that whether an individual experiences stress after encountering a stressful event depends on two key psychological processes: cognitive appraisal and coping [ 3 ]. Cognitive appraisal refers to the cognitive process by which an individual perceives whether an environmental stimulus is relevant to them. Coping involves effectively solving problems and alleviating negative emotions by utilizing personal coping resources. Psychological resilience is a quality or ability that helps individuals adapt well and cope positively with adversity. Therefore, this study proposes the following hypothesis: [When maternal psychological resilience is at a higher level, women may be more inclined towards positive coping, perceive less stress themselves, and be more conducive to maintaining good mental health. Therefore, based on the Stress and Coping Theory, this study explores the pathways through which psychological resilience and coping styles affect perceived stress in high-risk pregnant women, providing a reference for healthcare professionals to reduce perceived stress levels in this population. Objects and Methods Research Subjects From October 2024 to June 2025, postpartum women hospitalized in the postpartum ward of a Grade A tertiary hospital in Guangzhou were selected using convenience sampling. Inclusion criteria: Women meeting the diagnostic criteria for high-risk pregnancy [ 4 ] and aged ≥ 20 years; live newborn; voluntary participation and signed informed consent. Exclusion criteria: History of psychiatric illness or dependence on psychiatric medications. This study used the empirical estimation method [ 5 ] to calculate the sample size, taking 5–10 times the number of scale items. The sample size was estimated based on the Psychological Resilience Scale (25 items in total, the scale with the most items). Considering a 20% non-response rate, the final calculated sample size was N = [25 × (5–10)] / (1–20%) = 157 ~ 313. Since the study required the use of structural equation modeling (SEM), a minimum sample size of 200 was needed. This study ultimately included 331 patients, aged 20–47 years, [mean (33.11 ± 5.03) years.] Methods Survey Instruments General Information Questionnaire Self-designed, including information on the mother's personal details, family situation, pregnancy and childbirth history, and the condition of the newborn from this delivery. Perceived Stress Scale (PSS-10) : Developed by Cohen in 1983 [ 6 ], this scale assesses the subject's perceived subjective stress over the past month by asking them to indicate how frequently they felt or thought a particular way. Translated and adapted into Chinese by Professor Yang Tingzhong et al. in 2003 [ 7 ], it consists of 10 items divided into two dimensions: Perceived Stress and Perceived Coping Capability. Each item is rated on a 5-point Likert scale. Items D1 ~ D3, D6, D9 ~ D10 belong to the Perceived Stress dimension (negative affect items), scored positively: 1 = Never, 2 = Almost never, 3 = Sometimes, 4 = Fairly often, 5 = Very often. Items D4 ~ D5, D7 ~ D8 belong to the Perceived Coping Capability dimension (positive affect items), reverse scored: 5 = Never, 4 = Almost never, 3 = Sometimes, 2 = Fairly often, 1 = Very often. All item scores are summed for a total score ranging from 0 to 40; higher scores indicate greater stress. In this study, the Cronbach's α coefficient for the total scale was 0.834, and the Kaiser-Meyer-Olkin (KMO) value for factor analysis was 0.857. Simple Coping Style Questionnaire (SCSQ) : Translated, adapted, and revised by Chinese scholar Xie Yaning et al. [ 8 ]. It consists of 20 items, primarily divided into two dimensions: Positive Coping and Negative Coping (items 1–12: Positive Coping; items 13–20: Negative Coping). Scale options are selected based on the frequency and willingness with which individuals adopt certain approaches when facing different situations, scored as 0, 1, 2, or 3. The results are presented as the average score for the Positive Coping dimension and the average score for the Negative Coping dimension. The three dimensions are scored independently; a higher dimension score indicates a greater tendency towards that coping style. In a maternal population [ 9 ], the Cronbach's α coefficient for the Positive Coping subscale in this study was 0.90, and for the Negative Coping subscale it was 0.78, demonstrating good reliability. Connor-Davidson Resilience Scale (CD-RISC-25) : Developed by Connor and Davidson in 2003 [ 10 ], this scale originally included five dimensions: competence, tolerance of negative affect, acceptance of change, control, and spiritual influences (25 items). Yu et al. [ 11 ] translated and revised the CD-RISC-25 in 2007. The revised scale includes three dimensions: Tenacity, Strength, and Optimism, with 25 items. It uses a 5-point Likert scale: 0 = Not true at all, 1 = Rarely true, 2 = Sometimes true, 3 = Often true, 4 = True nearly all the time. The total score ranges from 0 to 100; higher scores indicate higher levels of psychological resilience. The Cronbach's α coefficient was 0.91, and it is widely used in China. Data Collection Methods Investigators were uniformly trained. During the survey, the purpose and significance of the study were explained to the mothers to gain their support and cooperation, and informed consent was obtained. Unified instructions were used to explain the questionnaire filling methods and requirements, and questions were answered promptly. After completing the questionnaire, if omissions or suspected errors were found, they were verified and supplemented with the patient. A total of 375 questionnaires were distributed, and 331 valid questionnaires were returned, resulting in an effective response rate of 88.5%. Statistical Analysis Data were analyzed using SPSS 26.0 statistical software. Descriptive analysis for categorical data used frequencies and percentages. Non-normally distributed measurement data were expressed as median and interquartile range M (P25, P75); group comparisons used non-parametric tests. Spearman correlation analysis was used to explore the correlation between psychological resilience, coping styles, and perceived stress in high-risk pregnant women. Amos 24.0 was used to construct a structural equation model (SEM). The Bootstrap resampling method (5000 repetitions) was used to test mediating effects. A significance level of P < 0.05 was used. Results Univariate Analysis of High-Risk Pregnancy Women Perceived stress total scores showed statistically significant differences among high-risk pregnant women with different delivery modes, gestational weeks at delivery, and newborn birth weights (all P < 0.05). Specific results are shown in Table 1 . Current Status of Perceived Stress, Psychological Resilience, and Coping Style Scores in High-Risk Pregnancy Women Results showed the median perceived stress score for high-risk pregnant women was [26.03 (23.0, 30.0)] points; the median psychological resilience score was 63.02 (55.0, 71.0) points. results are shown in Table 2 . Correlation Analysis of Perceived Stress, Psychological Resilience, and Coping Styles in High-Risk Pregnancy Women Spearman correlation analysis showed that perceived stress was negatively correlated with psychological resilience and positively correlated with the negative coping dimension, while being negatively correlated with the positive coping dimension (all P < 0.05). Psychological resilience was positively correlated with positive coping (P 0.05). Details are shown in Table 3 . Mediating Effect Analysis of Psychological Resilience and Coping Styles on Perceived Stress in High-Risk Pregnancy Women A structural equation model was constructed with perceived stress as the dependent variable, psychological resilience as the independent variable, and the positive coping dimension as the mediating variable. The mediating effect of positive coping style in the SEM was significant (95% CI: -0.113 ~ -0.001), see Fig. 1 . (Chi-square/degrees of freedom ratio (CMIN/DF) = 2.586, Goodness-of-Fit Index (GFI) = 0.982, Normed Fit Index (NFI) = 0.974, Comparative Fit Index (CFI) = 0.984, Root Mean Square Error of Approximation (RMSEA) = 0.069). The results showed that the direct effect of psychological resilience on perceived stress was − 0.178. The mediating effect of positive coping style between psychological resilience and perceived stress was − 0.025, accounting for 14.22% of the total effect, indicating a partial mediating role. See Table 4 . Discussion Psychological Resilience and Perceived Stress in High-Risk Pregnancy Women are at Moderate Levels, with a Tendency Towards Positive Coping The results of this study indicate that perceived stress in high-risk pregnant women is at a moderate level. Among the dimensions, the stress dimension had the highest average item score. This is consistent with previous findings in high-risk maternal populations [ 12 ]. Compared to women deemed low-risk, high-risk pregnant women experience greater stress during pregnancy and postpartum. A qualitative study on women with gestational diabetes found that blood glucose management during pregnancy caused them significant stress [ 13 ]; women with high-risk pregnancies face higher risks than low-risk women due to necessary lifestyle changes, increased prenatal check-ups, and potential neonatal problems, all of which are sources of stress [ 13 , 14 ]. This study found that psychological resilience in high-risk pregnant women was at a moderate level, differing from some past research [ 15 ]. Other studies suggest that resilience levels change dynamically during pregnancy; women with hyperemesis gravidarum had lower resilience than healthy pregnant women, and resilience increased with advancing gestational age and decreasing anxiety levels. High-risk pregnant women in this study were more inclined towards positive coping styles, similar to previous research, using optimistic coping strategies to face challenges during pregnancy and postpartum. A longitudinal study by Japanese researchers on high-risk pregnant women and their spouses [ 16 ] showed that scores on the parental identity questionnaire were higher during pregnancy and immediately after delivery than after discharge, with mothers' scores consistently higher than fathers'. Psychological Resilience Directly Predicts Perceived Stress in High-Risk Pregnancy Women This study showed a negative correlation between psychological resilience and perceived stress in high-risk pregnant women, meaning higher resilience levels were associated with lower perceived stress levels. This aligns with findings in populations such as dementia patients [ 17 ], spouses of women undergoing abortion [ 18 ], and low-risk pregnant women [ 19 ]. A study on low-risk pregnant women [ 19 ] emphasized the role of resilience in protecting women from vulnerability and perceived stress, potentially preventing complications and fostering positive experiences during pregnancy. A study on Brazilian nulliparous women [ 20 ] found that pregnant women with low resilience levels had higher perceived stress levels. Correlation Analysis of Positive Coping Style with Psychological Resilience and Perceived Stress The results of this study indicate that positive coping style was positively correlated with psychological resilience and negatively correlated with perceived stress. When maternal psychological resilience was higher, women were more inclined towards positive coping, a finding similar to research by scholar Wu Y [ 21 ]. In this study, negative coping did not show a significant correlation with psychological resilience, possibly because the negative coping sample accounted for only 10% of the total. Research shows [ 22 ] that most women after childbirth acknowledged at least some degree of positive psychological change in various life domains, with up to 20% reporting significant change. In a population of women with breast cancer, the proportion using positive coping styles was 51.1% [ 23 ]. One study [ 24 ] found that a large proportion of women acknowledged positive maternal psychological changes resulting from childbirth, particularly women at risk of adverse outcomes from traumatic birth experiences. This positive coping is not limited to mothers; fathers also showed increased parental identity due to their spouse's pregnancy and birth experience [ 16 ]. High resilience levels are associated with positive coping styles, and this association may lead mothers to adopt positive coping strategies more readily, thereby reducing perceived stress. Some evidence suggests women are more likely to choose emotion-focused or avoidant coping styles, while men tend to use more problem-focused approaches to handle stress [ 25 , 26 ]. Positive Coping Style Has a Mediating Effect Between Psychological Resilience and Perceived Stress in High-Risk Pregnancy Women Positive coping style played a partial mediating role in the effect of psychological resilience on perceived stress, accounting for 14.22% of the total effect. This suggests that psychological resilience can indirectly influence perceived stress in high-risk pregnant women through positive coping. Research shows that good psychological resilience helps individuals face life's difficulties positively, thereby reducing stress. Some studies found that women are more likely to use positive coping, social support, and problem-focused coping [ 27 , 28 ]. A positive coping attitude was observed in women with breast cancer [ 23 ] and hospitalized elderly patients [ 29 ], showing a willingness to change adverse situations. Many women with breast cancer transitioned from negative to positive coping strategies. However, similar research on coping strategy transitions during different pregnancy stages is lacking in the high-risk maternal population. Limitations However, some limitations of this study warrant consideration. Firstly, the use of convenience sampling and data collection from a single center limits the generalizability of the findings nationally and may introduce bias. Secondly, the cross-sectional design makes it difficult to infer causal relationships between these variables, and claims about the mediating effect of positive coping should be viewed with some caution. Thirdly, as negative coping samples accounted for only 10% of the total sample (33 cases), the study failed to detect the impact of negative coping styles on perceived stress. Finally, there is a lack of similar research on coping strategy transitions during different pregnancy stages within the high-risk maternal population. Future studies should investigate coping strategy changes across pregnancy stages in this group. Table 1 Project Example[n(%)] perceived pressure score[M(P25,P75),] H P planned pregnancy −2.389 0.017* YES 268(80.9) 26.00(23.0,29.0) NO 63(19.0) 28.00(25.0,31.0) Delivery Method 6.731 0.035* Natural Childbirth 67(20.2) 25.00(22.0,29.0) Cesarean Section 234(70.7) 27.00(23.0,30.0) Difficult Labour 30(9.1) 25.50(21.0,29.0) Gestational week of childbirth −3.944 0.000** 37 163(49.2) 25.00(21.0,29.0) Uterus removal −2.539 0.011* YES 9(2.7) 31.00(27.5,33.0) NO 322(97.3) 26.00(23.0,29.0) expectation of newborn sex 7.451 0.024* YES 138(41.7) 25.00(21.0,29.0) NO 42(12.7) 28.00(24.8,31.0) No Consequence 151(45.6) 26.00 (23.0,30.0) weight-appropriate −2.477 0.013* YES 188(56.8) 25.500(22.0,29.0) NO 143(43.2) 27.000(23.0,30.0) Location of newborns Neonatal Intensive Care Unit 224(67.7) 26.500(23.0,30.0) −2.768 0.006** Neonatology Department 107(32.3) 25.000(21.0,29.0) ※Difficult labour(including: shoulder dystocia、emergency cesarean section Table 2 Project Total Score Psychological Resilience Score[M(P25,P75)] 63.02(55.0, 71.0) Resilience[M(P25,P75)] 31.23(27.0, 35.0) Strong and Independent[M(P25,P75)] 21.97(19.0, 24.0) Optimistic[M(P25,P75)] 9.82(8.0, 11.0) Perceived Stress Score[M(P25,P75)] 26.03(23.0, 30.0) Coping Ability[M(P25,P75)] 10.45(9.0,12.0) Stress[M(P25,P75)] 15.58(13.0,18.0) Positive Coping[M(P25,P75)] 2.07(1.75,2.42) Negative Coping[M(P25,P75)] 1.28(0.88,1.63) Table 3 Psychological Resilience Score Resilience Strong and Independent Optimistic Perceived Stress Score Coping Ability Stress Positive Coping Negative Coping Psychological Resilience Score 1 Resilience 0.941** 1 Strong and Independent 0.907** 0.767** 1 Optimistic 0.733** 0.558** 0.628** 1 Perceived Stress Score -0.371** -0.353** -0.334** -0.286** 1 Coping Ability -0.432** -0.386** -0.413** -0.358** 0.682** 1 Stress -0.250** -0.244** -0.222** -0.177** 0.897** 0.330** 1 Positive Coping 0.495** 0.412** 0.486** 0.454** -0.233** -0.328** -0.120* 1 Negative Coping -0.077 -0.142** -0.017 0.020 0.251** 0.061 0.281** 0.139* 1 * p < 0.05 ** p < 0.01 Table 4 Pathway effect value standard error 95%CI total effect value ratio(%) Minimum Maximum total effect −0.178 0.023 −0.222 −0.133 — direct effect Psychological Resilience → Perceived Stress −0.147 0.028 −0.196 −0.097 82.6% Indirect effect Psychological Resilience → Positive Coping→ Perceived Stress −0.025 0.025 −0.113 −0.001 14.22% Declarations Ethics approval and consent to participate The Declaration of Helsinki was followed in the conduct of the research. The Third Affiliated Hospital Ethics Committee of Guangzhou Medical University granted ethical permission for this study (permission number: Linlun Review [2025] No.016), and subjects provided signed informed consent. The applicable rules and regulations are followed when using any method. Consent for publication Not applicable. Availability of data and materials This published article [together with its supplemental information files] contains all of the data created or examined during this investigation. Competing interests The authors declare that they have no competing interests. Funding This study was supported by the Guangzhou Teaching Achievement Cultivation Project in 2023 (Project No. 2023128541), and the Guangdong Teaching Achievement Cultivation Project in 2025 (No. 2024111263). The funding sources are not involved in the study design, data analysis and interpretation, paper writing, and decision to submit to the present journal. Authors' contributions Y L, XY Z, ZY C, JZ Y,B L,DF C and WT W carried out the studies, participated in collecting data, and drafted the manuscript. ML H and S Y performed the statistical analysis and participated in its design. Y L, XY Z,have contributed equally to this work as co-first author.All authors read and approved the final manuscript. References Prenatal checkups: mid- and late pregnancy-UpToDate[EB/OL]. [2023-09-25]. https://www.uptodate.cn/contents/zh-Hans/prenatal-care -second-and-third -trimesters. Valsamakis G, Chrousos G, Mastorakos G. Stress, female reproduction and pregnancy. Psychoneuroendocrinology. 2019 Feb;100:48-57. doi: 10.1016/j. psyneuen.2018.09.031. Epub 2018 Sep 22. PMID: 30291988. Folkman S, Lazarus RS, Gruen RJ, DeLongis A. Appraisal, coping, health status, and psycholo -gical symptoms. J Pers Soc Psychol. 1986 Mar;50(3):571-9. doi: 10.1037// 00223514.50.3.571. PMID: 3701593. National Health and Family Planning Commission of the People's Republic of China. Guidelines for the Assessment and Management of Pregnancy Risks in Pregnant Women and Mothers.[J].Chinese Journal of Practical Rural Medicine,2017,24(12):5-7. KLINERB．Principles and practice of structural equation model-ing[M]．2nded．New York:Guilford Press,2005:366． Cohen S,Mermelstein KR. Perceived Stress Scale (taken From a Global Measure of Perceived Stress) [J]. Journal of Health & Social Behavior, 1983, 24(4): 385-396. Yang T, Huang H. Epidemiological study of psychological stress among urban residents during social transition.[J]. Chinese Journal of Epidemiology, 2003, 24 (9): 760-764. Xie Y. A preliminary study on the reliability and validity of the Simple Coping Style Scale.[J].Chinese Journal of Clinical Psychology，1998,6 (2): 114-115. Xiao J, Gao Y, Chen Y, et al. A longitudinal study of perinatal depression in pregnant women and its influencing factors.[J]. Journal of Nursing Science,2021, 36(07):90-93. Connor K M, Davidson J R. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC)[J]. Depress Anxiety, 2003,18(2): 76-82. Yu X,Zhang J.Factor analysis and psychometric evaluation of the Connor -Davidson Resilience Scale (C D-RISC)with Chinese people[J].Social Behavior and Personality:an international journa l, 2007, 35(1): 19-30. Hui AL, Sevenhuysen G, Harvey D, Salamon E. Stress and anxiety in women with gestational diabetes during dietary management. Diabetes Educ. 2014 Sep-Oct;40(5):668-77. doi: 10.1177 /0145721714535991. Epub 2014 May 29. PMID: 24874692. Lee KW, Ching SM, Hoo FK, Ramachandran V, Chong SC, Tusimin M, Mohd Nordin N. Prevalence and factors associated with depressive, anxiety and stress symptoms among women with gestational diabetes mellitus in tertiary care centres in Malaysia: a cross-sectional study. BMC Pregnancy Childbirth. 2019 Oct 21;19(1):367. doi: 10.1186/s12884-019-2519-9. PMID: 31638930; PMCID: PMC6805560. Sürücü HA, Besen DB, Duman M, Yeter Erbil E. Coping with Stress among Pregnant Women with Gestational Diabetes Mellitus. J Caring Sci. 2018 Mar 1;7(1):9-15. doi: 10.15171 /jcs.2018.002. PMID: 29637051; PMCID: PMC5889800. Elmas B, Vatansever M, Civan Kahve A, Salman Özgü B, Asut G, Çakmak IB, Bestel A, Erkaya S. Evaluation of psychological resilience and anxiety levels of patients with hyperemesis gravidarum diagnosis and comparison with healthy pregnant women. Turk J Obstet Gynecol. 2021 Jun 2;18(2):115-123. doi: 10.4274/tjod.galenos.2021.05994. PMID: 34083634; PMCID: PMC8191320. Kawamura E, Asano M. Changes, differences, and factors of parenthood in high-risk pregnant women and their partners in Japan. BMC Pregnancy Childbirth. 2023 Mar 24;23 (1):205. doi: 10.1186/s12884-023-05519-3. PMID: 36964602; PMCID: PMC10037369. Franks KH, Bransby L, Cribb L, Buckley R, Yassi N, Chong TT, Saling MM, Lim YY, Pase MP. Associations of Perceived Stress and Psychological Resilience With Cognition and a Modifiable Dementia Risk Score in Middle-Aged Adults. J Gerontol B Psychol Sci Soc Sci. 2023 Dec 6;78 (12):1992-2000. doi: 10.1093/geronb/gbad131. PMID: 37718618; PMCID: PMC10699744. Jafari SZ, Hajifoghaha M, Azima S, Maghami PG, Panahi ZY. Investigating depression, anxiety, perceived stress and resilience in fathers faced with their spouse's abortion in Iran: a longitudinal study. BMC Psychiatry. 2024 Jul 8;24(1):496. doi: 10.1186/s12888-024-05887-w. PMID: 38978001; PMCID: PMC11232267. Huang J, Xu L, Xu Z, Luo Y, Liao B, Li Y, Shi Y. The relationship among pregnancy- related anxiety, perceived social support, family function and resilience in Chinese pregnant women: a structural equation modeling analysis. BMC Womens Health. 2022 Dec 26;22 (1):546. doi: 10.1186/s12905-022-02145-7. PMID: 36572883; PMCID: PMC9791157. Alves AC, Souza RT, Mayrink J, Galvao RB, Costa ML, Feitosa FE, Rocha Filho EA, Leite DF, Tedesco RP, Santana DS, Fernandes KG, Miele MJ, Souza JP, Cecatti JG; MAESI Study Group. Measuring resilience and stress during pregnancy and its relation to vulnerability and pregnancy outcomes in a nulliparous cohort study. BMC Pregnancy Childbirth. 2023 May 29;23(1):396. doi: 10.1186/s12884-023-05692-5. PMID: 37248450; PMCID: PMC10226234. Wu Y, Yu W, Wu X, Wan H, Wang Y, Lu G. Psychological resilience and positive coping styles among Chinese undergraduate students: a cross-sectional study. BMC Psychol. 2020 Aug 6;8(1):79. doi: 10.1186/s40359-020-00444-y. PMID: 32762769; PMCID: PMC7406959. Berman Z, Thiel F, Dishy GA, Chan SJ, Dekel S. Maternal psychological growth following childbirth. Arch Womens Ment Health. 2021 Apr;24(2):313-320. doi: 10.1007/s00737-020-01053-9. Epub 2020 Jul 23. PMID: 32705348. Kelkil BA, Atnafu NT, Dinegde NG, Wassie M. Coping strategies of stress and its associated factors among breast cancer patients in Tikur Anbesa specialized hospital, Ethiopia: Institution-based cross-sectional study. BMC Womens Health. 2022 Jun 24;22(1):252. doi: 10.1186/s12905-022-01792-0. PMID: 35751073; PMCID: PMC9233389. Babu MS, Chan SJ, Ein-Dor T, Dekel S. Traumatic childbirth during COVID-19 triggers maternal psychological growth and in turn better mother-infant bonding. J Affect Disord. 2022 Sep 15;313:163-166. doi: 10.1016/j.jad.2022.06.076. Epub 2022 Jun 27. PMID: 35772629; PMCID: PMC9235213. Kelly MM, Tyrka AR, Price LH, Carpenter LL. Sex differences in the use of coping strategies: predictors of anxiety and depressive symptoms. Depress Anxiety. 2008;25:839–46. Matud MP. Gender differences in stress and coping styles. Personal Individ Differ. 2004;37:1401–15. Felsten G. Gender and coping: use of distinct strategies and associations with stress and depression.Anxiety Stress Coping.1998;11:289–309. Tamres LK, Janicki D, Helgeson VS. Sex differences in coping behavior: a meta-analytic review and an examination of relative coping. Pers Soc Psychol Rev. 2002;6:2–30. Yang K, Bai J, Aliswag EG, Song J. Correlation between medical coping style and mindfulness level of hospitalized elderly: implications for enhancing psychological well-being. BMC Geriatr. 2024 Oct 12;24(1):823. doi: 10.1186/s12877-024-05437-9. PMID: 39395957; PMCID: PMC11470546. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 27 Nov, 2025 Reviewers agreed at journal 26 Oct, 2025 Reviewers agreed at journal 24 Oct, 2025 Reviews received at journal 21 Oct, 2025 Reviewers agreed at journal 21 Oct, 2025 Reviewers agreed at journal 10 Oct, 2025 Reviewers invited by journal 10 Oct, 2025 Editor invited by journal 09 Sep, 2025 Editor assigned by journal 06 Sep, 2025 Submission checks completed at journal 06 Sep, 2025 First submitted to journal 02 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7519801","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":532731944,"identity":"6d1c31d9-985d-44bd-8166-e9b989ca2e4b","order_by":0,"name":"Ying Liu","email":"","orcid":"","institution":"The Third School of Clinical Medicine, Guangzhou Medical UniversitySchool of Nursing","correspondingAuthor":false,"prefix":"","firstName":"Ying","middleName":"","lastName":"Liu","suffix":""},{"id":532731945,"identity":"e38b9b11-96e9-48b8-9c11-af0c6f91bc4b","order_by":1,"name":"XinYan Zhao","email":"","orcid":"","institution":"The Third School of Clinical Medicine, Guangzhou Medical UniversitySchool of Nursing","correspondingAuthor":false,"prefix":"","firstName":"XinYan","middleName":"","lastName":"Zhao","suffix":""},{"id":532731946,"identity":"5f96bb3b-5333-40cb-ac08-31b4aab7a512","order_by":2,"name":"ZhongYan Cao","email":"","orcid":"","institution":"Guangzhou HuaShang College，Guangzhou","correspondingAuthor":false,"prefix":"","firstName":"ZhongYan","middleName":"","lastName":"Cao","suffix":""},{"id":532731947,"identity":"0d7124ec-8415-4a85-924c-d354ef8fbba2","order_by":3,"name":"JinZhu Yin","email":"","orcid":"","institution":"Shandong Provincial Hospital Affiliated to Shandong First Medical University","correspondingAuthor":false,"prefix":"","firstName":"JinZhu","middleName":"","lastName":"Yin","suffix":""},{"id":532731948,"identity":"1c0f904d-3bcf-446b-8f8d-3de71faa20a0","order_by":4,"name":"Bing Liu","email":"","orcid":"","institution":"The Third Affiliated Hospital, Guangzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Bing","middleName":"","lastName":"Liu","suffix":""},{"id":532731949,"identity":"beba9690-4faf-40cd-af66-cb89ed6c253d","order_by":5,"name":"DeFeng Chen","email":"","orcid":"","institution":"The Third School of Clinical Medicine, Guangzhou Medical UniversitySchool of Nursing","correspondingAuthor":false,"prefix":"","firstName":"DeFeng","middleName":"","lastName":"Chen","suffix":""},{"id":532731950,"identity":"20e83642-f716-48e0-88e1-28d2646fb8bf","order_by":6,"name":"WenTing Wang","email":"","orcid":"","institution":"The Third School of Clinical Medicine, Guangzhou Medical UniversitySchool of Nursing","correspondingAuthor":false,"prefix":"","firstName":"WenTing","middleName":"","lastName":"Wang","suffix":""},{"id":532731951,"identity":"1089cd45-36e2-4589-9583-ad659442a4ff","order_by":7,"name":"Shuai Yang","email":"","orcid":"","institution":"The Third Affiliated Hospital, Guangzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Shuai","middleName":"","lastName":"Yang","suffix":""},{"id":532731952,"identity":"5f505454-136a-46ad-bd13-16a3d4e0064f","order_by":8,"name":"MeiLing Huang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAt0lEQVRIiWNgGAWjYBACAwbmBhAtx8befIBYLYxgLcZ8PMcSSNOSOE8iR4E4LeZiB5tf8/w5nN7GkMPA8KNiG2EtlrMT26x52w7ntjGcPcDYc+Y2EQ67ndhmzNsA1MLYl8DM2EasFpDD2Jh5DIjW0vyYh+1wAhsbCVraGOe2pRu28bAlHCTSL8mHP7z5Yy0vP//xwQc/KojQAgRsUjwMzWDWAaLUAwHzxx8MdcQqHgWjYBSMgpEIAGjKPzQi/i4SAAAAAElFTkSuQmCC","orcid":"","institution":"Guangdong Provincial Key Laboratory of Major Obstetric Diseases; Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology; The Third Affiliated Hospital, Medical University","correspondingAuthor":true,"prefix":"","firstName":"MeiLing","middleName":"","lastName":"Huang","suffix":""}],"badges":[],"createdAt":"2025-09-02 16:38:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7519801/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7519801/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":94398221,"identity":"8701656f-eb21-47f4-95da-2669f6b9482a","added_by":"auto","created_at":"2025-10-27 13:57:01","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":239383,"visible":true,"origin":"","legend":"","description":"","filename":"1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7519801/v1/fc160701eb61e33be6b23111.docx"},{"id":94396684,"identity":"5eaece53-cc47-4ed6-b51c-cb7b0d0adf0e","added_by":"auto","created_at":"2025-10-27 13:56:11","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":9757,"visible":true,"origin":"","legend":"","description":"","filename":"ac8d78beaaf24ffc86708796876ed02d.json","url":"https://assets-eu.researchsquare.com/files/rs-7519801/v1/4fb552d3d2e71b848154db5b.json"},{"id":94398864,"identity":"90df9a27-9c1b-4103-b9b4-6ff76e2c9841","added_by":"auto","created_at":"2025-10-27 13:57:13","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":98911,"visible":true,"origin":"","legend":"","description":"","filename":"ac8d78beaaf24ffc86708796876ed02d1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7519801/v1/91ceef9be01dc7a6e8e3a734.xml"},{"id":94489983,"identity":"52cfa482-8d9c-4b25-b95a-524ea11e4ee1","added_by":"auto","created_at":"2025-10-27 17:06:52","extension":"png","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":197163,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7519801/v1/deca1863c5743d959d517d9c.png"},{"id":94397296,"identity":"62c846a4-d745-4f09-ac16-d899055ed80b","added_by":"auto","created_at":"2025-10-27 13:56:36","extension":"png","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":35995,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7519801/v1/5f4cd62f68669934bee413e8.png"},{"id":94398412,"identity":"cb1e4998-e66f-406c-9e94-7856558a8411","added_by":"auto","created_at":"2025-10-27 13:57:04","extension":"xml","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":96860,"visible":true,"origin":"","legend":"","description":"","filename":"ac8d78beaaf24ffc86708796876ed02d1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7519801/v1/e70dbe1a2bc4e486159f7a7d.xml"},{"id":94397253,"identity":"73068cd2-5124-4290-ae12-36c50eb388bf","added_by":"auto","created_at":"2025-10-27 13:56:34","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":107818,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7519801/v1/83643cf334a6e7b949f92a82.html"},{"id":94398659,"identity":"dfd5d7be-3d65-4534-8230-b1d9865f1677","added_by":"auto","created_at":"2025-10-27 13:57:10","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":85270,"visible":true,"origin":"","legend":"\u003cp\u003eFigure legend not provided with this version\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7519801/v1/f000d43820c38d02a0f72fa4.png"},{"id":94491314,"identity":"ad511b8f-be4a-4c80-9e05-79967c7851e0","added_by":"auto","created_at":"2025-10-27 17:24:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1268858,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7519801/v1/4a2b86f1-9680-43a9-a282-21c5a9dbe92c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Influence of Psychological Resilience on Perceived Stress in High-Risk Pregnant Women: The Mediating Role of Positive Coping","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHigh-risk pregnancy (HRP) generally refers to pregnancies where the patient has certain medical or surgical conditions, past or current obstetric problems, or social or demographic factors that increase the risk of adverse maternal, fetal, or neonatal outcomes, or increase the risk of delivery complications. Consequently women with high-risk pregnancies require careful symptom observation, coping, and corresponding management at various stages of pregnancy. Completing these tasks places greater stress on these women, An increase in stressful events may heighten the risk of adverse pregnancy outcomes for women with high-risk pregnancies [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Scholar Lazarus proposed the Stress and Coping Theory proposed by American scholar Lazarus in the 1960s, which posits that stress arises from an imbalance between internal/external demands and the body's coping resources, disrupting the individual's homeostasis. The theory suggests that whether an individual experiences stress after encountering a stressful event depends on two key psychological processes: cognitive appraisal and coping [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Cognitive appraisal refers to the cognitive process by which an individual perceives whether an environmental stimulus is relevant to them. Coping involves effectively solving problems and alleviating negative emotions by utilizing personal coping resources. Psychological resilience is a quality or ability that helps individuals adapt well and cope positively with adversity. Therefore, this study proposes the following hypothesis: [When maternal psychological resilience is at a higher level, women may be more inclined towards positive coping, perceive less stress themselves, and be more conducive to maintaining good mental health. Therefore, based on the Stress and Coping Theory, this study explores the pathways through which psychological resilience and coping styles affect perceived stress in high-risk pregnant women, providing a reference for healthcare professionals to reduce perceived stress levels in this population.\u003c/p\u003e"},{"header":"Objects and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eResearch Subjects\u003c/h2\u003e\u003cp\u003eFrom October 2024 to June 2025, postpartum women hospitalized in the postpartum ward of a Grade A tertiary hospital in Guangzhou were selected using convenience sampling. Inclusion criteria: Women meeting the diagnostic criteria for high-risk pregnancy [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] and aged\u0026thinsp;\u0026ge;\u0026thinsp;20 years; live newborn; voluntary participation and signed informed consent. Exclusion criteria: History of psychiatric illness or dependence on psychiatric medications. This study used the empirical estimation method [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] to calculate the sample size, taking 5\u0026ndash;10 times the number of scale items. The sample size was estimated based on the Psychological Resilience Scale (25 items in total, the scale with the most items). Considering a 20% non-response rate, the final calculated sample size was N = [25 \u0026times; (5\u0026ndash;10)] / (1\u0026ndash;20%)\u0026thinsp;=\u0026thinsp;157\u0026thinsp;~\u0026thinsp;313. Since the study required the use of structural equation modeling (SEM), a minimum sample size of 200 was needed. This study ultimately included 331 patients, aged 20\u0026ndash;47 years, [mean (33.11\u0026thinsp;\u0026plusmn;\u0026thinsp;5.03) years.]\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eMethods\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eSurvey Instruments\u003c/h2\u003e\u003cp\u003e\u003cstrong\u003eGeneral Information Questionnaire\u003c/strong\u003e\u003cp\u003eSelf-designed, including information on the mother's personal details, family situation, pregnancy and childbirth history, and the condition of the newborn from this delivery.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003ePerceived Stress Scale (PSS-10)\u003c/b\u003e: Developed by Cohen in 1983 [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], this scale assesses the subject's perceived subjective stress over the past month by asking them to indicate how frequently they felt or thought a particular way. Translated and adapted into Chinese by Professor Yang Tingzhong et al. in 2003 [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], it consists of 10 items divided into two dimensions: Perceived Stress and Perceived Coping Capability. Each item is rated on a 5-point Likert scale. Items D1\u0026thinsp;~\u0026thinsp;D3, D6, D9\u0026thinsp;~\u0026thinsp;D10 belong to the Perceived Stress dimension (negative affect items), scored positively: 1\u0026thinsp;=\u0026thinsp;Never, 2\u0026thinsp;=\u0026thinsp;Almost never, 3\u0026thinsp;=\u0026thinsp;Sometimes, 4\u0026thinsp;=\u0026thinsp;Fairly often, 5\u0026thinsp;=\u0026thinsp;Very often. Items D4\u0026thinsp;~\u0026thinsp;D5, D7\u0026thinsp;~\u0026thinsp;D8 belong to the Perceived Coping Capability dimension (positive affect items), reverse scored: 5\u0026thinsp;=\u0026thinsp;Never, 4\u0026thinsp;=\u0026thinsp;Almost never, 3\u0026thinsp;=\u0026thinsp;Sometimes, 2\u0026thinsp;=\u0026thinsp;Fairly often, 1\u0026thinsp;=\u0026thinsp;Very often. All item scores are summed for a total score ranging from 0 to 40; higher scores indicate greater stress. In this study, the Cronbach's α coefficient for the total scale was 0.834, and the Kaiser-Meyer-Olkin (KMO) value for factor analysis was 0.857.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSimple Coping Style Questionnaire (SCSQ)\u003c/b\u003e: Translated, adapted, and revised by Chinese scholar Xie Yaning et al. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. It consists of 20 items, primarily divided into two dimensions: Positive Coping and Negative Coping (items 1\u0026ndash;12: Positive Coping; items 13\u0026ndash;20: Negative Coping). Scale options are selected based on the frequency and willingness with which individuals adopt certain approaches when facing different situations, scored as 0, 1, 2, or 3. The results are presented as the average score for the Positive Coping dimension and the average score for the Negative Coping dimension. The three dimensions are scored independently; a higher dimension score indicates a greater tendency towards that coping style. In a maternal population [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], the Cronbach's α coefficient for the Positive Coping subscale in this study was 0.90, and for the Negative Coping subscale it was 0.78, demonstrating good reliability.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConnor-Davidson Resilience Scale (CD-RISC-25)\u003c/b\u003e: Developed by Connor and Davidson in 2003 [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], this scale originally included five dimensions: competence, tolerance of negative affect, acceptance of change, control, and spiritual influences (25 items). Yu et al. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] translated and revised the CD-RISC-25 in 2007. The revised scale includes three dimensions: Tenacity, Strength, and Optimism, with 25 items. It uses a 5-point Likert scale: 0\u0026thinsp;=\u0026thinsp;Not true at all, 1\u0026thinsp;=\u0026thinsp;Rarely true, 2\u0026thinsp;=\u0026thinsp;Sometimes true, 3\u0026thinsp;=\u0026thinsp;Often true, 4\u0026thinsp;=\u0026thinsp;True nearly all the time. The total score ranges from 0 to 100; higher scores indicate higher levels of psychological resilience. The Cronbach's α coefficient was 0.91, and it is widely used in China.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData Collection Methods\u003c/h3\u003e\n\u003cp\u003eInvestigators were uniformly trained. During the survey, the purpose and significance of the study were explained to the mothers to gain their support and cooperation, and informed consent was obtained. Unified instructions were used to explain the questionnaire filling methods and requirements, and questions were answered promptly. After completing the questionnaire, if omissions or suspected errors were found, they were verified and supplemented with the patient. A total of 375 questionnaires were distributed, and 331 valid questionnaires were returned, resulting in an effective response rate of 88.5%.\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eData were analyzed using SPSS 26.0 statistical software. Descriptive analysis for categorical data used frequencies and percentages. Non-normally distributed measurement data were expressed as median and interquartile range M (P25, P75); group comparisons used non-parametric tests. Spearman correlation analysis was used to explore the correlation between psychological resilience, coping styles, and perceived stress in high-risk pregnant women. Amos 24.0 was used to construct a structural equation model (SEM). The Bootstrap resampling method (5000 repetitions) was used to test mediating effects. A significance level of P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was used.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eUnivariate Analysis of High-Risk Pregnancy Women\u003c/h2\u003e\u003cp\u003ePerceived stress total scores showed statistically significant differences among high-risk pregnant women with different delivery modes, gestational weeks at delivery, and newborn birth weights (all P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Specific results are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eCurrent Status of Perceived Stress, Psychological Resilience, and Coping Style Scores in High-Risk Pregnancy Women\u003c/h3\u003e\n\u003cp\u003eResults showed the median perceived stress score for high-risk pregnant women was [26.03 (23.0, 30.0)] points; the median psychological resilience score was 63.02 (55.0, 71.0) points. results are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eCorrelation Analysis of Perceived Stress, Psychological Resilience, and Coping Styles in High-Risk Pregnancy Women\u003c/h2\u003e\u003cp\u003eSpearman correlation analysis showed that perceived stress was negatively correlated with psychological resilience and positively correlated with the negative coping dimension, while being negatively correlated with the positive coping dimension (all P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Psychological resilience was positively correlated with positive coping (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) but showed no significant correlation with negative coping (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Details are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMediating Effect Analysis of Psychological Resilience and Coping Styles on Perceived Stress in High-Risk Pregnancy Women\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA structural equation model was constructed with perceived stress as the dependent variable, psychological resilience as the independent variable, and the positive coping dimension as the mediating variable. The mediating effect of positive coping style in the SEM was significant (95% CI: -0.113 ~ -0.001), see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. (Chi-square/degrees of freedom ratio (CMIN/DF)\u0026thinsp;=\u0026thinsp;2.586, Goodness-of-Fit Index (GFI)\u0026thinsp;=\u0026thinsp;0.982, Normed Fit Index (NFI)\u0026thinsp;=\u0026thinsp;0.974, Comparative Fit Index (CFI)\u0026thinsp;=\u0026thinsp;0.984, Root Mean Square Error of Approximation (RMSEA)\u0026thinsp;=\u0026thinsp;0.069). The results showed that the direct effect of psychological resilience on perceived stress was \u0026minus;\u0026thinsp;0.178. The mediating effect of positive coping style between psychological resilience and perceived stress was \u0026minus;\u0026thinsp;0.025, accounting for 14.22% of the total effect, indicating a partial mediating role. See Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cb\u003ePsychological Resilience and Perceived Stress in High-Risk Pregnancy Women are at Moderate Levels, with a Tendency Towards Positive Coping\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe results of this study indicate that perceived stress in high-risk pregnant women is at a moderate level. Among the dimensions, the stress dimension had the highest average item score. This is consistent with previous findings in high-risk maternal populations [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Compared to women deemed low-risk, high-risk pregnant women experience greater stress during pregnancy and postpartum. A qualitative study on women with gestational diabetes found that blood glucose management during pregnancy caused them significant stress [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]; women with high-risk pregnancies face higher risks than low-risk women due to necessary lifestyle changes, increased prenatal check-ups, and potential neonatal problems, all of which are sources of stress [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This study found that psychological resilience in high-risk pregnant women was at a moderate level, differing from some past research [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Other studies suggest that resilience levels change dynamically during pregnancy; women with hyperemesis gravidarum had lower resilience than healthy pregnant women, and resilience increased with advancing gestational age and decreasing anxiety levels. High-risk pregnant women in this study were more inclined towards positive coping styles, similar to previous research, using optimistic coping strategies to face challenges during pregnancy and postpartum. A longitudinal study by Japanese researchers on high-risk pregnant women and their spouses [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] showed that scores on the parental identity questionnaire were higher during pregnancy and immediately after delivery than after discharge, with mothers' scores consistently higher than fathers'.\u003c/p\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003ePsychological Resilience Directly Predicts Perceived Stress in High-Risk Pregnancy Women\u003c/h2\u003e\u003cp\u003eThis study showed a negative correlation between psychological resilience and perceived stress in high-risk pregnant women, meaning higher resilience levels were associated with lower perceived stress levels. This aligns with findings in populations such as dementia patients [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], spouses of women undergoing abortion [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], and low-risk pregnant women [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. A study on low-risk pregnant women [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] emphasized the role of resilience in protecting women from vulnerability and perceived stress, potentially preventing complications and fostering positive experiences during pregnancy. A study on Brazilian nulliparous women [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] found that pregnant women with low resilience levels had higher perceived stress levels.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eCorrelation Analysis of Positive Coping Style with Psychological Resilience and Perceived Stress\u003c/h2\u003e\u003cp\u003eThe results of this study indicate that positive coping style was positively correlated with psychological resilience and negatively correlated with perceived stress. When maternal psychological resilience was higher, women were more inclined towards positive coping, a finding similar to research by scholar Wu Y [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In this study, negative coping did not show a significant correlation with psychological resilience, possibly because the negative coping sample accounted for only 10% of the total. Research shows [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] that most women after childbirth acknowledged at least some degree of positive psychological change in various life domains, with up to 20% reporting significant change. In a population of women with breast cancer, the proportion using positive coping styles was 51.1% [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. One study [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] found that a large proportion of women acknowledged positive maternal psychological changes resulting from childbirth, particularly women at risk of adverse outcomes from traumatic birth experiences. This positive coping is not limited to mothers; fathers also showed increased parental identity due to their spouse's pregnancy and birth experience [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. High resilience levels are associated with positive coping styles, and this association may lead mothers to adopt positive coping strategies more readily, thereby reducing perceived stress. Some evidence suggests women are more likely to choose emotion-focused or avoidant coping styles, while men tend to use more problem-focused approaches to handle stress [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003ePositive Coping Style Has a Mediating Effect Between Psychological Resilience and Perceived Stress in High-Risk Pregnancy Women\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePositive coping style played a partial mediating role in the effect of psychological resilience on perceived stress, accounting for 14.22% of the total effect. This suggests that psychological resilience can indirectly influence perceived stress in high-risk pregnant women through positive coping. Research shows that good psychological resilience helps individuals face life's difficulties positively, thereby reducing stress. Some studies found that women are more likely to use positive coping, social support, and problem-focused coping [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. A positive coping attitude was observed in women with breast cancer [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] and hospitalized elderly patients [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], showing a willingness to change adverse situations. Many women with breast cancer transitioned from negative to positive coping strategies. However, similar research on coping strategy transitions during different pregnancy stages is lacking in the high-risk maternal population.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eHowever, some limitations of this study warrant consideration. Firstly, the use of convenience sampling and data collection from a single center limits the generalizability of the findings nationally and may introduce bias. Secondly, the cross-sectional design makes it difficult to infer causal relationships between these variables, and claims about the mediating effect of positive coping should be viewed with some caution. Thirdly, as negative coping samples accounted for only 10% of the total sample (33 cases), the study failed to detect the impact of negative coping styles on perceived stress. Finally, there is a lack of similar research on coping strategy transitions during different pregnancy stages within the high-risk maternal population. Future studies should investigate coping strategy changes across pregnancy stages in this group.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProject\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExample[n(%)]\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eperceived pressure score[M(P25,P75),]\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eH\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eplanned pregnancy\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;2.389\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.017*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYES\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e268(80.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26.00(23.0,29.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNO\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e63(19.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e28.00(25.0,31.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDelivery Method\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.731\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.035*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNatural Childbirth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e67(20.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25.00(22.0,29.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCesarean Section\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e234(70.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27.00(23.0,30.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDifficult Labour\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e30(9.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25.50(21.0,29.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGestational week of childbirth\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;3.944\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.000**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;36\u0026thinsp;\u003csup\u003e+\u0026thinsp;6\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e168(50.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27.00(24.0,30.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e163(49.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25.00(21.0,29.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eUterus removal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;2.539\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.011*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYES\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9(2.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e31.00(27.5,33.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNO\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e322(97.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26.00(23.0,29.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eexpectation of newborn sex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.451\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.024*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYES\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e138(41.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25.00(21.0,29.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNO\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e42(12.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e28.00(24.8,31.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo Consequence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e151(45.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26.00 (23.0,30.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eweight-appropriate\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;2.477\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.013*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYES\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e188(56.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25.500(22.0,29.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNO\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e143(43.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27.000(23.0,30.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLocation of newborns\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeonatal Intensive Care Unit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e224(67.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26.500(23.0,30.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;2.768\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.006**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeonatology Department\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e107(32.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25.000(21.0,29.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e※Difficult labour(including: shoulder dystocia、emergency cesarean section\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProject\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal Score\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePsychological Resilience Score[M(P25,P75)]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e63.02(55.0, 71.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResilience[M(P25,P75)]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e31.23(27.0, 35.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStrong and Independent[M(P25,P75)]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e21.97(19.0, 24.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOptimistic[M(P25,P75)]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9.82(8.0, 11.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerceived Stress Score[M(P25,P75)]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e26.03(23.0, 30.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCoping Ability[M(P25,P75)]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10.45(9.0,12.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStress[M(P25,P75)]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15.58(13.0,18.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePositive Coping[M(P25,P75)]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.07(1.75,2.42)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNegative Coping[M(P25,P75)]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.28(0.88,1.63)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"12\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePsychological Resilience Score\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eResilience\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eStrong and Independent\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eOptimistic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003ePerceived Stress Score\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eCoping Ability\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eStress\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003ePositive Coping\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003eNegative Coping\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePsychological Resilience Score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResilience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.941**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStrong and Independent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.907**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.767**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOptimistic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.733**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.558**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.628**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerceived Stress Score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.371**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.353**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.334**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.286**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCoping Ability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.432**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.386**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.413**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.358**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.682**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStress\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.250**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.244**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.222**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.177**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.897**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.330**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePositive Coping\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.495**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.412**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.486**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.454**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0.233**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-0.328**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-0.120*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNegative Coping\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.077\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.142**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.251**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.061\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.281**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.139*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"12\" nameend=\"c12\" namest=\"c1\"\u003e\u003cp\u003e*\u0026nbsp;\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 **\u0026nbsp;\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePathway\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eeffect value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003estandard error\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e95%CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003etotal effect value ratio(%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMinimum\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMaximum\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003etotal effect\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;0.178\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;0.222\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026minus;0.133\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003edirect effect\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePsychological Resilience\u003c/p\u003e\u003cp\u003e\u0026rarr; Perceived Stress\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;0.147\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.028\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;0.196\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026minus;0.097\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e82.6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIndirect effect\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePsychological Resilience\u003c/p\u003e\u003cp\u003e\u0026rarr; Positive Coping\u0026rarr;\u003c/p\u003e\u003cp\u003ePerceived Stress\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;0.025\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.025\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;0.113\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026minus;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14.22%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Declaration of Helsinki was followed in the conduct of the research. The Third Affiliated Hospital Ethics Committee of Guangzhou Medical University granted ethical permission for this study (permission number: Linlun Review [2025] No.016), and subjects provided signed informed consent. The applicable rules and regulations are followed when using any method.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis published article [together with its supplemental information files] contains all of the data created or examined during this investigation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Guangzhou Teaching Achievement Cultivation Project in 2023 (Project No. 2023128541), and the Guangdong Teaching Achievement Cultivation Project in 2025 (No. 2024111263). The funding sources are not involved in the study design, data analysis and interpretation, paper writing, and decision to submit to the present journal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eY L, XY Z, ZY C, JZ Y,B L,DF C and WT W carried out the studies, participated in collecting data, and drafted the manuscript. ML H and S Y performed the statistical analysis and participated in its design. Y L, XY Z,have contributed equally to this work as co-first author.All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePrenatal checkups: mid- and late pregnancy-UpToDate[EB/OL]. [2023-09-25]. https://www.uptodate.cn/contents/zh-Hans/prenatal-care -second-and-third -trimesters.\u003c/li\u003e\n\u003cli\u003eValsamakis G, Chrousos G, Mastorakos G. Stress, female reproduction and pregnancy. Psychoneuroendocrinology. 2019 Feb;100:48-57. doi: 10.1016/j. psyneuen.2018.09.031. Epub 2018 Sep 22. PMID: 30291988.\u003c/li\u003e\n\u003cli\u003eFolkman S, Lazarus RS, Gruen RJ, DeLongis A. Appraisal, coping, health status, and psycholo -gical symptoms. J Pers Soc Psychol. 1986 Mar;50(3):571-9. doi: 10.1037// 00223514.50.3.571. PMID: 3701593.\u003c/li\u003e\n\u003cli\u003eNational Health and Family Planning Commission of the People\u0026apos;s Republic of China. Guidelines for the Assessment and Management of Pregnancy Risks in Pregnant Women and Mothers.[J].Chinese Journal of Practical Rural Medicine,2017,24(12):5-7.\u003c/li\u003e\n\u003cli\u003eKLINERB．Principles and practice of structural equation model-ing[M]．2nded．New York:Guilford Press,2005:366．\u003c/li\u003e\n\u003cli\u003eCohen S,Mermelstein KR. Perceived Stress Scale (taken From a Global Measure of Perceived Stress) [J]. Journal of Health \u0026amp; Social Behavior, 1983, 24(4): 385-396.\u003c/li\u003e\n\u003cli\u003eYang T, Huang H. Epidemiological study of psychological stress among urban residents during social transition.[J]. Chinese Journal of Epidemiology, 2003, 24 (9): 760-764.\u003c/li\u003e\n\u003cli\u003eXie Y. A preliminary study on the reliability and validity of the Simple Coping Style Scale.[J].Chinese Journal of Clinical Psychology，1998,6 (2): 114-115.\u003c/li\u003e\n\u003cli\u003eXiao J, Gao Y, Chen Y, et al. A longitudinal study of perinatal depression in pregnant women and its influencing factors.[J]. Journal of Nursing Science,2021, 36(07):90-93.\u003c/li\u003e\n\u003cli\u003eConnor K M, Davidson J R. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC)[J]. Depress Anxiety, 2003,18(2): 76-82.\u003c/li\u003e\n\u003cli\u003eYu X,Zhang J.Factor analysis and psychometric evaluation of the Connor -Davidson Resilience Scale (C D-RISC)with Chinese people[J].Social Behavior and Personality:an international journa l, 2007, 35(1): 19-30.\u003c/li\u003e\n\u003cli\u003eHui AL, Sevenhuysen G, Harvey D, Salamon E. Stress and anxiety in women with gestational diabetes during dietary management. Diabetes Educ. 2014 Sep-Oct;40(5):668-77. doi: 10.1177 /0145721714535991. Epub 2014 May 29. PMID: 24874692.\u003c/li\u003e\n\u003cli\u003eLee KW, Ching SM, Hoo FK, Ramachandran V, Chong SC, Tusimin M, Mohd Nordin N. Prevalence and factors associated with depressive, anxiety and stress symptoms among women with gestational diabetes mellitus in tertiary care centres in Malaysia: a cross-sectional study. BMC Pregnancy Childbirth. 2019 Oct 21;19(1):367. doi: 10.1186/s12884-019-2519-9. PMID: 31638930; PMCID: PMC6805560.\u003c/li\u003e\n\u003cli\u003eS\u0026uuml;r\u0026uuml;c\u0026uuml; HA, Besen DB, Duman M, Yeter Erbil E. Coping with Stress among Pregnant Women with Gestational Diabetes Mellitus. J Caring Sci. 2018 Mar 1;7(1):9-15. doi: 10.15171 /jcs.2018.002. PMID: 29637051; PMCID: PMC5889800.\u003c/li\u003e\n\u003cli\u003eElmas B, Vatansever M, Civan Kahve A, Salman \u0026Ouml;zg\u0026uuml; B, Asut G, \u0026Ccedil;akmak IB, Bestel A, Erkaya S. Evaluation of psychological resilience and anxiety levels of patients with hyperemesis gravidarum diagnosis and comparison with healthy pregnant women. Turk J Obstet Gynecol. 2021 Jun 2;18(2):115-123. doi: 10.4274/tjod.galenos.2021.05994. PMID: 34083634; PMCID: PMC8191320.\u003c/li\u003e\n\u003cli\u003eKawamura E, Asano M. Changes, differences, and factors of parenthood in high-risk pregnant women and their partners in Japan. BMC Pregnancy Childbirth. 2023 Mar 24;23 (1):205. doi: 10.1186/s12884-023-05519-3. PMID: 36964602; PMCID: PMC10037369.\u003c/li\u003e\n\u003cli\u003eFranks KH, Bransby L, Cribb L, Buckley R, Yassi N, Chong TT, Saling MM, Lim YY, Pase MP. Associations of Perceived Stress and Psychological Resilience With Cognition and a Modifiable Dementia Risk Score in Middle-Aged Adults. J Gerontol B Psychol Sci Soc Sci. 2023 Dec 6;78 (12):1992-2000. doi: 10.1093/geronb/gbad131. PMID: 37718618; PMCID: PMC10699744.\u003c/li\u003e\n\u003cli\u003eJafari SZ, Hajifoghaha M, Azima S, Maghami PG, Panahi ZY. Investigating depression, anxiety, perceived stress and resilience in fathers faced with their spouse\u0026apos;s abortion in Iran: a longitudinal study. BMC Psychiatry. 2024 Jul 8;24(1):496. doi: 10.1186/s12888-024-05887-w. PMID: 38978001; PMCID: PMC11232267.\u003c/li\u003e\n\u003cli\u003eHuang J, Xu L, Xu Z, Luo Y, Liao B, Li Y, Shi Y. The relationship among pregnancy- related anxiety, perceived social support, family function and resilience in Chinese pregnant women: a structural equation modeling analysis. BMC Womens Health. 2022 Dec 26;22 (1):546. doi: 10.1186/s12905-022-02145-7. PMID: 36572883; PMCID: PMC9791157.\u003c/li\u003e\n\u003cli\u003eAlves AC, Souza RT, Mayrink J, Galvao RB, Costa ML, Feitosa FE, Rocha Filho EA, Leite DF, Tedesco RP, Santana DS, Fernandes KG, Miele MJ, Souza JP, Cecatti JG; MAESI Study Group. Measuring resilience and stress during pregnancy and its relation to vulnerability and pregnancy outcomes in a nulliparous cohort study. BMC Pregnancy Childbirth. 2023 May 29;23(1):396. doi: 10.1186/s12884-023-05692-5. PMID: 37248450; PMCID: PMC10226234.\u003c/li\u003e\n\u003cli\u003eWu Y, Yu W, Wu X, Wan H, Wang Y, Lu G. Psychological resilience and positive coping styles among Chinese undergraduate students: a cross-sectional study. BMC Psychol. 2020 Aug 6;8(1):79. doi: 10.1186/s40359-020-00444-y. PMID: 32762769; PMCID: PMC7406959.\u003c/li\u003e\n\u003cli\u003eBerman Z, Thiel F, Dishy GA, Chan SJ, Dekel S. Maternal psychological growth following childbirth. Arch Womens Ment Health. 2021 Apr;24(2):313-320. doi: 10.1007/s00737-020-01053-9. Epub 2020 Jul 23. PMID: 32705348.\u003c/li\u003e\n\u003cli\u003eKelkil BA, Atnafu NT, Dinegde NG, Wassie M. Coping strategies of stress and its associated factors among breast cancer patients in Tikur Anbesa specialized hospital, Ethiopia: Institution-based cross-sectional study. BMC Womens Health. 2022 Jun 24;22(1):252. doi: 10.1186/s12905-022-01792-0. PMID: 35751073; PMCID: PMC9233389.\u003c/li\u003e\n\u003cli\u003eBabu MS, Chan SJ, Ein-Dor T, Dekel S. Traumatic childbirth during COVID-19 triggers maternal psychological growth and in turn better mother-infant bonding. J Affect Disord. 2022 Sep 15;313:163-166. doi: 10.1016/j.jad.2022.06.076. Epub 2022 Jun 27. PMID: 35772629; PMCID: PMC9235213.\u003c/li\u003e\n\u003cli\u003eKelly MM, Tyrka AR, Price LH, Carpenter LL. Sex differences in the use of coping strategies: predictors of anxiety and depressive symptoms. Depress Anxiety. 2008;25:839\u0026ndash;46.\u003c/li\u003e\n\u003cli\u003eMatud MP. Gender differences in stress and coping styles. Personal Individ Differ. 2004;37:1401\u0026ndash;15.\u003c/li\u003e\n\u003cli\u003eFelsten G. Gender and coping: use of distinct strategies and associations with stress and depression.Anxiety Stress Coping.1998;11:289\u0026ndash;309.\u003c/li\u003e\n\u003cli\u003eTamres LK, Janicki D, Helgeson VS. Sex differences in coping behavior: a meta-analytic review and an examination of relative coping. Pers Soc Psychol Rev. 2002;6:2\u0026ndash;30.\u003c/li\u003e\n\u003cli\u003eYang K, Bai J, Aliswag EG, Song J. Correlation between medical coping style and mindfulness level of hospitalized elderly: implications for enhancing psychological well-being. BMC Geriatr. 2024 Oct 12;24(1):823. doi: 10.1186/s12877-024-05437-9. PMID: 39395957; PMCID: PMC11470546.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"High-Risk Pregnancy, Psychological Resilience, Coping Style, Perceived Stress, Mediating Effect","lastPublishedDoi":"10.21203/rs.3.rs-7519801/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7519801/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: High-risk pregnant women face more challenges during pregnancy and postpartum than low-risk pregnant women. This study aims to explore whether different coping strategies among high-risk pregnant women affect their perceived stress levels.\u003c/p\u003e\n\u003cp\u003eObjective: To understand the status of perceived stress in high-risk pregnancy (HRP) women and explore the mediating role of coping styles between psychological resilience and perceived stress.\u003c/p\u003e\n\u003cp\u003eMethods: A convenience sample of 331 high-risk pregnant women from a Grade A tertiary hospital in Guangzhou was surveyed using the Connor-Davidson Resilience Scale (CD-RISC-25), the Simple Coping Style Questionnaire (SCSQ), and the Perceived Stress Scale (PSS-10).\u003c/p\u003e\n\u003cp\u003eResults: The median total perceived stress score for high-risk pregnant women was 26.03 (23.0, 30.0); the median total psychological resilience score was 63.02 (55.0, 71.0). For coping styles, the positive coping score was 2.07 (1.75, 2.42), and the negative coping score was 1.28 (0.88, 1.63). Psychological resilience was negatively correlated with perceived stress (P \u0026lt; 0.05) and positively correlated with positive coping (P \u0026lt; 0.05); positive coping was negatively correlated with perceived stress (P \u0026lt; 0.05). Positive coping was a mediator between psychological resilience and perceived stress (effect value: -0.025), accounting for 14.22% of the total effect.\u003c/p\u003e\n\u003cp\u003eConclusion: Psychological resilience in high-risk pregnant women can influence perceived stress through positive coping. Healthcare workers should pay more attention to high-risk pregnant women with low psychological resilience in their daily work and guide patients to adopt positive coping styles to reduce their perceived stress.\u003c/p\u003e","manuscriptTitle":"The Influence of Psychological Resilience on Perceived Stress in High-Risk Pregnant Women: The Mediating Role of Positive Coping","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-26 00:31:54","doi":"10.21203/rs.3.rs-7519801/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-11-27T13:14:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"14235938890345230055118606166875496469","date":"2025-10-26T16:21:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"14527642917025668446390646657247268417","date":"2025-10-24T04:57:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-21T08:43:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"140817663486755148441986599187073337535","date":"2025-10-21T06:53:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"308560009286819027102574227718729475061","date":"2025-10-10T12:37:49+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-10T10:07:48+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-09T17:02:29+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-06T08:54:02+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-06T08:52:23+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2025-09-02T16:24:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1d90a90e-9034-45c3-bb68-f6370ea41325","owner":[],"postedDate":"October 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-26T00:31:54+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-26 00:31:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7519801","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7519801","identity":"rs-7519801","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}