Dual Mediation of Body Image Effects on Antenatal Depression in Late Pregnancy: Negative Rumination as the Dominant Pathway

Dual Mediation of Body Image Effects on Antenatal Depression in Late Pregnancy: Negative Rumination as the Dominant Pathway | 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 Dual Mediation of Body Image Effects on Antenatal Depression in Late Pregnancy: Negative Rumination as the Dominant Pathway Rufang Zhou, Qianzhi Lin, Xiuyun Cao, Jingjing Liu, Youjing Kong, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7975090/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Antenatal depression represents a significant public health concern, with body image disturbances identified as a prominent risk factor during pregnancy. However, the specific cognitive mechanisms, particularly the distinct roles of positive and negative rumination, underlying the relationship between body image and antenatal depression remain inadequately explored. This study aimed to investigate the associations between maternal body image, rumination subtypes, and antenatal depression, and to examine the parallel mediating roles of positive and negative rumination in late pregnancy. Methods A cross-sectional study recruited 288 women (gestational age ≥ 28 weeks) from a tertiary hospital in Guangzhou, China. Participants completed validated scales: the Body Image in Pregnancy Scale (BIPS), Positive and Negative Rumination Scale (PANRS), and Edinburgh Postnatal Depression Scale (EPDS). Pearson correlations assessed bivariate associations. Bootstrapped parallel mediation analysis (5,000 resamples) evaluated direct and indirect effects using structural equation modeling. Results Body image correlated positively with antenatal depression severity ( r = 0.37, P < 0.001) and negative rumination ( r = 0.36, P < 0.001), but negatively with positive rumination ( r = − 0.21, P < 0.001). Body image exerted a significant total effect on antenatal depression ( β = 0.12, 95% CI [0.09, 0.16]). Rumination subtypes jointly mediated 53.63% of this effect. Negative rumination demonstrated dominant mediation (indirect β = 0.05, 95% CI [0.03, 0.07]; proportion: 41.05%), significantly exceeding positive rumination (indirect β = 0.02, 95% CI [0.004, 0.03]; proportion: 12.66%; ratio = 3.24:1). The direct effect remained significant ( β = 0.06, 95% CI [0.02, 0.09]). Conclusion Negative body image elevates antenatal depression risk primarily by amplifying negative rumination while concurrently suppressing protective positive rumination. These findings validate objectification theory in pregnancy and underscore rumination’s dual-dimensional mediation. Antenatal interventions should integrate cognitive restructuring to mitigate maladaptive body-related cognitions and enhance positive reappraisal of gestational changes. Antenatal depression Body image Rumination Mediation analysis Objectification theory Figures Figure 1 1. Background Antenatal depression, a prevalent psychological disorder during pregnancy, is characterized by symptoms including low mood, anxiety, fear, diminished self-esteem, and feelings of meaninglessness and hopelessness (Khanghah et al., 2020 ). A meta-analysis indicated a substantial global prevalence of antenatal depressive symptoms, estimated at 20.7% (Yin et al., 2021 ). In China, the prevalence is similarly high at 19.7%, with studies reported a significant increase over the past decade (Nisar et al., 2020 ). These findings underscore antenatal depression as a pressing public health priority in China. Antenatal depression involves a complex interplay of sociological, biological, and cognitive psychological factors (Kaiyo-Utete et al., 2020 ; Osborne et al., 2020 ). For mothers, antenatal depression is associated with an increased risk of preeclampsia, suicidal ideation, and postpartum depression (Minschart et al., 2021 ; Tabb et al., 2023 ). For offspring, antenatal depression is linked to adverse birth outcomes, including preterm birth and low Apgar scores (Wang et al., 2024 ; Zhang et al., 2023 ), as well as poorer long-term developmental outcomes. These encompass deficits in socio-emotional, cognitive, language, motor, and adaptive behavioral development, extending from infancy through childhood and adolescence (Rogers et al., 2020 ). Sociocultural pressures, particularly the media-perpetuated aesthetic ideal equating thinness with beauty, are pervasive. This promotes unrealistic expectations and fosters cognitive biases toward non-conforming body features, contributing to the development of body image disturbance, also negative body image (Cinaroglu & Yilmazer, 2025 ; Cohen et al., 2019 ). Body image disturbance manifests as negative emotional states, including anxiety, depression, and feelings of inferiority (Linardon et al., 2023 ; White et al., 2024 ). In severe cases, it may progress to eating disorders, such as anorexia nervosa (Gutierrez & Carrera, 2016 ). Pregnancy constitutes a distinct period characterized by profound physiological and psychosocial transitions. Fetal growth necessitates significant anatomical adaptations in pregnant women, affecting structures including the uterus, breasts, and skin. These physical transformations become particularly pronounced during late gestation as fetal development accelerates (Cattani et al., 2024 ). Concurrently, women navigate an impending shift in social roles. The confluence of rapid bodily changes diverging from pre-pregnancy ideals and the psychological adaptation to motherhood can precipitate negative body image perceptions (Andrews et al., 2018 ). Extensive research underscores maternal body image disturbance as a critical factor impairing psychological well-being and quality of life during pregnancy. Affected women exhibit a significantly elevated risk of depression (Riquin et al., 2019 ). Furthermore, body imge disturbance is associated with disordered eating behaviors and maladaptive weight control practices (Barnhart et al., 2024 ). Given the fetus’s complete nutritional dependence on the mother, antenatal body image disturbance may increase risks of inadequate gestational weight gain, preterm birth, and adverse pregnancy outcomes (Shen et al., 2024 ). Consequently, body image disturbance poses substantial threats to perinatal health, highlighting the need for targeted interventions to mitigate its effects and optimize long-term maternal-infant health trajectories. Cognitive psychology conceptualizes rumination as a maladaptive cognitive style characterized by persistent, passive preoccupation with and uncontrollable recurrence of negative thoughts, recognized as a risk factor for depression (Nolen-Hoeksema, 2000 ). While Nolen-Hoeksema’s seminal definition emphasizes its dysfunctional nature, contemporary research posits that rumination may also exhibit adaptive functions. Feldman et al. pioneered the construct of positive ruminative thinking (Feldman et al., 2008 ), and subsequent empirical work by Chinese scholars has further delineated context-dependent manifestations of both positive and negative ruminative subtypes across emotional valences (Yang et al., 2020 ). This theoretical expansion facilitates multidimensional investigation of ruminative processes and their cognitive-affective mechanisms. According to objectification theory (Barbara L. Fredrickson, 1997 ), sociocultural pressures during pregnancy may prompt women to allocate excessive cognitive resources toward appearance monitoring. This self-objectifying tendency is theorized to impair mental health, with rumination posited as a critical mediator (Huang, 2008 ). Despite these advances, no prior study has explicitly investigated the differential roles of positive and negative rumination in the association between maternal body image disturbance and antenatal depression. This study bridges objectification theory and dual-dimensional rumination framework, we therefore hypothesize that: H1 Negative rumination exacerbates the association between maternal body image disturbances and antenatal depression during late pregnancy. This amplification likely occurs through an intensified focus on socially prescribed maternal body standards, thereby reinforcing a sequential pathway involving self-objectification, heightened appearance monitoring, and subsequent depression. (Laifer et al., 2023 ). H2 Conversely, positive rumination, characterized by adaptive acceptance of gestational bodily changes (Roomruangwong et al., 2017 ), will attenuate the impact of body image on antenatal depression. This protective effect is hypothesized to arise through cognitive reappraisal mechanisms that reduce maladaptive rumination through constructive self-referential processing (van der Velden et al., 2023 ). 2. Methods 2.1 Aims 2.1. 1 To quantify bivariate correlations among maternal body image, rumination subtypes (positive and negative), and antenatal depression symptomatology. 2.1.2 To validate a conceptual mediation framework wherein rumination mediates the association between maternal body image and antenatal depression symptomatology, employing bootstrapped structural equation modeling (SEM). 2.2. Study Design and Participants This study adopted a cross-sectional study design, which followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines (Appendix A). A convenience sample of 288 women in late pregnancy (gestational age ≥ 28 weeks) was recruited from the Department of Obstetrics at a tertiary care hospital in Guangzhou, China, between November 2024 and April 2025. Inclusion criteria comprised: (1) gestational age ≥ 28 weeks; (2) proficiency in Mandarin communication and literacy; and (3) provision of written informed consent. Exclusion criteria included: (1) history of psychiatric disorders or current psychotic disorders; (2) severe physical illness precluding valid questionnaire completion. Sample size determination followed Kline's methodological recommendations (Kline, 2016 ), which require 5 ~ 10 participants per scale item Based on the Edinburgh Postnatal Depression Scale (EPDS) as the primary measure, a total sample size of 125 cases (10 items × 10 participants per item + 20% attrition buffer) was required for this study. Ultimately, a total of 321 questionnaires were distributed. After excluding 33 invalid responses (15 due to indications of random responding and 18 due to incompleteness), 288 valid questionnaires were retained, yielding an effective response rate of 89.72%. 2.3. Data Collection The assessment instruments comprised a general information questionnaire, the Body Image in Pregnancy Scale (BIPS), the Edinburgh Postnatal Depression Scale (EPDS), and the Positive and Negative Rumination Scale (PANRS). Data collection was conducted during routine antenatal visits in the hospital’s obstetrics clinics. Trained research assistants, operating under departmental approval and following standardized protocols, administered the questionnaires on-site. After obtaining written informed consent, participants received a standardized verbal explanation outlining the study purpose, anonymity and confidentiality guarantees, and completion procedures. Research staff remained available throughout the process to clarify instructions and address participant queries. Participants completed the questionnaires independently. Upon completion, questionnaires were collected immediately and examined for missing responses, ambiguities, or errors. Any identified issues were resolved through direct clarification with the participant prior to final submission to ensure data validity and completeness. 2.4. Measuring Instruments 2.4.1. Socio-demographic characteristics The general information questionnaire encompassed variables such as age, height, weight, gestational week, education, per capita monthly income. 2.4.2. Body Image in Pregnancy Scale (BIPS) Originally developed by Watson et al. to assess pregnancy-specific body image characteristics (Watson et al., 2017 ), the Body Image in Pregnancy Scale (BIPS) provides a comprehensive evaluation of this construct. The Chinese version comprises 35 items across 9 dimensions, rated on a 5-point Likert scale (Sun, 2019 ). Higher total scores indicate more negative body image evaluations. In the present study, the scale demonstrated excellent internal consistency (Cronbach’s α = 0.898). 2.4.3. The Positive and Negative Rumination Scale (PANRS) The Positive and Negative Rumination Scale (PANRS), developed by Yang et al., comprises two subscales: the Positive Rumination Scale and the Negative Rumination Scale (Yang et al., 2020 ). Items are rated on a 4-point Likert scale ranging from 1 (never) to 4 (always), with higher scores indicating higher levels of rumination (Zhang et al., 2019 ). In the present study, the subscales demonstrated acceptable internal consistency (Cronbach’s α = 0.708 for positive rumination; α = 0.794 for negative rumination). 2.4.4. Edinburgh Postnatal Depression Scale (EPDS) The EPDS was originally developed by Cox et al. as a 10-item self-report instrument designed to screen for perinatal depressive symptoms. Each item is scored on a 4-point Likert scale (0 to 3), with higher total scores indicating greater severity of depressive symptoms (Cox et al., 1987 ). This scale has demonstrated robust psychometric properties, including high reliability, sensitivity, and specificity in detecting antenatal depression (Kozinszky & Dudas, 2015 ). In the current study, the Cronbach's α coefficient for the EPDS reached 0.870, confirming excellent internal consistency for antenatal depression assessment. 2.5. Ethical Considerations Ethical approval for this study was granted by the Ethics Committee of Southern Medical University (Approval No: SMUREC-2024-101). All participants provided written informed consent prior to enrollment, affirming their voluntary participation, right to withdraw at any time without penalty, and guaranteed data confidentiality. 2.6. Statistical Analysis The data, processed using SPSS 27.0 statistical software, contained no outliers or missing values. The normality of the data was assessed using P-P and Q-Q plots. Results indicated that the variables of body image, positive rumination, negative rumination and antenatal depression all followed a normal distribution. Continuous data were described using means and standard deviations, whereas categorical data were summarized by frequencies and percentages. Given this data followed a normal distribution, Pearson correlation analysis was employed to evaluate the relationships between body image, positive rumination, negative rumination and antenatal depression among pregnant women in late pregnancy. To explore the mediating effect of positive rumination and negative rumination between body image and antenatal depression, we used the PROCESS plugin in SPSS for analysis. The model was set to employ the bootstrap method for testing, which is a robust technique for assessing the significance of indirect effects in mediation analysis. All statistical analyses were conducted using a two-sided test, and differences were deemed statistically significant at P < 0.05. 3. Results 3.1. Common Method Variance Test (CMV) Since the data were collected from the participants’ self reports, there is a possibility of common method bias. Harman’s single-factor test method was used to check the common method bias in the data. All items were loaded into an exploratory factor analysis to examine the unrotated factor structure. Factor analysis revealed 16 factors with eigenvalues exceeding 1.0. The first factor accounted for 19.70% of the variance, which is below the threshold of 40%, indicating no substantial common method bias in this study. 3.2. General Information The final sample comprised 288 women in late pregnancy, with the following characteristics (presented as mean (SD)) (Table 1): age = 30.43 (4.19) years, height = 159.09 (5.18) cm, weight = 65.29 (9.99) kg, and gestational age = 34.66 (2.51) weeks. Educational attainment distribution was: college degree or higher (44.79%, n = 129), high school completion (47.57%, n =137), and secondary school or lower (7.64%, n = 22). Most participants resided in urban areas (88.19%, n = 254), while 11.81% (n = 34) were from rural areas. Per capita monthly income distribution was: below 2,000 yuan (0.35%, n = 1), 2,000-4,999 yuan (10.07%, n = 29), 5,000-10,000 (40.97%, n =29), and more than 10,000 yuan (48.61%, n =140) 3.3. Scores of Body Image, Positive Rumination, Negative Rumination and Antenatal Depression in Late-Pregnancy Women . Among the included participants, the scores averaged as follows (presented as mean (SD)): body image = 92.44 (15.18), positive rumination = 8.23 (5.06), negative rumination = 25.43 (5.23), and antenatal depression = 18.97 (4.94). Detailed results are presented in Table 1. 3.4. Pearson Correlation among the Body Image, Positive Rumination, Negative Rumination and Antenatal Depression in Late-Pregnancy Women. Pearson correlation analysis indicated significant associations among the variables (all P <0.001). Body image demonstrated a negative correlation with positive rumination, but positive correlations with both negative rumination and antenatal depression. Positive rumination was inversely associated with negative rumination and antenatal depression. Negative rumination showed a positive correlation with antenatal depression. Complete correlation coefficients (r) are detailed in Table 2. 3.5. The Mediating Roles of Positive and Negative Rumination in the Association Between Body Image and Antenatal Depression in Late-Pregnancy Women. The mediating roles of positive and negative rumination in the association between body image and antenatal depression were examined using bias-corrected bootstrapping with 5,000 resamples. Statistical significance was determined when the 95% confidence intervals ( CIs ) excluded zero. Results of the mediation analyses are presented in Table 3, Table 4, and Figure 1. Regression analyses (Table 3; Figure 1) revealed that body image directly predicted rumination patterns: it negatively influenced positive rumination ( β = -0.21, P <0.001) and positively influenced negative rumination ( β = 0.36, P <0.001). Crucially, antenatal depression was jointly predicted by these variables, with body image exhibiting a significant direct positive effect ( β = 0.17, P <0.001), while positive rumination showed a negative effect ( β = -0.22, P <0.001) and negative rumination demonstrated a strong positive effect ( β = 0.42, P <0.001). Parallel mediation analysis (Table 4) demonstrated significant effects of maternal body image on antenatal depression, with a total effect of β = 0.12 (95% CI [0.09, 0.16]). After controlling for rumination, the direct effect remained significant ( β = 0.06, 95% CI [0.02, 0.09]), accounting for 46.37% of the total effect. Crucially, 53.63% of the effect was mediated through dual pathways: Path 1 (body image → positive rumination → antenatal depression) contributed 12.66% ( β = 0.02, 95% CI [0.004, 0.03]), while Path 2 (body image → negative rumination → antenatal depression) contributed 41.05% ( β = 0.05, 95% CI [0.03, 0.07]). The negative rumination pathway constituted the dominant mechanism, exhibiting 3.24 times greater mediation than the positive rumination pathway (41.05% vs. 12.66%). 4. Discussion 4.1. Main Findings and Theoretical Contributions This study investigated the levels and interrelationships of body image, rumination (incorporating positive and negative dimensions), and antenatal depression among women in late pregnancy. Results demonstrated a significant positive association between negative body image and antenatal depression, with rumination functioning as parallel mediators. Crucially, negative rumination exhibited a substantially stronger mediating effect than positive rumination, approximately 3.24 times greater. These findings advance theoretical understanding of perinatal mental health by quantifying distinct cognitive pathways linking body perception to depression and establishing negative rumination as the dominant mechanistic pathway. We confirmed a significant positive correlation between negative body image appraisal and antenatal depression severity in late-pregnancy women: heightened body dissatisfaction predicted elevated depressive symptoms. This finding aligns with Riquin et al.’s report of body dissatisfaction increasing depression risk and substantiates Shen et al.'s assertion that gestational body image disturbance threatens maternal-infant mental health (Riquin et al., 2019 ; Shen et al., 2024 ). Physiologically, late pregnancy involves accelerated fetal development driving pronounced somatic changes: rapid abdominal expansion with striae formation, breast hypertrophy, and substantial weight gain (Cattani et al., 2024 ). These alterations disrupt pre-pregnancy cognitive equilibrium, triggering identity conflicts during the transition to motherhood. Socioculturally, pervasive “thin-ideal” norms and media-portrayed body expectations (Cohen et al., 2019 ; Rodgers & Nowicki, 2024 ) foster maladaptive self-monitoring behaviors (e.g., obsessive pre-pregnancy photo comparisons, weight-gain preoccupation)(Laifer et al., 2023 ). This objectification process, wherein the sociocultural emphasis on physical appearance is internalized into persistent self-surveillance, elucidates how the linkages between body image and depression extend beyond individual psychological factors to encompass broader biopsychosocial interactions. (Barbara L. Fredrickson, 1997 ). Mediation analyses revealed that rumination functioned as a significant parallel mediator in the body image-antenatal depression relationship, with markedly divergent effect magnitudes between negative and positive rumination pathways. The negative rumination pathway accounted for 41.05% of the total effect, substantially exceeding the positive rumination pathway (12.66%; ratio = 3.24:1). Specifically, negative body appraisal elevated depression risk through dual mechanisms: (1) Maladaptive cognitive activation : Negative body image potentiated negative rumination, manifesting as perseverative cognitions regarding body distortion, perceived aesthetic deviation, and attractiveness loss (Laifer et al., 2023 ). This process initiates a self-sustaining cycle in which body dissatisfaction promotes compulsive self-criticism, which in turn leads to the exacerbation of depressive symptoms. (2) Adaptive cognitive suppression : Negative body evaluation concurrently inhibited positive rumination (Yang et al., 2020 ), causing pregnant women to neglect the adaptive value of gestational physiological changes, including uterine fetal protection, placental nutrient transfer, and somatic transformations as life-nurturing symbols—thereby forfeiting emotion-regulatory opportunities through positive reappraisal (Zhang et al., 2019 ). These mechanisms demonstrate cross-population consistency with non-pregnant and clinical cohorts (Pehlivan et al., 2022 ; Rifkin et al., 2021 ), suggesting transdiagnostic cognitive-emotional pathways linking physical perception and psychopathology. Therefore, these findings necessitate interventions simultaneously targeting negative rumination reduction and positive reappraisal training, particularly through cognitive restructuring techniques focusing on gestational body image functionality appreciation. This discovery substantiates the premise of objectification theory, which posits that sociocultural norms disciplining female bodies, including implicit expectations for mothers to concurrently fulfill aesthetic and reproductive roles, become internalized as self-objectification during pregnancy. Crucially, rumination represents the cognitive manifestation of this internalization, wherein persistent focus on physical imperfections enables maladaptive self-monitoring. This establishes a pathological pathway from self-objectification through negative rumination to depression (Huang, 2008 ; Laifer et al., 2023 ). More significantly, our findings challenge the reductive conceptualization of rumination as solely maladaptive (Nolen-Hoeksema, 2000 ), instead validating Feldman et al.'s proposition that active rumination serves emotion-regulatory functions (Feldman et al., 2008 ). For the first time in a late-pregnancy population, we confirm the coexistence of positive rumination's protective capacity alongside negative rumination's detrimental effects. This corroborates Yang et al.'s dual-dimensional rumination framework (Yang et al., 2020 ), while providing novel empirical evidence that differential cognitive processing constitutes critical regulatory nodes determining whether body image perception translates into depression risk during gestational adaptation. 4.2. Relevance for Clinical Practice These findings hold significant implications for developing antenatal mental health interventions. Effective strategies should concurrently target body image reconstruction and rumination regulation through dual pathways. For body image reframing, interventions must integrate sociocultural deconstruction with health education to shift focus from aesthetic preoccupation toward appreciation of the body's reproductive functionality. A systematic elucidation of how somatic changes, including those facilitating uterine protection and placental nutrient transfer, support fetal development may contribute to challenging socially constructed beauty standards in antenatal education. This approach operationalizes objectification theory's “de-objectification” principle(Barbara L. Fredrickson, 1997 ), reducing self-objectification tendencies that amplify negative body appraisal. For rumination regulation, cognitive restructuring techniques (CBT) should disrupt maladaptive cycles linking body dissatisfaction to self-denial (Tulbure et al., 2025 ; Zeng et al., 2025 ). Furthermore, mindfulness-based interventions derived from Feldman's framework on positive rumination promote intentional awareness of adaptive gestational changes, such as breast hypertrophy that supports lactation, which in turn enhances the protective role of positive rumination. (Reangsing et al., 2024 ; van der Velden et al., 2023 ). This integrated model interrupts the progressive pathological sequence from body dissatisfaction to negative rumination and subsequently to antenatal depression, thereby enhancing psychological outcomes throughout the perinatal period. 4.3. Limitations Several limitations warrant consideration. Firstly, the cross-sectional design precludes definitive causal inferences regarding the temporal sequence from negative body image to rumination and depression; prospective cohort studies are needed to elucidate dynamic mechanisms. Secondly, sampling exclusively from a tertiary hospital in Guangzhou, where rural residents constituted only 11.81%, may introduce medical-accessibility bias, limiting generalizability to underserved populations and necessitating cautious interpretation. Thirdly, an exclusive dependence on self-reported measures may introduce response biases, such as social desirability effects. Subsequent studies would benefit from incorporating physiological indicators, including cortisol levels, along with observer-rated instruments. Finally, unexamined moderating factors, such as social support and marital dynamics, could potentially influence the observed relationships, highlighting the need for multivariate models to further refine theoretical frameworks. 4.4. Directions for Future Research Based on these findings, future research should prioritize prospective cohort designs to clarify the causal relationships linking body image, rumination, and depression throughout the perinatal period, spanning from late pregnancy to the postpartum stage. Furthermore, expanding the diversity of samples through multi-regional recruitment that covers a range of socioeconomic backgrounds, and including partners’ assessments of maternal embodiment, would significantly enhance the understanding of dyadic social influences on psychological adjustment. Finally, the development of targeted interventions, such as mindfulness-based protocols for rumination regulation, along with empirical validation of their efficacy in promoting appreciation of body functionality and reducing the risk of depression, will help establish more robust evidence-based frameworks for perinatal mental health care. 5. Conclusions This study investigated the interrelationships among body image, rumination, and antenatal depression in third-trimester pregnant women. Key findings revealed that negative body image significantly predicted increased antenatal depression levels, with rumination functioning as parallel mediators. Crucially, the negative rumination pathway demonstrated dominant mediation, while negative body appraisal simultaneously suppressed positive rumination's protective capacity. These results validate objectification theory's applicability to pregnancy by demonstrating how sociocultural pressures become internalized as self-objectification, clarify rumination's dual-dimensional attributes, and address prior oversimplification of rumination as unidimensional. Practically, antenatal interventions should incorporate cognitive restructuring techniques that foster body functionality appreciation and implement dual-pathway rumination regulation. Study limitations include cross-sectional design constraints and regional sampling limitations; future research should employ prospective cohorts and multi-site validation to optimize perinatal mental health interventions. Abbreviations BIPS Body Image in Pregnancy Scale EPDS Edinburgh Postnatal Depression Scale PANRS The Positive and Negative Rumination Scale CI Confidence Interval SD Standard Deviation​​ CMV Common Method Variance Test Declarations Ethics Approval Statement: Ethical approval for this study was granted by the Ethics Committee of Southern Medical University (Approval No: SMUREC-2024-101). All participants provided written informed consent prior to enrollment, affirming their voluntary participation, right to withdraw at any time without penalty, and guaranteed data confidentiality. Consent for Publication Statement: All participants who participated in the study consented to the publication of the article. Availability of data and materials The individual-level data from this cross-sectional study are not publicly available to protect participant confidentiality but are available from the corresponding author on reasonable request. Competing interests The authors have no financial conflict of interests related to the work described in the paper. Funding This work was supported by the National Natural Science Foundation of China [72274090，72574096，71874075 ]; Undergraduate Innovation and Entrepreneurship Training Program [S202412121164]；Guangdong Province Graduate Education Innovation Program Project [2025KCJS_022]; Guangdong Provincial Higher Education Research Projects [25GZD007]. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results. Authors' contributions All authors have agreed with the content of the manuscript and contributed to the work as follows: Supervision (Study design): Yu Chen * Investigation: Rufang Zhou, Qianzhi Lin, Xiuyun Cao, Jingjing Liu Methodology：Rufang Zhou, Qianzhi Lin, Youjing Kong Formal analysis: Rufang Zhou, Qianzhi Lin, Xiuyun Cao, Xingxing Liu Writing (original draft): Rufang Zhou Acknowledgements We would like to thank all the researchers who participated in this study, express our sincere gratitude to all the researchers who gave their time and knowledge to this study. Most of all, we would like to extend our sincere gratitude to all the pregnant women who willingly participated in this study, and we wish them and their babies every happiness in life. References Andrews B, Hill B, Skouteris H. The relationship between antenatal body attitudes, pre-pregnancy body mass index, and gestational weight gain [Journal Article]. 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Tables Table 1 Characteristics of Late-Pregnancy (N = 288) Characteristics n(%)/Means(SD) Age 30.43(4.18) Height 159.09(5.18) Weight 65.29(9.99) Gestational week 34.66(2.51) Education college degree or higher 129(44.79%) High school 137(47.57%) Secondary school or lower 22(7.64%) Residence Urban areas 254(88.19%) Rural areas 34(11.81%) Per capita monthly income below 2000 yuan 1(0.35%) 2000-4999 yuan 29(10.07%) 5000-10000 yuan 118(40.97%) more than 10000 yuan 140(48.61%) Body image 92.44(15.18) Positive rumination 8.23(5.06) Negative rumination 25.43(5.23) Antenatal depression 18.97(4.94) Table 2 Correlation analysis of body image, positive rumination and negative rumination, antenatal depression in late-pregnancy . Body image Positive rumination Negative rumination Antenatal depression Body image 1.00 Positive rumination -0.21* 1.00 Negative rumination 0.36* -0.22* 1.00 Antenatal depression 0.37* -0.35* 0.53* 1.00 * P ＜0.001 was considered statistically signifcant. Table 3 Parallel mediation model analysis of body image, positive rumination, negative rumination and antenatal depression in late-pregnancy . Regression equation Overall Fitting Index Significance of Regression Coefficient Outcome variable Predictors R R 2 F β LLCI ULCI t Positive rumination Body image 0.21 0.05 13.65 -0.21 -0.11 -0.03 -3.69* Negative rumination Body image 0.36 0.13 42.52 0.36 0.08 0.15 6.52* Antenatal depression Body image 0.60 0.37 54.57 0.17 0.02 0.09 3.368* Positive rumination -0.22 -0.31 -0.12 -4.48* Negative rumination 0.42 0.33 0.54 8.24* * P ＜0.001 was considered statistically signifcant. Table 4 Parallel mediating effect analysis of the positive rumination and negative rumination between body image and antenatal depression in late-pregnancy. Effect Paths Boot std Std. Estimate Bootstrap 95% CI Estimate Total effect / 0.12 0.02 0.09, 0.16 Total Indirect effect / 0.07 0.01 0.05, 0.09 53.63% Direct effect Body image→Antenatal depression 0.06 0.02 0.02, 0.09 46.37% Indirect effect 1 Body image→Positive rumination→Antenatal depression 0.02 0.01 0.004, 0.03 12.66% Indirect effect 2 Body image→Negative rumination→Antenatal depression 0.05 0.01 0.03, 0.07 41.05% Additional Declarations No competing interests reported. Supplementary Files AppendixA.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 30 Nov, 2025 Editor invited by journal 03 Nov, 2025 Editor assigned by journal 29 Oct, 2025 Submission checks completed at journal 29 Oct, 2025 First submitted to journal 28 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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11:36:25","extension":"html","order_by":19,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":171015,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7975090/v1/ff7b332d0adcbdc43948a271.html"},{"id":97343071,"identity":"09aa38ac-3751-4596-95d9-f3bb1ed35d7f","added_by":"auto","created_at":"2025-12-03 11:36:24","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":26450,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA schematic diagram of the mediating role of positive rumination and negative rumination in the relationship between body image and antenatal depression in late-pregnancy.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(*\u003c/strong\u003e\u003cem\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e＜0.001 was considered statistically signifcant.)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7975090/v1/47b56c851830fbc77454077b.jpg"},{"id":97373190,"identity":"1dcedd17-ca2d-4f97-ba9c-f461e30fa43b","added_by":"auto","created_at":"2025-12-03 16:34:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1512478,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7975090/v1/d7c7ad6b-15fd-4243-87c3-c1b6aeeb3738.pdf"},{"id":97371399,"identity":"2efcb79d-b6a3-49e1-9d8a-7265f11aa943","added_by":"auto","created_at":"2025-12-03 16:28:52","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":31328,"visible":true,"origin":"","legend":"","description":"","filename":"AppendixA.docx","url":"https://assets-eu.researchsquare.com/files/rs-7975090/v1/2bc5fecda6bc530fcd2cb7a3.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Dual Mediation of Body Image Effects on Antenatal Depression in Late Pregnancy: Negative Rumination as the Dominant Pathway","fulltext":[{"header":"1. Background","content":"\u003cp\u003eAntenatal depression, a prevalent psychological disorder during pregnancy, is characterized by symptoms including low mood, anxiety, fear, diminished self-esteem, and feelings of meaninglessness and hopelessness (Khanghah et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). A meta-analysis indicated a substantial global prevalence of antenatal depressive symptoms, estimated at 20.7% (Yin et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). In China, the prevalence is similarly high at 19.7%, with studies reported a significant increase over the past decade (Nisar et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). These findings underscore antenatal depression as a pressing public health priority in China.\u003c/p\u003e\u003cp\u003eAntenatal depression involves a complex interplay of sociological, biological, and cognitive psychological factors (Kaiyo-Utete et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Osborne et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). For mothers, antenatal depression is associated with an increased risk of preeclampsia, suicidal ideation, and postpartum depression (Minschart et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Tabb et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). For offspring, antenatal depression is linked to adverse birth outcomes, including preterm birth and low Apgar scores (Wang et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Zhang et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), as well as poorer long-term developmental outcomes. These encompass deficits in socio-emotional, cognitive, language, motor, and adaptive behavioral development, extending from infancy through childhood and adolescence (Rogers et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSociocultural pressures, particularly the media-perpetuated aesthetic ideal equating thinness with beauty, are pervasive. This promotes unrealistic expectations and fosters cognitive biases toward non-conforming body features, contributing to the development of body image disturbance, also negative body image (Cinaroglu \u0026amp; Yilmazer, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Cohen et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Body image disturbance manifests as negative emotional states, including anxiety, depression, and feelings of inferiority (Linardon et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; White et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). In severe cases, it may progress to eating disorders, such as anorexia nervosa (Gutierrez \u0026amp; Carrera, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Pregnancy constitutes a distinct period characterized by profound physiological and psychosocial transitions. Fetal growth necessitates significant anatomical adaptations in pregnant women, affecting structures including the uterus, breasts, and skin. These physical transformations become particularly pronounced during late gestation as fetal development accelerates (Cattani et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Concurrently, women navigate an impending shift in social roles. The confluence of rapid bodily changes diverging from pre-pregnancy ideals and the psychological adaptation to motherhood can precipitate negative body image perceptions (Andrews et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eExtensive research underscores maternal body image disturbance as a critical factor impairing psychological well-being and quality of life during pregnancy. Affected women exhibit a significantly elevated risk of depression (Riquin et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Furthermore, body imge disturbance is associated with disordered eating behaviors and maladaptive weight control practices (Barnhart et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Given the fetus\u0026rsquo;s complete nutritional dependence on the mother, antenatal body image disturbance may increase risks of inadequate gestational weight gain, preterm birth, and adverse pregnancy outcomes (Shen et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Consequently, body image disturbance poses substantial threats to perinatal health, highlighting the need for targeted interventions to mitigate its effects and optimize long-term maternal-infant health trajectories.\u003c/p\u003e\u003cp\u003eCognitive psychology conceptualizes rumination as a maladaptive cognitive style characterized by persistent, passive preoccupation with and uncontrollable recurrence of negative thoughts, recognized as a risk factor for depression (Nolen-Hoeksema, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2000\u003c/span\u003e). While Nolen-Hoeksema\u0026rsquo;s seminal definition emphasizes its dysfunctional nature, contemporary research posits that rumination may also exhibit adaptive functions. Feldman et al. pioneered the construct of positive ruminative thinking (Feldman et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2008\u003c/span\u003e), and subsequent empirical work by Chinese scholars has further delineated context-dependent manifestations of both positive and negative ruminative subtypes across emotional valences (Yang et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). This theoretical expansion facilitates multidimensional investigation of ruminative processes and their cognitive-affective mechanisms.\u003c/p\u003e\u003cp\u003eAccording to objectification theory (Barbara L. Fredrickson, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e1997\u003c/span\u003e), sociocultural pressures during pregnancy may prompt women to allocate excessive cognitive resources toward appearance monitoring. This self-objectifying tendency is theorized to impair mental health, with rumination posited as a critical mediator (Huang, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). Despite these advances, no prior study has explicitly investigated the differential roles of positive and negative rumination in the association between maternal body image disturbance and antenatal depression. This study bridges objectification theory and dual-dimensional rumination framework, we therefore hypothesize that:\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eH1\u003c/strong\u003e\u003cp\u003eNegative rumination exacerbates the association between maternal body image disturbances and antenatal depression during late pregnancy. This amplification likely occurs through an intensified focus on socially prescribed maternal body standards, thereby reinforcing a sequential pathway involving self-objectification, heightened appearance monitoring, and subsequent depression. (Laifer et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eH2\u003c/strong\u003e\u003cp\u003eConversely, positive rumination, characterized by adaptive acceptance of gestational bodily changes (Roomruangwong et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), will attenuate the impact of body image on antenatal depression. This protective effect is hypothesized to arise through cognitive reappraisal mechanisms that reduce maladaptive rumination through constructive self-referential processing (van der Velden et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003e\u003cb\u003e2.1 Aims\u003c/b\u003e\u003c/p\u003e\u003cp\u003e2.1. 1 To quantify bivariate correlations among maternal body image, rumination subtypes (positive and negative), and antenatal depression symptomatology.\u003c/p\u003e\u003cp\u003e2.1.2 To validate a conceptual mediation framework wherein rumination mediates the association between maternal body image and antenatal depression symptomatology, employing bootstrapped structural equation modeling (SEM).\u003c/p\u003e\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.2. Study Design and Participants\u003c/h2\u003e\u003cp\u003e This study adopted a cross-sectional study design, which followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines (Appendix A).\u003c/p\u003e\u003cp\u003eA convenience sample of 288 women in late pregnancy (gestational age\u0026thinsp;\u0026ge;\u0026thinsp;28 weeks) was recruited from the Department of Obstetrics at a tertiary care hospital in Guangzhou, China, between November 2024 and April 2025. Inclusion criteria comprised: (1) gestational age\u0026thinsp;\u0026ge;\u0026thinsp;28 weeks; (2) proficiency in Mandarin communication and literacy; and (3) provision of written informed consent. Exclusion criteria included: (1) history of psychiatric disorders or current psychotic disorders; (2) severe physical illness precluding valid questionnaire completion.\u003c/p\u003e\u003cp\u003eSample size determination followed Kline's methodological recommendations (Kline, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), which require 5\u0026thinsp;~\u0026thinsp;10 participants per scale item Based on the Edinburgh Postnatal Depression Scale (EPDS) as the primary measure, a total sample size of 125 cases (10 items \u0026times; 10 participants per item\u0026thinsp;+\u0026thinsp;20% attrition buffer) was required for this study. Ultimately, a total of 321 questionnaires were distributed. After excluding 33 invalid responses (15 due to indications of random responding and 18 due to incompleteness), 288 valid questionnaires were retained, yielding an effective response rate of 89.72%.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.3. Data Collection\u003c/h2\u003e\u003cp\u003eThe assessment instruments comprised a general information questionnaire, the Body Image in Pregnancy Scale (BIPS), the Edinburgh Postnatal Depression Scale (EPDS), and the Positive and Negative Rumination Scale (PANRS). Data collection was conducted during routine antenatal visits in the hospital\u0026rsquo;s obstetrics clinics. Trained research assistants, operating under departmental approval and following standardized protocols, administered the questionnaires on-site. After obtaining written informed consent, participants received a standardized verbal explanation outlining the study purpose, anonymity and confidentiality guarantees, and completion procedures. Research staff remained available throughout the process to clarify instructions and address participant queries. Participants completed the questionnaires independently. Upon completion, questionnaires were collected immediately and examined for missing responses, ambiguities, or errors. Any identified issues were resolved through direct clarification with the participant prior to final submission to ensure data validity and completeness.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.4. Measuring Instruments\u003c/h2\u003e\u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\u003ch2\u003e2.4.1. Socio-demographic characteristics\u003c/h2\u003e\u003cp\u003eThe general information questionnaire encompassed variables such as age, height, weight, gestational week, education, per capita monthly income.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section3\"\u003e\u003ch2\u003e2.4.2. Body Image in Pregnancy Scale (BIPS)\u003c/h2\u003e\u003cp\u003eOriginally developed by Watson et al. to assess pregnancy-specific body image characteristics (Watson et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), the Body Image in Pregnancy Scale (BIPS) provides a comprehensive evaluation of this construct. The Chinese version comprises 35 items across 9 dimensions, rated on a 5-point Likert scale (Sun, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Higher total scores indicate more negative body image evaluations. In the present study, the scale demonstrated excellent internal consistency (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.898).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section3\"\u003e\u003ch2\u003e2.4.3. The Positive and Negative Rumination Scale (PANRS)\u003c/h2\u003e\u003cp\u003eThe Positive and Negative Rumination Scale (PANRS), developed by Yang et al., comprises two subscales: the Positive Rumination Scale and the Negative Rumination Scale (Yang et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Items are rated on a 4-point Likert scale ranging from 1 (never) to 4 (always), with higher scores indicating higher levels of rumination (Zhang et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). In the present study, the subscales demonstrated acceptable internal consistency (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.708 for positive rumination; α\u0026thinsp;=\u0026thinsp;0.794 for negative rumination).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\u003ch2\u003e2.4.4. Edinburgh Postnatal Depression Scale (EPDS)\u003c/h2\u003e\u003cp\u003eThe EPDS was originally developed by Cox et al. as a 10-item self-report instrument designed to screen for perinatal depressive symptoms. Each item is scored on a 4-point Likert scale (0 to 3), with higher total scores indicating greater severity of depressive symptoms (Cox et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e1987\u003c/span\u003e). This scale has demonstrated robust psychometric properties, including high reliability, sensitivity, and specificity in detecting antenatal depression (Kozinszky \u0026amp; Dudas, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). In the current study, the Cronbach's α coefficient for the EPDS reached 0.870, confirming excellent internal consistency for antenatal depression assessment.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e2.5. Ethical Considerations\u003c/h2\u003e\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003cp\u003e for this study was granted by the Ethics Committee of Southern Medical University (Approval No: SMUREC-2024-101). All participants provided written informed consent prior to enrollment, affirming their voluntary participation, right to withdraw at any time without penalty, and guaranteed data confidentiality.\u003c/p\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e2.6. Statistical Analysis\u003c/h2\u003e\u003cp\u003eThe data, processed using SPSS 27.0 statistical software, contained no outliers or missing values. The normality of the data was assessed using P-P and Q-Q plots. Results indicated that the variables of body image, positive rumination, negative rumination and antenatal depression all followed a normal distribution. Continuous data were described using means and standard deviations, whereas categorical data were summarized by frequencies and percentages. Given this data followed a normal distribution, Pearson correlation analysis was employed to evaluate the relationships between body image, positive rumination, negative rumination and antenatal depression among pregnant women in late pregnancy. To explore the mediating effect of positive rumination and negative rumination between body image and antenatal depression, we used the PROCESS plugin in SPSS for analysis. The model was set to employ the bootstrap method for testing, which is a robust technique for assessing the significance of indirect effects in mediation analysis. All statistical analyses were conducted using a two-sided test, and differences were deemed statistically significant at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003e\u003cstrong\u003e3.1. Common Method Variance Test (CMV)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSince the data were collected from the participants’ self reports, there is a possibility of common method bias. Harman’s single-factor test method was used to check the common method bias in the data. All items were loaded into an exploratory factor analysis to examine the unrotated factor structure.\u0026nbsp;Factor analysis revealed 16 factors with eigenvalues exceeding 1.0. The first factor accounted for 19.70% of the variance, which is below the threshold of 40%, indicating no substantial common method bias in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2. General Information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe final sample comprised 288 women in late pregnancy, with the following characteristics (presented as mean (SD)) (Table 1): age = 30.43 (4.19) years, height = 159.09 (5.18) cm, weight = 65.29 (9.99) kg, and gestational age = 34.66 (2.51) weeks.\u0026nbsp;Educational attainment distribution was: college degree or higher (44.79%, n = 129), high school completion (47.57%, n =137), and secondary school or lower (7.64%, n = 22). Most participants resided in urban areas (88.19%, n = 254), while 11.81% (n = 34) were from rural areas. Per capita monthly income distribution was: below 2,000 yuan (0.35%, n = 1), 2,000-4,999 yuan (10.07%, n = 29), 5,000-10,000 (40.97%, n =29), and more than 10,000 yuan (48.61%, n =140)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3. Scores of\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eBody Image, Positive Rumination, Negative Rumination and Antenatal Depression\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ein Late-Pregnancy Women\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the included participants, the scores averaged as follows (presented as mean (SD)): body image = 92.44 (15.18), positive rumination = 8.23 (5.06), negative rumination = 25.43 (5.23), and antenatal depression = 18.97 (4.94). Detailed results are presented in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4. Pearson Correlation among the Body Image, Positive Rumination, Negative Rumination and Antenatal Depression in Late-Pregnancy Women.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePearson correlation analysis indicated significant associations among the variables (all \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt;0.001). Body image demonstrated a negative correlation with positive rumination, but positive correlations with both negative rumination and antenatal depression.\u0026nbsp;Positive rumination was inversely associated with negative rumination and antenatal depression.\u0026nbsp;Negative rumination showed a positive correlation with antenatal depression.\u0026nbsp;Complete correlation coefficients (r) are detailed in Table 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.5. The Mediating Roles of Positive and Negative Rumination in the Association Between Body Image and Antenatal Depression in Late-Pregnancy Women.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mediating roles of positive and negative rumination in the association between body image and antenatal depression were examined using bias-corrected bootstrapping with 5,000 resamples. Statistical significance was determined when the 95% confidence intervals (\u003cem\u003eCIs\u003c/em\u003e) excluded zero. Results of the mediation analyses are presented in Table 3, Table 4, and Figure 1.\u003c/p\u003e\n\u003cp\u003eRegression analyses (Table 3; Figure 1) revealed that body image directly predicted rumination patterns: it negatively influenced positive rumination (\u003cem\u003eβ\u0026nbsp;\u003c/em\u003e= -0.21, \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt;0.001) and positively influenced negative rumination (\u003cem\u003eβ\u0026nbsp;\u003c/em\u003e= 0.36, \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt;0.001). Crucially, antenatal depression was jointly predicted by these variables, with body image exhibiting a significant direct positive effect (\u003cem\u003eβ\u0026nbsp;\u003c/em\u003e= 0.17, \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt;0.001), while positive rumination showed a negative effect (\u003cem\u003eβ\u0026nbsp;\u003c/em\u003e= -0.22, \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt;0.001) and negative rumination demonstrated a strong positive effect (\u003cem\u003eβ\u0026nbsp;\u003c/em\u003e= 0.42, \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003eParallel mediation analysis (Table 4) demonstrated significant effects of maternal body image on antenatal depression, with a total effect of \u003cem\u003eβ\u0026nbsp;\u003c/em\u003e= 0.12 (95% \u003cem\u003eCI\u003c/em\u003e [0.09, 0.16]). After controlling for rumination, the direct effect remained significant (\u003cem\u003eβ\u0026nbsp;\u003c/em\u003e= 0.06, 95% \u003cem\u003eCI\u003c/em\u003e [0.02, 0.09]), accounting for 46.37% of the total effect. Crucially, 53.63% of the effect was mediated through dual pathways: Path 1 (body image → positive rumination → antenatal depression) contributed 12.66% (\u003cem\u003eβ\u003c/em\u003e = 0.02, 95% \u003cem\u003eCI\u003c/em\u003e [0.004, 0.03]), while Path 2 (body image → negative rumination → antenatal depression) contributed 41.05% (\u003cem\u003eβ\u003c/em\u003e = 0.05, 95% \u003cem\u003eCI\u003c/em\u003e [0.03, 0.07]). The negative rumination pathway constituted the dominant mechanism, exhibiting 3.24 times greater mediation than the positive rumination pathway (41.05% vs. 12.66%).\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e4.1. Main Findings and Theoretical Contributions\u003c/h2\u003e\u003cp\u003eThis study investigated the levels and interrelationships of body image, rumination (incorporating positive and negative dimensions), and antenatal depression among women in late pregnancy. Results demonstrated a significant positive association between negative body image and antenatal depression, with rumination functioning as parallel mediators. Crucially, negative rumination exhibited a substantially stronger mediating effect than positive rumination, approximately 3.24 times greater. These findings advance theoretical understanding of perinatal mental health by quantifying distinct cognitive pathways linking body perception to depression and establishing negative rumination as the dominant mechanistic pathway.\u003c/p\u003e\u003cp\u003eWe confirmed a significant positive correlation between negative body image appraisal and antenatal depression severity in late-pregnancy women: heightened body dissatisfaction predicted elevated depressive symptoms. This finding aligns with Riquin et al.\u0026rsquo;s report of body dissatisfaction increasing depression risk and substantiates Shen et al.'s assertion that gestational body image disturbance threatens maternal-infant mental health (Riquin et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Shen et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Physiologically, late pregnancy involves accelerated fetal development driving pronounced somatic changes: rapid abdominal expansion with striae formation, breast hypertrophy, and substantial weight gain (Cattani et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). These alterations disrupt pre-pregnancy cognitive equilibrium, triggering identity conflicts during the transition to motherhood. Socioculturally, pervasive \u0026ldquo;thin-ideal\u0026rdquo; norms and media-portrayed body expectations (Cohen et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Rodgers \u0026amp; Nowicki, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) foster maladaptive self-monitoring behaviors (e.g., obsessive pre-pregnancy photo comparisons, weight-gain preoccupation)(Laifer et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). This objectification process, wherein the sociocultural emphasis on physical appearance is internalized into persistent self-surveillance, elucidates how the linkages between body image and depression extend beyond individual psychological factors to encompass broader biopsychosocial interactions. (Barbara L. Fredrickson, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e1997\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMediation analyses revealed that rumination functioned as a significant parallel mediator in the body image-antenatal depression relationship, with markedly divergent effect magnitudes between negative and positive rumination pathways. The negative rumination pathway accounted for 41.05% of the total effect, substantially exceeding the positive rumination pathway (12.66%; ratio\u0026thinsp;=\u0026thinsp;3.24:1). Specifically, negative body appraisal elevated depression risk through dual mechanisms: \u003cb\u003e(1) Maladaptive cognitive activation\u003c/b\u003e: Negative body image potentiated negative rumination, manifesting as perseverative cognitions regarding body distortion, perceived aesthetic deviation, and attractiveness loss (Laifer et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). This process initiates a self-sustaining cycle in which body dissatisfaction promotes compulsive self-criticism, which in turn leads to the exacerbation of depressive symptoms. \u003cb\u003e(2) Adaptive cognitive suppression\u003c/b\u003e: Negative body evaluation concurrently inhibited positive rumination (Yang et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), causing pregnant women to neglect the adaptive value of gestational physiological changes, including uterine fetal protection, placental nutrient transfer, and somatic transformations as life-nurturing symbols\u0026mdash;thereby forfeiting emotion-regulatory opportunities through positive reappraisal (Zhang et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). These mechanisms demonstrate cross-population consistency with non-pregnant and clinical cohorts (Pehlivan et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Rifkin et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), suggesting transdiagnostic cognitive-emotional pathways linking physical perception and psychopathology. Therefore, these findings necessitate interventions simultaneously targeting negative rumination reduction and positive reappraisal training, particularly through cognitive restructuring techniques focusing on gestational body image functionality appreciation.\u003c/p\u003e\u003cp\u003eThis discovery substantiates the premise of objectification theory, which posits that sociocultural norms disciplining female bodies, including implicit expectations for mothers to concurrently fulfill aesthetic and reproductive roles, become internalized as self-objectification during pregnancy. Crucially, rumination represents the cognitive manifestation of this internalization, wherein persistent focus on physical imperfections enables maladaptive self-monitoring. This establishes a pathological pathway from self-objectification through negative rumination to depression (Huang, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Laifer et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). More significantly, our findings challenge the reductive conceptualization of rumination as solely maladaptive (Nolen-Hoeksema, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2000\u003c/span\u003e), instead validating Feldman et al.'s proposition that active rumination serves emotion-regulatory functions (Feldman et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). For the first time in a late-pregnancy population, we confirm the coexistence of positive rumination's protective capacity alongside negative rumination's detrimental effects. This corroborates Yang et al.'s dual-dimensional rumination framework (Yang et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), while providing novel empirical evidence that differential cognitive processing constitutes critical regulatory nodes determining whether body image perception translates into depression risk during gestational adaptation.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003e4.2. Relevance for Clinical Practice\u003c/h2\u003e\u003cp\u003eThese findings hold significant implications for developing antenatal mental health interventions. Effective strategies should concurrently target body image reconstruction and rumination regulation through dual pathways. For body image reframing, interventions must integrate sociocultural deconstruction with health education to shift focus from aesthetic preoccupation toward appreciation of the body's reproductive functionality. A systematic elucidation of how somatic changes, including those facilitating uterine protection and placental nutrient transfer, support fetal development may contribute to challenging socially constructed beauty standards in antenatal education. This approach operationalizes objectification theory's \u0026ldquo;de-objectification\u0026rdquo; principle(Barbara L. Fredrickson, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e1997\u003c/span\u003e), reducing self-objectification tendencies that amplify negative body appraisal. For rumination regulation, cognitive restructuring techniques (CBT) should disrupt maladaptive cycles linking body dissatisfaction to self-denial (Tulbure et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Zeng et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Furthermore, mindfulness-based interventions derived from Feldman's framework on positive rumination promote intentional awareness of adaptive gestational changes, such as breast hypertrophy that supports lactation, which in turn enhances the protective role of positive rumination. (Reangsing et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; van der Velden et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). This integrated model interrupts the progressive pathological sequence from body dissatisfaction to negative rumination and subsequently to antenatal depression, thereby enhancing psychological outcomes throughout the perinatal period.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003e4.3. Limitations\u003c/h2\u003e\u003cp\u003eSeveral limitations warrant consideration. Firstly, the cross-sectional design precludes definitive causal inferences regarding the temporal sequence from negative body image to rumination and depression; prospective cohort studies are needed to elucidate dynamic mechanisms. Secondly, sampling exclusively from a tertiary hospital in Guangzhou, where rural residents constituted only 11.81%, may introduce medical-accessibility bias, limiting generalizability to underserved populations and necessitating cautious interpretation. Thirdly, an exclusive dependence on self-reported measures may introduce response biases, such as social desirability effects. Subsequent studies would benefit from incorporating physiological indicators, including cortisol levels, along with observer-rated instruments. Finally, unexamined moderating factors, such as social support and marital dynamics, could potentially influence the observed relationships, highlighting the need for multivariate models to further refine theoretical frameworks.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003e4.4. Directions for Future Research\u003c/h2\u003e\u003cp\u003eBased on these findings, future research should prioritize prospective cohort designs to clarify the causal relationships linking body image, rumination, and depression throughout the perinatal period, spanning from late pregnancy to the postpartum stage. Furthermore, expanding the diversity of samples through multi-regional recruitment that covers a range of socioeconomic backgrounds, and including partners\u0026rsquo; assessments of maternal embodiment, would significantly enhance the understanding of dyadic social influences on psychological adjustment. Finally, the development of targeted interventions, such as mindfulness-based protocols for rumination regulation, along with empirical validation of their efficacy in promoting appreciation of body functionality and reducing the risk of depression, will help establish more robust evidence-based frameworks for perinatal mental health care.\u003c/p\u003e\u003c/div\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eThis study investigated the interrelationships among body image, rumination, and antenatal depression in third-trimester pregnant women. Key findings revealed that negative body image significantly predicted increased antenatal depression levels, with rumination functioning as parallel mediators. Crucially, the negative rumination pathway demonstrated dominant mediation, while negative body appraisal simultaneously suppressed positive rumination's protective capacity. These results validate objectification theory's applicability to pregnancy by demonstrating how sociocultural pressures become internalized as self-objectification, clarify rumination's dual-dimensional attributes, and address prior oversimplification of rumination as unidimensional. Practically, antenatal interventions should incorporate cognitive restructuring techniques that foster body functionality appreciation and implement dual-pathway rumination regulation. Study limitations include cross-sectional design constraints and regional sampling limitations; future research should employ prospective cohorts and multi-site validation to optimize perinatal mental health interventions.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBIPS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBody Image in Pregnancy Scale\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eEPDS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEdinburgh Postnatal Depression Scale\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePANRS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eThe Positive and Negative Rumination Scale\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eConfidence Interval\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eStandard Deviation​​\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCMV\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCommon Method Variance Test\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval Statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for this study was granted by the Ethics Committee of Southern Medical University (Approval No: SMUREC-2024-101). All participants provided written informed consent prior to enrollment, affirming their voluntary participation, right to withdraw at any time without penalty, and guaranteed data confidentiality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003efor Publication\u003c/strong\u003e\u003cstrong\u003eStatement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants who participated in the study consented to the publication of the article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe individual-level data from this cross-sectional study are not publicly available to protect participant confidentiality but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no financial conflict of interests related to the work described in the paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the National Natural Science Foundation of China [72274090，72574096，71874075 ]; Undergraduate Innovation and Entrepreneurship Training Program [S202412121164]；Guangdong Province Graduate Education Innovation Program Project [2025KCJS_022]; Guangdong Provincial Higher Education Research Projects [25GZD007]. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have agreed with the content of the manuscript and contributed to the work as follows:\u003c/p\u003e\n\u003cp\u003eSupervision (Study design): Yu Chen\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eInvestigation: Rufang Zhou, Qianzhi Lin,\u0026nbsp;Xiuyun Cao, Jingjing Liu\u003c/p\u003e\n\u003cp\u003eMethodology：Rufang Zhou, Qianzhi Lin,\u0026nbsp;Youjing Kong\u003c/p\u003e\n\u003cp\u003eFormal analysis: Rufang Zhou, Qianzhi Lin,\u0026nbsp;Xiuyun Cao, Xingxing Liu\u003c/p\u003e\n\u003cp\u003eWriting (original draft): Rufang Zhou\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank all the researchers who participated in this study, express our sincere gratitude to all the researchers who gave their time and knowledge to this study. Most of all, we would like to extend our sincere gratitude to all the pregnant women who willingly participated in this study, and we wish them and their babies every happiness in life.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAndrews B, Hill B, Skouteris H. The relationship between antenatal body attitudes, pre-pregnancy body mass index, and gestational weight gain [Journal Article]. Midwifery. 2018;56:142\u0026ndash;51. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.1016/j.midw.2017.10.012\u003c/span\u003e\u003cspan address=\"10.1016/j.midw.2017.10.012\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBarbara L, Fredrickson TR. Objectification theory: Towards understanding women\u0026rsquo;s lived experiences and mental health risks. 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J Affect Disord. 2023;323:490\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.1016/j.jad.2022.12.008\u003c/span\u003e\u003cspan address=\"10.1016/j.jad.2022.12.008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1 Characteristics of Late-Pregnancy (N = 288)\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"668\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en(%)/Means(SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 204px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e30.43(4.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 204px;\"\u003e\n \u003cp\u003eHeight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e159.09(5.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 204px;\"\u003e\n \u003cp\u003eWeight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e65.29(9.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 204px;\"\u003e\n \u003cp\u003eGestational week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e34.66(2.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 204px;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003ecollege degree or higher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e129(44.79%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 204px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e137(47.57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 204px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003eSecondary school or lower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e22(7.64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 204px;\"\u003e\n \u003cp\u003eResidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003eUrban areas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e254(88.19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 204px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003eRural areas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e34(11.81%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 204px;\"\u003e\n \u003cp\u003ePer capita monthly income\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003ebelow 2000 yuan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e1(0.35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 204px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003e2000-4999 yuan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e29(10.07%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 204px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003e5000-10000 yuan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e118(40.97%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 204px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003emore than 10000 yuan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e140(48.61%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 204px;\"\u003e\n \u003cp\u003eBody image\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e92.44(15.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 204px;\"\u003e\n \u003cp\u003ePositive rumination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e8.23(5.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 204px;\"\u003e\n \u003cp\u003eNegative rumination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e25.43(5.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 204px;\"\u003e\n \u003cp\u003eAntenatal depression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e18.97(4.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 Correlation analysis of body image, positive rumination and negative rumination, antenatal depression\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ein late-pregnancy .\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"692\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBody\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eimage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePositive\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003erumination\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNegative\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003erumination\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAntenatal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003edepression\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003eBody image\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003ePositive rumination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e-0.21*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003eNegative rumination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e0.36*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e-0.22*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003eAntenatal depression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e0.37*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e-0.35*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e0.53*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e*\u003cem\u003eP\u003c/em\u003e＜0.001 was considered statistically signifcant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3 Parallel mediation model analysis of body image, positive rumination, negative rumination and antenatal depression\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ein late-pregnancy .\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"983\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 369px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegression equation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 257px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall Fitting Index\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 357px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSignificance of Regression Coefficient\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome variable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePredictors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eR\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp; F\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e\u0026beta;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eLLCI\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eULCI\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003et\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003ePositive rumination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eBody image\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 106px;\"\u003e\n \u003cp\u003e13.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e-0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e-0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e-0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e-3.69*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003eNegative rumination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eBody image\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 106px;\"\u003e\n \u003cp\u003e42.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e6.52*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 190px;\"\u003e\n \u003cp\u003eAntenatal depression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eBody image\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 106px;\"\u003e\n \u003cp\u003e54.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e3.368*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003ePositive rumination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e-0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e-0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e-0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e-4.48*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eNegative rumination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e8.24*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e*\u003cem\u003eP\u003c/em\u003e＜0.001 was considered statistically signifcant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4 Parallel mediating effect analysis of the positive rumination and negative rumination between body image and antenatal depression in late-pregnancy.\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"1013\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEffect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 419px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePaths\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBoot std\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStd. Estimate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBootstrap\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e95%\u003cem\u003eCI\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEstimate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eTotal effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 432px;\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.12\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e0.02\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e0.09, 0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eTotal Indirect effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 432px;\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.07\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e0.01\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e0.05, 0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e53.63%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eDirect effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 432px;\"\u003e\n \u003cp\u003eBody image\u0026rarr;Antenatal depression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.06\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e0.02\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e0.02, 0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e46.37%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eIndirect effect 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 432px;\"\u003e\n \u003cp\u003eBody image\u0026rarr;Positive rumination\u0026rarr;Antenatal depression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.02\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e0.01\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e0.004, 0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e12.66%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eIndirect effect 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 432px;\"\u003e\n \u003cp\u003eBody image\u0026rarr;Negative rumination\u0026rarr;Antenatal depression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.05\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e0.01\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e0.03, 0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e41.05%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Antenatal depression, Body image, Rumination, Mediation analysis, Objectification theory","lastPublishedDoi":"10.21203/rs.3.rs-7975090/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7975090/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eAntenatal depression represents a significant public health concern, with body image disturbances identified as a prominent risk factor during pregnancy. However, the specific cognitive mechanisms, particularly the distinct roles of positive and negative rumination, underlying the relationship between body image and antenatal depression remain inadequately explored. This study aimed to investigate the associations between maternal body image, rumination subtypes, and antenatal depression, and to examine the parallel mediating roles of positive and negative rumination in late pregnancy.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cross-sectional study recruited 288 women (gestational age\u0026thinsp;\u0026ge;\u0026thinsp;28 weeks) from a tertiary hospital in Guangzhou, China. Participants completed validated scales: the Body Image in Pregnancy Scale (BIPS), Positive and Negative Rumination Scale (PANRS), and Edinburgh Postnatal Depression Scale (EPDS). Pearson correlations assessed bivariate associations. Bootstrapped parallel mediation analysis (5,000 resamples) evaluated direct and indirect effects using structural equation modeling.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eBody image correlated positively with antenatal depression severity (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.37, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and negative rumination (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.36, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), but negatively with positive rumination (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.21, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Body image exerted a significant total effect on antenatal depression (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.12, 95% \u003cem\u003eCI\u003c/em\u003e [0.09, 0.16]). Rumination subtypes jointly mediated 53.63% of this effect. Negative rumination demonstrated dominant mediation (indirect \u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.05, 95% \u003cem\u003eCI\u003c/em\u003e [0.03, 0.07]; proportion: 41.05%), significantly exceeding positive rumination (indirect \u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.02, 95% \u003cem\u003eCI\u003c/em\u003e [0.004, 0.03]; proportion: 12.66%; ratio\u0026thinsp;=\u0026thinsp;3.24:1). The direct effect remained significant (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.06, 95% \u003cem\u003eCI\u003c/em\u003e [0.02, 0.09]).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eNegative body image elevates antenatal depression risk primarily by amplifying negative rumination while concurrently suppressing protective positive rumination. These findings validate objectification theory in pregnancy and underscore rumination\u0026rsquo;s dual-dimensional mediation. Antenatal interventions should integrate cognitive restructuring to mitigate maladaptive body-related cognitions and enhance positive reappraisal of gestational changes.\u003c/p\u003e","manuscriptTitle":"Dual Mediation of Body Image Effects on Antenatal Depression in Late Pregnancy: Negative Rumination as the Dominant Pathway","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-03 11:36:19","doi":"10.21203/rs.3.rs-7975090/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-11-30T18:39:30+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-03T15:56:26+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-29T22:41:06+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-29T22:40:32+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychology","date":"2025-10-29T03:29:52+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9ebf1c59-372b-412e-9798-4be8e05f9256","owner":[],"postedDate":"December 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-03T11:36:19+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-03 11:36:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7975090","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7975090","identity":"rs-7975090","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}