Fear of childbirth and sleep quality among pregnant women: a generalized additive model and moderated mediation analysis

Objectives: The aim of this study is to examine the explore the associations among fear of childbirth, psychological distress, resilience and sleep quality among Chinese pregnant women. Methods 768 pregnant women participated in the Be Resilient to Postpartum Depression program (BRPD, Registration number: ChiCTR2100048465) and administered with Childbirth Attitudes Questionnaires (CAQ), Hospital Anxiety and Depression Scale (HADS), Connor-Davidson Resilience Scale (CD-RISC) and Pittsburgh Sleep Quality Index (PSQI). Generalized additive model and moderated mediation analysis were conducted. Results A non-linear and negative association between fear of childbirth and sleep quality was founded in the second trimester and antenatal period. Psychological distress significantly mediated the relationship between fear of childbirth and sleep quality (first trimester: B = 0.044, 95% CI = 0.022–0.071; second trimester: β = 0.029, 95%CI = 0.009–0.056; third trimester: β = 0.064, 95%CI = 0.046–0.088; antenatal period: β = 0.050, 95%CI = 0.037–0.063). The moderation role of resilience between fear of childbirth and sleep quality were significant (second trimester: β=-0.006, 95%CI=-0.012 - -0.001, P = 0.025; antenatal period: β=-0.004, 95%CI=-0.007 - -0.001, P = 0.014;), FoC and psychological distress (first trimester: β=-0.016, 95%CI=-0.026 - -0.005, P = 0.004; antenatal period: β=-0.005, 95%CI=-0.009 - -0.001, P = 0.014) . Conclusions Fear of childbirth, psychological distress and resilience are three important factors affecting sleep quality in Chinese pregnant women.