The Mediating Role of Prenatal Attachment Between Pregnancy Distress and Prenatal Coping Among Chinese Women in the Third Trimester: A Cross-Sectional Study.

PURPOSE: To investigate the status of pregnancy distress, prenatal attachment, and prenatal coping among women in the third trimester, and to analyze the mediating role of prenatal attachment in the relationship between pregnancy distress and prenatal coping. METHODS: This study employed a cross-sectional design. A convenience sampling method was utilized to select 351 women in the third trimester who visited the obstetric outpatient clinic of a tertiary Grade A obstetrics and gynecology hospital in mainland China from January 2024 to January 2025 as participants. The age of the 351 participants was 32.02 years (SD = 3.76), and 77.5% of the participants were under 35 years old. A questionnaire survey was conducted using a general demographic questionnaire, the Tilburg Pregnancy Distress Scale, the Prenatal Attachment Inventory, and the Revised Prenatal Coping Inventory. The scales demonstrated good internal consistency reliability in this sample, with Cronbach's α coefficients ranging from 0.891 to 0.904. Statistical Package for the Social Sciences software was utilized for descriptive statistics, correlation analysis, and mediation effect testing using the Bootstrap method (with 5,000 resamples). Multiple linear regression models were used to determine factors influencing prenatal coping among women in the third trimester. RESULTS: The mean scores for pregnancy distress, prenatal attachment, and prenatal coping among the 351 women in the third trimester were (28.27 ± 7.07), (50.59 ± 10.68), and (55.19 ± 14.12), respectively. Correlation analysis revealed that pregnancy distress was negatively correlated with prenatal attachment (r = -0.123, P < 0.05) and prenatal coping (r = -0.335, P < 0.05), whereas prenatal attachment was positively correlated with prenatal coping (r = 0.603, P < 0.05). Multiple linear regression analysis identified residence, educational level, history of threatened miscarriage hospitalization, pregnancy distress, and prenatal attachment as significant predictors of prenatal coping in women in the third trimester (standardized β = -3.348 to 3.518, all P < 0.05). The mediation effect test revealed that prenatal attachment plays a partial mediating role between pregnancy distress and prenatal coping, with the mediating effect accounting for 20.96% (95% CI: -0.270 to -0.075). CONCLUSION: Prenatal attachment plays a significant mediating role in the relationship between pregnancy distress and prenatal coping among women in the third trimester. These findings suggest that interventions aimed at enhancing prenatal attachment can help mitigate the adverse effects of pregnancy distress. Therefore, healthcare providers should routinely assess the level of pregnancy distress and implement strategies to strengthen prenatal attachment, thereby improving prenatal coping strategies and maternal-infant mental health.