The Mediating Effects Of Mother’s Parenting On The Association Between Prenatal Pregnancy-related Anxiety And Children’s Behavioral Development

ObjectiveTo explore the mediating role of mother’s parenting in the association between pregnancy-related anxiety and children’s behavioral development,and explore postpartum ways to avoid or reduce the influence of adverse stress during pregnancy(such as pregnancy-related anxiety)on children’s behavioral development,so as to provide scientific basis for promoting children’s behavioral development.MethodsThis study included pregnant women from the Ma’anshan Birth Cohort Study(MABC).From May 2013 to September 2014,we utilized a self-designed baseline questionnaire to gather data on pregnant women’s demographics,past pregnancies,medical histories,and current health status.A self-designed follow-up questionnaire was used to gather information on children’s growth and development,primary caregiver,and breastfeeding practices.The Pregnancy-Related Anxiety Questionnaire(PRAQ)was used to assess the level of anxiety in pregnant women.After the baby is born,delivery information was collected by the hospital’s electronic medical system.Ages & Stages Questionnaires-Chinese(ASQ-C)was used to evaluate the behavioral development of 18-month-old children.Parenting styles was collected by the scale of Brief Toddler Parenting Style Questionnaires(BTPSQ)designed by ourselves.Spearman correlation analysis was used to analyze the relationship between pregnancyrelated anxiety,parenting styles,breastfeeding and ASQ result.Multiple logistic regression model was used to analyze the intensity of correlation among the four variables.A structural equation model was constructed to analyze the mediating effect of parenting styles and breastfeeding on pregnancy-related anxiety and 18-month-old children’s ASQ results.ResultsA total of 2 069 pregnant women and their singleton offspring were included in this study.The average age of pregnant women was 26.62 ±3.83 years old.After grouping according to the pregnancy-related anxiety,there were statistical differences in age,primipara,education,smoking,drinking,level of attention and acceptance,level of warmth and interaction,level of neglect and restriction,level of outdoor sports and social interaction,communication,problem-solving of children.Pregnancy-related anxiety was associated with exclusive breastfeeding at 42 days(OR = 0.77,95%CI:0.61-0.97)and 6 months(OR = 0.69,95%CI: 0.48-0.99).Pregnancy-related anxiety in the second trimester increased the risk of lower scores in neglect and restriction dimensions(OR = 1.56,95%CI: 1.05-2.33).Pregnancy-related anxiety in the third trimester of pregnancy increased the risk of lower scores in warmth and interaction(OR= 1.96,95%CI: 1.31-2.92),attention and acceptance(OR = 1.79,95%CI: 1.15-2.80),and neglect and restriction(OR = 1.68,95%CI: 1.16-2.44).Pregnancy-related anxiety in the second and third trimester of pregnancy increased the risk of lower scores in the four dimensions of BTPSQ,with OR values of 1.46,1.51,1.62 and 1.98,respectively.Pregnancy-related anxiety in the second trimester increased the risk of communication problems in offspring(OR = 3.20,95%CI: 1.39-7.39),and persistent pregnancy-related anxiety in the second and third trimester increased the risk of problems in fine movements(OR = 1.77,95%CI: 1.02-3.04)and problem-solving ability(OR = 2.75,95%CI: 1.64-4.70).Exclusive breastfeeding at the age of 3 months was a protective factor for communication(OR = 0.36,95%CI: 0.19-0.69)and fine movement(OR =0.63,95%CI: 0.40-0.99),while breastfeeding at the age of 12 months was also a protective factor for communication(OR = 0.38,95%CI: 0.19-0.75)and fine motor(OR= 0.50,95%CI: 0.29-0.88).High levels of warmth and interaction reduced the risk of stunting in the five energy regions,with OR values of 0.05,0.46,0.32,0.30 and 0.54,respectively.A high level of attention and acceptance reduces the risk of communication(OR = 0.16,95%CI: 0.07-0.37),fine motor(OR = 0.46,95%CI: 0.25-0.84)and problem-solving(OR = 0.30,95%CI: 0.16-0.57).High level of outdoor and social interaction also reduced the risk of stunting in the five energy regions,with OR values of 0.10,0.48,0.29,0.37 and 0.44,respectively.Structural equation model analysis showed that pregnancy-related anxiety had significant direct effects(β=0.077,95%CI:0.005-0.160)on children’s ASQ results,and indirect effect of parenting styles(β = 0.028,95%CI: 0.014-0.046)explained 25.7% of the total effect of pregnancy-related anxiety in children behavioral development,while the indirect effect of breastfeeding was not statistical significance.ConclusionsPregnancy-related anxiety has a negative impact on children’s behavioral development.Parenting styles play an intermediary role in the process of pregnancyrelated anxiety affecting children’s behavioral development.Caregivers need to use positive parenting styles(such as warmth and interaction,attention and acceptance,outdoor and social interaction),and reduce negative parenting styles(such as neglect and restriction).