Current status and influencing factors of pregnancy related anxiety in Chinese pregnant women: a cross sectional study

Current status and influencing factors of pregnancy related anxiety in Chinese pregnant women: a cross sectional study | 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 Current status and influencing factors of pregnancy related anxiety in Chinese pregnant women: a cross sectional study Feng FU, Xiaotong Li, Yuhang Zhang, Juanjuan Yan, Mingyue Ma, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5781802/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objectives: This study aimed to: (1) Rigorously validate the Chinese PrAS-S psychometrically; (2) Precisely determine pregnancy-related anxiety prevalence and severity among pregnant women; (3) Scrutinize its significant influencing factors. Background: Given pregnancy-related anxiety’s importance for maternal mental health, we used PrAS-S for a cross-sectional study of 300 Urumqi pregnant women. We aimed to evaluate anxiety levels, analyze status and factors, and support clinical psychological nursing. Methods: Employing convenience sampling, 300 pregnant women from three Urumqi tertiary hospitals were surveyed with general and Chinese PrAS-S questionnaires. Univariate and multiple linear regression analyses explored determinants and assessed the scale’s reliability and validity. Results: The Chinese PrAS-S proved reliable and valid. CR values for differentiation were 9.670 - 18.920, I-CVI 0.83 - 1, Cronbach's α 0.778 - 0.906, and test-retest correlation coefficients 0.857 - 1. The prevalence of pregnancy-related anxiety was 61.67% (185/300). Age, marital status, gestational age, marital satisfaction, baby's gender expectation, and concurrent pregnancy complications had a profound impact. Conclusions: The Chinese PrAS-S is a convenient, reliable tool for quickly assessing pregnancy-related anxiety. With a high incidence rate, preventive and intervention strategies, considering influencing factors, must be strengthened to protect pregnant women's mental health. Pregnancy-related anxiety Chinese version Reliability Validity Influencing factors Mental health 1. Background In alignment with the evolving scenario and distinctive traits of China's population, economy, and social development, pregnant women have increasingly emerged as a focal point in society. Globally, as per the "2022 World Population Prospects" report by the United Nations, the global population hit 8 billion on November 15, 2022. Concomitantly, the number of pregnant women has exhibited an upward trajectory year after year. In 2018, approximately 140 million women worldwide were pregnant [1] . Since the enforcement of China's comprehensive two-child policy, the birth rate has witnessed a significant upsurge [2] . From 2015 to 2017, the number of new births amounted to 17.86 million, accompanied by a nearly 18-million increase in the number of pregnant women. With the relaxation of China's three-child policy, the substantial and annually escalating number of pregnant women presents novel hurdles to the maternal healthcare sector in the country. Pregnancy represents a distinctive physiological phase for women. During this period, pregnant women experience corresponding alterations in metabolism, hormonal levels, respiratory and circulatory systems, neurovascular function, the digestive tract, as well as breast physiology [3] . These changes also translate into inconveniences and discomforts in their daily lives, spanning aspects such as clothing, diet, accommodation, and mobility. Notably, for primiparas and older pregnant women, the susceptibility to pregnancy complications is heightened. The dearth of knowledge regarding these complications, compounded by excessive apprehension and dread, can precipitate depressive and anxious states, among other negative emotions, which may severely impede labor progress and disease management [4] . Moreover, fettered by traditional concepts like "carrying on the family line" and beleaguered by multiple pressures and mental quandaries endemic to modern society, including employment concerns, career advancement, marital issues, housing woes, and competitive stress, pregnant women encounter more arduous challenges compared to the general populace. The multifaceted complex changes and stressors preclude pregnant women from traversing pregnancy with equanimity. Consequently, a slew of adverse pregnancy-related emotions, such as tension, anxiety, and fear, pose health risks not only to the expectant mothers but also to the fetuses [5] . Pregnancy-related anxiety, a specific form of anxiety intimately linked to the gestational context, is typified by distinct fears and concerns that manifest during pregnancy. Pregnant women often agonize over the well-being of themselves and their fetuses, the impending delivery process, and the forthcoming responsibilities of motherhood [5] . The chronic persistence of such psychological distress can imperil women's psychological welfare throughout pregnancy, influence the birth outcomes, and even extend its ramifications into the postpartum period. Globally, epidemiological data indicates that the prevalence of anxiety among the general female population stands at 19.8% [6] , whereas during pregnancy, this figure escalates to as high as 35% [7] , highlighting a significantly elevated risk compared to non-pregnant counterparts. Anxiety during pregnancy not only compromises the quality of life for expectant mothers but also poses grave consequences for both maternal and infant health if left unaddressed. Research has established associations between prenatal depression and a plethora of adverse outcomes, such as preeclampsia, surgical modes of delivery (including cesarean sections and instrumental vaginal deliveries), preterm labor, low birth weight infants, postpartum depression, and an augmented risk of maternal suicide. Notably, pregnant women exhibiting high levels of anxiety symptoms face a 2.26-fold increased likelihood of adverse birth outcomes relative to those without symptoms [8,9] . It has been further elucidated that between 15% and 23% of pregnant women succumb to pregnancy-related anxiety, leading to unfavorable sequelae like severe pregnancy reactions, maladaptive psychological coping, and negative perceptions of impending motherhood [10,11] . Moreover, pregnancy-related anxiety has emerged as an independent predictor of postpartum depression [12,13] . Presently, there exist 18 scales available for gauging anxiety during pregnancy, which can be broadly classified into two principal categories: common scales (9 in number) and pregnancy-specific scales (also 9). The common scales encompass instruments like the Beck Anxiety Scale (1993), Hospital Anxiety and Depression Scale (1983), and the Penn State Worry Questionnaire (1990), among others. The pregnancy-specific scales comprise the Infant Patterns Questionnaire (1983), Edinburgh Postnatal Depression Scale (1987), Pregnancy Anxiety Inventory (1995, 1991), Pregnancy-Related Anxiety Questionnaire (1990, 2001), and the Pregnancy-Related Anxiety Scale (2018). Remarkably, only 7 of these pertain directly to the measurement of pregnancy-related anxiety. Empirical studies have substantiated that general anxiety scales are ill-equipped to comprehensively identify and dissect the idiosyncratic dimensions of mood disorders germane to pregnancy, underlining the necessity to distinguish between general anxiety and pregnancy-related anxiety [14,15] . Among the limited pool of seven pregnancy-related anxiety measurement scales, Dr. Robyn devised the Pregnancy-Related Anxiety Scale (PrAS) in 2018, building upon existing frameworks. This scale introduced novel measurement dimensions hitherto unexplored, bolstering the comprehensiveness of its content structure. Through robust theoretical underpinnings and scientifically rigorous psychological methodologies, the measurement validity of the PrAS was validated. Additionally, extensive clinical applications were carried out in large communities and psychological counseling clinics, involving sizable samples of women, thereby ensuring the PrAS better caters to the contemporary female population's exigencies for assessing pregnancy-related anxiety. In China, research efforts dedicated to pregnancy-related anxiety remain relatively scant. The majority of existing studies adopt a cross-sectional design [16– 18] , with only a few investigators delving into the correlation between antenatal anxiety and pregnancy outcomes [19,20] . A significant limitation is that pregnancy-related anxiety has often been imprecisely defined in most studies. Consequently, self-designed questionnaires or general anxiety scales have been employed for assessment, yet the measurement efficacy of these self-developed tools lacks robust validation, leading to non-specific measurements that fall short in scientific rigor and comprehensiveness. For instance, Xiao Limin et al. formulated the Pregnancy-related Anxiety Questionnaire in China [21] , which comprises merely 13 items across 3 dimensions, thereby exhibiting certain constraints in its assessment scope. Additionally, Wu Yang from Kunming Medical University undertook the translation and reliability testing of Dr. Robyn's Pregnancy-related Anxiety Scale (PrAS) into Chinese [22] . However, this scale contains a relatively large number of entries and is rather lengthy, posing its own set of limitations. In 2022, Dr. Robyn from Australia developed the Pregnancy-Related Anxiety Scale (Simplified Version) (PrAS-S), which stands out for its streamlined and precise design. It has garnered a high degree of respondent acceptance during questionnaire administration. Through cross-cultural adaptation and debugging, this scale has been translated into multiple languages and has undergone clinical application testing, demonstrating a high level of reliability [23] . In the current study, we introduced the PrAS-S into China with the aim of validating its reliability and validity within the Chinese context. By doing so, we seek to establish a female pregnancy-related anxiety assessment tool that is tailored to the Chinese pregnant population. This endeavor is geared towards accurately gauging the prevalence and severity of pregnancy-related anxiety among Chinese women, as well as probing into the current status and associated influencing factors. Ultimately, this research will furnish a theoretical foundation for the accurate assessment of pregnancy anxiety levels and the implementation of targeted clinical psychological care interventions, thereby catalyzing the advancement of pregnant women's mental health. 2. Methods 2.1 Design and samples A descriptive cross-sectional study was conducted. A total of 337 pregnant women were screened in the obstetrics outpatient clinics of three tertiary general hospitals in Urumqi using convenience sampling method. The inclusion criteria for the study population were as follows: a. Pregnant women with a healthcare facility diagnosis of clinical pregnancy; b. Pregnant women with a certain level of reading comprehension and good communication skills in Mandarin; c. Pregnant women who gave informed consent and were able to cooperate. The exclusion criteria were as follows: a. Pregnant women with a previous history of drug or alcohol abuse; b. Pregnant women with a previous diagnosis of bipolar disorder or schizophrenia or the presence of psychotic features. According to the methodological guideline stipulating that the sample size should ideally be 5–10 times the number of items in the study instrument [24] , since the scale under investigation comprised 15 items, and considering the requirements for exploratory factor analysis (a minimum of 100 cases) and validation factor analysis (a minimum of 200 cases), along with accounting for an estimated 20% of potentially invalid questionnaires, a minimum of 300 research subjects were selected for this study to ensure the robustness and reliability of the findings. 2.2 Instruments 2.2.1 General Information Questionnaire The general information questionnaire was compiled by the research team itself according to the content and needs of the study. It covered socio-demographic aspects such as age, education level (elementary school and below/junior high school/high school/university college/undergraduate/master's degree and above), marital status (unmarried/married/widowed/divorced), and degree of marital satisfaction (very satisfied/satisfied/fairly satisfied); and it also used other variables related to this study such as the mode of pregnancy (natural insemination/artificial insemination), the week of pregnancy (early pregnancy 28 weeks), whether or not to be pregnant, and whether or not to be married. Early stage 28 weeks), whether it was a first birth, whether it was a combined pregnancy complication, and whether it was expecting the sex of the baby. 2.2.2 Pregnancy-related Anxiety Scale-Short Version (PrAS-S) The Pregnancy-Related Anxiety Scale (Simplified Version) (PrAS-S) was developed by Prof. Robyn et al. in Australia in 2022, and is mainly used to measure the level of pregnancy-related anxiety in pregnant women [23] . A study by our research team debugged the scale in Chinese to adapt it to the Chinese women's population, and its validity has been confirmed [25] . The Chinese version of the questionnaire scale consisted of 15 items with 5 dimensions, namely, labor and delivery process (3 items), concern for self (3 items), self-concern (3 items), fetal status (3 items), and attitudes of medical personnel (3 items). A 4-point Likert scale was used, with each entry ranging from “not at all” to “very frequently”, and the total score ranging from 15 to 60, with 24.5 as the critical value, and a score of more than 24.5 was considered to indicate the presence of pregnancy-associated anxiety. The higher the score, the higher the degree of pregnancy-related anxiety, and the Cronbach's alpha coefficient of the original scale was 0.77 ~ 0.94. 2.3 Translation and cross-cultural debugging In this study, the Functional Assessment of Chronic Illness Therapy (FACIT) translation method was used to translate PrAS-S into Chinese, with the following steps: 1) forward translation; 2) proofreading; 3) reverse translation; 4) expert review; and 5) review by R&D organizations.The preliminary Chinese version of PrAS-S was formed through these steps. The preliminary Chinese version of PrAS-S was formed through these steps. In order to further test its validity, a panel of six nursing experts was invited to conduct expert correspondence at that stage, and content validity analysis was conducted simultaneously, and the scale entries were further modified according to the expert review comments and content validity results. According to the requirements of the Chinese version of the scale, 30 quantitative research subjects were prepared for the pre-test, and the Chinese version of the scale was distributed for questionnaire survey according to the inclusion and exclusion criteria, the purpose and significance of the project were introduced to the respondents, and the questionnaire survey was carried out after obtaining the consent, and the respondents were asked whether they understood the content of the entries of the scale, and whether they had any comments and suggestions on the scale and adjustments were made, so as to form the Chinese version of the Pregnancy-Related Anxiety Scale (PRAS) for Pregnant Women (PWA). The Chinese version of the Pregnant Women's Anxiety Scale (hereinafter referred to as the Chinese version of the PrAS-S) was formed. 2.4 Reliability and validity testing The purpose of the reliability analysis is to check the applicability of the scale in a specific population and to ensure the accuracy and generalizability of the results. The validity of the scale is used to examine whether the items of the scale can reflect the anxiety level of the respondents well. The reliability test includes internal consistency reliability and retest reliability to evaluate whether the scale has good consistency and stability across time. 2.5 Data collection The researchers conducted a cross-sectional survey on the pregnancy-related anxiety status of pregnant women attending the obstetrics outpatient clinics of three tertiary general hospitals in Urumqi City. Convenience sampling was used to collect data using an anonymous web-based questionnaire on the Questionnaire.com platform, and the questionnaire was distributed to the study participants in the form of an electronic QR code after they filled out an informed consent form indicating their voluntary participation. A total of 337 questionnaires were collected in this study, of which 8 questionnaires were excluded due to unfilled age, 10 questionnaires were excluded due to the short time of completion and more than 50% of the questions answered in the same way or routinely, and 19 questionnaires were excluded due to the fact that their authenticity could not be guaranteed because of their family members filling them out on behalf of them, and finally 300 questionnaires of pregnant women from outpatient clinics were included in the data analysis, and the validity rate of the questionnaires was 89%. 2.6 Data analysis All questionnaire data were data entered using Epidata 3.1 and data were analyzed using IBM SPSS Statistics 21.0 and AMOS software. Measurement data were expressed as mean ± standard deviation (S) and count data were expressed as numbers and percentages (%). Internal consistency reliability (Cronbach's alpha coefficient) and retest reliability were used to evaluate the reliability of the scale. Delphi method was used to assess the content validity of the scale, and exploratory factor analysis and validation factor analysis were used to assess its structural validity. Independent samples t-test and one-way ANOVA were used to determine the factors influencing pregnancy-related anxiety. Multiple linear regression analysis was used to determine the relationship between pregnancy-related anxiety levels and other variables. Differences were considered statistically significant at P < 0.05. 2.7 Ethics statement The study was approved by the Ethics Committee (approval number: XJYKDXR20241115001). The title and introduction of the online questionnaire contained information about the nature of the study, its purpose and the research team. Participants were also assured that they were voluntary and informed, the questionnaire did not collect personal information from participants, anonymization was assured, and all data were treated confidentially in accordance with data protection regulations. 3. Results 3.1 Socio-demographic characteristics of the study subjects Three hundred pregnant women participated in the survey, and Table 1 shows information on the characteristics of the participants. The age ranged from 19 to 46 (29.9 ± 4.76) years, with a predominance of late pregnancy. In terms of education, 87.33% of the pregnant women had a college degree or higher. For mode of pregnancy, 94.00% were naturally conceived and 6.00% were artificially conceived. For marital status, 94.33% were married and 5.67% were unmarried. For marital satisfaction, 42.67% were very satisfied and 49% were satisfied and 8.33% were average. Regarding the expectation of the sex of the baby, 47.33% of the pregnant women expressed expectation while 52.67% expressed no expectation. In addition, 58.67% of the pregnant women were first born and 41.67% had pregnancy complications. Table 1 Characteristics of pregnant women in the outpatient Clinic ( n = 300 ) Characteristics Number(%) Gestation period Early pregnancy ( 28 weeks) 185(61.67) Educational attainment Junior high school and below 6(2.00) High School / Junior College / Technical School 32(10.67) College and above 262(87.33) Type of pregnancy Natural Fertilization 282(94.00) Artificial insemination 18(6.00) Marital status Unmarried 17(5.67) Married 283(94.33) Widowed 0(0.00) Divorced 0(0.00) Marital satisfaction Very satisfied 128(42.67) Satisfactory 147(49.00) Average 25(8.33) Expectations for the sex of the baby Yes 142(47.33) No 158(52.67) Whether it is a first birth Yes 176(58.67) No 124(41.33) Complications of pregnancy Yes 125(41.67) No 175(58.33) 3.2 Reliability and validity analysis Decision value method was used to evaluate the differentiation degree of each entry of the scale among pregnant women with different anxiety levels, and the total scores of 300 pregnant women with pregnancy-related anxiety scale were arranged in accordance with the lowest to the highest, and the first 27% and the last 27% of the total scores were divided into two groups of low scores and high scores as the cut-off value, and independent samples t-tests were conducted, and the results of the analysis showed that the CR values of each entry were 9.670–18.920, all of which were > 3.000, with the differences is statistically significant (P < 0.001), suggesting that the scale entries have a good degree of differentiation; Pearson correlation analysis showed that the correlation coefficients between the scores of each entry and the total score of the scale were 0.642 ~ 0.761 (P < 0.001), and that the correlation coefficients between the dimensions and the total score of the scale were 0.772 ~ 0.761 (P 0.4, It suggests that the entries are highly homogeneous with the total scale, all in a unified measure of the same item, and all entries can be retained. The total Cronbach's alpha coefficient of the scale was 0.922, and the Cronbach's alpha coefficients of the dimensions of the scale ranged from 0.778 to 0.906. The retest correlation coefficient was 0.961, and the retest correlation coefficients between dimensions ranged from 0.857 to 0.960, which suggests that the reliability of the scale is good. In this study, the content validity of the scale was assessed using the Delphi method, and the item-content validity index (I-CVI) of the Chinese version of the PrAS-S scale was 0.83 ~ 1, and the scale-content validity index/mean (S-CVI/Ave) was 0.966, which suggests that the content validity is good. The Kaiser-Meyer-Olkin index (KMO) for EFA of this scale was 0.888, and the Bartlett's test of sphericity reached a significant level (P < 0.001), which is suitable for EFA.Using Principal Component Analysis (PCA) and Variance Maximization Rotation, the crushed stone graph shows that the slope tends to flatten after the 5th common factor, so it is more appropriate to extract 5 common factors, and the cumulative variance contribution rate reaches 79.1%, which is greater than 50%, and the factor extraction effect is up to standard. CFA analysis using AMOS resulted in a chi-square degrees of freedom ratio χ2/df of 3.33, root mean square error of approximation (RMSEA) of 0.088, goodness-of-fit index (GFI) of 0.912, comparative goodness-of-fit index (CFI) of 0.936, normative goodness-of-fit index (NFI) of 0.912, Tucker-Lewis index (TLI) of 0.916, and the Chinese version of the PrAS-S scale validated factor model fit index was good. 3.3 Current status of pregnancy-related anxiety in pregnant women The mean pregnancy related anxiety score of 300 pregnant women was 29.06 ± 9.96 with a median score of 27.00.The mean pregnancy related anxiety score of the non-anxious group was 19.55 ± 2.81 and the mean pregnancy related anxiety score of the anxious group was 34.98 ± 8.03.Out of these, 185 pregnant women had symptoms of pregnancy related anxiety and the prevalence rate of pregnancy related anxiety was 61.67%. 3.4 A univariate analysis of pregnancy-related anxiety On univariate analysis of variance, the difference in pregnancy-related anxiety scores between the anxious and non-anxious groups in terms of marital status, week of gestation, marital satisfaction, expectation of the baby's sex, and the presence or absence of co-morbidities of pregnancy was statistically significant (p < 0.05). There was a significant difference between the age of the non-anxious group (31.23 ± 4.50 years) and the age of the anxious group (29.07 ± 4.72 years) (t = 3.917, p = 0.000). There was no statistically significant difference between the non-anxious and anxious groups for the factors of literacy, mode of pregnancy, and whether it was a first birth, as shown in Table 2 . Table 2 Single factor analysis of pregnancy-related anxiety [ n (%) ] Characteristics Pregnancy-related anxiety score (Mean ± SD) t/F P -value Educational attainment F = 1.590 0.206 Junior high school and below 22.17 ± 7.00 High School/Junior College/Technical School 28.41 ± 11.36 College and above 29.30 ± 10.08 Marital status F = 20.752** 0.000 Unmarried 39.41 ± 13.07 Married 28.44 ± 9.41 Widowed 0(0.00) Divorced 0(0.00) Type of pregnancy t=-1.225 0.221 Natural Fertilization 29.24 ± 9.91 Artificial insemination 26.28 ± 10.53 Gestation period F = 8.327** 0.000 Early pregnancy ( 28 weeks) 27.46 ± 8.98 Marital Satisfaction Z=-3.558** 0.000 Very Satisfied 28.57 ± 9.27 Satisfied 29.01 ± 9.79 Average 30.77 ± 9.33 Expectation of the sex of the baby Z=-2.502** 0.012 Yes 30.66 ± 10.52 No 27.63 ± 9.22 Whether or not it's the first pregnancy t = 1.021 0.308 Yes 29.58 ± 10.28 No 28.39 ± 9.52 Complications of pregnancy Z=-2.302** 0.021 Yes 30.82 ± 10.84 No 27.81 ± 9.10 4. Multiple linear regression analysis of pregnancy-related anxiety The factors showing statistically significant differences in the univariate analysis were used as independent variables, and the pregnancy-related anxiety scale score was used as the dependent variable in the multiple linear regression analysis. Dummy variables were set for the unordered multicategorical variables, and the independent variable assignments and dummy variable settings are shown in Table 3 .After the multiple linear regression analysis, age, being married, marital satisfaction as satisfactory and average, the presence of gender expectations for the baby, co-morbid pregnancy complications, and the late stage of pregnancy were entered into the regression equation. The results showed that age (β=-0.566, P = 0.000), marital status (β=-8.739, P = 0.001), gestational week (β=-7.066, P = 0.000), marital satisfaction (β = 3.259, P = 0.003; β = 5.513, P = 0.011), gender expectation of infant (β = 2.570, P = 0.027), and the presence of comorbid pregnancy complications (β = 2.517, P = 0.032) had a major effect on pregnancy-related anxiety. As shown in Table 4 . Table 3 Assignment of respective variables for pregnancy-related anxiety Independent variable Assignment Marital status Unmarried = 1, Married = 2, Widowed 3, Divorced = 4 Gestation period Early gestation (≤ 12 weeks) = 1, mid-gestation (end of 13–27 weeks) = 2, Late pregnancy (≥ 28 weeks) = 3 Marital satisfaction Very satisfied = 1, Satisfied = 2, Fair = 3 Expectations for the sex of the baby Yes = 1, No = 2 Complications of pregnancy Yes = 1, No = 2 Table 4 Multifactorial linear regression analysis of factors influencing pregnancy-related anxiety Characteristics Partial Regression Coefficient SE β t P constant number 44.838 2.442 -- 18.363 0.000 Age -0.566 0.117 -0.271 -4.852 0.000 Marital status (married) -8.739 2.689 -0.203 -3.250 0.001 Marital satisfaction (satisfied) 3.259 1.104 0.164 2.951 0.003 Marital satisfaction (average) 5.513 2.143 0.142 2.572 0.011 Expectation of baby's gender (yes) 2.570 1.153 0.129 2.228 0.027 Whether pregnancy complications are combined (yes) 2.517 1.168 0.125 2.155 0.032 Gestational week (late pregnancy) -7.066 1.958 -0.346 -3.608 0.000 5. Discussion It is of utmost importance to devise an efficacious assessment tool for women's pregnancy-related anxiety. In the current study, we opted to develop a pregnancy-related anxiety assessment instrument with a more comprehensive structure and content, which could be more closely aligned with the contemporary clinical scenarios. To achieve this, we applied the Chinese version of the Pregnancy-Related Anxiety Scale (PRAS) to the Chinese female population, employing a scientific and rigorous translation protocol.We utilized the currently validated and scientific statistical methodologies to explore and validate the structure and content of the Chinese PRAS. In terms of content validity assessment, the item-content validity index (I-CVI) of this scale ranged from 0.83 to 1, and the scale-content validity index (S-CVI/Ave) was 0.966, meeting the stringent requirements of measurement standards [26]. This strongly suggests that each item within the questionnaire is highly capable of reflecting the anxiety levels of the surveyed individuals.Exploratory factor analysis was carried out, and a total of five principal factors were extracted, with a cumulative variance contribution rate reaching 79.1%. Concurrently, the factor loading value of each entry exceeded 0.40, indicating a favorable structural validity [27]. Moreover, the factor structure and item attributions remained largely consistent with the original scale, attesting to the good structural stability and reliability of the sinicized Pregnancy-Related Anxiety Scale.To further corroborate the scale's validity, a confirmatory factor analysis was performed. A structural equation model was constructed based on the five dimensions, and the results of the fitting indices indicated a satisfactory model fit [28]. This implies that the Chinese PRAS demonstrated excellent performance in the confirmatory factor analysis, thereby validating its structural integrity and validity.Regarding reliability, the Cronbach's alpha coefficient of the Chinese PrAS-S was 0.922, and the Cronbach's alpha coefficients of the respective dimensions ranged from 0.778 to 0.906, which were remarkably close to those of the original scale (0.77–0.95). This demonstrates that the scale exhibits a high level of internal consistency and reliability [29], signifying that the items within the scale are interrelated to an extent that they can effectively reflect the overall anxiety status of the respondents. Finally, the test-retest reliability of the full scale was evaluated, yielding a result of 0.961 [30]. This finding indicates that the scale possesses cross-temporal stability and excellent consistency, meaning that it provides highly consistent measurements when administered to the same group at different time points. In conclusion, through a comprehensive exploration and validation of the Chinese version of the Pregnancy-Related Anxiety Scale, we ascertained that it exhibits superior performance in terms of content validity, structural validity, confirmatory factor analysis, internal consistency reliability, and test-retest reliability. Hence, the Chinese PRAS can be reliably employed as a valid tool for assessing pregnancy-related anxiety among Chinese women. In recent years, with the liberalization of China's three-child policy and the state's policy support for childbearing, research on pregnancy-related anxiety has gradually gained attention. Pregnancy is a special physiological and psychological period, during which pregnant women may face many challenges and pressures, leading to the emergence of anxiety. A review of relevant domestic and international survey literature found that about 98% of pregnant women worldwide experience anxiety during pregnancy [31] . This anxiety may stem from worries about the labor and delivery process, concerns about the health of the fetus, fear of future parenting stress, and uncertainty about one's own physical condition. Without timely intervention, the endocrine changes, physical and psychological changes, and the stress of labor and delivery caused by the development of pregnancy are likely to aggravate the severity of pregnancy-related anxiety, ultimately leading to poor pregnancy outcomes and postpartum depression [32] . In China, the prevalence of anxiety in the general population is 3.4%, while the prevalence in women during pregnancy is as high as 28.4% [33] . This means that during pregnancy, women face much higher psychological stress than the rest of the population. In the present study, the prevalence of pregnancy-related anxiety among 300 pregnant women reached 61.67%. This rate is higher than other studies, which may be related to the small number of samples collected, the fact that the rating scale used was the Universal Screening Scale and the fact that most of the population surveyed was in the late stages of pregnancy [34] . In this study, the prevalence of pregnancy-related anxiety among pregnant women in late pregnancy was 55.14% (102/185). This may be due to the fact that the incidence increases significantly when pregnant women have a heavier physiological burden in late pregnancy and are faced with impending labor, fear of labor pains as well as increased difficulty in delivery, unknown about their own health and that of their fetus, as well as the stress of facing the pressure of future parenting and the presence of stressful psychological anxiety [35,36] . The current study used a combination of univariate analysis and multifactorial linear regression analysis to delve into the factors influencing pregnancy-related anxiety. The results of the study showed that there were significant and statistically significant differences in pregnancy-related anxiety scores between the anxious and non-anxious groups for age, marital status, gestational week, marital satisfaction, expectation of the baby's gender, and whether or not there were comorbid pregnancy complications (P < 0.05). Multifactorial linear regression analysis further revealed that age, marital status, marital satisfaction, expectation of the baby's gender, the presence of pregnancy complications, and gestational week were independent risk factors for pregnancy-related anxiety. For young pregnant women, the lack of experience in labor and parenting often leads to uneasiness and worry about the process. Moreover, young pregnant women may be more sensitive to their physical condition and fetal health, which increases their anxiety to some extent [37,38] . Young pregnant women may lack sufficient knowledge about the physical changes during pregnancy and may be prone to excessive worry. At the same time, they may also be fearful of the responsibilities and challenges of parenting, which adds to the anxiety. Secondly, the impact of marital status on pregnancy-related anxiety should not be underestimated. Unmarried or divorced pregnant women usually face more psychological pressures, such as financial burdens and discordant family relationships. These pressures may make them more prone to anxiety symptoms during pregnancy [39,40] . Unmarried pregnant women may worry about social pressures and future uncertainty, while divorced pregnant women may face difficulties and pressures of raising children alone. The effect of marital satisfaction on pregnancy-related anxiety should not be overlooked as well.Pregnant women with moderate to low marital satisfaction are more likely to experience anxiety symptoms. This may be due to the fact that pregnant women lack sufficient emotional support and sense of security in the event of marital disharmony. In order to improve the situation, couples are advised to strengthen communication and face problems in life together. Couples can share each other's feelings and needs through frank communication to enhance mutual understanding and support. At the same time, couples can also participate in the preparation for pregnancy together, such as attending prenatal classes and preparing baby supplies, to enhance their confidence in their future life. Expectations about the sex of the baby may also have an impact on the psychological state of the pregnant woman. In some families, there may be specific expectations about the sex of the fetus, and such expectations may put pressure on pregnant women and lead to anxiety during pregnancy [40,41] . Therefore, family members should respect the wishes of the pregnant woman and avoid putting too much pressure on her. Family members can reduce the psychological burden of pregnant women by expressing their care for the pregnant woman and the fetus rather than focusing too much on the gender of the fetus. Pregnancy complications are an important factor in pregnancy-related anxiety [42] . Pregnant women with pregnancy complications tend to worry about their physical condition as well as the health of the fetus. During pregnancy, pregnant women should undergo regular pregnancy tests and disease screening for timely diagnosis and treatment. At the same time, family members and the community should also give adequate care and support to pregnant women to help them ease their anxiety. Pregnant women themselves should also learn about the relevant knowledge, actively cooperate with the treatment and maintain a good state of mind. For example, pregnant women can learn about pregnancy complications and ways to cope with them by reading relevant books and attending maternity courses to enhance their ability of self-management [43] . In addition, pregnant women can also relieve anxiety and maintain physical and mental health through appropriate exercise and relaxation training. Effective interventions are necessary to reduce anxiety levels in women during pregnancy. These measures can include psychological counseling, health education, family support, and support from social policies. Through these methods, pregnant women can be helped to better cope with the challenges and pressures of pregnancy, thus reducing the incidence of pregnancy-related anxiety and improving the quality of life of women during pregnancy. The development of a more scientific and reliable assessment tool can promote the standardization and development of pregnancy-related anxiety research, which is of great theoretical and practical significance to increase the attention to pregnancy-related anxiety among women in China. At the same time, the application of pregnancy-related anxiety assessment tool in Chinese population provides a reference basis for the selection of psychotherapeutic programs and psychological counseling for this population, which has a broader application prospect. 6. Conclusions The Pregnancy-related Anxiety Scale (simplified version) (PrAS-S) developed in this study consists of 5 dimensions and 15 items, including labor and delivery process, self-concern, self-worry, fetal status, and attitude of medical personnel. The results of the study showed that the scale has good reliability and validity, and can accurately and comprehensively measure the current pregnancy-related anxiety status of the subjects, which can be used as a screening tool for pregnancy-related anxiety by providing a reference basis for the selection of psychotherapy programs, psychological counseling, and objective evaluation of the treatment effect of the clinical staff on this population. 7. Limitations In the questionnaire survey, the convenience sampling method was used for data collection, and in the construction of the questionnaire, due to time and regional constraints, the survey respondents were mainly from Urumqi City in the Xinjiang Uygur Autonomous Region, and the lack of research respondents from other provinces may lead to a certain degree of bias in the results, and there are certain geographical limitations, which may not be able to be completely universal in applicability. Second, there is a lack of specific applications of high-quality measurement tools in the country to provide comparable universal indicators, which may not clearly explain the test results. Due to time constraints, this study only used the self-assessment of the questionnaire to evaluate the level of pregnancy-related anxiety, which may be affected by its subjective conditions, and the results of the assessment may be biased. Declarations Ethics approval and consent to participate The study was approved by the Ethics Committee of Xinjiang Medical University (XJYKDXR20241115001). Prior to each interview, participants were provided oral explanation of the study. Study participation was voluntary, and the confidentiality of the data was strictly maintained. Study participation was voluntary, and the confidentiality of the data was strictly maintained. Consent for publication Not applicable Availability of data and material Data are available upon reasonable request. Data used for analysis are available on reasonable request. Datasets can be obtained from the corresponding author ( [email protected] ). Competing interests None declared. Funding This study was supported by the The Research Program of Xinjiang Nursing Association(2018XH12)and National College Students Innovation and Entrepre-neurship Training Program(Grant numbers:S202210760073). Authors' contributions FF: Conceptualization, methodology, Resources, formal analysis, writing-original draft preparation, Project administration, data curation, Visualization. XL:Conceptualization, data collection, writing-original draft preparation. YZ: Investigation, data analysis, validation. JY: Supervision, project administration. MM: Investigation, methodology, supervision. XD: Data collection, data curation, translation. XM: Writing-review and editing, critical revision, final approval of the manuscript. All authors approved the final version of this manuscript. Acknowledgements I sincerely thank all those who have contributed to the completion of this research. Firstly, I would like to express my deepest gratitude to all the mentors [FF, JY, XM] involved in the project. Your profound knowledge, valuable guidance, and patient guidance are the cornerstone of this research. Your insightful advice and continuous encouragement have led the project through the challenges of this research journey. I would also like to express my sincere gratitude to the members of the research team [XL, YZ, MM, XD]. Our collaborative efforts, shared ideas, and mutual support make this research possible. Each of you has brought unique perspectives and skills, greatly enriching the research process. I am very grateful to the participants who voluntarily participated in our research. Your contribution and collaboration are the foundation of the data in this study. Without your support, it would be impossible to draw meaningful conclusions. This study received financial support from The Research Program of Xinjiang Nursing Association, National College Students Innovation, and Entrepreneurial Entrepreneurship Training Program. I sincerely appreciate their investment in this research. In addition, I would like to thank my institutions [Xinjiang Medical University, Health Care Research Center for Xinjiang Regional Population] for providing excellent research facilities and a favorable academic environment. Finally, I thank all of you. Your support and assistance are crucial for achieving results in this research. References Han Jiapeng. Slight Decrease in the number of newborns worldwide in 2018. The world's population may be "Africanized". Netease news [EB/OL]. http://news.163.com/18/0228/15/DBO80FN20001875O.html,the 2018-02-28/2019-12-13. Liu Xing-hui.2018 annual review and future development of obstetrics in China. Sohu [EB/OL]. http://www.sohu.com/a/292228909_441376, 2019-01-29/2019-01-29. 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(in Chinese) QIN L M, SHI C Q, LI B J, et al.Chinese version of Interpersonal Geriatric Care Relationship Tool and its reliability and validity test [J].Chinese Nursing Research, 2023,37 (7) : 1164-1168. BI X Y, DENG J, GAO Y, et al.Chinese version of Negative Attitudes toward Robots Scale and its reliability and validity test [J].Chinese Nursing Research, 2023,37 (11) : 1921-1925. POLIT D F,BECK C T,OWEN S V.Is the CVI an acceptable indicator of content validity? Appraisal and recommendations[J]. Research in Nursing & Health,2007,30(4):459-467. JI X F, YU H Y, TAN M Y, et al.Chinese version of Scale for Dietary Behaviors in Heart Failure and its reliability and validity test [J].Chinese Nursing Research, 2023,37 (15) : 2723-2727. Ilska M, Przybya - Ba sista h.Telroie of partner supporI. egoresil. ency, prenatal attitudes towards maternity and pregnancy in psychoIogical well. being of women in high-risk and IOW-risk pregnancy[J]. Psychology. Health&Medicine, 2020.25 (5) : 630-638. 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Prevalence of Antenatal Anxiety in European Women: A Literature Review. Int J Environ Res Public Health. 2023 Jan 8; Two (2) : 1098. Tarafa H, Alemayehu Y, Nigussie M. Factors associated with pregnancy-related anxiety among pregnant women attending antenatal care follow-up at Bedelle general hospital and Metu Karl comprehensive specialized hospital, Southwest Ethiopia. Front Psychiatry. 2022 Sep 23; If 38277. Ford, J., Ayers, S., & Warner, R. (2018). Women’s experiences and perceptions of anxiety and stress during the perinatal period: a systematic review and qualitative evidence synthesis. BMC Pregnancy and Childbirth, 18(1), 227. Bedaso A, Adams J, Peng W, Xu F, Sibbritt D. An examination of the association between marital status and prenatal mental disorders using linked health administrative data. BMC Pregnancy Childbirth. 2022 Oct 1; 22(1):735. doi: 10.1186/ s12884-022-05045-8.PMID: 36182904; PMCID: PMC9526285. Huang, J., Xu, L., Xu, Z., Luo, Y., Liao, B., Li, Y., & Shi, Y. (2022). The relationship among pregnancy-related anxiety, perceived social support, family function and resilience in Chinese pregnant women: A structural equation modeling analysis. BMC Women's Health, 22(1), 546. Loo KK, Li Y, Tan Y, Luo X, Presson A, Shih W. Prenatal anxiety associated with male child preference among expectant mothers at 10-20 weeks of pregnancy in Xiangyun County, China. Int J Gynaecol Obstet. 2010 Dec; 111 (3) : 229-32. Fischbein RL, Nicholas L, Kingsbury DM, Falletta LM, Baughman KR, VanGeest J. State anxiety in pregnancies affected by obstetric complications: A systematic review. J Affect Disord. 2019 Oct 1; 257:214-240. Wang K, Li R, Li Q, Li Z, Li N, Yang Y, Wang J. Knowledge, attitude, and practice toward postpartum depression among the pregnant and lying-in women. BMC Pregnancy Childbirth. 2023 Oct 30; 23 (1) : 762. Additional Declarations No competing interests reported. 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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-5781802","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":403239077,"identity":"b6f5d703-4bab-485e-8147-5eee270852ff","order_by":0,"name":"Feng FU","email":"","orcid":"","institution":"Xinjiang Medical University","correspondingAuthor":false,"prefix":"","firstName":"Feng","middleName":"","lastName":"FU","suffix":""},{"id":403239078,"identity":"cb7584d4-c577-42ff-956c-5a142bbe88e7","order_by":1,"name":"Xiaotong Li","email":"","orcid":"","institution":"Xinjiang Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xiaotong","middleName":"","lastName":"Li","suffix":""},{"id":403239079,"identity":"7fe7a914-8940-40a3-b67e-b82bb1318118","order_by":2,"name":"Yuhang Zhang","email":"","orcid":"","institution":"Xinjiang Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yuhang","middleName":"","lastName":"Zhang","suffix":""},{"id":403239081,"identity":"707cd090-4077-4d97-88f5-3cb0e87cca23","order_by":3,"name":"Juanjuan Yan","email":"","orcid":"","institution":"Reproductive Medicine Center of the First Affiliated Hospital of Xinjiang Medical University","correspondingAuthor":false,"prefix":"","firstName":"Juanjuan","middleName":"","lastName":"Yan","suffix":""},{"id":403239083,"identity":"9b795e19-37c8-48bd-ada8-ef1ccb8cca03","order_by":4,"name":"Mingyue Ma","email":"","orcid":"","institution":"Xinjiang Medical University","correspondingAuthor":false,"prefix":"","firstName":"Mingyue","middleName":"","lastName":"Ma","suffix":""},{"id":403239086,"identity":"0d6c73e7-595d-40e7-bac2-4ee646ecbcaf","order_by":5,"name":"Xinxing Duan","email":"","orcid":"","institution":"Xinjiang Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xinxing","middleName":"","lastName":"Duan","suffix":""},{"id":403239089,"identity":"f62b877c-3470-4374-8ee4-1dd29c0dfac7","order_by":6,"name":"Xinmin Mao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1ElEQVRIiWNgGAWjYBACfobDBw5+qGCT42dvPkCcFsnGY4mPJc7wGUv2HEsgTovB4TPGBrxtcokbZuQYEOmyYwfMJCTbzBI38Jz5eOMNg52cbgMBHYw9B9IkCs6lGW9n791sOYch2djsAAEtzBIHjklIlB2T3dlzdps0D8OBxG2EtLDJP2yT4GH7z7jhRs4z4rTwMBxmNuBpY1MEamEjTosEwzFGYCCzgQLZ2HKOARF+sT9w/gMsKh/eeFNhJ0dQC6qVPMRGDZIWUnWMglEwCkbBiAAAiDtJQGefFqoAAAAASUVORK5CYII=","orcid":"","institution":"Reproductive Medicine Center of the First Affiliated Hospital of Xinjiang Medical University","correspondingAuthor":true,"prefix":"","firstName":"Xinmin","middleName":"","lastName":"Mao","suffix":""}],"badges":[],"createdAt":"2025-01-07 13:38:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5781802/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5781802/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101242982,"identity":"2db7dd3e-a6c3-4f98-9c47-c7c5d8bcbb7d","added_by":"auto","created_at":"2026-01-27 15:57:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":975367,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5781802/v1/4cd606ee-d8c8-4b0e-b8ce-bfed7eabd868.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Current status and influencing factors of pregnancy related anxiety in Chinese pregnant women: a cross sectional study","fulltext":[{"header":"1. Background","content":"\u003cp\u003eIn alignment with the evolving scenario and distinctive traits of China's population, economy, and social development, pregnant women have increasingly emerged as a focal point in society. Globally, as per the \"2022 World Population Prospects\" report by the United Nations, the global population hit 8\u0026nbsp;billion on November 15, 2022. Concomitantly, the number of pregnant women has exhibited an upward trajectory year after year. In 2018, approximately 140\u0026nbsp;million women worldwide were pregnant \u003csup\u003e[1]\u003c/sup\u003e. Since the enforcement of China's comprehensive two-child policy, the birth rate has witnessed a significant upsurge \u003csup\u003e[2]\u003c/sup\u003e. From 2015 to 2017, the number of new births amounted to 17.86\u0026nbsp;million, accompanied by a nearly 18-million increase in the number of pregnant women. With the relaxation of China's three-child policy, the substantial and annually escalating number of pregnant women presents novel hurdles to the maternal healthcare sector in the country.\u003c/p\u003e \u003cp\u003ePregnancy represents a distinctive physiological phase for women. During this period, pregnant women experience corresponding alterations in metabolism, hormonal levels, respiratory and circulatory systems, neurovascular function, the digestive tract, as well as breast physiology \u003csup\u003e[3]\u003c/sup\u003e. These changes also translate into inconveniences and discomforts in their daily lives, spanning aspects such as clothing, diet, accommodation, and mobility. Notably, for primiparas and older pregnant women, the susceptibility to pregnancy complications is heightened. The dearth of knowledge regarding these complications, compounded by excessive apprehension and dread, can precipitate depressive and anxious states, among other negative emotions, which may severely impede labor progress and disease management \u003csup\u003e[4]\u003c/sup\u003e. Moreover, fettered by traditional concepts like \"carrying on the family line\" and beleaguered by multiple pressures and mental quandaries endemic to modern society, including employment concerns, career advancement, marital issues, housing woes, and competitive stress, pregnant women encounter more arduous challenges compared to the general populace. The multifaceted complex changes and stressors preclude pregnant women from traversing pregnancy with equanimity. Consequently, a slew of adverse pregnancy-related emotions, such as tension, anxiety, and fear, pose health risks not only to the expectant mothers but also to the fetuses \u003csup\u003e[5]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003ePregnancy-related anxiety, a specific form of anxiety intimately linked to the gestational context, is typified by distinct fears and concerns that manifest during pregnancy. Pregnant women often agonize over the well-being of themselves and their fetuses, the impending delivery process, and the forthcoming responsibilities of motherhood \u003csup\u003e[5]\u003c/sup\u003e. The chronic persistence of such psychological distress can imperil women's psychological welfare throughout pregnancy, influence the birth outcomes, and even extend its ramifications into the postpartum period.\u003c/p\u003e \u003cp\u003eGlobally, epidemiological data indicates that the prevalence of anxiety among the general female population stands at 19.8% \u003csup\u003e[6]\u003c/sup\u003e, whereas during pregnancy, this figure escalates to as high as 35% \u003csup\u003e[7]\u003c/sup\u003e, highlighting a significantly elevated risk compared to non-pregnant counterparts. Anxiety during pregnancy not only compromises the quality of life for expectant mothers but also poses grave consequences for both maternal and infant health if left unaddressed. Research has established associations between prenatal depression and a plethora of adverse outcomes, such as preeclampsia, surgical modes of delivery (including cesarean sections and instrumental vaginal deliveries), preterm labor, low birth weight infants, postpartum depression, and an augmented risk of maternal suicide. Notably, pregnant women exhibiting high levels of anxiety symptoms face a 2.26-fold increased likelihood of adverse birth outcomes relative to those without symptoms \u003csup\u003e[8,9]\u003c/sup\u003e. It has been further elucidated that between 15% and 23% of pregnant women succumb to pregnancy-related anxiety, leading to unfavorable sequelae like severe pregnancy reactions, maladaptive psychological coping, and negative perceptions of impending motherhood \u003csup\u003e[10,11]\u003c/sup\u003e. Moreover, pregnancy-related anxiety has emerged as an independent predictor of postpartum depression \u003csup\u003e[12,13]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003ePresently, there exist 18 scales available for gauging anxiety during pregnancy, which can be broadly classified into two principal categories: common scales (9 in number) and pregnancy-specific scales (also 9). The common scales encompass instruments like the Beck Anxiety Scale (1993), Hospital Anxiety and Depression Scale (1983), and the Penn State Worry Questionnaire (1990), among others. The pregnancy-specific scales comprise the Infant Patterns Questionnaire (1983), Edinburgh Postnatal Depression Scale (1987), Pregnancy Anxiety Inventory (1995, 1991), Pregnancy-Related Anxiety Questionnaire (1990, 2001), and the Pregnancy-Related Anxiety Scale (2018). Remarkably, only 7 of these pertain directly to the measurement of pregnancy-related anxiety. Empirical studies have substantiated that general anxiety scales are ill-equipped to comprehensively identify and dissect the idiosyncratic dimensions of mood disorders germane to pregnancy, underlining the necessity to distinguish between general anxiety and pregnancy-related anxiety \u003csup\u003e[14,15]\u003c/sup\u003e. Among the limited pool of seven pregnancy-related anxiety measurement scales, Dr. Robyn devised the Pregnancy-Related Anxiety Scale (PrAS) in 2018, building upon existing frameworks. This scale introduced novel measurement dimensions hitherto unexplored, bolstering the comprehensiveness of its content structure. Through robust theoretical underpinnings and scientifically rigorous psychological methodologies, the measurement validity of the PrAS was validated. Additionally, extensive clinical applications were carried out in large communities and psychological counseling clinics, involving sizable samples of women, thereby ensuring the PrAS better caters to the contemporary female population's exigencies for assessing pregnancy-related anxiety.\u003c/p\u003e \u003cp\u003eIn China, research efforts dedicated to pregnancy-related anxiety remain relatively scant. The majority of existing studies adopt a cross-sectional design \u003csup\u003e[16\u0026ndash; 18]\u003c/sup\u003e, with only a few investigators delving into the correlation between antenatal anxiety and pregnancy outcomes \u003csup\u003e[19,20]\u003c/sup\u003e. A significant limitation is that pregnancy-related anxiety has often been imprecisely defined in most studies. Consequently, self-designed questionnaires or general anxiety scales have been employed for assessment, yet the measurement efficacy of these self-developed tools lacks robust validation, leading to non-specific measurements that fall short in scientific rigor and comprehensiveness. For instance, Xiao Limin et al. formulated the Pregnancy-related Anxiety Questionnaire in China \u003csup\u003e[21]\u003c/sup\u003e, which comprises merely 13 items across 3 dimensions, thereby exhibiting certain constraints in its assessment scope. Additionally, Wu Yang from Kunming Medical University undertook the translation and reliability testing of Dr. Robyn's Pregnancy-related Anxiety Scale (PrAS) into Chinese \u003csup\u003e[22]\u003c/sup\u003e. However, this scale contains a relatively large number of entries and is rather lengthy, posing its own set of limitations.\u003c/p\u003e \u003cp\u003eIn 2022, Dr. Robyn from Australia developed the Pregnancy-Related Anxiety Scale (Simplified Version) (PrAS-S), which stands out for its streamlined and precise design. It has garnered a high degree of respondent acceptance during questionnaire administration. Through cross-cultural adaptation and debugging, this scale has been translated into multiple languages and has undergone clinical application testing, demonstrating a high level of reliability \u003csup\u003e[23]\u003c/sup\u003e. In the current study, we introduced the PrAS-S into China with the aim of validating its reliability and validity within the Chinese context. By doing so, we seek to establish a female pregnancy-related anxiety assessment tool that is tailored to the Chinese pregnant population. This endeavor is geared towards accurately gauging the prevalence and severity of pregnancy-related anxiety among Chinese women, as well as probing into the current status and associated influencing factors. Ultimately, this research will furnish a theoretical foundation for the accurate assessment of pregnancy anxiety levels and the implementation of targeted clinical psychological care interventions, thereby catalyzing the advancement of pregnant women's mental health.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003e2.1 Design and samples\u003c/h2\u003e\n \u003cp\u003eA descriptive cross-sectional study was conducted. A total of 337 pregnant women were screened in the obstetrics outpatient clinics of three tertiary general hospitals in Urumqi using convenience sampling method. The inclusion criteria for the study population were as follows: a. Pregnant women with a healthcare facility diagnosis of clinical pregnancy; b. Pregnant women with a certain level of reading comprehension and good communication skills in Mandarin; c. Pregnant women who gave informed consent and were able to cooperate. The exclusion criteria were as follows: a. Pregnant women with a previous history of drug or alcohol abuse; b. Pregnant women with a previous diagnosis of bipolar disorder or schizophrenia or the presence of psychotic features. According to the methodological guideline stipulating that the sample size should ideally be 5\u0026ndash;10 times the number of items in the study instrument \u003csup\u003e[24]\u003c/sup\u003e, since the scale under investigation comprised 15 items, and considering the requirements for exploratory factor analysis (a minimum of 100 cases) and validation factor analysis (a minimum of 200 cases), along with accounting for an estimated 20% of potentially invalid questionnaires, a minimum of 300 research subjects were selected for this study to ensure the robustness and reliability of the findings.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003e2.2 Instruments\u003c/h2\u003e\n \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e\n \u003ch2\u003e2.2.1 \u003cem\u003eGeneral Information Questionnaire\u003c/em\u003e\u003c/h2\u003e\n \u003cp\u003eThe general information questionnaire was compiled by the research team itself according to the content and needs of the study. It covered socio-demographic aspects such as age, education level (elementary school and below/junior high school/high school/university college/undergraduate/master\u0026apos;s degree and above), marital status (unmarried/married/widowed/divorced), and degree of marital satisfaction (very satisfied/satisfied/fairly satisfied); and it also used other variables related to this study such as the mode of pregnancy (natural insemination/artificial insemination), the week of pregnancy (early pregnancy\u0026thinsp;\u0026lt;\u0026thinsp;12 weeks/middle pregnancy 13 weeks\u0026thinsp;~\u0026thinsp;27 weeks/late pregnancy\u0026thinsp;\u0026gt;\u0026thinsp;28 weeks), whether or not to be pregnant, and whether or not to be married. Early stage\u0026thinsp;\u0026lt;\u0026thinsp;12 weeks/middle stage 13 weeks to end of 27 weeks/late stage\u0026thinsp;\u0026gt;\u0026thinsp;28 weeks), whether it was a first birth, whether it was a combined pregnancy complication, and whether it was expecting the sex of the baby.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\n \u003ch2\u003e2.2.2 \u003cem\u003ePregnancy-related Anxiety Scale-Short Version (PrAS-S)\u003c/em\u003e\u003c/h2\u003e\n \u003cp\u003eThe Pregnancy-Related Anxiety Scale (Simplified Version) (PrAS-S) was developed by Prof. Robyn et al. in Australia in 2022, and is mainly used to measure the level of pregnancy-related anxiety in pregnant women \u003csup\u003e[23]\u003c/sup\u003e. A study by our research team debugged the scale in Chinese to adapt it to the Chinese women\u0026apos;s population, and its validity has been confirmed \u003csup\u003e[25]\u003c/sup\u003e. The Chinese version of the questionnaire scale consisted of 15 items with 5 dimensions, namely, labor and delivery process (3 items), concern for self (3 items), self-concern (3 items), fetal status (3 items), and attitudes of medical personnel (3 items). A 4-point Likert scale was used, with each entry ranging from \u0026ldquo;not at all\u0026rdquo; to \u0026ldquo;very frequently\u0026rdquo;, and the total score ranging from 15 to 60, with 24.5 as the critical value, and a score of more than 24.5 was considered to indicate the presence of pregnancy-associated anxiety. The higher the score, the higher the degree of pregnancy-related anxiety, and the Cronbach\u0026apos;s alpha coefficient of the original scale was 0.77\u0026thinsp;~\u0026thinsp;0.94.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003e2.3 Translation and cross-cultural debugging\u003c/h2\u003e\n \u003cp\u003eIn this study, the Functional Assessment of Chronic Illness Therapy (FACIT) translation method was used to translate PrAS-S into Chinese, with the following steps: 1) forward translation; 2) proofreading; 3) reverse translation; 4) expert review; and 5) review by R\u0026amp;D organizations.The preliminary Chinese version of PrAS-S was formed through these steps. The preliminary Chinese version of PrAS-S was formed through these steps. In order to further test its validity, a panel of six nursing experts was invited to conduct expert correspondence at that stage, and content validity analysis was conducted simultaneously, and the scale entries were further modified according to the expert review comments and content validity results.\u003c/p\u003e\n \u003cp\u003eAccording to the requirements of the Chinese version of the scale, 30 quantitative research subjects were prepared for the pre-test, and the Chinese version of the scale was distributed for questionnaire survey according to the inclusion and exclusion criteria, the purpose and significance of the project were introduced to the respondents, and the questionnaire survey was carried out after obtaining the consent, and the respondents were asked whether they understood the content of the entries of the scale, and whether they had any comments and suggestions on the scale and adjustments were made, so as to form the Chinese version of the Pregnancy-Related Anxiety Scale (PRAS) for Pregnant Women (PWA). The Chinese version of the Pregnant Women\u0026apos;s Anxiety Scale (hereinafter referred to as the Chinese version of the PrAS-S) was formed.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003e2.4 Reliability and validity testing\u003c/h2\u003e\n \u003cp\u003eThe purpose of the reliability analysis is to check the applicability of the scale in a specific population and to ensure the accuracy and generalizability of the results. The validity of the scale is used to examine whether the items of the scale can reflect the anxiety level of the respondents well. The reliability test includes internal consistency reliability and retest reliability to evaluate whether the scale has good consistency and stability across time.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003e2.5 Data collection\u003c/h2\u003e\n \u003cp\u003eThe researchers conducted a cross-sectional survey on the pregnancy-related anxiety status of pregnant women attending the obstetrics outpatient clinics of three tertiary general hospitals in Urumqi City. Convenience sampling was used to collect data using an anonymous web-based questionnaire on the Questionnaire.com platform, and the questionnaire was distributed to the study participants in the form of an electronic QR code after they filled out an informed consent form indicating their voluntary participation. A total of 337 questionnaires were collected in this study, of which 8 questionnaires were excluded due to unfilled age, 10 questionnaires were excluded due to the short time of completion and more than 50% of the questions answered in the same way or routinely, and 19 questionnaires were excluded due to the fact that their authenticity could not be guaranteed because of their family members filling them out on behalf of them, and finally 300 questionnaires of pregnant women from outpatient clinics were included in the data analysis, and the validity rate of the questionnaires was 89%.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003e2.6 Data analysis\u003c/h2\u003e\n \u003cp\u003eAll questionnaire data were data entered using Epidata 3.1 and data were analyzed using IBM SPSS Statistics 21.0 and AMOS software. Measurement data were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (S) and count data were expressed as numbers and percentages (%). Internal consistency reliability (Cronbach\u0026apos;s alpha coefficient) and retest reliability were used to evaluate the reliability of the scale. Delphi method was used to assess the content validity of the scale, and exploratory factor analysis and validation factor analysis were used to assess its structural validity. Independent samples t-test and one-way ANOVA were used to determine the factors influencing pregnancy-related anxiety. Multiple linear regression analysis was used to determine the relationship between pregnancy-related anxiety levels and other variables. Differences were considered statistically significant at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003e2.7 Ethics statement\u003c/h2\u003e\n \u003cp\u003eThe study was approved by the Ethics Committee (approval number: XJYKDXR20241115001). The title and introduction of the online questionnaire contained information about the nature of the study, its purpose and the research team. Participants were also assured that they were voluntary and informed, the questionnaire did not collect personal information from participants, anonymization was assured, and all data were treated confidentially in accordance with data protection regulations.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003e3.1 Socio-demographic characteristics of the study subjects\u003c/h2\u003e\n \u003cp\u003eThree hundred pregnant women participated in the survey, and Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e shows information on the characteristics of the participants. The age ranged from 19 to 46 (29.9\u0026thinsp;\u0026plusmn;\u0026thinsp;4.76) years, with a predominance of late pregnancy. In terms of education, 87.33% of the pregnant women had a college degree or higher. For mode of pregnancy, 94.00% were naturally conceived and 6.00% were artificially conceived. For marital status, 94.33% were married and 5.67% were unmarried. For marital satisfaction, 42.67% were very satisfied and 49% were satisfied and 8.33% were average. Regarding the expectation of the sex of the baby, 47.33% of the pregnant women expressed expectation while 52.67% expressed no expectation. In addition, 58.67% of the pregnant women were first born and 41.67% had pregnancy complications.\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCharacteristics of pregnant women in the outpatient Clinic (\u003cem\u003en\u0026thinsp;=\u0026thinsp;300\u003c/em\u003e)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber(%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eGestation period\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEarly pregnancy (\u0026lt;\u0026thinsp;12 weeks)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42(14.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMiddle Gestation\u003c/p\u003e\n \u003cp\u003e(end of 13\u0026thinsp;~\u0026thinsp;27 weeks)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e73(24.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLate pregnancy (\u0026gt;\u0026thinsp;28 weeks)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e185(61.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eEducational attainment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJunior high school and below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6(2.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh School / Junior College / Technical School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32(10.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCollege and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e262(87.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eType of pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNatural Fertilization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e282(94.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eArtificial insemination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18(6.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17(5.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e283(94.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0(0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0(0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eMarital satisfaction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVery satisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e128(42.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSatisfactory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e147(49.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAverage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25(8.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eExpectations for the sex of the baby\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e142(47.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e158(52.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eWhether it is a first birth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e176(58.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e124(41.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eComplications of pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e125(41.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e175(58.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003e3.2 Reliability and validity analysis\u003c/h2\u003e\n \u003cp\u003eDecision value method was used to evaluate the differentiation degree of each entry of the scale among pregnant women with different anxiety levels, and the total scores of 300 pregnant women with pregnancy-related anxiety scale were arranged in accordance with the lowest to the highest, and the first 27% and the last 27% of the total scores were divided into two groups of low scores and high scores as the cut-off value, and independent samples t-tests were conducted, and the results of the analysis showed that the CR values of each entry were 9.670\u0026ndash;18.920, all of which were \u0026gt;\u0026thinsp;3.000, with the differences is statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), suggesting that the scale entries have a good degree of differentiation; Pearson correlation analysis showed that the correlation coefficients between the scores of each entry and the total score of the scale were 0.642\u0026thinsp;~\u0026thinsp;0.761 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and that the correlation coefficients between the dimensions and the total score of the scale were 0.772\u0026thinsp;~\u0026thinsp;0.761 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), all of which were \u0026gt;\u0026thinsp;0.4, It suggests that the entries are highly homogeneous with the total scale, all in a unified measure of the same item, and all entries can be retained. The total Cronbach\u0026apos;s alpha coefficient of the scale was 0.922, and the Cronbach\u0026apos;s alpha coefficients of the dimensions of the scale ranged from 0.778 to 0.906. The retest correlation coefficient was 0.961, and the retest correlation coefficients between dimensions ranged from 0.857 to 0.960, which suggests that the reliability of the scale is good. In this study, the content validity of the scale was assessed using the Delphi method, and the item-content validity index (I-CVI) of the Chinese version of the PrAS-S scale was 0.83\u0026thinsp;~\u0026thinsp;1, and the scale-content validity index/mean (S-CVI/Ave) was 0.966, which suggests that the content validity is good. The Kaiser-Meyer-Olkin index (KMO) for EFA of this scale was 0.888, and the Bartlett\u0026apos;s test of sphericity reached a significant level (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), which is suitable for EFA.Using Principal Component Analysis (PCA) and Variance Maximization Rotation, the crushed stone graph shows that the slope tends to flatten after the 5th common factor, so it is more appropriate to extract 5 common factors, and the cumulative variance contribution rate reaches 79.1%, which is greater than 50%, and the factor extraction effect is up to standard. CFA analysis using AMOS resulted in a chi-square degrees of freedom ratio \u0026chi;2/df of 3.33, root mean square error of approximation (RMSEA) of 0.088, goodness-of-fit index (GFI) of 0.912, comparative goodness-of-fit index (CFI) of 0.936, normative goodness-of-fit index (NFI) of 0.912, Tucker-Lewis index (TLI) of 0.916, and the Chinese version of the PrAS-S scale validated factor model fit index was good.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003e3.3 Current status of pregnancy-related anxiety in pregnant women\u003c/h2\u003e\n \u003cp\u003eThe mean pregnancy related anxiety score of 300 pregnant women was 29.06\u0026thinsp;\u0026plusmn;\u0026thinsp;9.96 with a median score of 27.00.The mean pregnancy related anxiety score of the non-anxious group was 19.55\u0026thinsp;\u0026plusmn;\u0026thinsp;2.81 and the mean pregnancy related anxiety score of the anxious group was 34.98\u0026thinsp;\u0026plusmn;\u0026thinsp;8.03.Out of these, 185 pregnant women had symptoms of pregnancy related anxiety and the prevalence rate of pregnancy related anxiety was 61.67%.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n \u003ch2\u003e3.4 A univariate analysis of pregnancy-related anxiety\u003c/h2\u003e\n \u003cp\u003eOn univariate analysis of variance, the difference in pregnancy-related anxiety scores between the anxious and non-anxious groups in terms of marital status, week of gestation, marital satisfaction, expectation of the baby\u0026apos;s sex, and the presence or absence of co-morbidities of pregnancy was statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). There was a significant difference between the age of the non-anxious group (31.23\u0026thinsp;\u0026plusmn;\u0026thinsp;4.50 years) and the age of the anxious group (29.07\u0026thinsp;\u0026plusmn;\u0026thinsp;4.72 years) (t\u0026thinsp;=\u0026thinsp;3.917, p\u0026thinsp;=\u0026thinsp;0.000). There was no statistically significant difference between the non-anxious and anxious groups for the factors of literacy, mode of pregnancy, and whether it was a first birth, as shown in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSingle factor analysis of pregnancy-related anxiety [\u003cem\u003en (%)\u003c/em\u003e]\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePregnancy-related anxiety score (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et/F\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducational attainment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.590\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.206\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJunior high school\u003c/p\u003e\n \u003cp\u003eand below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.17\u0026thinsp;\u0026plusmn;\u0026thinsp;7.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh School/Junior College/Technical School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.41\u0026thinsp;\u0026plusmn;\u0026thinsp;11.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCollege and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29.30\u0026thinsp;\u0026plusmn;\u0026thinsp;10.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u0026thinsp;=\u0026thinsp;20.752**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.41\u0026thinsp;\u0026plusmn;\u0026thinsp;13.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.44\u0026thinsp;\u0026plusmn;\u0026thinsp;9.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0(0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0(0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eType of pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003et=-1.225\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.221\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNatural Fertilization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29.24\u0026thinsp;\u0026plusmn;\u0026thinsp;9.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eArtificial insemination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.28\u0026thinsp;\u0026plusmn;\u0026thinsp;10.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGestation period\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u0026thinsp;=\u0026thinsp;8.327**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEarly pregnancy\u003c/p\u003e\n \u003cp\u003e(\u0026lt;\u0026thinsp;12 weeks)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.90\u0026thinsp;\u0026plusmn;\u0026thinsp;11.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMiddle Gestation\u003c/p\u003e\n \u003cp\u003e(end of 13\u0026thinsp;~\u0026thinsp;27 weeks)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.33\u0026thinsp;\u0026plusmn;\u0026thinsp;10.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLate pregnancy\u003c/p\u003e\n \u003cp\u003e(\u0026gt;\u0026thinsp;28 weeks)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.46\u0026thinsp;\u0026plusmn;\u0026thinsp;8.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarital Satisfaction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eZ=-3.558**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVery Satisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.57\u0026thinsp;\u0026plusmn;\u0026thinsp;9.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSatisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29.01\u0026thinsp;\u0026plusmn;\u0026thinsp;9.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAverage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.77\u0026thinsp;\u0026plusmn;\u0026thinsp;9.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExpectation of the sex of the baby\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eZ=-2.502**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.66\u0026thinsp;\u0026plusmn;\u0026thinsp;10.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.63\u0026thinsp;\u0026plusmn;\u0026thinsp;9.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWhether or not it\u0026apos;s the first pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003et\u0026thinsp;=\u0026thinsp;1.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.308\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29.58\u0026thinsp;\u0026plusmn;\u0026thinsp;10.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.39\u0026thinsp;\u0026plusmn;\u0026thinsp;9.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eComplications of pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eZ=-2.302**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.82\u0026thinsp;\u0026plusmn;\u0026thinsp;10.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.81\u0026thinsp;\u0026plusmn;\u0026thinsp;9.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e"},{"header":"4. Multiple linear regression analysis of pregnancy-related anxiety","content":"\u003cp\u003eThe factors showing statistically significant differences in the univariate analysis were used as independent variables, and the pregnancy-related anxiety scale score was used as the dependent variable in the multiple linear regression analysis. Dummy variables were set for the unordered multicategorical variables, and the independent variable assignments and dummy variable settings are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.After the multiple linear regression analysis, age, being married, marital satisfaction as satisfactory and average, the presence of gender expectations for the baby, co-morbid pregnancy complications, and the late stage of pregnancy were entered into the regression equation. The results showed that age (β=-0.566, P\u0026thinsp;=\u0026thinsp;0.000), marital status (β=-8.739, P\u0026thinsp;=\u0026thinsp;0.001), gestational week (β=-7.066, P\u0026thinsp;=\u0026thinsp;0.000), marital satisfaction (β\u0026thinsp;=\u0026thinsp;3.259, P\u0026thinsp;=\u0026thinsp;0.003; β\u0026thinsp;=\u0026thinsp;5.513, P\u0026thinsp;=\u0026thinsp;0.011), gender expectation of infant (β\u0026thinsp;=\u0026thinsp;2.570, P\u0026thinsp;=\u0026thinsp;0.027), and the presence of comorbid pregnancy complications (β\u0026thinsp;=\u0026thinsp;2.517, P\u0026thinsp;=\u0026thinsp;0.032) had a major effect on pregnancy-related anxiety. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\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 \u003cp\u003eAssignment of respective variables for pregnancy-related anxiety\u003c/p\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=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndependent variable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAssignment\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnmarried\u0026thinsp;=\u0026thinsp;1, Married\u0026thinsp;=\u0026thinsp;2,\u003c/p\u003e \u003cp\u003eWidowed 3, Divorced\u0026thinsp;=\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestation period\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEarly gestation (\u0026le;\u0026thinsp;12 weeks)\u0026thinsp;=\u0026thinsp;1,\u003c/p\u003e \u003cp\u003emid-gestation (end of 13\u0026ndash;27 weeks)\u0026thinsp;=\u0026thinsp;2,\u003c/p\u003e \u003cp\u003eLate pregnancy (\u0026ge;\u0026thinsp;28 weeks)\u0026thinsp;=\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital satisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery satisfied\u0026thinsp;=\u0026thinsp;1, Satisfied\u0026thinsp;=\u0026thinsp;2, Fair\u0026thinsp;=\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExpectations for the sex of the baby\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u0026thinsp;=\u0026thinsp;1, No\u0026thinsp;=\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplications of pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u0026thinsp;=\u0026thinsp;1, No\u0026thinsp;=\u0026thinsp;2\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 \u003cp\u003eMultifactorial linear regression analysis of factors influencing pregnancy-related anxiety\u003c/p\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=\"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=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePartial Regression Coefficient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\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\u003econstant number\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44.838\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.442\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18.363\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.566\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.271\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-4.852\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003cp\u003e(married)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-8.739\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.689\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.203\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-3.250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital satisfaction (satisfied)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.259\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.164\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.951\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital satisfaction\u003c/p\u003e \u003cp\u003e(average)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5.513\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.572\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExpectation of baby's\u003c/p\u003e \u003cp\u003egender (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.570\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhether pregnancy complications are combined (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.517\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestational week\u003c/p\u003e \u003cp\u003e(late pregnancy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-7.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.958\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.346\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-3.608\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"5. Discussion","content":"\u003cp\u003eIt is of utmost importance to devise an efficacious assessment tool for women\u0026apos;s pregnancy-related anxiety. In the current study, we opted to develop a pregnancy-related anxiety assessment instrument with a more comprehensive structure and content, which could be more closely aligned with the contemporary clinical scenarios. To achieve this, we applied the Chinese version of the Pregnancy-Related Anxiety Scale (PRAS) to the Chinese female population, employing a scientific and rigorous translation protocol.We utilized the currently validated and scientific statistical methodologies to explore and validate the structure and content of the Chinese PRAS. In terms of content validity assessment, the item-content validity index (I-CVI) of this scale ranged from 0.83 to 1, and the scale-content validity index (S-CVI/Ave) was 0.966, meeting the stringent requirements of measurement standards [26]. This strongly suggests that each item within the questionnaire is highly capable of reflecting the anxiety levels of the surveyed individuals.Exploratory factor analysis was carried out, and a total of five principal factors were extracted, with a cumulative variance contribution rate reaching 79.1%. Concurrently, the factor loading value of each entry exceeded 0.40, indicating a favorable structural validity [27]. Moreover, the factor structure and item attributions remained largely consistent with the original scale, attesting to the good structural stability and reliability of the sinicized Pregnancy-Related Anxiety Scale.To further corroborate the scale\u0026apos;s validity, a confirmatory factor analysis was performed. A structural equation model was constructed based on the five dimensions, and the results of the fitting indices indicated a satisfactory model fit [28]. This implies that the Chinese PRAS demonstrated excellent performance in the confirmatory factor analysis, thereby validating its structural integrity and validity.Regarding reliability, the Cronbach\u0026apos;s alpha coefficient of the Chinese PrAS-S was 0.922, and the Cronbach\u0026apos;s alpha coefficients of the respective dimensions ranged from 0.778 to 0.906, which were remarkably close to those of the original scale (0.77\u0026ndash;0.95). This demonstrates that the scale exhibits a high level of internal consistency and reliability [29], signifying that the items within the scale are interrelated to an extent that they can effectively reflect the overall anxiety status of the respondents. Finally, the test-retest reliability of the full scale was evaluated, yielding a result of 0.961 [30]. This finding indicates that the scale possesses cross-temporal stability and excellent consistency, meaning that it provides highly consistent measurements when administered to the same group at different time points.\u003c/p\u003e\n\u003cp\u003eIn conclusion, through a comprehensive exploration and validation of the Chinese version of the Pregnancy-Related Anxiety Scale, we ascertained that it exhibits superior performance in terms of content validity, structural validity, confirmatory factor analysis, internal consistency reliability, and test-retest reliability. Hence, the Chinese PRAS can be reliably employed as a valid tool for assessing pregnancy-related anxiety among Chinese women.\u003c/p\u003e\n\u003cp\u003eIn recent years, with the liberalization of China\u0026apos;s three-child policy and the state\u0026apos;s policy support for childbearing, research on pregnancy-related anxiety has gradually gained attention. Pregnancy is a special physiological and psychological period, during which pregnant women may face many challenges and pressures, leading to the emergence of anxiety. A review of relevant domestic and international survey literature found that about 98% of pregnant women worldwide experience anxiety during pregnancy \u003csup\u003e[31]\u003c/sup\u003e. This anxiety may stem from worries about the labor and delivery process, concerns about the health of the fetus, fear of future parenting stress, and uncertainty about one\u0026apos;s own physical condition. Without timely intervention, the endocrine changes, physical and psychological changes, and the stress of labor and delivery caused by the development of pregnancy are likely to aggravate the severity of pregnancy-related anxiety, ultimately leading to poor pregnancy outcomes and postpartum depression \u003csup\u003e[32]\u003c/sup\u003e. In China, the prevalence of anxiety in the general population is 3.4%, while the prevalence in women during pregnancy is as high as 28.4% \u003csup\u003e[33]\u003c/sup\u003e. This means that during pregnancy, women face much higher psychological stress than the rest of the population. In the present study, the prevalence of pregnancy-related anxiety among 300 pregnant women reached 61.67%. This rate is higher than other studies, which may be related to the small number of samples collected, the fact that the rating scale used was the Universal Screening Scale and the fact that most of the population surveyed was in the late stages of pregnancy \u003csup\u003e[34]\u003c/sup\u003e. In this study, the prevalence of pregnancy-related anxiety among pregnant women in late pregnancy was 55.14% (102/185). This may be due to the fact that the incidence increases significantly when pregnant women have a heavier physiological burden in late pregnancy and are faced with impending labor, fear of labor pains as well as increased difficulty in delivery, unknown about their own health and that of their fetus, as well as the stress of facing the pressure of future parenting and the presence of stressful psychological anxiety \u003csup\u003e[35,36]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe current study used a combination of univariate analysis and multifactorial linear regression analysis to delve into the factors influencing pregnancy-related anxiety. The results of the study showed that there were significant and statistically significant differences in pregnancy-related anxiety scores between the anxious and non-anxious groups for age, marital status, gestational week, marital satisfaction, expectation of the baby\u0026apos;s gender, and whether or not there were comorbid pregnancy complications (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Multifactorial linear regression analysis further revealed that age, marital status, marital satisfaction, expectation of the baby\u0026apos;s gender, the presence of pregnancy complications, and gestational week were independent risk factors for pregnancy-related anxiety. For young pregnant women, the lack of experience in labor and parenting often leads to uneasiness and worry about the process. Moreover, young pregnant women may be more sensitive to their physical condition and fetal health, which increases their anxiety to some extent \u003csup\u003e[37,38]\u003c/sup\u003e. Young pregnant women may lack sufficient knowledge about the physical changes during pregnancy and may be prone to excessive worry. At the same time, they may also be fearful of the responsibilities and challenges of parenting, which adds to the anxiety. Secondly, the impact of marital status on pregnancy-related anxiety should not be underestimated. Unmarried or divorced pregnant women usually face more psychological pressures, such as financial burdens and discordant family relationships. These pressures may make them more prone to anxiety symptoms during pregnancy \u003csup\u003e[39,40]\u003c/sup\u003e. Unmarried pregnant women may worry about social pressures and future uncertainty, while divorced pregnant women may face difficulties and pressures of raising children alone. The effect of marital satisfaction on pregnancy-related anxiety should not be overlooked as well.Pregnant women with moderate to low marital satisfaction are more likely to experience anxiety symptoms. This may be due to the fact that pregnant women lack sufficient emotional support and sense of security in the event of marital disharmony. In order to improve the situation, couples are advised to strengthen communication and face problems in life together. Couples can share each other\u0026apos;s feelings and needs through frank communication to enhance mutual understanding and support. At the same time, couples can also participate in the preparation for pregnancy together, such as attending prenatal classes and preparing baby supplies, to enhance their confidence in their future life. Expectations about the sex of the baby may also have an impact on the psychological state of the pregnant woman. In some families, there may be specific expectations about the sex of the fetus, and such expectations may put pressure on pregnant women and lead to anxiety during pregnancy \u003csup\u003e[40,41]\u003c/sup\u003e. Therefore, family members should respect the wishes of the pregnant woman and avoid putting too much pressure on her. Family members can reduce the psychological burden of pregnant women by expressing their care for the pregnant woman and the fetus rather than focusing too much on the gender of the fetus. Pregnancy complications are an important factor in pregnancy-related anxiety \u003csup\u003e[42]\u003c/sup\u003e. Pregnant women with pregnancy complications tend to worry about their physical condition as well as the health of the fetus. During pregnancy, pregnant women should undergo regular pregnancy tests and disease screening for timely diagnosis and treatment. At the same time, family members and the community should also give adequate care and support to pregnant women to help them ease their anxiety. Pregnant women themselves should also learn about the relevant knowledge, actively cooperate with the treatment and maintain a good state of mind. For example, pregnant women can learn about pregnancy complications and ways to cope with them by reading relevant books and attending maternity courses to enhance their ability of self-management \u003csup\u003e[43]\u003c/sup\u003e. In addition, pregnant women can also relieve anxiety and maintain physical and mental health through appropriate exercise and relaxation training. Effective interventions are necessary to reduce anxiety levels in women during pregnancy. These measures can include psychological counseling, health education, family support, and support from social policies. Through these methods, pregnant women can be helped to better cope with the challenges and pressures of pregnancy, thus reducing the incidence of pregnancy-related anxiety and improving the quality of life of women during pregnancy.\u003c/p\u003e\n\u003cp\u003eThe development of a more scientific and reliable assessment tool can promote the standardization and development of pregnancy-related anxiety research, which is of great theoretical and practical significance to increase the attention to pregnancy-related anxiety among women in China. At the same time, the application of pregnancy-related anxiety assessment tool in Chinese population provides a reference basis for the selection of psychotherapeutic programs and psychological counseling for this population, which has a broader application prospect.\u003c/p\u003e"},{"header":"6. Conclusions","content":"\u003cp\u003eThe Pregnancy-related Anxiety Scale (simplified version) (PrAS-S) developed in this study consists of 5 dimensions and 15 items, including labor and delivery process, self-concern, self-worry, fetal status, and attitude of medical personnel. The results of the study showed that the scale has good reliability and validity, and can accurately and comprehensively measure the current pregnancy-related anxiety status of the subjects, which can be used as a screening tool for pregnancy-related anxiety by providing a reference basis for the selection of psychotherapy programs, psychological counseling, and objective evaluation of the treatment effect of the clinical staff on this population.\u003c/p\u003e"},{"header":"7. Limitations","content":"\u003cp\u003eIn the questionnaire survey, the convenience sampling method was used for data collection, and in the construction of the questionnaire, due to time and regional constraints, the survey respondents were mainly from Urumqi City in the Xinjiang Uygur Autonomous Region, and the lack of research respondents from other provinces may lead to a certain degree of bias in the results, and there are certain geographical limitations, which may not be able to be completely universal in applicability. Second, there is a lack of specific applications of high-quality measurement tools in the country to provide comparable universal indicators, which may not clearly explain the test results. Due to time constraints, this study only used the self-assessment of the questionnaire to evaluate the level of pregnancy-related anxiety, which may be affected by its subjective conditions, and the results of the assessment may be biased.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Ethics Committee of Xinjiang Medical University (XJYKDXR20241115001). Prior to each interview, participants were provided oral explanation of the study. Study participation was voluntary, and the confidentiality of the data was strictly maintained. Study participation was voluntary, and the confidentiality of the data was strictly maintained.\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 material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData are available upon reasonable request. Data used for analysis are available on reasonable request. Datasets can be obtained from the corresponding author ([email protected]).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone declared.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the\u0026nbsp;The Research Program of Xinjiang Nursing Association(2018XH12)and National College Students Innovation and Entrepre-neurship Training Program(Grant numbers:S202210760073).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eFF: Conceptualization, methodology, Resources, formal analysis, writing-original draft preparation, Project administration, data curation, Visualization. XL:Conceptualization, data collection, writing-original draft preparation.\u0026nbsp;YZ: Investigation, data analysis, validation.\u0026nbsp;JY: Supervision, project administration.\u0026nbsp;MM:\u0026nbsp;Investigation, methodology, supervision.\u0026nbsp;XD: Data collection,\u0026nbsp;data\u0026nbsp;curation, translation.\u0026nbsp;XM: Writing-review and editing, critical revision, final approval of the manuscript. All authors approved the final version of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI sincerely thank all those who have contributed to the completion of this research.\u003c/p\u003e\n\u003cp\u003eFirstly, I would like to express my deepest gratitude to all the mentors [FF, JY, XM] involved in the project. Your profound knowledge, valuable guidance, and patient guidance are the cornerstone of this research. Your insightful advice and continuous encouragement have led the project through the challenges of this research journey.\u003c/p\u003e\n\u003cp\u003eI would also like to express my sincere gratitude to the members of the research team [XL, YZ, MM, XD]. Our collaborative efforts, shared ideas, and mutual support make this research possible. Each of you has brought unique perspectives and skills, greatly enriching the research process.\u003c/p\u003e\n\u003cp\u003eI am very grateful to the participants who voluntarily participated in our research. Your contribution and collaboration are the foundation of the data in this study. Without your support, it would be impossible to draw meaningful conclusions.\u003c/p\u003e\n\u003cp\u003eThis study received financial support from The Research Program of Xinjiang Nursing Association, National College Students Innovation, and Entrepreneurial Entrepreneurship Training Program. I sincerely appreciate their investment in this research. In addition, I would like to thank my institutions [Xinjiang Medical University, Health Care Research Center for Xinjiang Regional Population] for providing excellent research facilities and a favorable academic environment.\u003c/p\u003e\n\u003cp\u003eFinally, I thank all of you. Your support and assistance are crucial for achieving results in this research.\u003c/p\u003e"},{"header":"References","content":"\u003col class=\"decimal_type\"\u003e\n \u003cli\u003eHan Jiapeng. Slight Decrease in the number of newborns worldwide in 2018. The world\u0026apos;s population may be \u0026quot;Africanized\u0026quot;. Netease news [EB/OL]. http://news.163.com/18/0228/15/DBO80FN20001875O.html,the 2018-02-28/2019-12-13.\u003c/li\u003e\n \u003cli\u003eLiu Xing-hui.2018 annual review and future development of obstetrics in China. Sohu [EB/OL]. http://www.sohu.com/a/292228909_441376, 2019-01-29/2019-01-29.\u003c/li\u003e\n \u003cli\u003eMirzakhani K, Khadivzadeh T, Faridhosseini F.et al. 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BMC Pregnancy Childbirth. 2022 Oct 1; 22(1):735. doi: 10.1186/ s12884-022-05045-8.PMID: 36182904; PMCID: PMC9526285.\u003c/li\u003e\n \u003cli\u003eHuang, J., Xu, L., Xu, Z., Luo, Y., Liao, B., Li, Y., \u0026amp; Shi, Y. (2022). The relationship among pregnancy-related anxiety, perceived social support, family function and resilience in Chinese pregnant women: A structural equation modeling analysis. BMC Women\u0026apos;s Health, 22(1), 546.\u003c/li\u003e\n \u003cli\u003eLoo KK, Li Y, Tan Y, Luo X, Presson A, Shih W. Prenatal anxiety associated with male child preference among expectant mothers at 10-20 weeks of pregnancy in Xiangyun County, China. Int J Gynaecol Obstet. 2010 Dec; 111 (3) : 229-32.\u003c/li\u003e\n \u003cli\u003eFischbein RL, Nicholas L, Kingsbury DM, Falletta LM, Baughman KR, VanGeest J. State anxiety in pregnancies affected by obstetric complications: A systematic review. J Affect Disord. 2019 Oct 1; 257:214-240.\u003c/li\u003e\n \u003cli\u003eWang K, Li R, Li Q, Li Z, Li N, Yang Y, Wang J. Knowledge, attitude, and practice toward postpartum depression among the pregnant and lying-in women. BMC Pregnancy Childbirth. 2023 Oct 30; 23 (1) : 762.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Pregnancy-related anxiety, Chinese version, Reliability, Validity, Influencing factors, Mental health","lastPublishedDoi":"10.21203/rs.3.rs-5781802/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5781802/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjectives: \u003c/strong\u003eThis study aimed to: (1) Rigorously validate the Chinese PrAS-S psychometrically; (2) Precisely determine pregnancy-related anxiety prevalence and severity among pregnant women; (3) Scrutinize its significant influencing factors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Given pregnancy-related anxiety’s importance for maternal mental health, we used PrAS-S for a cross-sectional study of 300 Urumqi pregnant women. We aimed to evaluate anxiety levels, analyze status and factors, and support clinical psychological nursing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Employing convenience sampling, 300 pregnant women from three Urumqi tertiary hospitals were surveyed with general and Chinese PrAS-S questionnaires. Univariate and multiple linear regression analyses explored determinants and assessed the scale’s reliability and validity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The Chinese PrAS-S proved reliable and valid. CR values for differentiation were 9.670 - 18.920, I-CVI 0.83 - 1, Cronbach's α 0.778 - 0.906, and test-retest correlation coefficients 0.857 - 1. The prevalence of pregnancy-related anxiety was 61.67% (185/300). Age, marital status, gestational age, marital satisfaction, baby's gender expectation, and concurrent pregnancy complications had a profound impact.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e The Chinese PrAS-S is a convenient, reliable tool for quickly assessing pregnancy-related anxiety. With a high incidence rate, preventive and intervention strategies, considering influencing factors, must be strengthened to protect pregnant women's mental health.\u003c/p\u003e","manuscriptTitle":"Current status and influencing factors of pregnancy related anxiety in Chinese pregnant women: a cross sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-17 04:22:11","doi":"10.21203/rs.3.rs-5781802/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f5e0fac7-82b2-4296-ae8c-14e7c06fbc64","owner":[],"postedDate":"January 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-27T15:56:23+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-17 04:22:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5781802","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5781802","identity":"rs-5781802","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}