Relationship between fear of childbirth and oral health-related quality of life in pregnant women: the mediating effect of pregnancy anxiety

Relationship between fear of childbirth and oral health-related quality of life in pregnant women: the mediating effect of pregnancy anxiety | 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 Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Relationship between fear of childbirth and oral health-related quality of life in pregnant women: the mediating effect of pregnancy anxiety Yujia Chen, Jing Zhao, Jin Zheng, Zhijie Zou, Xiaoli Chen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3257324/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 Background Oral health is an important public health issue. Many studies have explored the relationship between mental health and oral health-related quality of life. However, no studies have explored the relationship between fear of childbirth and oral health-related quality of life in pregnant women. However, several studies have shown that pregnancy anxiety is associated with fear of childbirth and oral health-related quality of life. This study aimed to investigate the relationship between fear of childbirth and pregnant women's oral health-related quality of life and explore the mediating role of pregnancy anxiety. Methods This study is a cross-sectional design. The cross-sectional data from 478 pregnant women were included. A descriptive analysis was conducted to describe the sample characteristics. Multiple linear regressions were used to evaluate the relationship between fear of childbirth and oral health-related quality of life. PROCESS software was used to analyze the mediating effect of pregnancy anxiety. Results A significant direct effect between fear of childbirth and oral health-related quality of life has been indicated (β = 0.107, SE = 0.019, 95% CI (0.002,0.076)), and the direct effect accounted for 60% of the total effect. Pregnancy anxiety partially mediated between fear of childbirth and oral health-related quality of life (β = 0.072, SE = 0.030, 95% CI (0.015, 0.131)), and the indirect effect accounted for 40% of the total effect. Conclusions Pregnancy anxiety mediates the relationship between fear of childbirth and oral health-related quality of life in pregnant women. Therefore, attention should be paid to maternal fear of childbirth and pregnancy anxiety to improve pregnant women's oral health-related quality of life. pregnancy mediating effect fear of childbirth oral health-related quality of life pregnancy anxiety Figures Figure 1 1. Introduction Oral health is increasingly recognized as an important public health issue, especially among pregnant women [ 1 ] . Pregnant women are at higher risk of developing oral diseases due to physiological, hormonal, and dietary changes during pregnancy [ 2 ] . Studies found that the prevalence of periodontitis in pregnant women was 40% [ 3 ] , the prevalence of gingivitis in pregnant women was 88% [ 4 ] , and the incidence of dental caries in pregnant women was 74% [ 5 ] . Maternal periodontal disease increases the risk of adverse pregnancy outcomes such as preterm birth, low birth weight, and pre-eclampsia [ 6 ] . Meanwhile, poor maternal oral health has been linked to an increased risk of dental caries in children [ 7 ] . Although routine oral care during pregnancy is safe [ 8 ] , many pregnant women delay dental treatment due to their misunderstanding of the safety of oral treatment during pregnancy [ 9 ] . Studies show that 66.6% − 70.1% of women visit a dentist during non-pregnancy [ 10 ] , while 16%-83% visit a dentist during pregnancy [ 11 ] . Poor oral health during pregnancy is associated with poor oral health-related quality of life [ 12 ] . Oral health-related quality of life is a concept generated by the application of health-related quality of life in the field of stomatology [ 13 ] , which reflects the comprehensive evaluation of the impact of oral diseases and their prevention and treatment on physiological, psychological and social functions, and reflects the impact of oral health on quality of life [ 14 ] . Oral health-related quality of life is increasingly used as a substitute for clinical assessment of oral health surveillance. Contrary to normative clinical indicators, oral health-related quality of life aims to capture the broad consequences of poor oral health from different perspectives [ 15 ] . Oral health-related quality of life can reflect patients' self-cognition of oral conditions, which in turn determines patients' treatment compliance [ 16 ] . Therefore, oral health-related quality of life is an effective tool for assessing patients' treatment compliance. At the same time, oral health-related quality of life assessments can provide a better understanding of patient needs so that treatment plans can be adjusted and improved according to oral health-related quality of life [ 17 ] . However, based on the subjectivity of oral health-related quality of life assessment, it may be affected by the psychological state of patients [ 18 ] . The mental health of childbearing women is a growing concern for society. Fear of childbirth is a common negative emotion among pregnant women, characterized by stress in the process of pregnancy and childbirth [ 19 ] . The epidemic rate of fear of childbirth among pregnant women in China is 67.1% [ 20 ] . Studies have shown that high fear of childbirth negatively correlates with quality of life [ 21 ] . The oral health-related quality of life as a derivative concept of quality of life is unclear in the relationship with fear of childbirth. Studies have shown that fear of childbirth can predict anxiety in pregnant women [ 22 , 23 ] , and anxiety, another common negative emotion in pregnant women, can affect oral health-related quality of life [ 24 , 25 ] . Therefore, this study aimed to assess the effect of fear of childbirth on oral health-related quality of life in pregnant women and to verify whether pregnancy anxiety mediates the relationship between fear of childbirth and oral health-related quality of life. 2. Materials and methods 2.1 Participants Between September 2022 and March 2023, 478 pregnant women were recruited in our ongoing perinatal women cohort at a grade A tertiary hospital in Wuhan, China [ 26 ] . The inclusion criteria were: (1) Aged 18–50 years; (2) Less than 14 weeks of gestation; (3) Planning to receive perinatal medicine examinations and delivery at the predetermined hospital; (4) Able to read and complete questionnaires in Chinese; (5) Having access to smartphone and internet. The exclusion criterion was: pregnant women who plan to leave the study area (Wuhan) for delivery or postpartum recuperation. 2.2 Measurements 2.2.1 Independent variable Fear of childbirth was the study’s independent variable. We use the fear of birth scale (FOBS) to measure the fear of childbirth in pregnant women. This scale was developed by Australian scholar Haines in 2011, with a Cronbach's Alpha of 0.91, showing strong internal consistency. It required participants to respond to the following question, "How do you feel now about the upcoming birth" with two 100mm scales ranging from 0 to 100, "calm" to "worried," and "no fear" to "intense fear" [ 27 ] . The two questions' scores were averaged to obtain a fear of childbirth score, ranging from 0 to 100. The higher the score, the higher the degree of fear of childbirth, and the mean score of ≥ 50 was rated as fear of childbirth. In this study, Cronbach's Alpha was 0.93. 2.2.2 Mediator Pregnancy-related anxiety was used as a mediator in this study. It was measured by a pregnancy-related anxiety questionnaire (PAQ). The questionnaire is compiled based on the characteristics of pregnant women in China, with a Cronbach's Alpha of 0.81 [ 28 ] . The questionnaire has 13 items, including three dimensions: worry about fetal health, concern about oneself and worry about childbirth. The questionnaire used a four-point Likert scale ranging from 1 (never) to 4 (almost always), with scores ranging from 13 to 52. An overall score of ≥ 24 indicates pregnancy-related anxiety. In this study, Cronbach's Alpha was 0.75. 2.2.3 Dependent variable Oral health-related quality of life was the study's dependent variable. Oral health impact profile-14 (OHIP-14) assesses oral health-related quality of life. Slade originally developed it in 1997 with a Cronbach's Alpha of 0.88 [ 29 ] . The Chinese version of OHIP-14 was developed by Xin Weini et al. in 2006, and its Cronbach's Alpha was 0.93 [ 30 ] . There are 14 items in OHIP-14. The scale can be divided into four dimensions: functional limitation, pain and discomfort, psychological discomfort, and disability. The scale used a five-point Likert scale ranging from 0 (never) to 4 (very often) on a scale ranging from 0 to 56, with higher scores indicating poorer oral health-related quality of life. In this study, Cronbach's Alpha was 0.92. 2.2.4 Control variables Control variables included the following components: sociodemographic information included age, nationality, place of residence, education, occupation, workload, and income; health behaviors included cigarette smoking, alcohol drinking, and caffeine intake; pregnancy-related information included gestational age, whether the pregnancy was planned, whether or not the pregnancy was taking folic acid, production experience, and nausea and vomiting; it also included intimate relationship, whether or not there was a history of depression and anxiety, whether or not they were living with their parents, and social networking site usage in the past week. 2.3 Data analysis SPSS was used to analyze the data. Missing values were filled with multiple interpolations. First, countable data were described by component ratio; the measurement data that conformed to normal distribution were represented by mean and standard deviation ( \(\stackrel{-}{X}\) ± S). Otherwise, they were described by median and quartile (M (Q1, Q3)). Second, the data fitted the normal distribution, the independent sample T-test was used for comparison between the two groups, and the analysis of variance was used for comparison between multiple groups; otherwise, the Mann-Whitney U test in the non-parametric test was used for comparison between the two groups, and the Kruskal Wallis H test was used for statistical inference between multiple groups. Third, Pearson's correlation was used to test the relationship between the corresponding variables. Then, multiple linear regression analysis was used to investigate the predictive effect of significant variables in univariate and correlation analyses on oral health-related quality of life. Finally, PROCESS software was used to model the structural equations and validated by the Bootstrap method, setting the sampling number to 5000. When 95% CI does not contain 0 in the middle, it indicates that the mediation effect is significant. 3. Results 3.1 Descriptive analysis The results of descriptive statistics are shown in Table S1 and Table 1 . Table S1 shows the demographic information of 478 pregnant women. The median age of the 478 pregnant women was 31 years, and the median gestational age was 22 weeks. The majority of pregnant women were Han (96.4%). 51.5% of pregnant women work less after pregnancy. 56.5% of pregnant women live with their parents. 81.6% of pregnant women had planned pregnancies. Table 1 shows the total score of OHIP-14 and the score on each dimension. Table 1 Overall scores and four different dimensional score of oral health-related quality. Scales (±s) OHIP-14 7.70 ± 9.09 Functional limitation 1.64 ± 2.13 Pain and discomfort 2.26 ± 2.34 Psychological discomfort 1.75 ± 2.18 Disablility 2.06 ± 3.26 3.2 Univariate analysis The results of the univariate analysis are shown in Table S1 and Table 2 . The results of categorical variables indicate statistical differences between nationality, changes in workload, intimacy between partners, whether they had ever suffered from depression or anxiety, social networking site usage in the past week, and whether the pregnancy was unplanned on the OHIP-14 score of pregnant women (Table S1 ). Table 2 provides a correlation matrix for quantitative variables. Pearson correlation analysis showed a significant positive correlation between fear of childbirth and poorer oral health-related quality of life (r = 0.183, P ＜ 0.01). Pregnancy anxiety was positively correlated with fear of childbirth (r = 0.507, P ＜ 0.01) and poorer oral health-related quality of life (r = 0.207, P ＜ 0.01). Table 2 Intercorrelations among the study variables Oral health-related quality of life Age Current gestational age Pregnancy anxiety Fear of childbirth Oral health-related quality of life 1 Age -0.059 1 Current gestational age -0.031 0.04 1 Pregnancy anxiety .207 ** -0.09 -0.02 1 Fear of childbirth .183 ** -0.06 0.069 .507 ** 1 * p < 0.05, ** p < 0.01, 3.3 Mediating effect analyses The results of multiple linear regression analysis with oral health-related quality of life as the dependent variable are presented in Table S2. The model without a mediator (pregnancy anxiety) showed that fear of childbirth was associated with poorer oral health-related quality of life. When including pregnancy anxiety in the model, the association between fear of childbirth and poorer oral health-related quality of life remained statistically significant. Pregnancy anxiety and fear of childbirth remained risk factors for oral health-related quality of life for pregnant women after adjusting for social networking site usage in the past week, intimate relationship, pregnancy workload, whether the pregnancy was unplanned, nationality, and presence of depression and anxiety. Table 3 The effects of fear of childbirth on oral health-related quality of life with pregnancy anxiety. Model pathways β S.E. 95% C.I. Mediating effect Total effect fear of childbirth→oral health-related quality of life 0.178 0.016 (0.033,0.097) 100% Direct effect fear of childbirth→oral health-related quality of life 0.107 0.019 (0.002,0.076) 60% Indirect effect fear of childbirth→pregnancy anxiety→oral health-related quality of life 0.072 0.030 (0.015,0.131) 40% All analyses were controlled for the workload and a history of anxiety or depression. Figure 1 shows the mediation path model. The path coefficients showed that all relationships in the model are significant. The direct effect of fear of childbirth on oral health-related quality of life remained significant after including the mediator of pregnancy anxiety. Thus, the association between fear of childbirth and oral health-related quality of life was achieved partly through the mediator. The total, direct, and indirect effects are described in Table 3 . Specifically, the standardized effect of fear of childbirth on oral health-related quality of life through pregnancy anxiety was 0.072, with a mediating effect of 40%. 4. Discussion The oral health of pregnant women is a common problem. However, there are few existing studies on pregnant women's oral health-related quality of life. The study of oral health-related quality of life in pregnant women has practical significance for improving health. To the authors' knowledge, this is the first study to use a mediation model to examine the relationship between fear of childbirth and oral health-related quality of life in pregnant women. Overall, our findings suggest that fear of childbirth predicted poorer oral health-related quality of life in pregnant women and that the association between fear of childbirth and oral health-related quality of life is partially mediated by pregnancy anxiety. Thus, it reveals the relationship between mental health and oral health-related quality of life in pregnant women, suggesting that society should pay attention to the fear of childbirth and promote the physical health of pregnant women by regulating their poor psychological status. Higher OHIP-14 scores indicate poorer oral health-related quality of life. The mean OHIP-14 score in this study (7.7) was similar to the mean OHIP-14 score of pregnant women in Shanghai (7.9), China and pregnant women in India (7.0) [ 31 ] but was higher than the OHIP-14 score of pregnant women in Brazil (3.8) [ 32 ] . This phenomenon may be caused by the fact that some women in China and India, influenced by traditional culture, believe that oral health care should be prohibited during pregnancy, which leads to the neglect of the oral health of women during pregnancy [ 33 , 34 ] , and thus leads to the deviation of their oral health-related quality of life. The higher oral health-related quality of life among pregnant women in Brazil may be due to the support of the Brazilian government's "Smiling Brazil" policy, which promotes oral health in primary health care methods and encourages the addition of fluoride to the drinking water supply, since which Brazilian indicators of oral health have improved significantly [ 35 , 36 ] . A study has shown that fear of childbirth can predict poorer quality of life for women [ 37 ] . The results of our study indicated that fear of childbirth is a predictor of oral health-related quality of life. Specifically, women with a higher fear of childbirth had poorer oral health-related quality of life. There were two possible explanations for the relationship between fear of childbirth and oral health-related quality of life. Firstly, it has been shown that salivary and blood stress markers change when a person is under stress. Such markers are associated with inflammatory responses and the progression of periodontitis [ 38 ] . At the same time, stressful events reduce cell-mediated immune activity, leading to a decrease in body immunity and poor oral health [ 39 ] . Under the influence of fear of childbirth, childbirth may act as a stressor in pregnant women, and fear of childbirth may affect oral health-related quality of life through this mechanism. Secondly, because sugary foods induce hormonal release to reduce stress and increase pleasure, childbirth acts as a stressor that increases their desire for comfort foods [ 40 ] , making women during pregnancy more susceptible to oral health problems [ 41 ] . In addition, this study also found a positive correlation between fear of childbirth and pregnancy anxiety, which is consistent with the results of previous studies [ 23 , 42 ] . A study has shown that fear of childbirth can directly cause anxiety and indirectly cause anxiety through resilience [ 22 ] . Meanwhile, this study found a positive correlation between pregnancy anxiety and poor oral health-related quality of life, and a previous study also showed that anxiety can cause poorer oral health-related quality of life in young women [ 43 ] . It may be that pregnancy anxiety causes women to pay more attention to negative events during pregnancy, which causes them to amplify their oral health discomfort, thus resulting in poorer oral health-related quality of life. In addition, a study has shown that when the pressure rises, the frequency of brushing teeth will decrease [ 44 ] . As a kind of stress, pregnancy anxiety may reduce the frequency of brushing teeth of pregnant women and thus lead to the reduction of oral health and quality of life of women. Moreover, this study confirmed the indirect effect of fear of childbirth on oral health-related quality of life through pregnancy anxiety. The results showed that pregnancy anxiety partially mediated the relationship between fear of childbirth and oral health-related quality of life (β = 0.072, SE = 0.030, 95% CI (0.015, 0.131), and the indirect effect accounted for 40% of the total effect. These findings show a more comprehensive process in which fear of childbirth affects oral health-related quality of life and suggest that oral health-related quality of life is not only related to oral disease but also influenced by psychological status. Therefore, to improve the quality of life related to the oral health of pregnant women, we should pay attention to the mental health of pregnant women and oral health. 5. Limitations This study has several limitations. Firstly, as this is a cross-sectional survey, causal inference cannot be made based on the results. Future longitudinal studies can be conducted to address this issue and explore the potential mechanisms in more detail. Secondly, this study only discussed the oral health-related quality of life of pregnant women who underwent antenatal examination in Wuhan city. Since women in different economic level cities pay different attention to oral health, a larger sample survey nationwide is needed to confirm this result in the future. 6. Conclusion The study found that pregnancy anxiety mediates the relationship between fear of childbirth and oral health-related quality of life in pregnant women. This study provides a theoretical mechanism for the association between fear of childbirth and oral health-related quality of life of pregnant women and a new idea for improving the oral health-related quality of pregnant women. Psychological interventions for women with higher fear of childbirth directly improve oral health-related quality of life and indirectly improve oral health-related quality of life by alleviating pregnancy anxiety. The results of this study remind medical professionals to pay attention to women's mental health during pregnancy. Declarations Acknowledgments We appreciate the support of the Renmin Hospital of Wuhan University for our data collection. Authors’ contributions Yujia Chen and Jing Zhao analyzed the data and completed the original draft. Xiaoli Chen, Zhijie Zou, and Jin Zheng provided research ideas and data as well as revised the article to form the final version of the manuscript. All authors reviewed the final version of the manuscript and approved the manuscript for publication. Funding Our research is supported by the National Social Science Foundation of China (Project No. 21BSH073) to the author Xiaoli Chen. Availability of data and materials The datasets that support the conclusions of this study are all available in the article. Ethics approval and consent to participate The study was approved by the Research Ethic Committee of Wuhan University of Medicine -number WHU 2021-YF001. Informed consent was signed by all participants at the time of inclusion. 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Also discoverable on Platform About Our Team In Review Editorial Policies 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-3257324","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":231569207,"identity":"1285a749-56c7-4aff-a109-986f133230fb","order_by":0,"name":"Yujia Chen","email":"","orcid":"","institution":"Wuhan University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yujia","middleName":"","lastName":"Chen","suffix":""},{"id":231569208,"identity":"fb3867fd-4028-4827-8afd-211beb63b59b","order_by":1,"name":"Jing Zhao","email":"","orcid":"","institution":"Wuhan University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jing","middleName":"","lastName":"Zhao","suffix":""},{"id":231569209,"identity":"0e335a03-a863-4920-8a32-39d2c87afec7","order_by":2,"name":"Jin Zheng","email":"","orcid":"","institution":"Hospital of Stomatology, Wuhan University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jin","middleName":"","lastName":"Zheng","suffix":""},{"id":231569210,"identity":"6fba3d11-a0a7-4be7-b68e-26a4987b0a81","order_by":3,"name":"Zhijie Zou","email":"","orcid":"","institution":"Wuhan University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zhijie","middleName":"","lastName":"Zou","suffix":""},{"id":231569211,"identity":"5a9b2813-cf23-4778-a8c0-0a793fa30ef8","order_by":4,"name":"Xiaoli Chen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAx0lEQVRIiWNgGAWjYBACfobDx39+MKjhYWNvIFKLZOOxBGmJimMy/DwHiNRicPiMggTPGWYbyRkJxNrSdobBQLKNjcfg5uONNxhqbKIJauHnOXsgobBNhsfgdlqxBcOxtNwGgrbMOJdwAGzL7RwzCcaGw4S1GNx/Y9jA28YMdNgZYrUcOGPMAPQ+j+QMHiK1SDYcS2MGBjIPPw/QLwnE+AUYlccYgVFpz8Z+eOONDzU2hLWgOFIigRTlEC2k6hgFo2AUjIKRAQC+qUBaauvOagAAAABJRU5ErkJggg==","orcid":"","institution":"Wuhan University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Xiaoli","middleName":"","lastName":"Chen","suffix":""}],"badges":[],"createdAt":"2023-08-12 06:14:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3257324/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3257324/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":43010145,"identity":"f1972b4d-cceb-4818-9990-dc0a008c2c9d","added_by":"auto","created_at":"2023-09-12 14:27:54","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":29470,"visible":true,"origin":"","legend":"\u003cp\u003eMediation model result.\u003c/p\u003e\n\u003cp\u003eStandard error in the parentheses and path coefficients are shown. Note, * P-value\u0026lt;0.05.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-3257324/v1/681c00909defbe7da82ba394.png"},{"id":44149178,"identity":"e81f627f-4bac-44e9-804c-402c81c90047","added_by":"auto","created_at":"2023-10-05 16:07:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":367467,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3257324/v1/99fd5e29-6dd1-441f-8947-3f44bc632431.pdf"},{"id":43010147,"identity":"919a70b9-ed70-47ae-afaa-64040db7a052","added_by":"auto","created_at":"2023-09-12 14:27:54","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":22495,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterials.docx","url":"https://assets-eu.researchsquare.com/files/rs-3257324/v1/91d7dcdbdedecf43d83441d6.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Relationship between fear of childbirth and oral health-related quality of life in pregnant women: the mediating effect of pregnancy anxiety","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eOral health is increasingly recognized as an important public health issue, especially among pregnant women\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Pregnant women are at higher risk of developing oral diseases due to physiological, hormonal, and dietary changes during pregnancy\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Studies found that the prevalence of periodontitis in pregnant women was 40%\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e, the prevalence of gingivitis in pregnant women was 88%\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e, and the incidence of dental caries in pregnant women was 74%\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Maternal periodontal disease increases the risk of adverse pregnancy outcomes such as preterm birth, low birth weight, and pre-eclampsia\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Meanwhile, poor maternal oral health has been linked to an increased risk of dental caries in children\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Although routine oral care during pregnancy is safe\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e, many pregnant women delay dental treatment due to their misunderstanding of the safety of oral treatment during pregnancy\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Studies show that 66.6% \u0026minus;\u0026thinsp;70.1% of women visit a dentist during non-pregnancy\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e, while 16%-83% visit a dentist during pregnancy\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003ePoor oral health during pregnancy is associated with poor oral health-related quality of life\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. Oral health-related quality of life is a concept generated by the application of health-related quality of life in the field of stomatology\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e, which reflects the comprehensive evaluation of the impact of oral diseases and their prevention and treatment on physiological, psychological and social functions, and reflects the impact of oral health on quality of life\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. Oral health-related quality of life is increasingly used as a substitute for clinical assessment of oral health surveillance. Contrary to normative clinical indicators, oral health-related quality of life aims to capture the broad consequences of poor oral health from different perspectives\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. Oral health-related quality of life can reflect patients' self-cognition of oral conditions, which in turn determines patients' treatment compliance\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. Therefore, oral health-related quality of life is an effective tool for assessing patients' treatment compliance. At the same time, oral health-related quality of life assessments can provide a better understanding of patient needs so that treatment plans can be adjusted and improved according to oral health-related quality of life\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. However, based on the subjectivity of oral health-related quality of life assessment, it may be affected by the psychological state of patients\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe mental health of childbearing women is a growing concern for society. Fear of childbirth is a common negative emotion among pregnant women, characterized by stress in the process of pregnancy and childbirth\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. The epidemic rate of fear of childbirth among pregnant women in China is 67.1%\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. Studies have shown that high fear of childbirth negatively correlates with quality of life\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. The oral health-related quality of life as a derivative concept of quality of life is unclear in the relationship with fear of childbirth. Studies have shown that fear of childbirth can predict anxiety in pregnant women\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e, and anxiety, another common negative emotion in pregnant women, can affect oral health-related quality of life\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. Therefore, this study aimed to assess the effect of fear of childbirth on oral health-related quality of life in pregnant women and to verify whether pregnancy anxiety mediates the relationship between fear of childbirth and oral health-related quality of life.\u003c/p\u003e"},{"header":"2. Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Participants\u003c/h2\u003e \u003cp\u003eBetween September 2022 and March 2023, 478 pregnant women were recruited in our ongoing perinatal women cohort at a grade A tertiary hospital in Wuhan, China\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. The inclusion criteria were: (1) Aged 18\u0026ndash;50 years; (2) Less than 14 weeks of gestation; (3) Planning to receive perinatal medicine examinations and delivery at the predetermined hospital; (4) Able to read and complete questionnaires in Chinese; (5) Having access to smartphone and internet. The exclusion criterion was: pregnant women who plan to leave the study area (Wuhan) for delivery or postpartum recuperation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Measurements\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e2.2.1 Independent variable\u003c/h2\u003e \u003cp\u003eFear of childbirth was the study\u0026rsquo;s independent variable. We use the fear of birth scale (FOBS) to measure the fear of childbirth in pregnant women. This scale was developed by Australian scholar Haines in 2011, with a Cronbach's Alpha of 0.91, showing strong internal consistency. It required participants to respond to the following question, \"How do you feel now about the upcoming birth\" with two 100mm scales ranging from 0 to 100, \"calm\" to \"worried,\" and \"no fear\" to \"intense fear\"\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e. The two questions' scores were averaged to obtain a fear of childbirth score, ranging from 0 to 100. The higher the score, the higher the degree of fear of childbirth, and the mean score of \u0026ge;\u0026thinsp;50 was rated as fear of childbirth. In this study, Cronbach's Alpha was 0.93.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.2.2 Mediator\u003c/h2\u003e \u003cp\u003ePregnancy-related anxiety was used as a mediator in this study. It was measured by a pregnancy-related anxiety questionnaire (PAQ). The questionnaire is compiled based on the characteristics of pregnant women in China, with a Cronbach's Alpha of 0.81\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e. The questionnaire has 13 items, including three dimensions: worry about fetal health, concern about oneself and worry about childbirth. The questionnaire used a four-point Likert scale ranging from 1 (never) to 4 (almost always), with scores ranging from 13 to 52. An overall score of \u0026ge;\u0026thinsp;24 indicates pregnancy-related anxiety. In this study, Cronbach's Alpha was 0.75.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.2.3 Dependent variable\u003c/h2\u003e \u003cp\u003eOral health-related quality of life was the study's dependent variable. Oral health impact profile-14 (OHIP-14) assesses oral health-related quality of life. Slade originally developed it in 1997 with a Cronbach's Alpha of 0.88\u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. The Chinese version of OHIP-14 was developed by Xin Weini et al. in 2006, and its Cronbach's Alpha was 0.93\u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e. There are 14 items in OHIP-14. The scale can be divided into four dimensions: functional limitation, pain and discomfort, psychological discomfort, and disability. The scale used a five-point Likert scale ranging from 0 (never) to 4 (very often) on a scale ranging from 0 to 56, with higher scores indicating poorer oral health-related quality of life. In this study, Cronbach's Alpha was 0.92.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e2.2.4 Control variables\u003c/h2\u003e \u003cp\u003eControl variables included the following components: sociodemographic information included age, nationality, place of residence, education, occupation, workload, and income; health behaviors included cigarette smoking, alcohol drinking, and caffeine intake; pregnancy-related information included gestational age, whether the pregnancy was planned, whether or not the pregnancy was taking folic acid, production experience, and nausea and vomiting; it also included intimate relationship, whether or not there was a history of depression and anxiety, whether or not they were living with their parents, and social networking site usage in the past week.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Data analysis\u003c/h2\u003e \u003cp\u003eSPSS was used to analyze the data. Missing values were filled with multiple interpolations. First, countable data were described by component ratio; the measurement data that conformed to normal distribution were represented by mean and standard deviation (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\stackrel{-}{X}\\)\u003c/span\u003e\u003c/span\u003e \u0026plusmn; S). Otherwise, they were described by median and quartile (M (Q1, Q3)). Second, the data fitted the normal distribution, the independent sample T-test was used for comparison between the two groups, and the analysis of variance was used for comparison between multiple groups; otherwise, the Mann-Whitney U test in the non-parametric test was used for comparison between the two groups, and the Kruskal Wallis H test was used for statistical inference between multiple groups. Third, Pearson's correlation was used to test the relationship between the corresponding variables. Then, multiple linear regression analysis was used to investigate the predictive effect of significant variables in univariate and correlation analyses on oral health-related quality of life. Finally, PROCESS software was used to model the structural equations and validated by the Bootstrap method, setting the sampling number to 5000. When 95% CI does not contain 0 in the middle, it indicates that the mediation effect is significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Descriptive analysis\u003c/h2\u003e \u003cp\u003eThe results of descriptive statistics are shown in Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e shows the demographic information of 478 pregnant women. The median age of the 478 pregnant women was 31 years, and the median gestational age was 22 weeks. The majority of pregnant women were Han (96.4%). 51.5% of pregnant women work less after pregnancy. 56.5% of pregnant women live with their parents. 81.6% of pregnant women had planned pregnancies. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the total score of OHIP-14 and the score on each dimension.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOverall scores and four different dimensional score of oral health-related quality.\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=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScales\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(\u0026plusmn;s)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOHIP-14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e7.70\u0026thinsp;\u0026plusmn;\u0026thinsp;9.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFunctional limitation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.64\u0026thinsp;\u0026plusmn;\u0026thinsp;2.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain and discomfort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.26\u0026thinsp;\u0026plusmn;\u0026thinsp;2.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychological discomfort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.75\u0026thinsp;\u0026plusmn;\u0026thinsp;2.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisablility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.06\u0026thinsp;\u0026plusmn;\u0026thinsp;3.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Univariate analysis\u003c/h2\u003e \u003cp\u003eThe results of the univariate analysis are shown in Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The results of categorical variables indicate statistical differences between nationality, changes in workload, intimacy between partners, whether they had ever suffered from depression or anxiety, social networking site usage in the past week, and whether the pregnancy was unplanned on the OHIP-14 score of pregnant women (Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e provides a correlation matrix for quantitative variables. Pearson correlation analysis showed a significant positive correlation between fear of childbirth and poorer oral health-related quality of life (r\u0026thinsp;=\u0026thinsp;0.183, P ＜ 0.01). Pregnancy anxiety was positively correlated with fear of childbirth (r\u0026thinsp;=\u0026thinsp;0.507, P ＜ 0.01) and poorer oral health-related quality of life (r\u0026thinsp;=\u0026thinsp;0.207, P ＜ 0.01).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIntercorrelations among the study variables\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=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOral health-related quality of life\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCurrent gestational age\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePregnancy anxiety\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFear of childbirth\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOral health-related quality of life\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.059\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent gestational age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePregnancy anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.207\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFear of childbirth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.183\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.069\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.507\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e*\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01,\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Mediating effect analyses\u003c/h2\u003e \u003cp\u003eThe results of multiple linear regression analysis with oral health-related quality of life as the dependent variable are presented in Table S2. The model without a mediator (pregnancy anxiety) showed that fear of childbirth was associated with poorer oral health-related quality of life. When including pregnancy anxiety in the model, the association between fear of childbirth and poorer oral health-related quality of life remained statistically significant. Pregnancy anxiety and fear of childbirth remained risk factors for oral health-related quality of life for pregnant women after adjusting for social networking site usage in the past week, intimate relationship, pregnancy workload, whether the pregnancy was unplanned, nationality, and presence of depression and anxiety.\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\u003eThe effects of fear of childbirth on oral health-related quality of life with pregnancy anxiety.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel pathways\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eS.E.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% C.I.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMediating effect\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal effect fear of childbirth\u0026rarr;oral health-related quality of life\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.033,0.097)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDirect effect fear of childbirth\u0026rarr;oral health-related quality of life\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.002,0.076)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e60%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndirect effect fear of childbirth\u0026rarr;pregnancy anxiety\u0026rarr;oral health-related quality of life\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.015,0.131)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eAll analyses were controlled for the workload and a history of anxiety or depression.\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\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the mediation path model. The path coefficients showed that all relationships in the model are significant. The direct effect of fear of childbirth on oral health-related quality of life remained significant after including the mediator of pregnancy anxiety. Thus, the association between fear of childbirth and oral health-related quality of life was achieved partly through the mediator. The total, direct, and indirect effects are described in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Specifically, the standardized effect of fear of childbirth on oral health-related quality of life through pregnancy anxiety was 0.072, with a mediating effect of 40%.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe oral health of pregnant women is a common problem. However, there are few existing studies on pregnant women's oral health-related quality of life. The study of oral health-related quality of life in pregnant women has practical significance for improving health. To the authors' knowledge, this is the first study to use a mediation model to examine the relationship between fear of childbirth and oral health-related quality of life in pregnant women. Overall, our findings suggest that fear of childbirth predicted poorer oral health-related quality of life in pregnant women and that the association between fear of childbirth and oral health-related quality of life is partially mediated by pregnancy anxiety. Thus, it reveals the relationship between mental health and oral health-related quality of life in pregnant women, suggesting that society should pay attention to the fear of childbirth and promote the physical health of pregnant women by regulating their poor psychological status.\u003c/p\u003e \u003cp\u003eHigher OHIP-14 scores indicate poorer oral health-related quality of life. The mean OHIP-14 score in this study (7.7) was similar to the mean OHIP-14 score of pregnant women in Shanghai (7.9), China and pregnant women in India (7.0)\u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e but was higher than the OHIP-14 score of pregnant women in Brazil (3.8)\u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e. This phenomenon may be caused by the fact that some women in China and India, influenced by traditional culture, believe that oral health care should be prohibited during pregnancy, which leads to the neglect of the oral health of women during pregnancy\u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e, and thus leads to the deviation of their oral health-related quality of life. The higher oral health-related quality of life among pregnant women in Brazil may be due to the support of the Brazilian government's \"Smiling Brazil\" policy, which promotes oral health in primary health care methods and encourages the addition of fluoride to the drinking water supply, since which Brazilian indicators of oral health have improved significantly\u003csup\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eA study has shown that fear of childbirth can predict poorer quality of life for women\u003csup\u003e[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]\u003c/sup\u003e. The results of our study indicated that fear of childbirth is a predictor of oral health-related quality of life. Specifically, women with a higher fear of childbirth had poorer oral health-related quality of life. There were two possible explanations for the relationship between fear of childbirth and oral health-related quality of life. Firstly, it has been shown that salivary and blood stress markers change when a person is under stress. Such markers are associated with inflammatory responses and the progression of periodontitis\u003csup\u003e[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]\u003c/sup\u003e. At the same time, stressful events reduce cell-mediated immune activity, leading to a decrease in body immunity and poor oral health\u003csup\u003e[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]\u003c/sup\u003e. Under the influence of fear of childbirth, childbirth may act as a stressor in pregnant women, and fear of childbirth may affect oral health-related quality of life through this mechanism. Secondly, because sugary foods induce hormonal release to reduce stress and increase pleasure, childbirth acts as a stressor that increases their desire for comfort foods\u003csup\u003e[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]\u003c/sup\u003e, making women during pregnancy more susceptible to oral health problems\u003csup\u003e[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn addition, this study also found a positive correlation between fear of childbirth and pregnancy anxiety, which is consistent with the results of previous studies\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]\u003c/sup\u003e. A study has shown that fear of childbirth can directly cause anxiety and indirectly cause anxiety through resilience\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. Meanwhile, this study found a positive correlation between pregnancy anxiety and poor oral health-related quality of life, and a previous study also showed that anxiety can cause poorer oral health-related quality of life in young women\u003csup\u003e[\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]\u003c/sup\u003e. It may be that pregnancy anxiety causes women to pay more attention to negative events during pregnancy, which causes them to amplify their oral health discomfort, thus resulting in poorer oral health-related quality of life. In addition, a study has shown that when the pressure rises, the frequency of brushing teeth will decrease\u003csup\u003e[\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]\u003c/sup\u003e. As a kind of stress, pregnancy anxiety may reduce the frequency of brushing teeth of pregnant women and thus lead to the reduction of oral health and quality of life of women.\u003c/p\u003e \u003cp\u003eMoreover, this study confirmed the indirect effect of fear of childbirth on oral health-related quality of life through pregnancy anxiety. The results showed that pregnancy anxiety partially mediated the relationship between fear of childbirth and oral health-related quality of life (β\u0026thinsp;=\u0026thinsp;0.072, SE\u0026thinsp;=\u0026thinsp;0.030, 95% CI (0.015, 0.131), and the indirect effect accounted for 40% of the total effect. These findings show a more comprehensive process in which fear of childbirth affects oral health-related quality of life and suggest that oral health-related quality of life is not only related to oral disease but also influenced by psychological status. Therefore, to improve the quality of life related to the oral health of pregnant women, we should pay attention to the mental health of pregnant women and oral health.\u003c/p\u003e"},{"header":"5. Limitations","content":"\u003cp\u003eThis study has several limitations. Firstly, as this is a cross-sectional survey, causal inference cannot be made based on the results. Future longitudinal studies can be conducted to address this issue and explore the potential mechanisms in more detail. Secondly, this study only discussed the oral health-related quality of life of pregnant women who underwent antenatal examination in Wuhan city. Since women in different economic level cities pay different attention to oral health, a larger sample survey nationwide is needed to confirm this result in the future.\u003c/p\u003e"},{"header":"6. Conclusion","content":"\u003cp\u003eThe study found that pregnancy anxiety mediates the relationship between fear of childbirth and oral health-related quality of life in pregnant women. This study provides a theoretical mechanism for the association between fear of childbirth and oral health-related quality of life of pregnant women and a new idea for improving the oral health-related quality of pregnant women. Psychological interventions for women with higher fear of childbirth directly improve oral health-related quality of life and indirectly improve oral health-related quality of life by alleviating pregnancy anxiety. The results of this study remind medical professionals to pay attention to women's mental health during pregnancy.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe appreciate the support of the Renmin Hospital of Wuhan University for our data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYujia Chen and Jing Zhao analyzed the data and completed the original draft. Xiaoli Chen, Zhijie Zou, and Jin Zheng provided research ideas and data as well as revised the article to form the final version of the manuscript. All authors reviewed the final version of the manuscript and approved the manuscript for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur research is supported by the National Social Science Foundation of China\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e(Project No. 21BSH073) to the author Xiaoli Chen.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets that support the conclusions of this study are all available in the article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study\u0026nbsp;was approved by the Research Ethic Committee of Wuhan University of Medicine -number WHU 2021-YF001. Informed consent was signed by all participants at the time of inclusion. All methods were carried out in accordance with relevant guidelines and regulations.\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\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGIL-MONTOYA J A, RIVERO-BLANCO T, LEON-RIOS X, EXPOSITO-RUIZ M, PEREZ-CASTILLO I, AGUILAR-CORDERO M J. Oral and general health conditions involved in periodontal status during pregnancy: a prospective cohort study. Arch Gynecol Obstet. 2022.\u003c/li\u003e\n\u003cli\u003eSILVA DE ARAUJO FIGUEIREDO C, GONCALVES CARVALHO ROSALEM C, COSTA CANTANHEDE A L, ABREU FONSECA THOMAZ E B, FONTOURA NOGUEIRA DA CRUZ M C. Systemic alterations and their oral manifestations in pregnant women. 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Associations among fear of childbirth, resilience and psychological distress in pregnant women: A response surface analysis and moderated mediation model. Front Psychiatry. 2022, 13: 1091042.\u003c/li\u003e\n\u003cli\u003eNATH S, LEWIS L N, BICK D, DEMILEW J, HOWARD L M. Mental health problems and fear of childbirth: A cohort study of women in an inner-city maternity service. Birth. 2021, 48(2): 230-41.\u003c/li\u003e\n\u003cli\u003eGOH V, HASSAN F W, BAHARIN B, ROSLI T I. Impact of psychological states on periodontitis severity and oral health-related quality of life. J Oral Sci. 2022, 64(1): 1-5.\u003c/li\u003e\n\u003cli\u003eHAJEK A, KONIG H H. Oral health-related quality of life, probable depression and probable anxiety: evidence from a representative survey in Germany. BMC Oral Health. 2022, 22(1): 9.\u003c/li\u003e\n\u003cli\u003eCHEN J, TIAN R, ZOU Z, WU J, ZHAO J, CHEN Y, et al. Longitudinal study of multidimensional factors influencing maternal and offspring health outcomes: a study protocol. BMC Pregnancy Childbirth. 2023, 23(1): 466.\u003c/li\u003e\n\u003cli\u003eHAINES H, PALLANT J F, KARLSTROM A, HILDINGSSON I. Cross-cultural comparison of levels of childbirth-related fear in an Australian and Swedish sample. Midwifery. 2011, 27(4): 560-7.\u003c/li\u003e\n\u003cli\u003eLI-MIN X, FANG-BIAO T, JING-LI Z J 中. Development and reliability evaluation of a pregnancy-related anxiety questionnaire. 2012, 28(3): 275-7.\u003c/li\u003e\n\u003cli\u003eSLADE G D. Derivation and validation of a short-form oral health impact profile. Community Dent Oral Epidemiol. 1997, 25(4): 284-90.\u003c/li\u003e\n\u003cli\u003eXIN W, LING J J Z K Q Y X Z Z Z K Y Z C J O S. Validation of a Chinese version of the oral health impact profile-14. 2006, 41(4): 242-5.\u003c/li\u003e\n\u003cli\u003eACHARYA S, BHAT P V. Oral-health-related quality of life during pregnancy. J Public Health Dent. 2009, 69(2): 74-7.\u003c/li\u003e\n\u003cli\u003eLAMARCA G A, LEAL MDO C, LEAO A T, SHEIHAM A, VETTORE M V. Oral health related quality of life in pregnant and post partum women in two social network domains; predominantly home-based and work-based networks. Health Qual Life Outcomes. 2012, 10: 5.\u003c/li\u003e\n\u003cli\u003eJAIN L, JUNEJA R, KANSAL R, KUMAR V. Prevalence of myths regarding oral health among pregnant women in North India. Int J Dent Hyg. 2021, 19(1): 127-34.\u003c/li\u003e\n\u003cli\u003eWU Y M, LIU J, SUN W L, CHEN L L, CHAI L G, XIAO X, et al. Periodontal status and associated risk factors among childbearing age women in Cixi City of China. J Zhejiang Univ Sci B. 2013, 14(3): 231-9.\u003c/li\u003e\n\u003cli\u003ePUCCA G A, JR., GABRIEL M, DE ARAUJO M E, DE ALMEIDA F C. Ten Years of a National Oral Health Policy in Brazil: Innovation, Boldness, and Numerous Challenges. J Dent Res. 2015, 94(10): 1333-7.\u003c/li\u003e\n\u003cli\u003eNASCIMENTO A C, MOYSES S T, WERNECK R I, MOYSES S J. Oral health in the context of primary care in Brazil. Int Dent J. 2013, 63(5): 237-43.\u003c/li\u003e\n\u003cli\u003eGRUNDSTROM H, MALMQUIST A, IVARSSON A, TORBJORNSSON E, WALZ M, NIEMINEN K. Fear of childbirth postpartum and its correlation with post-traumatic stress symptoms and quality of life among women with birth complications - a cross-sectional study. Arch Womens Ment Health. 2022, 25(2): 485-91.\u003c/li\u003e\n\u003cli\u003eAKCALI A, HUCK O, TENENBAUM H, DAVIDEAU J L, BUDUNELI N. Periodontal diseases and stress: a brief review. J Oral Rehabil. 2013, 40(1): 60-8.\u003c/li\u003e\n\u003cli\u003eIRWIN M, PATTERSON T, SMITH T L, CALDWELL C, BROWN S A, GILLIN J C, et al. Reduction of immune function in life stress and depression. Biol Psychiatry. 1990, 27(1): 22-30.\u003c/li\u003e\n\u003cli\u003eJACQUES A, CHAAYA N, BEECHER K, ALI S A, BELMER A, BARTLETT S. The impact of sugar consumption on stress driven, emotional and addictive behaviors. Neurosci Biobehav Rev. 2019, 103: 178-99.\u003c/li\u003e\n\u003cli\u003eLIU L, MA F, LIU Q, YU X, ZENG X. Association Between the SLC2A2 Gene rs1499821 Polymorphism and Caries Susceptibility. Genet Test Mol Biomarkers. 2023, 27(5): 149-56.\u003c/li\u003e\n\u003cli\u003eHALL W A, HAUCK Y L, CARTY E M, HUTTON E K, FENWICK J, STOLL K. Childbirth fear, anxiety, fatigue, and sleep deprivation in pregnant women. J Obstet Gynecol Neonatal Nurs. 2009, 38(5): 567-76.\u003c/li\u003e\n\u003cli\u003eCOSTA F S, CADEMARTORI M G, SILVA M F, NASCIMENTO G G, SHQAIR A Q, PINHEIRO R T, et al. Anxiety symptoms have a direct effect on oral health perception in young women. Qual Life Res. 2018, 27(6): 1583-8.\u003c/li\u003e\n\u003cli\u003eROSANIA A E, LOW K G, MCCORMICK C M, ROSANIA D A. Stress, depression, cortisol, and periodontal disease. J Periodontol. 2009, 80(2): 260-6.\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, mediating effect, fear of childbirth, oral health-related quality of life, pregnancy anxiety","lastPublishedDoi":"10.21203/rs.3.rs-3257324/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3257324/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eOral health is an important public health issue. Many studies have explored the relationship between mental health and oral health-related quality of life. However, no studies have explored the relationship between fear of childbirth and oral health-related quality of life in pregnant women. However, several studies have shown that pregnancy anxiety is associated with fear of childbirth and oral health-related quality of life. This study aimed to investigate the relationship between fear of childbirth and pregnant women's oral health-related quality of life and explore the mediating role of pregnancy anxiety.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study is a cross-sectional design. The cross-sectional data from 478 pregnant women were included. A descriptive analysis was conducted to describe the sample characteristics. Multiple linear regressions were used to evaluate the relationship between fear of childbirth and oral health-related quality of life. PROCESS software was used to analyze the mediating effect of pregnancy anxiety.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA significant direct effect between fear of childbirth and oral health-related quality of life has been indicated (β\u0026thinsp;=\u0026thinsp;0.107, SE\u0026thinsp;=\u0026thinsp;0.019, 95% CI (0.002,0.076)), and the direct effect accounted for 60% of the total effect. Pregnancy anxiety partially mediated between fear of childbirth and oral health-related quality of life (β\u0026thinsp;=\u0026thinsp;0.072, SE\u0026thinsp;=\u0026thinsp;0.030, 95% CI (0.015, 0.131)), and the indirect effect accounted for 40% of the total effect.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003ePregnancy anxiety mediates the relationship between fear of childbirth and oral health-related quality of life in pregnant women. Therefore, attention should be paid to maternal fear of childbirth and pregnancy anxiety to improve pregnant women's oral health-related quality of life.\u003c/p\u003e","manuscriptTitle":"Relationship between fear of childbirth and oral health-related quality of life in pregnant women: the mediating effect of pregnancy anxiety","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-09-12 14:27:49","doi":"10.21203/rs.3.rs-3257324/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":"b9f5d9e1-3fa9-48e4-93ab-bc150302f4a9","owner":[],"postedDate":"September 12th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-10-05T15:59:23+00:00","versionOfRecord":[],"versionCreatedAt":"2023-09-12 14:27:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3257324","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3257324","identity":"rs-3257324","version":["v1"]},"buildId":"oE6Zbj460LM0Up2FdVbMZ","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}