Development Of The Pregnancy-specific Anxiety Questionnaire And Pregnancy-specific Anxiety Status In Early Pregnancy

Objectives The purpose of the present study was to develop and evaluate the reliability, validity and responsiveness of the Pregnancy-specific Anxiety Questionnaire(PAQ), and to examine the status and influential factors of pregnancy-specific anxiety in early pregnancy.Methods The original questionnaire contained 13 items which was developed based on literature review, focus group discussion and expert advice. A total of 4 156 pregnant women were selected from Hefei for the pregnancy-specific anxiety study. We developed Student's t-test, correlate analysis, factor analysis and other methods for item screening, and the initial framework of the PAQ was determined by exploratory factor analysis. A total of 2 861 pregnant women were selected from Maanshan for psychometric analysis. The internal consistency reliability of the PAQ was assessed by Cronbach's alpha coefficient. Test-retest stability was evaluated using Paired t-test and Pearson correlations among 87 pregnant women in 2 to 4 weeks. Structural equation modeling(SEM) was applied to assess construct validity.A total of 7 017 pregnant women were recruited from 7 maternal and child health (MCH) centers between October 1, 2008 and September 30, 2009. Pregnancy-specific anxiety, general anxiety and depressive symptoms were measured using PAQ, SAS and CES-D, respectively. The questionnaire included the socio-demographic characteristics, pregnancy history, family history, disease history, environmental exposure within 6 months of pre-pregnancy and in early pregnancy, self-perception in early pregnancy, tense family atmosphere in early pregnancy. The total score of PAQ were ranked from lowest to highest, the first 27% and the last 27% were defined as low and high score group respectively, these two groups consited of 3 951 cases totally. The data were analyzed using statistical package for the social sciences (SPSS for Windows, version 13.0) software. Descriptive statistics were developed to describe the women's demographic characteristics. The correlation between total pregnancy-specific anxiety and general anxiety scores / depression scores was tested using Pearson's correlation (two-tailed). Chi-square analysis and multiple stepwise regression analysis were performed to compare difference between pregnancy-specific anxiety in different groups of each possible risk factor. The odds ratios were presented with their 95% confidence intervals (CIs). p<0.05 was considered to be statistically significant.Results Items in original version of questionnaire were modified on the basis of the principia of important, sensitive, independent, representative, certain and so on. The results of Student's t-test and stepwise regression analysis demonstrated the good discriminatory power of the items and all the items were retained. Almost all items are adopted after performing correlation coefficient method, factor analysis (extraction method: principal component analysis) and internal consistency analysis. So based on the item analysis, the initially PAQ had 13 items. The results of exploratory factor analysis showed that 3 factors were extracted and the cumulative common variance was 51.6%. Factor 1 was anxiety of self and it explained 32.2% of the total variance, factor 2 was anxiety of fetal health and it explained 10.5% of the total variance, factor 3 was anxiety of child birth and it explained 8.8% of the total variance. The test-retest reliability coefficient and Cronbach's alpha coefficient were 0.786 and 0.812, respectively. We used AMOS 7.0 software to perform confirmatory factor analysis, which indicated that the values of GFI, NFI, RFI, CFI and RMSEA were 0.949, 0.897, 0.871, 0.904 and 0.070, respectively.Of 3 951 pregnant women, the mean scores of the 13-item PAQ was 21.16±6.35. The correlation coefficients between total pregnancy-specific anxiety and anxiety self-evaluation score, the depression total score were 0.587 and 0.532, repectively(p<0.01). In a stepwise multivariable logistic regression analysis model developed for higher score of PAQ in early pregnant women, the following factors were found to be statistically significant associated with the experience of pregnancy-specific anxiety: lower age, unplanned pregnancy, having gynecopathia within 6 months before pregnancy, vaginal bleeding in early pregnancy, fever in early pregnancy, smoking within 6 months before pregnancy, taking contraceptive drug or other medicine within 6 months before pregnancy, high work stress in early pregnancy, noisy living environment in early pregnancy, noisy working environment in early pregnancy, passive smoking in early pregnancy, negative self-perception in early pregnancy, tense family atmosphere in early pregnancy, anxiety symptoms and depression symptoms.Conclusions The development of the PAQ has been preliminary completed and the PAQ is evaluated to be reliable, valid and sensitive. The responsiveness of the Pregnancy-specific Anxiety Questionnaire (PAQ) is relatively good. Healthy body, positive self-perception, warm family atmosphere, quiet living environment and lower working pressure can help pregnant women to keep in good spirit. It's important to note that strengthening health education and reducing exposure to risk factors before pregnancy would be helpful to decrease the risk of pregnancy-specific anxiety.